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Cited by 29Fibromyalgia and Chronic Fatigue Syndrome ResearchPain Mechanisms and TreatmentsMyofascial pain diagnosis and treatment

Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review

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El-Shewy, Kholoud M., Kunbaz, Ahmad, Gad, Mohamed M., Al-Husseini, Muneer J., Saad, Anas M., Sammour, Yasser M., Abdel-Daim, Mohamed M.·2019·Biomedicine & Pharmacotherapy
DOI 10.1016/j.biopha.2018.10.157
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Abstract

Chronic pain is one of the most common clinical presentations in the primary care settings. In the US, Fibromyalgia (FM) affects about 1-3% of adults and commonly occurs in adults between the ages of 40-50 years. FM causes widespread muscular pain and tenderness with hyperalgesia and allodynia and may be associated with other somatic complaints. Hyperbaric oxygen therapy (HBOT) has been utilized and has recently shown promising effects in the management of FM and other chronic pain disorders. In HBOT, the intermittent breathing of 100% oxygen in a pressurized chamber where the pressure is higher than 1 atmosphere absolute (ATA) has been utilized. HBOT exhibits a significant anti-inflammatory effect through reducing production of glial cells and inflammatory mediators which results in pain alleviation in different chronic pain conditions. HBOT can also influence neuroplasticity and affects the mitochondrial mechanisms resulting in functional brain changes. In addition to that, HBOT stimulates nitric oxide (NO) synthesis which helps in alleviating hyperalgesia and NO-dependent release of endogenous opioids which seemed to be the primary HBOT mechanism of antinociception. Moreover, aerobic exercise and meditative movement therapies (MMT) have gained attention for their role in pain alleviation through different anti-inflammatory and antioxidant mechanisms. In this review, we aim to elucidate the different mechanisms of HBOT and aerobic exercise in attenuating pain as adjuvant therapy in the multidisciplinary treatment strategy of chronic pain, and more particularly fibromyalgia.

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  • FM patients have symptoms of central sensitization, characterized by hypersensitivity to bright light, touch, noise, temperature, and mechanical pressure.

    “as have symptoms of central sensitization, characterized by hypersensitivity to bright light, touch, noise, temperature, and mechanical pressure.4,7,16”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [7]

    The Introduction describes fibromyalgia-related sensitivity to touch, mechanical stimuli, and heat or cold. Section 2 discusses increased sensitivity to a wide range of stimuli and central sensitization, but does not specifically identify hypersensitivity to bright light or noise in FM patients. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Fibromyalgia is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.

    “Fibromyalgia (FM) is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.1–11”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [7]

    The Introduction describes fibromyalgia as chronic and reports widespread pain, sleep disturbances, anxiety, cognitive dysfunction, and depressive symptoms; section 3 also mentions fatigue. Section 2 notes a lack of evidence for structural abnormalities, but the paper does not clearly characterize the pain as medically unexplained or fibromyalgia as disabling. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • FM has an unknown aetiology but has been described as a complex hyperalgesic pain syndrome in which abnormalities of central sensory processing interact with peripheral pain generators.

    “FM has an unknown aetiology but has been described as a complex hyperalgesic pain syndrome in which abnormalities of central sensory processing interact with peripheral pain generators.1,5,7”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [7]

    The Introduction describes fibromyalgia as involving hyperalgesia, and Section 2 discusses possible abnormalities in central pain processing and says nociceptive input can maintain central sensitization. Section 3 also describes hypothesized muscle abnormalities. The review does not clearly establish the claimed interaction between central abnormalities and peripheral pain generators; it presents these mechanisms as possibilities. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Understanding the underlying disease process will provide insights for targeted therapeutic approaches.

    “Understanding the underlying disease process will provide insights for targeted therapeutic approaches.7,10”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [7]

  • Fibromyalgia patients exhibit reduced blood flow and degenerative changes in the muscles.

    “FM patients exhibit reduced blood flow and degenerative changes in the muscles, presumably due to local hypoxia, creating higher levels of free radicals that induce apoptosis, reduce ATP and increase lactate concentrations in muscle cells, leading to muscle weakness and pain.7,15”

    From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [7]

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Sorted by citations

Authors
El-Shewy, K. M., Kunbaz, A., Gad, M. M., Al-Husseini, M. J., Saad, A. M., Sammour, Y. M., & Abdel-Daim, M. M.
Affiliations
  • Ain Shams University (EG)
  • Istanbul University-Cerrahpaşa (TR)
  • Cleveland Clinic (US)
Corresponding author
Saad, Anas M.
ORCID
Venue
Biomedicine & Pharmacotherapy
Publisher
Elsevier BV
Published
2019-01
Volume
109
Pages
629-638
ISSN
0753-3322 (ISSN-L)
DOI
10.1016/j.biopha.2018.10.157
OpenAlex
W2899377289
Cited by
29
References
8
Citations by year
2026: 3 · 2025: 2 · 2024: 5 · 2023: 6 · 2022: 1 · 2021: 5 · 2020: 3 · 2019: 2 · 2018: 2
FWCI
0.46
Type
journal article
Language
en
Open access
Licence
Locations
  • Biomedicine & Pharmacotherapy (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
Keywords
fibromyalgia, hyperbaric oxygen therapy, aerobic exercise, chronic pain, hyperalgesia, allodynia, anti-inflammatory mechanism, neuroplasticity, nitric oxide, endogenous opioids, adjuvant therapy
MeSH terms
Clinical Trials as Topic, Combined Modality Therapy, Fibromyalgia, Humans, Hyperbaric Oxygenation, Time Factors, Exercise, Treatment Outcome, Pain Management

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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