Hyperbaric oxygen therapy (HBOT) sounds like a "new agey" fluff treatment mostly employed by the athletes and the rich. The revelation that the 120 HBOT sessions improved Joe Namaths cognition, memory and feelings of well-being might feed into that perception. SPECT scans of Namath's' brain showed clear changes which remained a year after the treatment stopped, however, and HBOT therapy therapy has been used to good effect in traumatic brain injury. HBOT therapy has been the object of serious study and is used in a variety of conditions. Best known for its ability to treat the bends but it's also used in wound healing, to treat necrotizing infections, hearing loss, gangrene, burns and radiation injury.
The increased atmospheric pressure found in hyperbaric oxygen chambers allows them to push oxygen into the bloodstream and ultimately into the brain - a part of the body with a fierce demand for oxygen. Those increased oxygen levels appear to able to enhance brain functioning and may even help form new neural pathways. [fright]
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[/fright]While HBOT is commonly used in burn and wound healing and is getting interest in traumatic brain injury it's record in central nervous system conditions is mixed. A review of 12 multiple sclerosis studies
(all completed between 1983 and 1987) concluded HBOT provided no clinical effectiveness. A 2012 review of autism studie
s found mixed results. Some evidence suggests HBOT could, however, help relieve migraine attacks
. HBOT's effectiveness in depression, Parkinson's or Alzheimer's has simply not been studied.
Some work has been done in chronic pain. A 2009 study found HBOT improved pain threshold scores and various symptom measures in myofascial pain syndrome
. Pain was decreased in a small 2004 complex regional pain syndrome (CRPS) study
. A 2015 paper "Hyperbaric Oxygen Therapy: A New Treatment for Chronic Pain?
" that reviewed 25 studies concluded that HBOT may be helpful in treating pain but that further studies are needed to assess its efficacy. A 2013 rat study
suggested it may be able to reverse allodynia.
HBOT has not gotten much play in FM or ME/CFS or related conditions. A successful 2004 Turkish fibromyalgia study (titled "A new treatment modality for Fibromyalgia
") didn't spark much interest. It took 11 years and another team from the Mideast (and Texas) to produce another study.
The Isreali researchers producing the study got interested in HBOT after two colleagues tried it out. They reported that a graduate student who developed fibromyalgia after suffering a traumatic brain injury in a train crash, and a sociology professor with FM both received "remarkable improvement" from the therapy.
Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial. Shai Efrati1,2,3,4*, Haim Golan3,5, Yair Bechor2, Yifat Faran6, Shir Daphna-Tekoah6,7, Gal Sekler8, Gregori Fishlev2,3, Jacob N. Ablin9,3, Jacob Bergan2,3, Olga Volkov3,5, Mony Friedman2,3, Eshel Ben-Jacob1,4,8,10*, Dan Buskila. PLoS ONE
10(5): e0127012. doi:10.1371/journal.pone.0127012
Because it was impossible to design an effective sham control group a crossover design in employed. Each of the two groups received the treatment or no treatment for two months and then crossed over and took the option remaining to them.
Multiple assessments were done including a tender point count, pain threshold tests and measures of functional impairment (Fibromyalgia Impact Questionnaire—FIQ), symptom severity (SCL-90 questionnaire), and Quality of life (SF-36 questionnaire). SPECT scan imaging was done to rates of regional cerebral blood flow before and after the hyperbaric oxygen treatments.
The protocol was intense: five days a week for 90 minutes for two months. The final SPECT scan was done a weeks after the last HBOT session. The study involved 60 women with fibromyalgia.
All the measures - pain sensitivity, number of tender points, psychological distress, physical functioning and quality of life - were all significantly improved after the HBOT treatment. The "effect sizes" of the treatments ranged from medium (psychological distress, physical functioning) to large medium (quality of life) to large (pain thresholds, physical functioning (one group)). All the patients who made it through the study (12 dropped out for various reasons) reported improvement. Most were able to reduce their pain medication levels significantly. Many also reported improvements in sleep and energy in addition to the pain and mood enhancements.
In something of a surprise some of the patients felt worse before they felt better. In fact, for some it took up to 20 sessions to begin to turn corner on their pain.
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[/fleft]The changes in brain functioning the SPECT scan picked up mirrored the symptom improvement found. Prior to the study the FM patients had higher activity in the somatosensory cortex and reduced activity in the frontal, cingulate, medial temporal and cerebellar cortices. After the therapy their brain patterns started to shift towards normal: somatosensory cortex activity decreased and frontal, cingulate, medial temporal and cerebellar cortices activity increased.
Essentially the activity in the parts of the brain that sensed pain declined and activity in the parts of the brain that control or interpret pain signals increased.
In a press release one of the study authors stated the HBOT therapy cured traumatic brain injury triggered FM. While the results of the study were quite positive the clinical effects (from medium to large) did not suggest a cure had taken place for most.
The authors suggested HBOT may have increased the "feel-good" chemicals GABA and/or opioids in the brain. Increased levels of these factors then turned on the inhibitory pain pathways leading to the spinal cord. Balky inhibitory pathways that reduce the intensity of pain signals leading from the spinal cord (the body) to the brain appear to play an important role in FM. Inhibiting those pathways appears to allow the pain regulating portions of the brain to be overwhelmed by pain signals.
Other studies involving traumatic brain injury and stroke suggest HBOT effects the central nervous system in ways that might make sense for ME/CFS and FM and allied disorders. Blood vessel functioning, for instance, is of great interest in ME/CFS, migraine and POTS and HBOT appears to be able to trigger blood vessel repair mechanisms and improve blood flows. It also reportedly acts as an anti-inflammatory, can promote the integrity of the blood-brain barrier, alleviates oxidative stress, enhances mitochondrial functioning, and, the authors suggested, may normalize glial cell activity. It appears to be helpful in reversing the effects of traumatic brain injury.
HBOT has not proved effective, however, in some other central nervous system disorders and has been little studied in others.
The big knock on therapy has been cost. Most companies promoting HBOT therapy on the web do not post charges but general cost estimates posted on the web they range from $1-200 per hour session. According to one website using an HBOT in a hospital setting for an hour could cost 4 to 6x's more. [fright]
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[/fright] If these numbers are correct engaging in a 40 session treatment at a private clinic in the U.S. similar to that which occurred in the study would cost from $6-10,000. (This is despite one company bemoaning the fact oxygen is too cheap for drug companies to be interested in it. )
Cost wouldn't be so much of an issue if the results stuck. Ten grand to reduce significantly reduce pain and improve cognition and sleep in FM patients is a bargain if the brain reset sticks. The fact that HBOT appears in other conditions to foster the development of new neural pathways suggests the results could hold. The authors of the study asserted that people with traumatic brain injury triggered FM might just be cured. People with infection triggered FM, on the other hand, would probably need follow up sessions.
The cheapest hyperbaric oxygen chamber I could find was a portable one for about $4,000 and they can cost ten times that much. Most appear to be made by small companies. The most cost-effective way to use HBOT for those who can afford it might be try 10 or 20 sessions on one's own and if it appears effective to buy a unit. Companies promoting HBOT treatment assert that multiple sessions are needed. If HBOT is tried enough sessions should be done to be able to assess the results.
Clinical trials are currently examining HBOT effectiveness in brain injury, diabetes, interstitial cystitis, Crohn's disease, ulcerative colitis, small blood vessel disease and diabetic retinopathy.
The big question for most fibromyalgia and ME/CFS patients wishing to try this therapy is whether enough studies will be done to validate the treatment enough for insurance companies to pay for it. In that regard HBOT is in the same place as low dose naltrexone except worse. It's an expensive treatment without the possibility of producing a dividend for a major drug company. Since oxygen is cheap and and the hyperbaric oxygen chamber field is populated by small producers more trials are probably not going to come from industry. That leaves, at least in the U.S., academia or non-profits with cash to fill the gaps.
Still, one study was done and given the right situation others may happen. Jarred Younger, for instance, has been willing - and successful - at exploring non-traditional treatments such as LDN. He's looking at a variety of substances that probably don't have much commercial value but could bring benefit to people with FM and ME/CFS. His goal is finding treatments - not producing profits - and and he has a lab and a budget he controls. That's the kind of researcher that will hopefully pick up and explore HBOT therapy further in FM and ME/CFS.