CRPS type 2

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I would like your thoughts of diving a patient with diagnosis of complex regional pain syndrome type 2. Past history of crush injury to right foot 18 years ago with recurring and worsening right foot pain. Current treatments and medication regime not working in controlling his pain. Do you think he would get any benefit from HBO treatment so long after initial injury? He has Medicare which from my understanding does not cover HBO for CRPS. Patient says he is willing to pay out of pocket if not covered by his insurance. I have never encountered a patient paying out of pocket for HBOT especially for a treatment that might not work for them. What are your thoughts about paying out of pocket (I work in hospital outpatient setting).

Aug 6, 2024 by Tina Steichen-Smith,

2 replies

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

Great question, to which there is very little data ... and nothing that would be overwhelming in my estimation.

Unfortunately, no third party payer is going to cover this diagnosis.

And, I would not want the patient to be out of pocket a tremendous amount of money that I can't really justify.

Here is the only paper in the literature that I know about.

Good luck.

gene

Aug 6, 2024

Craig Lindsey
MD

To build upon Gene's reply, here is one more article I came across.

Hyperbaric oxygen treatment in recurrent development of complex regional pain syndrome: A case report.

As far a treating off label in a hospital outpatient clinic setting, if you opt to explore this alternative, you could engage your hospital administration and to try to get their approval and support with respect to the following two issues:

1) Talk with your compliance and legal teams to ensure they are on board with treating off label. I have done this at my hospital based program and have, after an in depth legal and risk review, have not found any reason to deny off label treatment

2) Work with the hospital finance people to arrive at a cash out of pocket payment for this treatment that is acceptable to all parties involved. The ranges I have seen are between $150-$600 per session.

If you decide to go ahead with treatment, please let us know what the outcome was.

Hope this helps.

Craig

Aug 8, 2024

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