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Hyperbaric Oxygenation Therapy: Can it Relieve Your Pain?
By Patricia McAdams
Hyperbaric Oxygenation Therapy (HBOT) is a new therapy for
many individuals with CRPS. Interestingly, however, this
therapy is not new at all. According to Allan Spiegel, MD,
Palm Harbor, Florida, the field is almost 100 years old. In
countless countries, there are 55 recognized clinical diagnoses
that experts perceive can be helped by HBOT. The United States,
however, recognizes only 14 of these diagnoses—and CRPS
is not on this list.
Spiegel, who has been a practicing neurologist for more than
21 years, discovered HBOT seven years ago through the internet
when he was searching for therapies to help a family member
who had suffered a stroke. "As a neurologist, I didn't
believe this would work until I saw it firsthand," he
says. He has since become a certified hyperbaric clinician
and is passionate about the healing potential of this therapy.
With HBOT, patients enter a small bed-size chamber where they
inhale 100 percent oxygen (instead of 21 percent) at higher-than-normal
atmospheric pressure. These pressures are equivalent to different
depths undersea—except that there is no water.
Spiegel says that HBOT supersaturates tissues that have been
deprived of oxygen because of the swelling of a limb. Specifically,
saturation levels of oxygen in blood and tissues increase
10 to 20 times while in the chamber. Further, HBOT has a tendency
to constrict vessels by about 15 percent, which causes a decrease
in swelling from the edema present in most people with CRPS.
"With HBOT," Spiegel says, "we are looking
at long-term improvement, reduction in pain, improvement in
sleep—and reduction in depression, because pain causes
depression."
Of the 15 patients with CRPS that Dr. Spiegel has treated,
12 have been helped by the therapy, he says. One patient,
who had been a nurse at a local hospital, developed CRPS involving
her leg following a trauma. She had undergone about 60 or
70 nerve blocks through a pain management specialist, but
these only temporarily eased her pain. When Spiegel first
met her, she was on high dose narcotics and had been unable
to work. "After about six weeks and 20 treatments of
HBOT therapy, she was off narcotics and went back to work
for the first time in nine years." Spiegel calls her
his "Poster Child" for CRPS because her experience
was so remarkable.
How Does Hyperbaric Oxygenation Therapy Work?
Susan Rodriguez, a certified hyperbaric specialist from San
Bernardino, California, believes that to understand how HBOT
works for CRPS, you need to understand the disease itself.
"CRPS is neurological in nature and yet it manifests itself
in physical symptoms," she says. "What that means
is that the disease needs to be treated with two approaches.
One goal is to restore circulation, reduce inflammation or
edema, and remove the swelling in affected limbs so the limbs
can live. The other goal—if you want to eliminate the disease—is to work on the brain."
If you were to stub your toe, for example, the central nervous
system would tell your brain that your toe hurts. This pain
is rooted in a physical injury. But sometimes trauma and inflammation mysteriously trigger
a reaction from the sympathetic nervous system, which is a
different part of the brain. With CRPS, pain is read through
sensors in the sympathetic nervous system. (The sympathetic
nervous system is what is activated in phantom leg pain, for
example.) "Hyperbaric Oxygenation Therapy, however, can
make the switch in the brain back to the central nervous system,"
Rodriguez says. Under a doctor's direction, she treats both
the affected limb and the brain by different atmospheric pressures
when the patient is inside the chamber.
"Different undersea depths work on different parts of
the body," she explains. "Deeper depths (up to 33
to 45 feet undersea) work more on tissue and bone, while milder
hyperbarics (such as 18 to 24 feet undersea) work on the brain.
Since we are working on both things, I take patients to all
those levels. Almost always, the first symptom to come is
the last to go. And then the symptoms are gone!"
Rodriguez learned about the effectiveness of HBOT therapy
in treating CRPS first hand, when her husband Patrick was diagnosed
in the mid-1990s following surgery. Because she had already
been working in this field, they decided to try Hyperbaric
Oxygenation Therapy to treat his CRPS. Not only is Patrick
working today, but he has become a certified hyperbaric technician.
The couple opened Rapid Recover Hyperbarics in 1998, with
Donald Underwood, DO, MD, JD, serving as medical director.
A physician should review all aspects of a patient's medical
history before starting therapy. There are a few medical conditions
that may prevent an individual from receiving HBOT -- either
permanently (certain lung and heart disorders) or temporarily
(sinus infections, fevers).
"I have seen some very dramatic improvements," says
Rodriguez. "In some cases we have seen improvements to
the point of a remission." she says. "Nothing works
for everyone, but I've seen this work for many people if they
stick with it."
Paying for Hyberbaric Oxygenation Therapy
According to Spiegel, the Food and Drug Administration (FDA)
has approved this therapy for only 14 clinical conditions,
including the treatment of external diabetic ulcers and internal
radiation wounds. These 14 treatment categories appear to
have been arbitrarily set more than 40 years ago.
Without FDA approval, however, insurance companies cannot
cover the cost of this treatment, nor can hospitals provide
treatment, even for those who can pay. Instead, only free-standing
clinics are legally permitted to treat for "off-list"
conditions such as CRPS. Formal clinical studies are required
for this scenario to change, a cost prohibitive proposition
thus far.
While insurance is unlikely to cover the cost of these treatments
for the time being, Spiegel feels HBOT therapy is still "very,
very cost effective" in the long term. Session lengths
average 1-1/2 to 2 hours for individuals with CRPS, with
costs around $150 to $250 per session.
For example, if ordinary pain management therapies like injections
and narcotics don't help CRPS patients, then surgical procedures
may be necessary, he says. One of these is a morphine pump,
which costs upwards of $20,000 just to install. "It needs
to be monitored monthly by a physician and replaced every
four or five years, with all the associated costs for doctor
visits along the way." Most free-standing centers, however,
provide HBOT for thousands of dollars less than hospital-based
centers.
Spiegel and others are doing what they can to get the FDA
and other groups to re-evaluate the current limitations on
approved diagnoses to treat with HBOT. This past summer, for
example, he gave a talk at the Undersea Hyperbaric Medical
Society annual meeting. The talk raised considerable interest.
Currently, two clinical trials are underway at the National
Institutes of Health involving HBOT, but neither involve people
with CRPS.
Choosing a Treatment Center
Hospitals are not permitted to provide Hyperbaric Oxygenation
Therapy for patients suffering with CRPS.
Instead, you must select a free-standing medical clinic. Choose a reputable center for your treatment, where your therapists
understand all the risks and take all the safety precautions
necessary to avoid a problem.
A reputable center will
• be staffed by a physician and other health care
professionals certified by the Hyperbaric and Undersea Medical
Society.
• require a doctor's prescription before giving therapy.
• have two or more staff members in the building at all
times in the event one has an emergency.
•have strict rules about allowing nothing whatsoever
in the chamber with the patient that could be combustible.
Resources:
A number of research and patient articles are posted on the
following sites:
National Hyperbaric Oxygen Therapy
Palm Harbor, Florida
Allan Spiegel, MD
http://rsdtherapy.com
Rapid Recovery Hyperbarics
San Bernardino, California
Patrick and Susan Rodriguez, CHT, EMT, DMT
Donald Underwood, DO, MD, JD
http://hbot4u.com
Read stories of people who have used HBOT:
Eduardo's
Story
People
who have CRPS and have used HBOT |
