Schiavo S, DeBacker J, Djaiani C, Bhatia A, Englesakis M, Katznelson R, et al.
Pain research & management. Date of publication 2021 Apr 22;volume 2021():8817504.
1. Pain Res Manag. 2021 Apr 22;2021:8817504. doi: 10.1155/2021/8817504.
eCollection 2021.
Mechanistic Rationale and Clinical Efficacy of Hyperbaric Oxygen Therapy in
Chronic Neuropathic Pain: An Evidence-Based Narrative Review.
Schiavo S(1), DeBacker J(1), Djaiani C(1), Bhatia A(2), Englesakis M(3),
Katznelson R(1).
Author information:
(1)Hyperbaric Medicine Unit, Department of Anesthesiology and Pain Medicine,
Toronto General Hospital, University Health Network, University of Toronto,
Toronto, Ontario, Canada.
(2)Department of Anesthesiology and Pain Medicine, Toronto Western Hospital,
University Health Network, University of Toronto, Toronto, Ontario, Canada.
(3)Library and Information Services, Toronto General Hospital, University Health
Network, Toronto, Ontario, Canada.
BACKGROUND: Chronic neuropathic pain is a condition affecting an increasing
proportion of the general population and its management requires a
comprehensive, multidisciplinary program. A growing body of evidence supports
the use of hyperbaric oxygen therapy (HBOT) in several chronic neuropathic pain
conditions; however, its role and efficacy remain unclear.
PURPOSE: To summarize current evidence for the mechanistic rationale of HBOT in
chronic neuropathic pain conditions and to evaluate its clinical efficacy.
METHODS: This narrative review was conducted after searching the following
databases (Medline, Embase, Cochrane, PsycINFO, the Web of Science, Scopus,
ClinicalTrials. gov, WHO ICTRP, and ProQuest Digital Dissertation) from January
1946 to March 2020. Articles published in English that involved either animal or
human studies with acute or chronic neuropathic pain evaluating any HBOT-related
intervention were included.
RESULTS: A total of 2971 citations were identified. A total of 29 studies were
included in this review. The mechanisms of action for HBOT use in neuropathic
conditions included the primary effects of hyperoxia and edema resolution, as
well as the secondary effects pertinent to the production of oxygen and nitrogen
reactive species (serving as pain signaling molecules), nitric oxide-dependent
release of opioid peptides, and reduction of inflammatory mediators. A robust
evidence for HBOT use in the clinical setting was associated with chronic
regional pain syndrome and chronic primary bladder pain syndrome. Some evidence
supported its use for chronic secondary (peripheral) neuropathic pain including
radiation-induced plexus neuropathies, postherpetic neuralgia, and trigeminal
neuralgia.
CONCLUSIONS: HBOT has been shown to have antinociceptive and analgesic effects
in animal models of inflammatory, neuropathic, and chronic pain. Human studies
demonstrated beneficial effects of HBOT in improving clinical outcomes such as
pain scores, pain-related symptoms, and quality of life. A systematic
methodology of HBOT application is necessary to confirm its safety and efficacy.
Copyright © 2021 Simone Schiavo et al.
DOI: 10.1155/2021/8817504
PMCID: PMC8084668
PMID: 33976752 [Indexed for MEDLINE]
Conflict of interest statement: The authors declare that they have no conflicts
of interest.
