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LetterCORRESPONDENCE

Hyperbaric Oxygen Therapy

Using Evidence-Based Medicine to Heal Injured Brain Tissue

James S. Hooker
North Carolina Medical Journal January 2016, 77 (1) 69-70; DOI: https://doi.org/10.18043/ncm.77.1.69
James S. Hooker
advocate for wounded veterans
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To the Editor—I am writing in response to the NCMJ issues published in April 2015 and September/October 2015, which addressed traumatic brain injury (TBI) in North Carolina [1] and evidence-based practice [2], respectively.

TBI and post-traumatic stress disorder (PTSD) are “neurocognitive disorders” according to government treatment protocols stipulated by the Defense and Veterans Brain Injury Center and the Veterans Administration. The medical community uses these protocols for treatment [3, 4], despite compelling evidence that symptoms result from a physical injury to the brain [4-6].

Difficulties in diagnosing brain injuries [3, 7]—as well as the challenge of categorizing TBI and PTSD in the Diagnostic and Statistical Manual of Mental Disorders [8]—have tended to validate the use of drug therapy for these conditions [6]. Unfortunately, the drugs prescribed for symptom mitigation frequently result in serious side effects, including an increased risk of suicide [6]. According to the results of a Congressional study, government protocols for treatment of PTSD, which include alternative counseling, are in question. A study by the National Academy of Medicine concluded that neither the Department of Defense nor the US Department of Veterans Affairs “knows whether its many programs and services are effective in reducing the prevalence of PTSD in service members or veterans” [9]. Of the 30 drugs and 25 alternative therapies addressed in this study, only 2 are authorized by the government; those are used in treating PTSD symptoms. All of the remaining therapies are provided off label based on standards of care established through evidence-based medicine [10, 11].

Oxygen has been used successfully to treat wounds for more than 30 years. It is a prerequisite for successful healing due to cells' increased demand for oxygen during reparative processes such as proliferation, angiogenesis, and collagen synthesis [12-14], all of which contribute to the wound-healing cascade. The brain represents less than 2% of body weight but uses 20% of oxygen consumed by the body. This helps to explain why “cerebral ischemia is the most important pathological condition encountered in TBI” and why restoration of an adequate oxygen supply is a critical factor for brain recovery [14].

Hyperbaric oxygen therapy (HBOT) takes advantage of the fact that oxygen is transported in the blood; increasing atmospheric pressure therefore maximizes tissue oxygenation [15], thus stimulating wound repair [12-14]. The US Food and Drug Administration has approved HBOT for 14 indications, providing 30 years of safe and successful clinical use. Four approved indications are supported by clinical trials; the remaining 10 indications are supported by evidence-based medicine [13].

TBI and PTSD are seriously debilitating injuries that affect millions of Americans [16]. HBOT is a safe and highly effective therapy for healing an oxygen-deprived organ such as an injured brain. Government protocols for treatment of TBI and PTSD are off-label, have no documented evidence of efficacy, and are prescribed in spite of significant deleterious side effects. Compelling evidence exists from clinical studies [17, 18] and from growing numbers of clinical reports of military veterans, National Football League veterans [19], and civilian patients that HBOT can restore patients' ability to once again function normally as spouses, parents, employers, employees, and contributing citizens of the community.

This situation warrants the earliest availability of HBOT for treatment of TBI and PTSD among injured civilians and military personnel through federal and state government health care systems based on evidence-based medicine criteria.

Acknowledgments

Potential conflicts of interest. J.S.H. has no relevant conflicts of interest.

  • ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

References

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    1. Hooker JS,
    2. Moore DP
    Traumatic brain injury among North Carolina's veterans. N C Med J. 2015;76(2):101-104.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Morris PJ
    What, how, and why. N C Med J. 2015;76(4):228-229.
    OpenUrlAbstract/FREE Full Text
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    1. Humphries C
    The traumatized brain: investigating injury, recovery, and repair. Harvard Magazine website. http://harvardmagazine.com/2012/03/the-traumatized-brain. Published March-April 2012. Accessed November 25, 2014.
  4. ↵
    1. Defense and Veterans Brain Injury Center
    TBI basics. Defense and Veterans Brain Injury Center website. http://dvbic.dcoe.mil/about-traumatic-brain-injury/article/tbi-basics. Updated December 16, 2015. Accessed December 16, 2015.
    1. Dennis KC
    Current perspectives on traumatic brain injury. American Speech-Language-Hearing Association website. http://www.asha.org/aud/articles/CurrentTBI/. Published 2009. Accessed December 16, 2015.
  5. ↵
    1. Harch PG
    Testimony for the record: effective treatment exists for mild-moderate TBI & PTSD. Harch Hyperbaric Oxygen Therapy website. http://www.hbot.com/blog/infinitee/testimony-record-effective-treatment-exists-mild-moderate-tbi-ptbd. Published June 23, 2010. Accessed December 18, 2015.
  6. ↵
    1. Gean AD
    Brain Injury Applications from War and Terrorism. Wolters Kluwer Health: Philadelphia, PA; 2014.
  7. ↵
    1. American Psychiatric Association
    Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. Arlington, VA: American Psychiatric Association; 2013.
  8. ↵
    1. Institute of Medicine,
    2. Board on the Health of Select Populations,
    3. Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder
    Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. Washington, DC: National Academies Press; 2014.
  9. ↵
    1. Moffett P,
    2. Moore G
    The standard of care: legal history and definitions: the bad and good news. West J Emerg Med. 2011;12(1):109-112.
    OpenUrlPubMed
  10. ↵
    1. NYU School of Medicine,
    2. Frederick L. Ehrman Medical Library
    Evidence-based medicine definitions. NYU School of Medicine website. https://library.med.nyu.edu/library/instruction/handouts/pdf/ebmdefinitions.pdf. Accessed May 20, 2015.
  11. ↵
    1. Schreml S,
    2. Szeimies RM,
    3. Prantl L,
    4. Karrer S,
    5. Landthaler M,
    6. Babilas P
    Oxygen in acute and chronic wound healing. Br J Dermatol. 2010;163(2):257-268.
    OpenUrlCrossRefPubMed
  12. ↵
    1. Weaver LE
    , ed. Hyperbaric Oxygen Therapy Indications. 13th ed. North Palm Beach, FL: Undersea and Hyperbaric Medical Society; 2014.
  13. ↵
    1. Zhang J
    , ed. Hyperbaric Oxygen for Neurological Disorders. Flagstaff, AZ: Best Publishing Company; 2008.
  14. ↵
    1. Singh S,
    2. Gambert SR
    Hyperbaric oxygen therapy: a brief history and review of its benefits and indications for the older adult patient. Annals of Long-Term Care. 2014;22(7-8). http://www.annalsoflongtermcare.com/article/hyperbaric-oxygen-therapy-brief-history-and-review-its-benefits-and-indications-older-adult. Accessed December 18, 2015.
  15. ↵
    Coming crisis in veteran care. The Virginian-Pilot. May 31, 2015. http://www.pilotonline.com/opinion/editorial/coming-crisis-in-veterans-care/article_19196dfb-5f36-5d17-95c0-76cefed71d3f.html. Accessed June 1, 2015.
  16. ↵
    1. Boussi-Gross R,
    2. Golan H,
    3. Fishlev G, et al.
    Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury-randomized prospective trial. PLoS One. 2013;8(11):e79995.
    OpenUrlPubMed
  17. ↵
    1. Harch PG,
    2. Andrews SR,
    3. Fogarty EF, et al.
    A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. J Neurotrauma. 2012;29(1):168-185.
    OpenUrlCrossRefPubMed
  18. ↵
    1. Keating P
    Out of thin air. ESPN The Magazine. July 14, 2015. http://espn.go.com/espn/feature/story/_/id/13186859/joe-namath-believes-found-cure-brain-damage-caused-football. Accessed December 18, 2015.
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Hyperbaric Oxygen Therapy
James S. Hooker
North Carolina Medical Journal Jan 2016, 77 (1) 69-70; DOI: 10.18043/ncm.77.1.69

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Hyperbaric Oxygen Therapy
James S. Hooker
North Carolina Medical Journal Jan 2016, 77 (1) 69-70; DOI: 10.18043/ncm.77.1.69
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