By Patricia McAdams

Hyperbaric Oxygenation Therapy (HBOT) is a new therapy for many individuals with CRPS/RSD. 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 RSD 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 RSD. “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/RSD 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 RSD 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 RSD 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 RSD, you need to understand the disease itself. “RSD 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 RSD, 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 RSD 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 RSD. 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 RSD. 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/RSD, with costs around $150 to $250 per session.
For example, if ordinary pain management therapies like injections and narcotics don’t help RSD 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 RSD.