February 28, 2023, by mbzva

Breathing oxygen may be the new treatment for chronic pain

By Argyro Philippidou, 3^rd Year Neuroscience BSc

Hyperbaric oxygen treatment (HBOT) is not a treatment you commonly or routinely hear. It actually has the potential to be an alternative therapy to any disease in which cell regeneration and decrease of inflammation are the therapeutic targets. A close person of mine has undergone HBOT for their chronic pain ailment, trigeminal neuralgia, and that is how I stumbled across it. Once I had heard about it and researched HBOT, I felt that this is an alternative therapy that people ought to know more about. It is painless and almost effortless- except if one may consider breathing an effortful action. Patients with chronic pain may therefore prefer this kind of therapy compared to classic chronic pain treatments such as antidepressants, muscle relaxants and anti-epileptic drugs which come with a package of side effects.

Establishing  the basic mechanism of chronic pain is therefore crucial to understand  how such a therapy may be useful and the multidisciplinary approach taken to treat chronic pain syndromes. Chronic pain is defined as a pain response that usually lasts over a period of 3 months either persistently acting or recurrently acting (Treede R et al., 2015). Chronic pain is tightly paired with the word maladaptive amongst scientists. In this case, chronic pain disrupts the physiological pain actions and processes of our body making it incapable of adapting to our normal processing of sensory stimuli and thus adopts a maladaptive nature. Such physiological pain processes consist of the regulation of substances called neurotransmitters and inflammatory mediating substances like interleukin 1β and TNF-alpha (Yildis S et al.,2006), in both the Central nervous system which consists of the brain and spinal cord as well as the peripheral nervous system that consists of the nerves that branch out from our brain and spinal cord and reach the rest of the body.

HBOT has been a pivotal step for over 40 years now (Leach RM. Et al., 1998) in treating sea divers from the rapid change in pressure and its physiological effects like decompression sickness, it has on their bodies. Nowadays research suggests that HBOT can also treat chronic pain syndromes such as chronic headaches, fibromyalgia as well as trigeminal neuralgia (Sutherland AM. et al, 2015). HBOT allows patients to breathe 100% oxygen at very high pressures than we are used to. This allows oxygen to travel in plentiful amounts in all areas of our body that need it including blood and lungs. This spreading of oxygen allows the body to restore itself (Thom SR., 2011) and eliminate chronic pain scales by reducing inflammation in each patient’s designated painful area. This has been proven in both animal and human studies by researchers in the university of Toronto (Sutherland AM. et al, 2015). In fact, it can decrease pain responses up to 80-95% for up to 90 mins after HBO therapy (Zelinski LM et al., 2009). Inflammatory substances causing pain like interleukin 1β and TNF-alpha are significantly decreased as studies by Yildis S et al. 2006 have shown (Yildis S et al., 2006)

Unfortunately, HBO comes in when conventional treatments fail.  Pharmacological approaches although not always the best option, seem to be the research field where more funding is placed in and thus marketing and promotion of those drugs as well as high sales rates is what pharmaceutical companies prefer and indirectly demand. We must take into consideration how exposure to different pain relief drugs may alter the effect of HBOT on patients with chronic pain. Many fore coming studies should consider these factors when treating patients with HBO treatment. However, it is an ever more promising alternative to the traditional and dated pharmacological approach to treating chronic pain syndromes.

 

References:

• Leach, R.M., Rees, P.J. and Wilmshurst, P. (1998). ABC of oxygen: Hyperbaric oxygen therapy. BMJ, 317(7166), pp.1140–1143. doi:10.1136/bmj.317.7166.1140.
• Sutherland, A.M., Clarke, H.A., Katz, J. and Katznelson, R. (2015). Hyperbaric Oxygen Therapy: A New Treatment for Chronic Pain? Pain Practice, [online] 16(5), pp.620–628. doi:10.1111/papr.12312.
• Thom SR. (2011) Hyperbaric oxygen: its mechanisms and efficacy. Plast Reconstr Surg. ;127(Suppl 1):131S–141S.
• Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M.I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N.B., First, M.B., Giamberardino, M.A., Kaasa, S., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B.H. and Svensson, P. (2015). A classification of chronic pain for ICD-11. Pain, [online] 156(6), pp.1003–1007. doi:10.1097/j.pain.0000000000000160.
• Yildiz, S., Uzun, G. and Kiralp, M.Z. (2006). Hyperbaric oxygen therapy in chronic pain management. Current Pain and Headache Reports, [online] 10(2), pp.95–100. doi:10.1007/s11916-006-0019-x.
• ‌Zelinski LM, Ohgami Y, Chung E, Shirachi DY, Quock RM. (2009) A prolonged nitric oxide-dependent, opioid- mediated antinociceptive effect of hyperbaric oxygen in mice. J Pain.;10:167–172.

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