How Hyperbaric Oxygen Therapy Reduces Chronic Inflammation and Pain
Hyperbaric oxygen therapy (HBOT) is a treatment that provides high amounts of oxygen to cellular tissue. Due to certain laws of chemistry and physics, the pressure is what differentiates this therapy from standard oxygen therapy using an oxygen tank or concentrator. Under pressure, oxygen gas is compressed into smaller molecules (Boyle’s Law) allowing concentrated amounts of oxygen to dissolve in liquid plasma. This high concentration of oxygen then travels to low areas of oxygen in the tissues (Henry’s Law).
Studies have investigated the effects of hypoxia, or low oxygen, in high altitude environments1. At hight altitude there is lower available oxygen in the air. The lower the oxygen levels, the more susceptible cells are to inflammation. The mechanisms are complex, but what has been discovered is that there is a protein called Hypoxia-Inducible Factor, or HIF. Low oxygen levels can be caused by injury to tissue, infection, sleep apnea, or high altitude. The HIF protein is sensitive to oxygen levels and when oxygen is low, it stimulates production of another protein called NF-kappaB. This protein is responsible for stimulating many cytokines responsible for inflammation. The opposite occurs when there is more oxygen in the area, HIF protein gets shut down and therefore cannot stimulate NF-kappaB thereby decreasing inflammation.
Multiple HBOT studies have shown that HBOT therapy decreases inflammatory markers such as c-reactive protein (CRP) and sedimentation rate (ESR). In December of 2021, the Journal of Clinical Rheumatology published a finding that rheumatoid arthritis patients who received 30 treatments over 6-10 weeks had significant improvements in pain levels and lower CRP and ESR levels2.
In another study conducted on 32 patients with fibromyalgia who underwent 20 HBOT sessions 3 days per week, there were significant improvements in symptoms of anxiety, fatigue, and pain compared to baseline3.
Multiple studies have also investigated the effects of HBOT on traumatic brain injury and chronic traumatic encephalopathy4. Both are conditions of inflammation in the brain. In the largest study performed on patients suffering from chronic neurocognitive damage due to TBI, it was found that HBOT therapy was associated with significant cognitive improvements. 154 patients underwent 40-70 one hour sessions 5 days per week under 1.5-2.0 ATM. CT scans showed increased activity in the anterior cingulate and the post-central cortex, in the prefrontal areas and in the temporal areas of the brain along with the cognitive improvements5.
Many conventional therapies treat inflammation with medications that intend to block inflammatory cytokines but this does not always lead to resolution of inflammation and pain. It is clear that low oxygen levels cause inflammation. It then makes sense that high oxygen levels would decrease inflammation. Many published studies investigating inflammation, inflammatory conditions, and HBOT have already begun shown this relationship.
Illustration of mechanism of hyperbaric oxygen therapy affect on inflammatory cytokines4
Chronic inflammatory diseases associated with NF-κB activation
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NF-κB activation in human inflammatory diseases |
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Rheumatoid arthritis |
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Atherosclerosis |
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Chronic obstructive pulmonary disease (COPD) |
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Asthma |
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Multiple sclerosis |
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Inflammatory bowel disease (IBD) |
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Ulcerative colitis |
Adapted from Tak and Firestein 2001.
- Hypoxia and Inflammation: Insights From High-Altitude Physiology
Kathy Pham
https://www.frontiersin.org/ar...
2. J Clin Rheumatology
. 2021 Dec 1;27(8):e462-e468.
The Effects of Hyperbaric Oxygen on Rheumatoid Arthritis: A Pilot Study
Michelle T Sit et al
https://pubmed.ncbi.nlm.nih.go...
3. Clin Exp Rheumatol
action
Jan-Feb 2019;37 Suppl 116(1):63-69. Epub 2019 Feb 6.
Hyperbaric oxygen treatment of fibromyalgia: a prospective observational clinical study
Fabiola Atzeni et al
https://pubmed.ncbi.nlm.nih.gov/30747099/
4.
Med Gas Res. 2016 Apr-Jun; 6(2): 102–110.
Published online 2016 Jul 11. doi: 10.4103/2045-9912.184720
Hyperbaric oxygen therapy for traumatic brain injury: bench-to-bedside
5. Neurology Research
Effect of hyperbaric oxygen therapy on chronic neurocognitive deficits of post-traumatic brain injury patients: retrospective analysis
Amir Hadanny et al
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