Hyperbaric Oxygen Therapy For Chronic Conditions

  • Harry Sutherland Master of Science - MS, Cell/Cellular and Molecular Biology, Victoria University of Wellington

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative

Introduction

What is hyperbaric oxygen therapy?

Hyperbaric oxygen therapy (HBOT) involves exposing patients to pure oxygen within a pressurised chamber to yield potential positive therapeutic effects. Individuals are placed in a sealed chamber where pure oxygen is administered at pressures higher than the normal atmospheric pressure (>1.4 atmospheres).1 This procedure facilitates the thorough penetration of oxygen into tissues and blood, resulting in significantly elevated oxygen levels compared to those typically maintained by the body under normal conditions.1

History and development of HBOT

1662 British physician Henshaw pioneered hyperbaric medical therapy by placing patients in pressurised containers with air. Further advancements were hindered by Lavoisier and Seguin's observations of oxygen-related side effects at high concentrations in 1789. In 1872, Paul Bert elucidated the physiological effects of pressurised air on the human body and identified oxygen's neurotoxic effects, becoming known as the Paul Bert effect. HBOT gained traction during WW2 for treating divers with decompression illness and remains a standard treatment today. This led to the establishment of numerous HBOT facilities by the 21st century to further explore its potential therapeutic value.1

Currently, most studies investigating HBOT find it difficult to approach the treatment regime in a completely safe and standardised way, as the chemical and physical principles governing HBOT treatments make it difficult. However, research is still ongoing, and some models have offered the possibility that some patients and conditions in particular may benefit from HBOT. 1,2

Understanding chronic conditions

What are chronic conditions?

It is difficult to define the term “Chronic condition” as many factors must be considered. As such, there is not yet one single definition which has been universally accepted. However, the general consensus is that a chronic condition is a long-term or recurring, potentially incurable disease or condition that may impact the lives of those affected.3 Some chronic conditions get rapidly worse, and some can stay nearly the same for long periods of time. One well-known example is Alzheimer's disease, which can have a range of progression rates and severity. Another well-known example of a chronic condition is diabetes, which requires the affected individual to constantly manage their glucose and insulin levels, which can have a significant impact on daily life.4

The most obvious challenges associated with managing chronic conditions are the ongoing cost,5 effectiveness of the treatment and progression of the condition.6 Moreover, the chronic nature of these conditions often makes following complex treatment procedures challenging for patients, potentially exacerbating the aforementioned challenges.7 The exacerbation of any of these challenges can, therefore, begin to have large impacts on patients' quality of life and the load and cost on healthcare systems supporting those affected. Therefore, developing innovative, personalised and simplified treatment approaches is essential for optimising the health and general well-being of those living with chronic conditions and relieving the costs and load on healthcare systems.

Exploring hyperbaric oxygen therapy

How does HBOT work?

HBOT involves administering pure or higher oxygen levels under higher-than-normal pressures to boost oxygen levels in the body.1 Unlike most nutrients absorbed through the digestive system, oxygen is absorbed via the lungs. Oxygen is an important nutrient, allowing cells to efficiently produce usable energy through aerobic respiration via adenosine triphosphate (ATP) generation. Through HBOT, tissues become saturated with oxygen, enhancing cellular energy production and supporting various functions, such as blood vessel growth (angiogenesis). This therapy can help in scenarios where oxygen availability has been restricted (hypoxia) or where healing/repair processes are required (e.g. wound healing).1,8

HBOT has been shown to produce therapeutic effects for a range of conditions. It does this through several identified mechanisms. It has been shown to promote blood vessel growth, interact with the immune system to help resolve inflammation, modulate autoimmune cells and assist in healing/repair processes of damaged tissue.9

HBOT as a treatment

HBOT has been in development since it was first conceived in 1662. However, as mentioned, there are several factors that have made it difficult to produce consistent treatment regimes. As such, consistent large-scale evidence supporting the use of HBOT in a clinical setting is relatively sparse.2 However, sparse does not mean non-existent. Many clinical trials have been conducted which utilise HBOT as a treatment for a range of chronic conditions such as MS10,11,12, chronic wounds2,13 or chronic pain.14 While promising, the majority of the studies that have found positive results are still unable to recommend them as an established treatment as they still require further improvement in trial designs and procedural unification. Regardless of the clinical conclusions, many patients who have utilised HBOT believe it beneficial.12

What is involved in HBOT treatments?

Patients are sealed inside a chamber (of which there can be a few different sizes), which is then slowly brought to a higher pressure. With the system sealed, the chamber has an air mixture, exposing the patient(s) to pure or higher oxygen concentrations.2 The patients remain in the pressurised chamber for a length of time dictated by the treatment protocol. These treatments are repeated over a certain period of time as determined by the protocol. For example, an intensive protocol involved treating patients with HBOT for 45 minutes 5 times per week for 3 weeks.12

Potential applications for chronic conditions

  • Multiple Sclerosis

In addition to normal therapies, HBOT has been shown to reduce inflammation levels and modulate auto-immune activity in Multiple Sclerosis models.9

  • Chronic traumatic brain injury

No clear, supportive evidence for this yet but remains a possibility which is being further investigated.2

  • Chronic wounds

HBOT is shown to improve healing of chronic wounds (e.g. diabetic foot ulcers), via mechanisms such as reductions in inflammation levels, growth factor involvement and increased angiogenesis.

  • Chronic pain

Several studies have demonstrated that HBOT may reduce pain and pain-related symptoms for those suffering from some chronic pain conditions, improving quality of life.14

These are a few examples of some potential applications for HBOT that have been explored in literature and hold potential to be integrated with current treatment regimes. As research continues, it is possible this list will grow as the technologies and mechanisms are further explored.

Safety and risks

Side effects of HBOT

The side effects of HBOT can generally be divided into oxygen- and pressure-based side effects. Generally speaking, the side effects are relatively few, mild, and can be managed easily. 

The most significant oxygen based side effect is oxygen toxicity which commonly begins at around three times normal air pressure.1 These side effects can be avoided by keeping pressure levels below this threshold and by keeping the exposures/treatments short. 

The most common pressure based side effects include discomfort of any areas containing quantities of air (lungs, sinuses, digestive system etc.). This can be managed through gradual pressure changes and the teaching of equalisation strategies. Other side effects include headaches, ocular side effects, and claustrophobia, which can be managed with coaching and anxiolytic medications.15 Though many of these risks are relatively avoidable with appropriate countermeasures, it highlights the importance of professional supervision, appropriate planning and adherence to safety protocols.

Integrating HBOT into chronic condition management

Many conditions utilising HBOT have limited treatments available, and there is still minimal large-scale evidence that HBOT alone would provide the therapeutic effects required for the successful treatment of many chronic conditions. Regardless, they appear to complement the existing treatments by improving the body’s response to the medication.1

Those with contraindications or those experiencing severe side effects should be wary of pursuing HBOT as a treatment. Patients looking to add HBOT to their current treatment regime should consult a medical professional before doing so to ensure that the treatment is advisable and suitable for their individual scenario.

The technical knowledge and expense of the equipment means that chambers are not plentiful, and thus planning is required to ensure that the costs and availability are not prohibitive. It is currently debated whether HBOT will represent a cost effective treatment, which may create a barrier preventing its integration into treatment regimes.2 Criteria for determining which patients should have access to HBOT would help ensure accessibility for those who might most benefit from treatment, also potentially helping improve cost-effectiveness.

Challenges and future directions

As mentioned above, the chambers required are not widespread, potentially limiting HBOT as an option in many cases. Relatively few large-scale clinical trials have investigated HBOT as a treatment, limiting awareness and limiting the establishment of it as a therapy. 

The number of smaller-scale trials and studies that do support it indicates that further research is worth doing as it may present a relatively simple treatment for patients suffering from chronic conditions in support of already existing treatments.

Unification and standardisation of protocols are required to allow for large scale comparisons and analysis of protocols. Similarly, the development of standardised clinical trial formats are required to provide meaningful clinical results at larger scales. Finally, it may lead to further optimisation of treatment regimes and could thus further improve the quality of life for those who are living with chronic conditions.

Summary

HBOT has been shown to improve patient outcomes alongside normal treatments for various chronic conditions. It can do this through various mechanisms, such as immune system regulation, inflammation resolution and angiogenesis. Any simple treatments that may improve symptoms or quality of life for those suffering from chronic conditions are worth further investigating. While it is currently not established as a treatment option for many chronic diseases, improving awareness may help to gather greater funding for research and improved accessibility to treatments, which may hopefully lead towards HBOT being established as a viable treatment. This would enable those affected by chronic conditions to reap the benefits of HBOT when the current treatments for their conditions may be lacking.

References

  1. Ortega MA, Fraile-Martinez O, García-Montero C, Callejón-Peláez E, Sáez MA, Álvarez-Mon MA, et al. A general overview on the hyperbaric oxygen therapy: applications, mechanisms and translational opportunities. Medicina (Kaunas) [Internet]. 2021 Aug 24 [cited 2024 Mar 1];57(9):864. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465921/
  2. Fife CE, Eckert KA, Carter MJ. An update on the appropriate role for hyperbaric oxygen: indications and evidence. Plast Reconstr Surg [Internet]. 2016 Sep [cited 2024 Mar 1];138(3):107S-116S. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4996355/
  3. Bernell S, Howard SW. Use your words carefully: what is a chronic disease? Frontiers in Public Health [Internet]. 2016 [cited 2024 Mar 1];4. Available from: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2016.00159
  4. Wilkinson A, Whitehead L, Ritchie L. Factors influencing the ability to self-manage diabetes for adults living with type 1 or 2 diabetes. International Journal of Nursing Studies [Internet]. 2014 Jan 1 [cited 2024 Mar 1];51(1):111–22. Available from: https://www.sciencedirect.com/science/article/pii/S002074891300031X
  5. McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs. RMHP [Internet]. 2016 Jul 5 [cited 2024 Mar 1];9:143–56. Available from: https://www.dovepress.com/multimorbidity-in-chronic-disease-impact-on-health-care-resources-and--peer-reviewed-fulltext-article-RMHP
  6. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. The Lancet [Internet]. 2013 Nov [cited 2024 Mar 1];382(9903):1525–33. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673613618097
  7. Dunbar-Jacob J, Mortimer-Stephens MK. Treatment adherence in chronic disease. Journal of Clinical Epidemiology [Internet]. 2001 Dec 1 [cited 2024 Mar 1];54(12, Supplement 1):S57–60. Available from: https://www.sciencedirect.com/science/article/pii/S0895435601004577
  8. Brugniaux JV, Coombs GB, Barak OF, Dujic Z, Sekhon MS, Ainslie PN. Highs and lows of hyperoxia: physiological, performance, and clinical aspects. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology [Internet]. 2018 Jul 1 [cited 2024 Mar 1];315(1):R1–27. Available from: https://www.physiology.org/doi/10.1152/ajpregu.00165.2017
  9. Chiou HYC, Huang SH, Hung CH, Tsai SM, Kuo HR, Huang YR, et al. Hyperbaric oxygen therapy alleviates autoimmune encephalomyelitis via the reduction of il-17a and gm-CSF production of autoreactive t cells as well as boosting the immunosuppressive il-10 in the central nervous system tissue lesions. Biomedicines [Internet]. 2021 Aug [cited 2024 Mar 1];9(8):943. Available from: https://www.mdpi.com/2227-9059/9/8/943
  10. Boschetty V, Cernoch J. [Use of hyperbaric oxygen in various neurologic diseases. (Preliminary report)]. Bratisl Lek Listy. 1970 Mar 1;53(3):298–302.
  11. Fischer BH, Marks M, Reich T. Hyperbaric-oxygen treatment of multiple sclerosis: a randomized, placebo-controlled, double-blind study. N Engl J Med [Internet]. 1983 Jan 27 [cited 2024 Mar 1];308(4):181–6. Available from: http://www.nejm.org/doi/abs/10.1056/NEJM198301273080402
  12. Moore L, Eggleton P, Smerdon G, Newcombe J, Holley JE, Gutowski NJ, et al. Engagement of people with multiple sclerosis to enhance research into the physiological effect of hyperbaric oxygen therapy. Multiple Sclerosis and Related Disorders [Internet]. 2020 Aug 1 [cited 2024 Mar 1];43:102084. Available from: https://www.sciencedirect.com/science/article/pii/S2211034820301607
  13. Hajhosseini B, Kuehlmann BA, Bonham CA, Kamperman KJ, Gurtner GC. Hyperbaric oxygen therapy: descriptive review of the technology and current application in chronic wounds. Plast Reconstr Surg Glob Open [Internet]. 2020 Sep 25 [cited 2024 Mar 1];8(9):e3136. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544320/
  14. Schiavo S, DeBacker J, Djaiani C, Bhatia A, Englesakis M, Katznelson R. Mechanistic rationale and clinical efficacy of hyperbaric oxygen therapy in chronic neuropathic pain: an evidence-based narrative review. Pain Research and Management [Internet]. 2021 Apr 22 [cited 2024 Mar 1];2021:e8817504. Available from: https://www.hindawi.com/journals/prm/2021/8817504/
  15. Zhang Y, Zhou Y, Jia Y, Wang T, Meng D. Adverse effects of hyperbaric oxygen therapy: a systematic review and meta-analysis. Frontiers in Medicine [Internet]. 2023 [cited 2024 Mar 1];10. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2023.1160774
  16. Ortega MA, Fraile-Martinez O, García-Montero C, Callejón-Peláez E, Sáez MA, Álvarez-Mon MA, et al. A general overview on the hyperbaric oxygen therapy: applications, mechanisms and translational opportunities. Medicina [Internet]. 2021 Sep [cited 2024 Mar 1];57(9):864. Available from: https://www.mdpi.com/1648-9144/57/9/864

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative
[optin-monster-inline slug="yw0fgpzdy6fjeb0bbekx"]
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Harry Sutherland

Master of Science - MS, Cell/Cellular and Molecular Biology, Victoria University of Wellington

Holding a Bachelor’s degree in Biomedical Science and a Master’s degree in Cell and Molecular Bioscience from Victoria University of Wellington, I have a strong foundation in scientific research.

My experience extends beyond the laboratory, having collaborated with diverse teams during my master’s program. This has honed my ability to communicate complex scientific concepts effectively to individuals from various backgrounds.

My strengths lie in my abilities to bridge the gap between intricate scientific ideas and their broader implications, and in making science accessible and engaging for all.

I am particularly interested in the fields of genetics and reproductive biology and am dedicated to ongoing learning and research. With several years of writing experience, I am dedicated to producing well-researched, insightful and educational content that resonates with a wide audience.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Email:
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818