HBOT for Fibromyalgia
and Chronic Fatique Syndrome (CFS)
CHAPTER  16 OF THE HBOT MANUAL
Treatment: Hyperbaric Therapy in Chronic Fatigue Syndrome
ImmuneSupport.com

12-01-2003

Source: Journal: J of Chronic Fatigue Syndrome, Vol. 11(3) 2003, pp. 37-49

Authors: EIke Van Hoof, Clin Psych; Danny Coomans, PhD; Pascale De Becker,
PhD; Romain Meeusen; Raymond Cluydts, PhD; Kenny De Meirleir, MD, PhD

Affiliations:
EIke Van Hoof, Pascale De Becker, and Kenny De Meirleir are affiliated with
the Chronic Fatigue Clinic, Department of Internal Medicine, Faculty of
Medicine, Vrije Universiteit Brussel, Belgium. Danny Coomans is affiliated
with the School of Mathematical and Physical Sciences, James Cook
University, Australia. Romain Meeusen is affiliated with the Department of
Human Physiology and Sports Medicine, Vrije Universiteit Brussel, Belgium.
Raymond Cluydts is affiliated with the Department of Psychology, Vrije
Universiteit Brussel, Belgium. Address correspondence to: EIke Van Hoof,
Vakgroep MFAB/ Sportgeneeskunde, AZ-VUB KRO gebouw niveau-l, Laarbeeklaan
101, 1090 Brussels, Belgium(E-mail: EIke.Van.Hoof@vub.ac.be ).

The authors would like to thank Dr. Neil McGregor for his advice in writing
this article.

ABSTRACT. The aim of this study was to determine if hyperbaric oxygen
treatment (HBOT) could be used as adjunctive therapy and if HBOT could
increase the quality of life in such a way that the functional status would
improve in patients with an infection. A randomized, controlled trial was
conducted on 15 Mycoplasma sp. infected CFS (CDC 1994) patients and 14 CFS
(CDC 1994) patients with no evidence of a Mycoplasma infection [who] were
enrolled in a convenience randomization sample from our referral clinic. No
statistical differences were found by use of univariate repeated measures
although Bodily Pain as measured by the SF-36 seems to decrease after
hyperbaric therapy (Greenhouse-Geisser: p = .010).

Trends were found using paired t-testing for Mycoplasma infected CFS
patients. The general perceived fatigue seemed to decrease after hyperbaric
therapy (General Fatigue: p = .06). Directly after one week of hyperbaric
therapy general fatigue improved (p = .03) but there was a reduction of
activity (reduced activity: p = .05) and general perceived health (general
health: p = .04). One month later the physical role increased
(Role-Physical: p = .07). Although more data is required to make firm
conclusions, trends were found. Reduced fatigue, increased levels of
activity and an improved reaction time improved significantly their quality
of life and therefore, enhanced also their functional status and thus could
be used as an adjunctive therapy.

KEYWORDS. Chronic systemic infections, hyperbaric oxygen therapy, adjunctive
therapy, quality of life

INTRODUCTION

Chronic Fatigue Syndrome (CFS) was first described in the 1930s and due to
its definition by exclusion, its pathogenesis has been difficult to
delineate. During the last few decades an increasing number of studies have
started to unravel the pathogenesis of CFS. Currently the etiology is not
known and no definite pathological abnormalities have been identified,
therefore CFS is still called a syndrome and not a disease or group of
diseases.

The controversy around this syndrome is intense with the overriding theme
being whether its origin is physical or psychological. Interestingly this
very same debate has taken place for many other chronic diseases in which
initially no objective abnormalities were found followed by findings which
clearly establish a physical/organic basis to the disease, leading to their
wide acceptance.

Up until now, many therapies have been investigated in this population with
different results (1). One of the most promoted therapies seems to be
'Cognitive Behavioral Therapy (CBT) with Graded Exercise' (2). The
restricted lifestyle of CFS patients has led to the suggestion that a
reduction in exercise capacity contributes and prolongs their illness. It is
for this reason that exercise-training programs are added to the treatment
of CFS-patients (2). Different ailments, however, inhibits wide spread
application. First of all, CBT has not been adequately assessed for severely
affected CFS patients (3). In fact, CBT seems applicable only when a
Karnofsky Performance Score (KPS)-threshold of 70 is reached (4,5).

The Karnofsky Performance Score indicates functional disability in different
populations and is used as a communication tool in CFS. A KPS of 70 means
that the CFS patient "cares for him/herself but is unable to carry on normal
activity or do active work." This threshold (70) is in contrast with the
overall score of the CFS population which is 60-65. A person with a KPS of
60-65 "requires occasional assistance but is able to care for most needs."
Secondly, CBT is characterized by a high dropout rate (6).

So, in order to bring CFS patients to a threshold of 70 and in order to
bring CFS patients in the ability to start up an exercise program, different
strategies should be used. While CFS patients do have abnormal immune
parameters which indicate infections agents (7), hyperbaric oxygen therapy
could be considered. By applying HBOT, the quality of life should be
influenced in those patients with distorted immune parameters. A higher
quality of life suggests a higher functional status. If patients increase
their area of control by more activity or less fatigability, such as more
walking around or leaving the home, leading to more independence, this
implies a higher functional status.

Rationale for the Use of Hyperbaric Therapy in CFS

The immune system, wound healing, and vascular tone are all affected by
oxygen supply. Oxygen alone has little direct antimicrobial effect, even for
most anaerobes (8) like Mycoplasma infections. It is, however, a crucial
factor in immune function. Neutrophils require molecular oxygen as a
substrate for microbial killing. The oxidative burst seen in neutrophils
after phagocytosis of bacteria involves a 10 to I5-fold increase in oxygen
consumption (9). Here oxygen serves as a substrate in the formation of free
radicals, which directly or indirectly initiate phagocytic killing. This
endogenous antimicrobial system virtually ceases functioning under
conditions of hypoxia (10). In short, increasing the oxygen level in tissue
can allow restoration of white blood cell function and thus the return of
adequate antimicrobial action. However, whether this is applicable in a
normal physiological system or some other process may be involved is not
known.

History of Hyperbaric Therapy

The use of hyperbaric air therapy was apparently attempted before anyone
knew of the existence of oxygen (11). A physician named Henshaw first
attempted to treat patients in a chamber with altered air pressure about 300
years ago (12).

Hyperbaric oxygen therapy (HBOT) involves intermittent inhalation of 100%
oxygen under a pressure greater than one atmosphere. Initial widespread
enthusiasm for HBOT led to its inappropriate use, resulting in a backlash
against the use of HBOT (12). More recent and reputable studies have
demonstrated that the technique has a role in treating specific illnesses
(11).

The Undersea Medical Society that evaluates clinical applications of HBOT
has categorized disorders of which it is or may be useful (11). Table 1
gives an overview of the different treatment areas suggested for HBOT:
category 1 is widely accepted and category 4 has little evidence to support
its use. CFS patients with chronic bacterial infections are categorized as
an adjunctive therapy by the Undersea Medical Society.

Complications and Side Effects of HBOT

The complications of HBOT are related to. the changes in barometric pressure
and oxygen toxicity. Patients can receive mild inner ear discomfort that may
occur by using certain maneuvers. The most common complication is middle ear
or sinus trauma (9) due to the change in pressure. Any air filled cavity
that cannot equilibrate with ambient pressure, such as the middle ear is
subject to deformity and barotraumas during pressure changes in HBOT. Other
complications sometimes observed at this pressure can include nausea, tooth
and sinus pain and blurred vision (9).

Hypotheses

This controlled pilot study evaluates the utility of HBOT in CFS patients
infected with Mycoplasma hominis. In other words, can HBOT improve the
quality of life of this subgroup of CFS patients as investigated by
validated psychological questionnaires? If the quality of life improves,
patients may reach a KPS-threshold of 70 and additionally, attend CBT and
graded exercise to improve their functional status.


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Fibromyalgia Syndrome

J Int Med Res. 2004 May-Jun;32(3):263-7.

A new treatment modality for fibromyalgia syndrome:
Hyperbaric Oxygen Therapy.

Yildiz S, Kiralp MZ, Akin A, Keskin I, Ay H, Dursun H, Cimsit M.
GATA Haydarpasa Military Hospital, Istanbul, Turkey.

Fibromyalgia syndrome (FMS) is characterized by longstanding multifocal pain
with generalized allodynia/hyperalgesia. There are several treatment methods
but none has been specifically approved for this application. We conducted a
randomized controlled study to evaluate the effect of hyperbaric oxygen
(HBO) therapy in FMS (HBO group: n = 26; control group: n = 24). Tender
points and pain threshold were assessed before, and after the first and
fifteenth sessions of therapy. Pain was also scored on a visual analogue
scale (VAS). There was a significant reduction in tender points and VAS
scores and a significant increase in pain threshold of the HBO group after
the first and fifteenth therapy sessions. There was also a significant
difference between the HBO and control groups for all parameters except the
VAS scores after the first session.

We conclude that HBO therapy has an important role in managing FMS.

PMID: 15174219 [PubMed - in process]


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ew Treatment Modality for Fibromyalgia Syndrome: Hyperbaric Oxygen Therapy
S¸ YILDIZ1, MZ KIRALP1, A AKIN1, I KESKIN1, H AY1, H DURSUN1 AND M CIMSIT2

1GATA Haydarpas¸a Military Hospital, Istanbul, Turkey;

2Istanbul University Medical Faculty, Istanbul, Turkey

Fibromyalgia syndrome (FMS) is characterized by longstanding multifocal pain with generalized allodynia/hyperalgesia.

There are several treatment methods but none has been specifically approved for this application. We conducted a randomized controlled study to evaluate the effect of hyperbaric oxygen (HBO) therapy in FMS (HBO group: n = 26; control group: n = 24). Tender points and pain threshold were assessed before, and after the first and fifteenth sessions of therapy. Pain was also scored on a visual analogue scale (VAS). There was a significant reduction in tender points and VAS scores and a significant increase in pain threshold of the HBO group after the first and fifteenth therapy sessions.

There was also a significant difference between the HBO and control groups for all parameters except the VAS scores after the first session. We conclude that HBO therapy has an important role in managing FMS.

KEY WORDS: ALGOMETER; HYPERBARIC OXYGEN THERAPY; FIBROMYALGIA; PAIN
THRESHOLD;

VISUAL ANALOGUE SCALE Introduction

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder. It is characterized by widespread pain, tenderness at specific anatomical sites (i.e. tender points) and clinical manifestations such as fatigue, sleep disturbance and irritable bowel syndrome.1,2

Its prevalence is 1 - 3% and it occurs predominantly in females, commonly between the ages of 40 and 50 years.3

The most frequently reported musculoskeletal or fibrous connective tissue symptoms are aches and pains, stiffness, swelling in soft tissues, tender points and muscle spasms or nodules.2 There is a global decrease in pressure pain threshold rather than specific changes limited to the tender points.4 The aetiopathology of FMS is still not known although it is thought that the disease is caused by several interacting factors such as muscle overload, poor spinal posture, disturbed sleep, psychogenic factors, local hypoxia5,6 and reduced concentrations of high-energy phosphate. Fassbender and Wegner have hypothesized that local hypoxia causes degenerative changes in the muscles in FMS.5

There is no proven effective long-term management program for FMS.2 Hyperbaric oxygen (HBO) therapy has been used worldwide for the past 30 years to treat many diseases, including conditions caused by local hypoxia or ischemia such as diabetic wounds, chronic non-healing wounds, compromised skin grafts and flaps, and cerebral ischaemia.7 HBO therapy involves breathing 100% oxygen via an endotracheal tube, mask or hood in a pressure chamber at pressures higher than 1 atmosphere absolute (ATA). During HBO therapy, the increased concentration and the partial pressure of oxygen provide increased oxygenation to the whole body. Oxygen tension is raised to 10 - 13 times above its normal level when a patient breathes 100% oxygen at 2.8 ATA.

When the circulation is compromised, there sultant ischemia lowers the concentration of adenosine triphosphate (ATP) and increases the concentration of lactic acid. Increased oxygen delivery to the tissue with HBO may prevent tissue damage in ischemic tissues by decreasing the tissue lactic acid concentration and helping maintain the ATP level.

The aim of HBO therapy in patients with FMS is to reduce muscle hypoxia and increase levels of high-energy phosphate.

Patients and methods

We carried out a randomized, double blind controlled study of HBO therapy in patients with FMS.

PATIENTS

Patients with FMS (meeting the American College of Rheumatology diagnostic criteria8) who had persistent symptoms in spite of medical and physical therapy were included in the study. Patients were randomized (alternately) to receive HBO therapy (HBO group) or normal air (control group). After randomization, patients were evaluated for their suitability to receive HBO therapy. Patients with contraindications were excluded from the study by the evaluating physician. The evaluating physician did not know which therapy the patient was to have received. The physician administering therapy was the only one to know which therapy the patients received. This disclosure was necessary for evacuation purposes in the event of an emergency during a therapy session.

The HBO group underwent 15 90-min sessions of HBO therapy at 2.4 ATA. There was one session per day for 5 days of the week. The control group breathed air at 1 ATA for 90 min following the same schedule as the HBO group. During the study period, no other therapeutic modalities were used. All patients gave informed consent and the GATA Military Medical Faculty Ethical Committee approved the study.

ASSESSMENT PROCEDURE

The patients were examined just before and after the first and fifteenth therapy sessions.

At each examination, the number of tender points was determined by palpation and the number of tender points was noted. The pain threshold was measured with an algometer and pain evaluated using a visual analogue scale (VAS).

To measure the pressure pain threshold the top of the algometer was placed on the tender point and the pressure was increased until the patient confirmed that they felt pain.9 The contact area was 1 cm2 and covered with 2-mm thick rubber to minimize irritation of the skin. The compression pressure was increased gradually by approximately 1 kg/s. The patient was asked to say 'yes' when he or she began to feel pain or any discomfort. A needle on the manometer scale recorded the pressure pain threshold in kilograms. 264 S¸ Yildiz, MZ Kiralp, A Akin et al. Hyperbaric oxygen therapy in Fibromyalgia syndrome

STATISTICAL ANALYSIS

Numerical variables are presented as mean ± SD. The Wilcoxon test and Student's t-test were used for within group (HBO group only) and between group comparisons.

A P-value of < 0.05 was accepted as statistically significant. SPSS version 11.0 software (SPSS Inc., Chicago, IL, USA) was used for all statistical calculations.

Results

There were 26 patients (17 female, nine male; mean age 40.46 ± 4.79 years) in the HBO group and 24 (18 female, six male; mean age 39.88 ± 4.71 years) in the control group. The symptoms of FMS had been present for an average of 4 ± 1.1 years (range 1 - 30). The number of tender points, pain threshold (as measured by the algometer) and the VAS pain scores for both groups before and after treatment are given in

Table 1.

In the HBO group there was a statistically significant difference between the results of all parameters after the first and fifteenth sessions (P < 0.001). There was also a significant difference between the HBO group and control group for all parameters (P < 0.001) except the VAS scores after the first session.

Discussion

Fassbender and Wegner studied the clinical features, symptoms and pathogenesis of FMS, and postulated that local hypoxia has an aetiological role in the development and symptomatology of FMS.5 Recently published reports on FMS are compatible with the theory of chronic hypoxia. Relative hypoxia has been demonstrated in patients with FMS,5 and symptoms of FMS have improved following aerobic conditioning. The oxygen pressure in the tissues of tender muscles and the total mean oxygen pressure in the subcutaneous tissue of patients with FMS are significantly lower than in normal controls.10 This suggests that the hypoxic condition is not limited to the tender muscles. Jeschonneck et al.11 studied tender points in patients with FMS and concluded that vasoconstriction occurs in the skin above the tender points. This supports the hypothesis that FMS is related to local hypoxia in the skin covering the tender points. Bengtsson and Henriksson12 thought 265 S¸ Yildiz, MZ Kiralp, A Akin et al. Hyperbaric oxygen therapy in fibromyalgia syndrome

TABLE 1:

Mean ± SD of the number of tender points, pain threshold and visual analogue Scale (VAS) pain scores of patients with fibromyalgia syndrome in the group receiving hyperbaric oxygen (HBO group) and control group Before treatment After first session After 15 sessions

HBO Control HBO Control HBO Control

(n = 26) (n = 24) (n = 26) (n = 24) (n = 26) (n = 24)

No. of tender points 14.96 ± 1.50 15.25 ± 1.18 12.46 ± 1.10a,b 13.75 ± 1.07b 6.04 ± 1.18a 12.54 ± 1.10

Pain threshold 0.71 ± 0.09 0.75 ± 0.13 0.93 ± 0.09a,b 0.81 ± 0.12b 1.33 ± 0.12a 0.84 ± 0.12

VAS score 64.62 ± 10.28 68.33 ± 10.28 59.23 ± 8.44a 60.42 ± 8.58 31.54 ± 8.34a 55.42 ± 6.58

A Statistically significant difference between first and fifteenth sessions of HBO therapy (P < 0.001). b Statistically significant difference between study and control group (P < 0.001).

References

1 Bennett RM: The fibromyalgia syndrome. In:

Textbook of Rheumatology, 5th edn (Kelley WN, Harris ED, Ruddy S, Sledge CB eds). Philadelphia: WB Saunders Company, 1997; pp511 - 519. 2 Krsnich-Shriwise S: Fibromyalgia syndrome: an overview. Phys Ther 1997; 77: 68 - 75. 3 Yunus MB, Holt GS, Masi AT, Aldag JC: Fibromyalgia syndrome among the elderly. Comparison with younger patients. J Am Geriatr Soc 1988; 36: 987- 995. 4 Tunks E, McCain GA, Hart LE, Teasell RW, Goldsmith CH, Rollman GB, et al: The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls. J Rheumatol 1995; 22: 944 - 952.

5 Fassbender HG, Wegner K: Morphologie und Pathogenese des Weichteilrheumatismus. [Morphology and pathogenesis of soft-tissue rheumatism]. Z Rheumaforsch 1973; 32: 355 - 374. 6 Lund N, Bengtsson A, Thorborg P: Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol 1986; 15: 165 - 173. 7 Jain KK: Physical, physiological, and biochemical aspects of hyperbaric oxygenation.

In: Textbook of Hyperbaric Medicine, 2nd ed Received for publication 26 November 2003 . Accepted subject revision

13 December 2003

. Revised accepted 21 January 2004

266

S¸ Yildiz, MZ Kiralp, A Akin et al.

Hyperbaric oxygen therapy in fibromyalgia syndrome that any condition, such as establishment of abnormal motor patterns, that could lead to constant muscle hypoxia might be a possible cause of fibromyalgic pain. Another study concluded that in patients with primary

FMS, the muscle oxygenation is abnormal or low, at least in the trigger point area of the muscle as shown by an oxygen multipoint electrode on the muscle surface.6

Patients with FMS have been found to have a lower density of capillaries in muscles,13 thicker capillary endothelium, derangement of muscle capillaries after tourniquet-induced ischaemia and more frequent endothelial changes,14 and lower values of muscle blood flow.10 These changes are either caused by localized hypoxia or cause the hypoxia.15

A study of pain in patients with FMS produced data consistent with the hypothesis that the intensity of pain experienced in patients with FMS is associated with increased synthesis of nitric oxide (NO).16

Another study, based on the recent evidence that NO is involved in hyperoxic vasoconstriction, tested the hypothesis that decreased NO availability to brain tissue during hyperbaric oxygen exposure contributes to decreases in regional cerebral blood flow. We think that HBO therapy may be effective for treating patients with FMS because of the decreasing NO effect.17

In clinical experience, HBO therapy often stimulates production of red granulation tissue consisting mainly of new blood vessels and the supporting collagenous matrix. The vascular endothelial growth factor (VEGF) concentration significantly increases with HBO. If VEGF concentration directly responds to hyperoxia, it may be possible for VEGF to stimulate angiogenesis.18 This is another reason why HBO therapy may be effective in FMS and may play an important role in its management.

There is no information about HBO therapy for managing FMS in the current literature. The proposed role of hypoxia in FMS, however, prompted us to evaluate the effectiveness of hyperoxia provided by HBO therapy. In our study, we think that HBO therapy was successful in breaking the pain-hypoxia vicious cycle since it decreased the number of tender points and VAS pain scores by increasing the pain threshold. HBO may be an effective and relatively cheap (US$15/h) alternative treatment modality for patients with FMS, especially for those with chronic pain.

267

S¸ Yildiz, MZ Kiralp, A Akin et al.

Hyperbaric oxygen therapy in fibromyalgia syndrome

(Jain KK, Neubauer R, Correa JG, Camporesi

EM, eds). Seattle-Toronto-Bern-Göttingen:

Hogrefe & Huber Publishers, 1996; pp11 - 26.

8 Wolfe F, Smythe HA, Yunus MB, Bennett RM,

Bombardier C, Goldenberg DL, et al: The

American College of Rheumatology 1990

criteria for the classification of fibromyalgia.

Report of the Multicenter Criteria Committee.

Arthritis Rheum 1990; 33: 160 - 172.

9 Lautenschläger J: Die Erfassung der Druckpunkte

bei generalisierter Tendomyopathie-GTM.

(Evaluation of tender points in fibromyalgia)

(in German). In: Generalisierte Tendomyopathie

(Fibromyalgie) (Müller W, ed). Darmstadt:

Steinkopff, 1991; pp95 - 104.

10 Bennett RM, Clark SR, Goldberg L, Nelson D,

Bonafede RP, Porter J, et al: Aerobic fitness in patients with fibrositis. A controlled study of respiratory gas exchange and 133xenon clearance from exercising muscle. Arthritis Rheum 1989;

32: 454 - 460.

11 Jeschonneck M, Grohmann G, Hein G, Sprott H:

Abnormal microcirculation and temperature in skin above tender points in patients with fibromyalgia. Rheumatology (Oxford) 2000; 39:

917 - 921.

12 Bengtsson A, Henriksson KG: The muscle in fibromyalgia - a review of Swedish studies.

J Rheumatol 1989; 19 (Suppl): 144 - 149.

13 Lindh M, Johansson G, Hedberg M, Henning

GB, Grimby G: Muscle fiber characteristics, capillaries and enzymes in patients with fibromyalgia and controls. Scand J Rheumatol

1995; 24: 34 - 37.

14 Gidlöf A, Lewis DH, Hammarsen F: The effect of prolonged ischemia of human skeletal muscle.

A morphometric analysis. Int J Microcirc Clin Exp

1987; 7: 67 - 86.

15 Lindman R, Hagberg M, Bengtsson A,

Henriksson KG, Thornell L-E: Capillary structure and mitochondrial volume density in the trapezius muscle of chronic trapezius myalgia, fibromyalgia and healthy subjects.

J Musculoskelatal Pain 1995; 3: 5 - 22.

16 Larson AA, Giovengo SL, Russell IJ, Michalek

JE: Changes in the concentrations of amino acids in the cerebrospinal fluid that correlate with pain in patients with fibromyalgia:

implications for nitric oxide pathways. Pain

2000; 87: 201 - 211.

17 Demchenko IT, Boso AE, Bennett PB, Whorton

AR, Piantadosi CA: Hyperbaric oxygen reduces cerebral blood flow by inactivating nitric oxide.

Nitric Oxide 2000; 4: 597 - 608.

18 Sheik AY, Gibson JJ, Rollins MD, Hoph HW,

Hussain Z, Hunt TK: Effect of hyperoxia on vascular endothelial growth factor levels in a wound model. Arch Surg 2000; 135: 1293 - 1297.

Address for correspondence

S¸ Yildiz
GATA Haydarpasa Egt Hast. Deniz ve Sualti Hekimligi,
81010 Kadikoy, Istanbul, Turkey.
E-mail: senolyildiz@hotmail.com

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Will Hyperbaric Oxygen Therapy Become a Viable Treatment Modality for Fibromyalgia Syndrome?
RSD
Pavel I. Yutsis, M.D.

In the present era of scientifically oriented medicine it has become increasingly difficult to design and conduct scientific research to prove or disprove efficacy of a given therapeutic modality. Often times, however, we learn how new modalities can help sufferers of different health conditions only by accident.

Many fibromyalgia patients can easily appreciate how much pain and swelling in the extremities can effect their well being and quality of life.

There is a condition, symptoms of which remind me of symptoms of fibromyalgia. The condition that I am referring to is called Reflex Sympathetic Dystrophy Syndrome (RSDS)

Reflex Sympathetic Dystrophy Syndrome (RSDS) is a painful condition that in addition to “burning” pain, tenderness and swelling of extremities can include swelling, sweating, warmth and/or coolness, flushing, discoloration and shiny skin. RSDS is also known as “the shoulder-hand syndrome,” “causalgia” and “Sudeck’s atrophy.” There are many theories why RSDS can take place. Some of them suggest that irritation of nervous tissue can cause abnormal impulses along nerves that subsequently effect blood vessels and skin.

The onset of RSDS symptoms can come unexpectedly and sometimes it can come in several stages.

Stage I Acute (3-6 months) - during this stage, pain, swelling, burning, flushing, sweating and tenderness can develop. Also during this stage, physician can notice patchy bone thinning on the X-ray.

Stage II Dystrophic (3-6 months) - during this stage, swelling and flushing usually diminish, but changes in skin when it becomes shiny, thickened coupled with development of contracture and persistent pain can occur.

Stage III Atrophic - during this stage, loss of motion and function in the involved extremities, thinning of the fatty layers under the skin and significant osteoporosis will take place.

Usual treatment for RSDS includes:

   * Cool, moist applications
   * Gradual exercising
   * Non – steroid anti-inflammatory drugs
   * High doses of Pregnasone
   * In severe cases a nerve block with anaesthetic is injected into the specialized area
   * A few reports reflecting efficacy of hyperbaric oxygen therapy (HBOT) attracted my attention. One of them tells how a patient who was suffering from acute smoke inhalation also had a long medical history that included Reflex Sympathetic Dystrophy Syndrome of the left foot and ankle. The entire foot and ankle were tender and cool to palpation and range of motion was severely reduced. Patient was referred for hyperbaric oxygen therapy to ward off symptoms of smoke inhalation. She underwent a number of HBOT sessions. Fifteen minutes inside the hyperbaric chamber during her first session patient enthusiastically reported lessening of pain in her foot. She also was extremely happy to tell the whole world that her foot is much warmer to the touch and is not as blue as it used to be. Subsequent treatment improved her condition.

Pain, inflammation, tenderness and swelling are the terms too familiar to fybromyalgia sufferers and I am sure that many of them have been wondering if hyperbaric oxygen therapy (HBOT) could be their savior.

Case in Point: BD, a 55 year old nutritionist from Costa Rica, has been suffering from fibromyalgia syndrome for a period of ten years prior to coming into my office and requesting hyperbaric oxygen therapy (HBOT). She also recently suffered a ruptured appendicitis with leftover necrotic tissues in her lower abdominal region. BD has the whole “bouquet,” Epstein-Barr virus, cytomegalo virus (CMV), yeast overgrowth, allergies, asthma, you mention it, she had it. I saw BD following twenty hyperbaric oxygen treatments (HBOT) and guess what? Her fibromyalgia pains disappeared completely and took along the whole myriad of concurrent symptoms!

A number of patients who suffer from fibromyalgia and have been treated with hyperbaric oxygen therapy have reported the same improvement in their pain severity, anxiety levels and fatigue. Certainly, they were ecstatic to learn that their energy level has risen to the sky and finally libido showed up for a change and their outlook moved to the other side.

Pavel I. Yutsis, M.D.
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