Does it really work? Why are there some they say “Yes” and others say “No”? A Medical Q&A session by Herald Tribune could help explain.
Q: Will hyperbaric treatment help with recovery from a brain injury?
A: Each year, thousands of Americans suffer a traumatic brain injury. Most of these are mild traumatic brain injuries, or mTBIs — head injuries that don’t cause a coma. People with an mTBI typically get better within a few weeks, but for some, problems can linger for months or years.
Many of these patients find themselves stuck with depression, cognitive problems, headaches, fatigue and other symptoms. Known as post-concussion syndrome, this phenomenon is often difficult to treat. Antidepressants can lift moods, painkillers can ease headaches and physical therapy may ease dizziness, but most researchers agree that these remedies don’t heal the injury.
Could oxygen do the trick? A growing group of scientists and physicians say that hyperbaric treatment, which exposes patients to pure oxygen at higher-than-normal air pressure, may work.
“These patients don’t have enough oxygen to heal the injured parts of their brains,” said Shai Efrati, a researcher and physician at Tel Aviv University in Israel. “Hyperbaric treatment massively increases the amount of oxygen available to the brain.”
But other researchers believe that the treatment has no merit.
“People want to believe that hyperbaric can fix” brain injuries — “and it can’t,” said David Cifu, a researcher at Virginia Commonwealth University, who has spent much of his career treating veterans with brain injuries.
Compressed air has been used by doctors since the 17th century. In 1917, two German inventors first used pressurized pure oxygen to treat decompression sickness, which occurs when divers return to the surface too quickly. For 50 years, hyperbaric therapy has been approved by the Food and Drug Administration as a treatment for non-healing wounds, carbon monoxide poisoning, burns and decompression sickness.
The nature of the human brain makes it particularly susceptible to chronic injury. The organ requires large amounts of energy under normal circumstances, and even more to heal. Often, Efrati and others say, injured brain cells don’t die, but may persist for years, alive but hobbled. Hyperbaric therapy, he said, can return them to full function.
“Oxygen is different, because it has a direct biological effect on brain tissue,” said Paul G. Harch, a physician in New Orleans who has used hyperbaric oxygen to treat hundreds of people with chronic brain injury as well as stroke.
Patients typically receive between 40 and 60 hour-long hyperbaric treatments over two to three months. During each treatment, they sit or lie inside a hyperbaric chamber, and breathe in pure oxygen, typically pressurized to about twice the density of sea-level air.
Efrati said pressurized oxygen has the power to repair many kinds of tissue damage.
“A non-healing wound in the leg and a non-healing wound in the brain,” he said, “they are the same basic thing.”
As the use of hyperbaric therapy for brain injury has grown, it has become increasingly controversial. Critics argue that it remains unproven and that desperate patients are wasting thousands of dollars — between $200 and $400 per session, rarely covered by insurance — on a technique that rarely if ever helps.
Between 2009 and 2015, Cifu oversaw three studies for the Department of Veterans Affairs — reportedly at a taxpayer cost of about $70 million — of about 60 active-duty service members with post-concussion syndrome. The studies found that hyperbaric treatment had little effect on their symptoms.
Overall, there is relatively little research on hyperbaric treatment for brain injury, in part because pressurized oxygen can’t be patented, which limits its potential profitability.
“It’s very difficult to get funding for studies on this topic,” Harch said.
— David Kohn, The Washington Post