Chronic Pain, The Opioids Crisis, and HBOT

Published on
January 18, 2019

While acute pain occurs as a normal way of your body letting you know of a problem or possible injury and it only lasts for a short time, chronic pain is different. Chronic pain doesn’t go away. According to the American Academy of Pain Medicine, an estimated 100 million American adults suffer from chronic pain, with over 1.5 billion suffering worldwide. While many of these chronic pain patients receive opioids medications to manage their pain, the recent opioid crisis has found many doctors no longer willing to prescribe these medications. This has left doctors and patients searching for other chronic pain relief options. Hyperbaric oxygen therapy, or HBOT, is one option many chronic pain patients turn to and, in many cases, it proves very beneficial and often more effective than opioid medications.

What is Chronic Pain and What Causes It?

Chronic pain is pain that continues or persists for more than 12 weeks despite treatment. To understand chronic pain, you must first understand the pain in general. Your brain and spinal nerves make up your central nervous system. When you experience an injury, your spinal nerves send a signal to the brain to register pain. Depending on the extent of the injury, the brain determines the level of pain you feel. In the case of chronic pain, the signal doesn’t stop and can often continue for no reason. In many cases, the underlying cause of chronic pain is not understood, but that doesn’t make it any easier for patients.

Medical Conditions Causing Chronic Pain

In addition to unexplained chronic pain, there are many different medical conditions that can also cause chronic pain. In these cases, it is not so much the nerve signals malfunctioning as it is the conditions causing continuous pain stimulation to the nerves. Some of the most common causes of chronic pain include:

  • Ankylosing Spondylitis
  • Arthritis
  • Autoimmune Diseases
  • Back Conditions, such as herniated discs and degenerative disc disease
  • Cancer pain
  • Carpal Tunnel
  • Complex Regional Pain Syndrome (CRPS/RSD)
  • Crohn’s Disease
  • Diabetic Peripheral Neuropathy
  • Ehlers-Danlos Syndrome
  • Fibromyalgia
  • Migraines
  • Lupus
  • Lyme Disease
  • Multiple Sclerosis
  • Myositis
  • Neuropathic pain
  • Peripheral Neuropathy
  • Phantom limb pain
  • Rheumatoid Arthritis
  • Spinal Cord Injury
  • Spinal Stenosis
  • TMJ
  • Ulcerative colitis
A sign reading "Pain Relief"

And while these may seem like many medical conditions, this only begins to touch the surface. In addition to pain, many chronic pain sufferers deal with the loss of ability to work or participate in regular activities, depression, anxiety, and fear, making the need to treat pain essential. In the United States, the total annual cost of chronic pain-related health care ranges between $560 to $635 billion. With all these patients suffering from chronic pain, it is no surprise that the use of opioids has increased over the years. Many patients depend on opioid pain medications to live their daily lives, but unfortunately, the current opioid crisis is leaving many of them struggling.

Opioid Use Statistics and the Opioid Crisis

The opioid crisis began in the 1990s when pharmaceutical companies assured the medical community that opioids were not addictive. With this news, many physicians began prescribing them for many different pain conditions. Unfortunately, this led to serious misuse of the medications, and, unfortunately, they did prove addictive. The numbers, according to the United States Department of Health and Human Services, really show the problem. In the United States, 130 people die every day from opioid-related drug overdoses, with 42,249 people dying between 2016 and 2017. The National Institute on Drug Abuse reports that 21 to 29 percent of patients prescribed opioids misuse them and eight to 12 percent develop some sort of addiction.

To battle the opioid crisis, the U.S. Department of Health and Human Services developed five major priorities that include improving access to treatment and recovery, promoting overdose-reversing drugs, strengthening the understanding of the epidemic, providing cutting edge research on pain and addiction, and advancing better pain management treatments.

Opioid Prescription Guidelines

In addition, the Centers for Disease Control and Prevention have created new guidelines for physicians when it comes to prescribing opioids. Some highlights of these new guidelines include:

  • Opioids should not be a first-line or routine therapy for chronic pain
  • Establish and measure goals for pain and function regularly
  • Make patients aware of the benefits and risks of opioids, as well as the availability of non-opioid treatment options
  • When starting opioid treatment, use immediate-release instead of extended-release options
  • Always use the lowest effective dose
  • When prescribed for acute pain, follow the lowest dose and time-frame, often no more than three days
  • Regular patient evaluations must occur every three months to weigh the risks and benefits of opioid treatments.
  • Physicians must check the prescription drug monitoring program (PDMP) for possible prescriptions from other providers
  • Regular urine drug testing to identify prescribed and illicit drug use
  • Avoid prescribing opioids and benzodiazepine at the same time
  • Arrange for treatment when an opioid disorder is suspected

Chronic Pain Patients Stuck in the Middle

While the new rules, and new laws in many states, are designed to reduce the crisis and reduce the death rates, many patients with chronic medical conditions are left suffering. Patients that have spent years working with their doctor to create a treatment plan that works and allows them to get some quality of life back have found their doctor’s hands are tied and they must reduce the medications that have been successful. These patients are the collateral damage of the opioid crisis.

With the reduction of a treatment plan that was working, many chronic patients are forced to once again lose their quality of life or go through the process of trying more and more treatment options to find something that works. While some can find relief with non-opioid options, many chronic pain patients feel they are will never find relief again. This is where hyperbaric oxygen is a new source of hope for chronic pain patients.

Alternative Treatments for Chronic Pain When Opioids Are Not Available

Without opioids to help manage pain, chronic pain sufferers turn to alternative treatment options to find relief. While some of these can help reduce the pain temporarily, not all can reduce the pain to the management point that their opioid treatment plan provided. Some alternative treatment options include:

  • Acupuncture
  • Yoga
  • Relaxation techniques
  • Tai Chi
  • Massage
  • Osteopathic or spinal manipulation
  • Hypnosis
  • Electromagnetic therapy
  • Meditation
  • Physical therapy
  • Implanted spinal cord stimulators
  • Injections or nerve blocks
  • Pain pumps

How can HBOT Help with Chronic Pain Relief?

A man preparing to receive Hyperbaric Oxygen Treatment

When it comes to hyperbaric oxygen, HBOT, and chronic pain relief, we have evidence that it works with conditions such as RSD/CRPS and fibromyalgia. But how does it help the pain? With hyperbaric oxygen therapy, a patient’s body is flooded with high concentrations of oxygen at higher than normal air pressure. This allows oxygen to reach areas that may be low in oxygen due to things such as inflammation. By flooding these areas, the increased oxygen helps the body decrease inflammation, increase cell metabolism, reduce oxidative stress, reduce cell death, increase neurotrophin levels which help the neurons function, as well as promote the growth of neural stem cells.

In the case of fibromyalgia, it is believed that the pain may be a result of hyperexcitability in the pain processing pathways as well as underactivity in the pain inhibiting pathways of the brain. HBOT and the increased oxygen levels help repair brain function, stabilize the pain pathways, and reduce pain levels.

Studies with HBOT and Chronic Pain

In June of 2018, a study published looking at the use of HBOT for pain in fibromyalgia patients. The study looked at 33 female patients, all suffering from chronic pain from fibromyalgia. The study found that those that completed 20 HBOT sessions all saw a reduction in fibromyalgia tender points, a significant reduction in all symptoms, not just pain, as well as significant improvement in the quality of life.

Another study conducted by graduate student Yangmiao Zhang, under the direction of Raymon M. Quock, Ph.D., professor of Pharmaceutical Sciences at Washington State University, looked at the use of HBOT in relation to neuropathic chronic pain. While many pain models look at HBOT and how it affects inflammatory mechanisms, this research looked at how the increased oxygen affects the brain and reduces neuropathic pain.

Dr. Spiegel has seen great success with hyperbaric oxygen in treating patients with chronic pain as a result of RSD/CRPS (for information on RSD/CRPS treatment, click HERE) and other conditions. Many that have come into his office have been able to reduce or eliminate pain medications and return to normal daily living. If your current pain management physician is no longer prescribing opioids for chronic pain, or you are looking for an alternative to pharmaceutical pain management, hyperbaric oxygen and HBOT could be your answer.

If you suffer from chronic pain and are looking for an opioid alternative, give our office a call today to set up a consultation. Dr. Spiegel and his team will evaluate your case and medical history and work to develop a treatment plan that will work for you. You may also visit HERE and fill out our online request form.