THU0512 Hyperbaric oxygen therapy (HBOT) treatment in fibromyalgia
Authors: M. Muratore, L. Quarta, P. Sarzi Puttini, C. Cosentino, A. Grimaldi, E. Quarta
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Chronic pain conditions, such as fibromyalgia(FM), are among the most common health problems managed by general practitioners, rheumatologists, clinical psychologists.FM is characterised by multifocal pain, fatigue, non-restorative sleep, cognitive complaints high levels of distress, associated with greater affect intensity. There's evidence from randomised controlled trials that some treatments like pharmacotherapy, patient education,behavioural therapy and physiotherapy are effective in reducing symptoms;however the majority of the patients aren't satisfied with the current treatments.HBOT showed some clinical effects that may induce a significant improvement of the FM symptoms. <h3>Objectives</h3> The goal of this work was to evaluate the effect of HBOT on FM symptoms. <h3>Methods</h3> 33 female patients aged 29–63 y, with FM were included in this work. Patients initially pharmacologically treated(Pregabalin 150 mg/die, Duloxetine 60 mg/die) with unsatisfactory clinical improvement, were enrolled at the Rheumatology Unit San Cesario-Italy. The HBOT protocol comprised 20 sessions,3d/w,90 min,100% oxygen at 2.5ATA. Patients were randomly assigned to treated and control groups and evaluated every month for the next 4 months:patients in group A were treated with 20 sessions of HOBT in the first 2 months and evaluated for the following 2 months;patients in group B used the pharmacological treatment for the first 2 months and then were treated with 20 session of HOBT in the last 2 months. During HOBT no pharmacological treatment was allowed. The treated group patients were evaluated at baseline and after 10 and 20 HBOT sessions. Evaluations consisted of physical examination, including tender point count, and socio-demographic and clinimetric questionnaires:Fibromyalgia Impact Questionnaire(FIQ), Functional Assessment of Chronic IllnessTherapy, Pittsburgh Sleep Quality Index, Quality of life, Beck Depression Inventory, State Trait Anxiety Inventory, Pain Catastrophizing Scale. <h3>Results</h3> 5 patients withdrew from the HBOT treatment for claustrophobia.HBOT led to significant amelioration of all FM symptoms, with significant improvement in life quality.HOBT leads to a reduction in the number of tender points in the 2 groups. This reduction occurs in the group A without changing during the following 2 months of osservation. In the group B the improvement is more related to the HOBT than to the therapy. The FIQ score improves in group A. No improvement was observed in the control group. <h3>Conclusions</h3> The analgesic effects of HBOT have been studied in nociceptive, in inflammatory and neuropathic pain models, and may be useful for the treatment of various chronic pain syndromes. Excessive pain in FM may be due to hyperexcitability of the pain processing pathways and under-activity of the pain inhibiting pathways in the brain. It has been shown that HBOT increases cell metabolism, reduces apoptosis, alleviates oxidative stress, increases neurotrophin and nitric oxide levels by enhancing mitochondrial function in neurons and glial cells, it may even promote the neurogenesis of endogenous neural stem cells.HBOT-induced neuroplasticity also leads to the repair of chronically impaired brain functions. Our data confirm the effecicy of HBOT in treating FM. Further studies are required to evaluate the protocol and to understand the duration of the clinical effect. <h3>Disclosure of Interest</h3> None declared