Hyperbaric oxygen therapy in chronic pain management

Abstract

Chronic pain is one of the frequently encountered clinical problems that is difficult to cure. Hyperbaric oxygen (HBO) therapy has been reported in chronic pain syndromes with promising results. In this review, we focus on the effectiveness of HBO in fibromyalgia syndrome, complex regional pain syndrome, myofascial pain syndrome, migraine, and cluster headaches. HBO may be beneficial if appropriate patients are selected. HBO is a reliable method of treatment. However, physicians performing HBO must be aware of oxygen toxicity. Another problem regarding HBO is the scarcity of centers administering it. Further research is required focusing on the optimal treatment protocol, the cost/benefit ratio, and the safety of HBO in chronic pain management.

Revisiting the expanded use of hyperbaric oxygen therapy for treatment of resistant migraines

“…Wilson et al 15 showed a significant decrease in subjective pain in those who underwent HBO versus the control group of females with migraine with aura. Other studies by Eftedal et al 1,22,23 showed insignificant prophylactic measure against migraines with the use of HBO. It is important to note that these studies have limited sample sizes.…”

“…This leads to higher levels of dissolved oxygen in plasma and subsequent arterial constriction in the brain, thus aborting and preventing the migraine. [1][2][3][4]15,19 The current understanding of the pathophysiology behind migraines with aura combined with the increasing evidence supporting the anti-inflammatory and anti-vasodilatory effects of HBO, suggests that our patients' relief could be related to HBO decreasing the inflammatory response that leads to the activation of the trigeminovascular pathway. 10,13,15,20 A study by Myers et al 21 demonstrated a significant reduction (P < 0.05) in migraine relief in patients undergoing HBO versus those who underwent normobaric oxygen therapy.…”

“…12 HBO substantially increases the amount of arterial oxygen and therefore effectively achieves cerebral vasoconstriction, thus treating the migraine. 1,13 Based on this case report, we believe the current approved indications for HBO need to be expanded to include resistant migraines after further randomized control trials demonstrate efficacy in a larger patient population ( Table 1).…”

“…This allows tissue to meet its oxygen demand through the dissolved oxygen alone without the need to utilize the oxygen linked to hemoglobin. [1][2][3][4][5] As a class II medical device, hyperbaric chambers are currently approved for 13 indications by the U.S. Food and Drug Administration (FDA) and Hyperbaric Medical Society. 6,7 Indications currently include adjuvant therapy in wound ischemia, thermal burn treatment, blood loss anemia, air embolisms, carbon monoxide poisoning, clostridial myonecrosis, crush injury, decompression sickness, chronic refractory osteomyelitis, necrotizing soft-tissue infections, radiation tissue injury, ischemic skin grafts and flaps, and intracranial abscess ( Table 1), but does not include neurologic conditions.…”

Advances in treatment of complex regional pain syndrome: recent insights on a perplexing disease

“…Alternatives that are being explored include graded imagery, repetitive transcranial magnetic simulation [52], hyperbaric oxygen [53], intravenous infusion of iloprost (a prostacyclin analogue) [54] and immunoglobulin [55], as well as subanesthetic infusion of ketamine [56,57]. Of these options, graded motor imagery has shown benefit in a randomized controlled trial [58] consisting of 13 patients with CRPS who were given 2 weeks each of a hand laterality recognition task, imagined hand movements, and mirror therapy.…”