Fibromyalgia affects an estimated 4 million adults in the United States, and conventional treatments often provide incomplete relief. Medications like pregabalin, duloxetine, and milnacipran help some patients but leave many still struggling with widespread pain, fatigue, and cognitive dysfunction. Hyperbaric Oxygen Therapy (HBOT) has emerged as a potential treatment after a landmark 2015 randomized controlled trial showed significant pain reduction and measurable changes in brain activity. The research is still early, but the quality of that initial evidence is noteworthy.
This guide covers the key HBOT research for fibromyalgia, how the therapy may work for this condition, typical protocols, costs, and where the evidence stands today.
Key Takeaways
- The Efrati 2015 RCT (48 women) showed HBOT significantly reduced pain, improved quality of life, and normalized brain activity patterns in fibromyalgia patients1
- SPECT imaging revealed that HBOT corrected abnormal brain perfusion patterns associated with fibromyalgia pain processing1
- 70% of HBOT-treated patients no longer met fibromyalgia diagnostic criteria after treatment1
- HBOT protocols for fibromyalgia typically use 2.0 ATA (atmospheres absolute) for 60 to 90 minutes, 5 days per week, for 40 sessions1
- Treatment costs range from $6,000 to $12,000 for a full 40-session protocol; insurance does not cover HBOT for fibromyalgia
- More large-scale RCTs are needed before HBOT can be considered a standard treatment for fibromyalgia
The Efrati 2015 Study: What It Found
The most important piece of evidence for HBOT in fibromyalgia is the randomized controlled trial published by Efrati et al. in 2015 in the journal PLOS ONE.1 This study stands out because of its design quality and the objective brain imaging data it produced.
Study design: 48 women with fibromyalgia were randomized into two groups. The treatment group received 40 HBOT sessions (2.0 ATA, 100% medical-grade oxygen, 90 minutes per session, 5 days per week for 8 weeks). The control group received no treatment for the first 8 weeks, then crossed over to receive the same HBOT protocol.
Results:
- Significant reduction in pain scores (measured by the Widespread Pain Index and Symptom Severity Scale)
- Improved quality of life across all measured domains
- Reduced tender point count
- 70% of treated patients no longer met the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia after completing the protocol
- SPECT brain imaging showed normalization of abnormal perfusion patterns in pain-processing brain regions
The SPECT imaging data is particularly significant. It showed that fibromyalgia patients had abnormal blood flow patterns in specific brain regions (posterior cortex, frontal cortex, and temporal lobes) before treatment. After 40 HBOT sessions, these patterns normalized, correlating with clinical improvement.
“The HBOT-treated group showed a significant reduction in all fibromyalgia symptoms, with 70% of patients no longer meeting diagnostic criteria. SPECT imaging confirmed corresponding changes in brain activity.”
Efrati et al., 2015, PLOS ONE
How HBOT May Help Fibromyalgia
Fibromyalgia is increasingly understood as a disorder of central sensitization, where the brain and spinal cord amplify pain signals. HBOT may address this through several mechanisms:
Neuroplasticity. HBOT at 2.0 ATA delivers oxygen at levels 10 to 15 times higher than normal breathing. This hyperoxygenation can stimulate neuroplasticity, the brain’s ability to form new neural connections and repair damaged pathways. The Efrati group’s research has consistently shown that HBOT induces neuroplastic changes in brain regions involved in pain processing.2
Reduced neuroinflammation. Fibromyalgia is associated with elevated inflammatory markers in the brain, particularly glial cell activation. HBOT has demonstrated anti-inflammatory effects in neural tissue, potentially dampening the neuroinflammatory processes that drive central sensitization.3
Improved cerebral blood flow. The SPECT imaging from the Efrati study showed that fibromyalgia patients had abnormal cerebral perfusion (blood flow). HBOT improved perfusion to these areas, which correlates with reduced pain signaling and improved cognitive function.
Mitochondrial support. Fibromyalgia patients often show evidence of mitochondrial dysfunction, with reduced ATP production and increased oxidative stress. HBOT supports mitochondrial function by increasing oxygen availability for the electron transport chain and upregulating antioxidant enzyme production.4
Other Studies
| Study | Design | Key Finding |
|---|---|---|
| Efrati et al., 2015 | RCT, 48 women, crossover design | Significant pain reduction, 70% no longer met fibromyalgia criteria, brain SPECT changes1 |
| Yildiz et al., 2004 | Prospective study, 26 patients | Significant improvement in pain, fatigue, morning stiffness, and tender point count5 |
| Atzeni et al., 2019 | Pilot study with brain imaging | Confirmed functional brain changes after HBOT consistent with reduced central sensitization6 |
The consistent finding across these studies is that HBOT does not simply mask fibromyalgia symptoms. It appears to address the underlying neurological dysfunction, as evidenced by objective brain imaging changes that correlate with clinical improvement.
Typical HBOT Protocol for Fibromyalgia
Based on the published research, the standard HBOT protocol for fibromyalgia follows the Efrati model:
- Pressure: 2.0 ATA
- Oxygen: 100% medical-grade oxygen
- Session duration: 60 to 90 minutes at pressure (plus compression and decompression time)
- Frequency: 5 sessions per week
- Total sessions: 40 (8 weeks)
- Chamber type: Hard chamber (monoplace or multiplace)
This is a medical HBOT protocol requiring a hard chamber operating at pressures above what soft chambers can achieve. Soft chambers (1.3 ATA maximum, ambient air with an oxygen concentrator) have not been studied for fibromyalgia and should not be assumed to produce the same results.
Some patients pursue additional sessions beyond the initial 40 for sustained benefit, though no published data guides the optimal maintenance protocol.
What to Expect During Treatment
HBOT sessions for fibromyalgia follow the standard HBOT experience:
- Compression (5-10 minutes): Pressure gradually increases to 2.0 ATA. You may feel pressure in your ears, similar to airplane descent. Swallowing or gentle Valsalva maneuvers equalize the pressure.
- Treatment (60-90 minutes): You breathe 100% oxygen at pressure. Most patients rest, read, or sleep. The chamber is climate-controlled.
- Decompression (5-10 minutes): Pressure gradually returns to normal.
Potential side effects include temporary ear pressure or mild barotrauma, transient lightheadedness, and fatigue after sessions (particularly during the first week). Serious side effects are rare. For a comprehensive overview, see our guide on hyperbaric chamber for fibromyalgia.
Costs
| Item | Cost Range |
|---|---|
| Per session (hard chamber) | $150 to $300 |
| 40-session protocol | $6,000 to $12,000 |
| Insurance coverage | Not covered (fibromyalgia is not an FDA-cleared indication) |
| Payment options | Many clinics offer package discounts and payment plans |
Fibromyalgia is not one of the 14 FDA-cleared indications for HBOT, which means insurance will not cover it. Some patients have had partial success with appeals citing the Efrati study, but this is uncommon.
Current Evidence Quality
The Efrati 2015 study is methodologically strong for a single RCT. It used objective brain imaging (not just self-reported symptoms), a crossover design (the control group eventually received treatment, confirming benefits), and standardized outcome measures.
However, the evidence has important limitations:
- Small sample size: 48 patients is a good start but not enough to generalize confidently
- Single center: All studies have come from the same research group (Efrati’s lab at Tel Aviv University)
- No long-term follow-up: Published data shows results immediately post-treatment, but durability of benefits beyond 6 months is not well-documented
- No placebo control: The crossover design means the control group knew they were waiting for treatment, introducing potential expectation effects
- Female-only: The Efrati study included only women, though fibromyalgia disproportionately affects women
Multi-center RCTs with sham-controlled designs, longer follow-up, and larger sample sizes are needed before HBOT can be recommended as a standard fibromyalgia treatment.
The Bottom Line
HBOT for fibromyalgia has stronger initial evidence than most alternative therapies for this condition. The Efrati 2015 RCT demonstrated not just symptom improvement but objective brain changes that correlated with pain reduction. The finding that 70% of patients no longer met diagnostic criteria is striking, though it comes from a single study.
For fibromyalgia patients who have not responded adequately to conventional medications, HBOT is a scientifically plausible option worth discussing with their healthcare team. The main barriers are cost ($6,000 to $12,000 for a full protocol), time commitment (8 weeks of daily sessions), and the lack of insurance coverage. Patients should seek clinics using hard chambers at 2.0 ATA, consistent with the published protocol.
References
- Efrati, S., et al. (2015). Hyperbaric oxygen therapy can diminish fibromyalgia syndrome: Prospective clinical trial. PLOS ONE, 10(5), e0127012. doi:10.1371/journal.pone.0127012
- Hadanny, A., & Efrati, S. (2020). The hyperoxic-hypoxic paradox. Biomolecules, 10(6), 958. doi:10.3390/biom10060958
- Rossignol, D.A. (2012). Hyperbaric oxygen treatment for inflammatory bowel disease: A systematic review and analysis. Medical Gas Research, 2(1), 6. doi:10.1186/2045-9912-2-6
- Akarsu, S., et al. (2013). Mitochondrial complex I and III mRNA levels in fibromyalgia syndrome. Clinical Rheumatology, 32(8), 1251-1255. doi:10.1007/s10067-013-2261-5
- Yildiz, S., et al. (2004). A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. The Journal of International Medical Research, 32(3), 263-267. doi:10.1177/147323000403200305
- Atzeni, F., et al. (2019). Hyperbaric oxygen therapy in fibromyalgia and the diseases involving the central nervous system. Clinical and Experimental Rheumatology, 37(1), 116.
Medical Disclaimer
The content on BaricBoost.com is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Author
Seph Fontane Pennock is the founder of BaricBoost.com and Regenerated.com, a clinic directory for regenerative medicine serving 10,000+ providers across the United States. He previously built and sold PositivePsychology.com, which grew to 19 million users and became the largest evidence-based positive psychology resource on the web. Seph brings direct experience as an HBOT patient, having completed protocols at clinics across three continents while navigating mold illness, systemic inflammation, and autoimmune conditions. His treatment journey includes hyperbaric oxygen therapy, peptide protocols, NAD+ therapy, and consultations with specialists from Dubai to Cape Town to Mexico. This combination of entrepreneurial track record and lived patient experience shapes everything published on BaricBoost.com. Every article is grounded in peer-reviewed research, informed by real clinical encounters, and written for patients making high-stakes treatment decisions. Seph's focus is on bringing transparency, scientific rigor, and practical guidance to the hyperbaric oxygen therapy space.
