Oxygen Therapy for Pain Flares

Last updated: 07-27-2020

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Oxygen Therapy for Pain Flares

Oxygen therapy has been used for centuries to help manage serious health conditions, from asthma and pneumonia to decompression sickness, a hazard of scuba diving, and more recently, cluster headache. There are two types of oxygen therapy – regular and hyperbaric – and new research is showing that their use may benefit other pain conditions as well, such as fibromyalgia.

Regular oxygen therapy is used to treat pulmonary conditions such as chronic obstructive pulmonary disorder (COPD) and pneumonia. It is also commonly used to halt a cluster headache attack. This type of oxygen is released through nasal prongs, a mask, or a breathing tube via a portable tank or machine.

Hyperbaric oxygen therapy, or HBOT, is most commonly associated with treating carbon monoxide poisoning or decompression sickness, but it has also  been used to treat wounds and serious infections. Typically used in combination with other treatments, the therapy involves breathing pure oxygen through a pressurized room or tube. In these hyperbaric chambers, the atmospheric pressure is raised up to three times higher than normal. According to the FDA, “your lungs can gather up to three times more oxygen than would be possible breathing oxygen at normal air pressure.”

Regular oxygen therapy has been proven to be effective for cluster headaches, according to Zubair Ahmed, MD, who works in the headache division of adult neurology at the Cleveland Clinic. In fact, he says, “It is one of the most effective therapies for cluster headache,” he says. (More on this painful headache type.)

When a person feels a cluster headache coming on, says Dr. Ahmed, the patient can put on a “non-rebreather mask,” which enables them to obtain high flow (regular, not HBOT) oxygen. “Cluster headaches, while not common, are thought to be one of the most painful conditions known to man and can be extremely debilitating,” he shares, adding that, “It’s great that there is a straightforward treatment like oxygen and there is enough data that we are comfortable using it as a frontline treatment.”

Adds Robert Cowan, MD, professor of neurology and director of the Headache and Facial Pain Program at Stanford University, oxygen therapy for cluster headache “is well-tolerated, relatively inexpensive, and doesn’t have side effects.” It works within 15 minutes to break the pain cycle, he explains.

If you are considering oxygen for cluster headache, the good news is that up to 90% of people with this form of headache find that it provides relief, says Robert Shapiro, MD, PhD, professor of neurological sciences and director of the Division of Headache Medicine at the Larner College of Medicine at the University of Vermont.  But, the type of mask that is used is key, he says.

“It is important that you are given the right mask and that it is on properly so that you don’t dilute the pure oxygen with your carbon-dioxide-laden breath,” he explains. And it’s essential that people with cluster headache are in a position to avail themselves of the oxygen treatment, Dr. Shapiro says. “It is one of the worst types of pain,” he says.  “But if you have a tank of oxygen in your car or at work or at home, most will get relief from the pain.”

Researchers recently published a clinical review of 25 studies on the role of HBOT in relieving chronic pain. Their preliminary research suggests that HBOT may be useful in treating chronic headache, complex regional pain syndrome (CRPS/RSK), trigeminal neuralgia, and fibromyalgia, but they point out, larger-scale studies are needed to be certain.

In a related but separate study, researchers also found a positive effect when using  HBOT for fibromyalgia syndrome, which affects 1 to 3% of people in the US.

Researchers alsofound that two months of high-pressure oxygen therapy not only increased pain thresholds and physical functionality, but also improved the health-related quality of life and decreased tender points and psychological distress in women with fibromyalgia. The women also were found to have “beneficial changes in brain activity within the regions of the brain known to be previously associated with abnormal activity in patients with FMS.”

It is important to note that HBOT is not yet approved for treating chronic pain conditions in the United States. According to the Food and Drug Administration, people receiving HBOT may risk suffering an injury that could be mild, like a sinus infection, or more serious, such as air embolism, in which a blood vessel becomes blocked by one or more bubbles of air in the circulatory system.

As a result, the therapy is not covered by private health insurance or Medicare. If you are considering HBOT, the FDA advises patients to discuss options with their healthcare professional. Coverage options may change as research proves HBOT’s effectiveness.

Regular oxygen therapy is not indicated for treating pain, and therefore, also not covered by Medicare or most private insurance companies. “We have been engaged with CMS, the federal agency that manages Medicare, and they provided no specific indication that they would even begin to review our appeals,” says Dr. Shapiro. “Other insurers take their cue from CMS about whether to cover oxygen for cluster headache. So large numbers of people are being denied coverage for oxygen that could effectively treat one of the worst types of pain known.”

Talk to your headache specialist or pain provider about your options.

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