KORN KURATED RESEARCH

Hyperbaric Oxygen Therapy for Trauma and Long COVID Symptoms

Hyperbaric Oxygen Therapy (HBOT) has enduring effects on long COVID patients and combat veterans with treatment-resistant PTSD, revealing its capacity to induce neuroplasticity and alleviate persistent clinical symptoms.

I used to scuba dive in the reefs of the Pacific Mexican Sea, delighting in angel fish, mantas, and nearby dolphins. When my fishing companion speared an octopus and handed it to me, it bit me. I decided then never to eat or harm an octopus again. As divers, we know the safety required to prevent decompression illness (DCI). Yet, as a bodyworker, I have treated my share of divers whose rustic equipment failed, leaving them with too much nitrogen in their blood and trauma in their hearts.

Hyperbaric Oxygen Therapy (HBOT) is the gold standard for treating DCI; every port has a chamber. Hyperbaric Oxygen Therapy involves breathing pure oxygen in a pressurized room or tank at 2-3 times sea-level atmospheric pressure, allowing oxygen to perfuse tissue more effectively. Units in hospitals treat decompression sickness, carbon monoxide poisoning, diabetic and non-healing wounds, and burns. It speeds wound healing, prevents post-surgical infections, and is applied to long COVID. Hyperbaric Oxygen Therapy can stimulate the release of growth factors and stem cells, aiding tissue repair and regeneration.

I have long been familiar with the research on Hyperbaric Oxygen Therapy for use in traumatic brain injury (TBI), and I write about it in my book Rhythms of Recovery as part of the protocol. I have always wanted to try it (It's costly!), and I finally had the opportunity to do 20 sessions. Its use for mental health and neurological disorders is well established. I refer my cardiovascular, traumatic brain injury, and dementia clients for Hyperbaric Oxygen Therapy. 

The evidence of Hyperbaric Oxygen Therapy for traumatic brain injury is all over the map. A pioneer in this field, Paul Harch, reports positive results, and the U.S. Department of Veterans Affairs demonstrates mixed results, with better results for mild traumatic brain injury (which is more common) than acute and severe TBI. This is often the case when research is pooled and analyzed. Research can point us in the right direction, but we have to assess and personalize the intervention(s) for the individual.

For example, in my clinical practice, we see improved results when we also combine the use of high dose omega-3 fatty acids (pioneered by the military physician Michael Lewis), which helps repair neuronal integrity, reduce inflammation with specific right brain left brain balancing exercises to engage communication between hemispheres,

You will be interested in this diverse research and seeing how Hyperbaric Oxygen Therapy can improve outcomes with clients experiencing mild traumatic brain injury, PTSD, concussion syndrome, and cognitive decline.

Tags: Hyperbaric oxygen therapy, neuroplasticity, treatment-resistant PTSD, long COVID

Interested in Learning More?

• Course(s): PTSD, Complex Trauma, and Traumatic Brain Injury
• Book(s): Rhythms of Recovery

Referenced Research Publications

Military Medicine
2022, November 26
DOI: 10.1093/milmed/usac360

Hyperbaric Oxygen Therapy for Veterans With Treatment-resistant PTSD: A Longitudinal Follow-up Study

Abstract

Introduction: PTSD is common among veteran combatants. PTSD is characterized by brain changes, for which available treatments have shown limited effect. In a short-term study, we showed that hyperbaric oxygen therapy (HBOT) induced neuroplasticity and improved clinical symptoms of veterans with treatment-resistant PTSD. Here, we evaluated the long-term clinical symptoms of the participants of that study.

Materials and methods: Veterans from our short-term study were recruited 1 or more years after completing HBOT. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and self-reported questionnaires were administered at a single site visit. Changes in clinical scores between long-term, short-term, and pretreatment evaluations were analyzed.

Results: Of the 28 participants who received HBOT during or following the short-term study, 22 agreed to participate in the current study. At a mean of 704 ± 230 days after completing the HBOT course, the mean CAPS-5 score (26.6 ± 14.4) was significantly better (lower) than at the pre-HBOT evaluation (47.5 ± 13.1, P < .001) and not statistically different from the short-term evaluation (28.6 ± 16.7, P = .745). However, for the CAPS-5 subcategory D (cognition and mood symptoms), the mean score was significantly better (lower) at long-term than at short-term evaluation (7.6 ± 5.1 vs. 10.0 ± 6.0, P < .001). At the long-term compared to the pretreatment evaluation, higher proportions of the participants were living with life partners (10 (46%) vs. 17 (77%), P = .011) and were working (9 (41%) vs. 16 (73%), P = .033). Decreases were observed between pretreatment and the long-term follow-up, in the number of benzodiazepine users (from 10 (46%) to 4 (18%), P = .07) and in the median (range) cannabis daily dose (from 40.0 g (0-50) to 22.5 g (0-30), P = .046).

Conclusions: The beneficial clinical effects of HBOT are persistent and were not attenuated at long-term follow-up of about 2 years after completion of HBOT. Additional long-term effects of the treatment were observed in social function and in decreased medication use.

Reference

Doenyas-Barak, K., Kutz, I., Levi, G., Lang, E., Beberashvili, I., & Efrati, S. (2022). Hyperbaric Oxygen Therapy for Veterans With Treatment-resistant PTSD: A Longitudinal Follow-up Study. Military medicine, usac360. https://doi.org/10.1093/milmed/usac360

Scientific Reports
2024, February 15
DOI: 10.1038/s41598-024-53091-3

Long term outcomes of hyperbaric oxygen therapy in post covid condition: longitudinal follow-up of a randomized controlled trial

Abstract

In our previous randomized controlled trial, we documented significant improvements in cognitive, psychiatric, fatigue, sleep, and pain symptoms among long Coronavirus disease 2019 (COVID) patients who underwent hyperbaric oxygen therapy (HBOT). The primary objective of the present study was to evaluate the enduring 1 year long term effects of HBOT on long COVID syndrome. This longitudinal long-term follow-up included 31 patients with reported post COVID-19 cognitive symptoms, who underwent 40 daily sessions of HBOT. Participants were recruited more than one year (486 ± 73) after completion of the last HBOT session. Quality of life, assessed using the short form-36 (SF-36) questionnaire revealed, that the long-term results exhibited a similar magnitude of improvement as the short-term outcomes following HBOT across most domains. Regarding sleep quality, improvements were observed in global score and across five sleep domains with effect sizes of moderate magnitude during the short-term evaluation, and these improvements persisted in the long-term assessment (effect size (ES1) = 0.47-0.79). In the realm of neuropsychiatric symptoms, as evaluated by the brief symptom inventory-18 (BSI-18), the short-term assessment following HBOT demonstrated a large effect size, and this effect persisted at the long-term evaluation. Both pain severity (ES1 = 0.69) and pain interference (ES1 = 0.83), had significant improvements during the short-term assessment post HBOT, which persisted at long term. The results indicate HBOT can improve the quality of life, quality of sleep, psychiatric and pain symptoms of patients suffering from long COVID. The clinical improvements gained by HBOT are persistent even 1 year after the last HBOT session.

Reference

Hadanny, A., Zilberman-Itskovich, S., Catalogna, M., Elman-Shina, K., Lang, E., Finci, S., Polak, N., Shorer, R., Parag, Y., & Efrati, S. (2024). Long term outcomes of hyperbaric oxygen therapy in post covid condition: longitudinal follow-up of a randomized controlled trial. Scientific reports, 14(1), 3604. https://doi.org/10.1038/s41598-024-53091-3

Frontiers in Neuroscience
2023, October 25
DOI: 10.3389/fnins.2023.1259473

The use of hyperbaric oxygen for veterans with PTSD: basic physiology and current available clinical data

Abstract

Post-traumatic stress disorder (PTSD) affects up to 30% of veterans returning from the combat zone. Unfortunately, a substantial proportion of them do not remit with the current available treatments and thus continue to experience long-term social, behavioral, and occupational dysfunction. Accumulating data implies that the long-standing unremitting symptoms are related to changes in brain activity and structure, mainly disruption in the frontolimbic circuit. Hence, repair of brain structure and restoration of function could be a potential aim of effective treatment. Hyperbaric oxygen therapy (HBOT) has been effective in treating disruptions of brain structure and functions such as stroke, traumatic brain injury, and fibromyalgia even years after the acute insult. These favorable HBOT brain effects may be related to recent protocols that emphasize frequent fluctuations in oxygen concentrations, which in turn contribute to gene expression alterations and metabolic changes that induce neuronal stem cell proliferation, mitochondrial multiplication, angiogenesis, and regulation of the inflammatory cascade. Recently, clinical findings have also demonstrated the beneficial effect of HBOT on veterans with treatment-resistant PTSD. Moderation of intrusive symptoms, avoidance, mood and cognitive symptoms, and hyperarousal were correlated with improved brain function and with diffusion tensor imaging-defined structural changes. This article reviews the current data on the regenerative biological effects of HBOT, and the ongoing research of its use for veterans with PTSD.

Reference

Doenyas-Barak, K., Kutz, I., Lang, E., Merzbach, R., Lev Wiesel, R., Boussi-Gross, R., & Efrati, S. (2023). The use of hyperbaric oxygen for veterans with PTSD: basic physiology and current available clinical data. Frontiers in neuroscience, 17, 1259473. https://doi.org/10.3389/fnins.2023.1259473