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Conditions we do NOT treat

Indications NOT currently treated at DDRC Healthcare

Hyperbaric oxygen (HBO) therapy has been used to treat a huge range of different medical conditions, some with more evidence than others. DDRC Healthcare strives to work to best current evidence for use of HBO.

Much effort has been made and is ongoing to add to the evidence base looking at which medical conditions could benefit from HBO and by what mechanisms HBO actually works for these conditions.

We do receive enquiries about some conditions for which we do not feel sufficient evidence exists to warrant treatment with HBO. Below is an outline of conditions for which we do not use HBO and why. This list is far from comprehensive and it will be reviewed as evidence is published. If you have any queries, please get in touch.

It should be noted organisations such as DDRC Healthcare undertake stringent internal and external review to demonstrate provision of safe, quality and evidence based operation.

DDRC Healthcare is registered with the Care Quality Commission and medically trained staff are always present whilst patients are undergoing HBO.

Neural tissue sensitivity to hypoxia has been an area of interest studies involving HBO in a variety of neurological diseases involving ischaemia, oedema and more recently, prevention of damage due to cell death. Laboratory data has not to date been translated or reflected in clinical evidence of a level felt to justify use of HBO for various neurological syndromes at DDRC Healthcare. 

Below are discussed a few of the most common pathologies for which hyperbaric oxygen therapy has been attempted but which are not currently treated at DDRC Healthcare. New research in many areas is ongoing and evidence will be reviewed as it becomes available.

Conditions that we do NOT treat with HBO

Multiple Sclerosis

Cerebral Palsy

Pervasive Developmental Disorders including Autism

Complex Regional Pain Syndrome

Chronic Fatigue Syndrome (Myalgic Encephalomyeitis)

Fibromyalgia

Ischaemic Stroke

Palliative Treatment for Terminal Cancer

Fibromyalgia

Fibromyalgia is a long-term condition that causes pain all over the body. The cause for this is unknown and it is often classified as a medically unexplained condition. As with Chronic Fatigue Syndrome, it is difficult to propose how HBO could benefit when the cause of the condition itself is unknown. DDRC Healthcare does not currently advocate its use in these cases. Recent studies have been noted but further research is warranted.

Multiple Sclerosis

Multiple Sclerosis (MS) is a disease which causes varied, unpredictable and often intermittent neurological problems. The damage in the nervous system causing these symptoms is thought to be inflammatory in nature and results in demyelination of the nerves.

There has been much interest in HBO as a method of slowing or reversing MS. Some trials have suggested benefit of HBO for MS however a Cochrane Review (1) undertaken in 2011 found that the majority of trials did not find benefit in use of HBO for MS. There are however numerous centres around the UK which provide oxygen at increased pressure for people with MS, with reports of personal benefit.

DDRC Healthcare does not advocate HBO for the treatment of MS currently, and has no links with any of the MS National Therapy Centres.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003057.pub2/abstract 

Cerebral Palsy

Various clinical studies of differing quality have been published, as well as a systematic review of HBO for Cerebral Palsy. (1) The stronger randomised study (2) is flawed in view of the large spread of symptoms in patients enrolled and demonstrated equivalent improvement in motor function both for the HBO group (1.75 ATA HBO for 40 daily sessions) and the control group (air at 1.3 ATA for 40 sessions). This was interpreted by some as no effect from HBO, and by others as a significant motor improvement from “mild” (1.3 ATA) hyperbaric air exposure, when compared to the starting level of disability. The authors and the Advisory Scientific Committee of the American Academy of Cerebral Palsy and Developmental Medicine agreed that the positive results in both groups were due to a participation effect. (3) Despite some impressive individual improvements and video demonstrations, the use of HBO for cerebral palsy is not recommended given the lack of clinical evidence of benefit.

1; M S Mcdonagh, D Morgan, S Carson and B S Russman: “Systematic review of hyperbaric oxygen therapy for cerebral palsy: the state of the evidence” Developmental Med and Child Neurology 2007, 49: 942-947

2; Collet JP, Vanasse M, Marois P, Amar M, Goldberg J, Lambert J, Lassonde M, Hardy P, Fortin J, Tremblay SD, Montgomery D, Lacroix J, Robinson A, Majnemer A. Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group. Lancet. 2001 Feb 24;357(9256):582-6

3; Papazian O, Alfonso I. Hyperbaric oxygen treatment for children with cerebral palsy. Rev Neurol. 2003 Aug 16-31;37(4):359-64.

Pervasive Developmental Disorders including Autism

These include disorders that cause a wide spectrum of symptoms disability. They can cause a person to have problems with social interaction, imaginative thought and communication. HBO has been used in attempt to improve symptoms but currently there is no evidence to suggest that HBO can provide benefit. Given that autism is thought to have a genetic basis, the theoretical mechanism by which HBO could offer benefit is doubtful.

In 2009 a randomized double-blind controlled trial was published by Rossignol et al (1) reached a conclusion favourable towards use of breathing 24% oxygen at 1.3 ATA in 40 one hourly sessions. This study was repeated by Jepson et al. and published in 2011 and no benefit was found. DDRC Healthcare does not currently advocate using HBO to treat Pervasive Developmental Disorders.

1; Rossignol DA, Rossignol LW, Smith S, Schneider C, Logerquist S, Usman A, Neubrander J, Madren EM, Hintz G, Grushkin B, Mumper EA. Hyperbaric treatment for children with autism: a multicenter, randomizes, double-blind, controlled trial. BMC Pediatr. 2009 Mar 13;9:21

2; Jepson B, Granpeesheh D, Tarbox J, Olive ML, Stott C, Braud S, Yoo JH, Wakefield A, Allen MS. Controlled evaluation of the effects of hyperbaric oxygen therapy on the behaviour of 16 children with autism spectrum disorders. J Autism Dev Disord. 2011 May; 41(5):575-88 

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome is not well understood, which in itself means it is not easy to postulate the theoretical basis for how HBO could provide benefit. CRPS can cause severe symptoms involving pain, problems with use and abnormal sensation in the affected limb. Often there is a history of trauma and the ongoing symptoms are disproportionate to the severity of the original injury.

There is currently only one study to suggest some benefit of HBO in treating CRPS of the wrist (1). In our own experience {non published observations and one published case report (2)} HBO does not provide benefit for CRPS. Until the publication of larger randomised studies showing benefit, DDRC Healthcare does not use HBO to treat CRPS.

1; Kiralp MZ, Yildiz S, Vural D, Keskin I, Ay H, Dursun H. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res 2004; 32:258-262.

2; Williams ST, Davies A, Bryson P.Chronic Regional Pain Syndrome after subtalar arthrodesis is not prevented by early hyperbaric oxygen. Pain Physician. 2009 Sep-Oct; 12(5):E335-9.

Chronic Fatigue Syndrome (also known as Myalgic Encephalomyelitis, ME)

Chronic fatigue syndrome (CFS) is a disorder of which the cause is unknown however many factors may contribute to the development of the condition. It is difficult to propose how HBO could benefit CFS when the cause of the condition itself is unknown. There are to date no published studies showing a benefit of HBO in the treatment of CFS and DDRC Healthcare does not currently advocate the use of HBO in the treatment of CFS.

Ischaemic stroke

There is evidence from multiple animal research and limited human patient series that there is clinical benefit from HBO. It has been suggested HBO may reduce the amount of brain tissue that may infarct (die) as a result of a stroke by increasing the oxygen available to damaged tissue and reducing brain swelling which can cause secondary damage. This is an area where the most recent Cochrane Review felt warranted further research. However, it is not routinely used to treat a stroke and until this research is completed HBOT is not advised.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004954.pub2/abstract

Terminal Cancer

There is not enough evidence for DDRC Healthcare to offer hyperbaric oxygen therapy as a treatment for terminal cancer. Considering how HBO works and the underlying process in an individual with end stage cancer, we do not think the treatment is appropriate or helpful. Palliative care according to national guidelines is the priority for these individuals. Staying at home and close to those who care in combination with good pain control is paramount. There is no evidence it will prolong life or improve quality of life.

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