How HBOT Can Help RSD/CRPS Patients

Researchers do not fully understand what causes chronic regional pain syndrome (RSD/CRPS) and the pain associated with it. However, a review published in the International Association for the Study of Pain, and led by Leif Ostergaard, looked at possible causes of the pain associated with RSD/CRPS. They concluded that RSD/CRPS begins when a compartment-like syndrome occurs after an injury or medical procedure. The swelling associated with such injury causes a disturbance in the flow of blood through the capillaries.

This disturbance leads to reduced oxygen levels in the tissues, resulting in hypoxia. The lack of oxygen breaks down the tissue, be it in the muscle or skin. As a result, patients experience pain, increased sensitivity, muscle atrophy, and many of the other symptoms. For this reason, it makes sense that hyperbaric oxygen and HBOT treatments can show success with RSD/CRPS when traditional treatments fail.

What HBOT Does Inside the Body

When a patient undergoes HBOT treatments, pure oxygen under higher than normal pressure floods the body. As a result, this pushes oxygen into areas that may be oxygen deprived. This increased oxygen helps reduce edema, promotes capillary growth and proper function. In addition, the increased oxygen levels help tissue repair and rebuild.

The increased oxygen helps the body restore itself to a healthy stage. In other words, patients often experience no more swelling, no more pain, and an increase in quality of life. Many patients receiving HBOT treatments can reduce or eliminate their need for pain medications. In addition, they see an increased range of motion and strength in the muscles. Finally, many are able to return to work and a normal everyday routine.

Studies Show Success with Hyperbaric Oxygen and HBOT Treatments and Improvement in RSD/CRPS

While many studies have looked at patients with chronic regional pain syndrome (RSD/CRPS) to determine what may be causing the disease, many others have looked at different treatments and their possible effectiveness in treating the disease. As a result, many of those studies have looked at hyperbaric oxygen and HBOT treatments, as the oxygen they deliver to the body treats the capillary and blood flow issues that they believe to be behind RSD/CRPS and the pain it causes.

A Comparison of HBOT and Normal Air

A 2004 paper, led by MZ Kiralp and published in The Journal of International Medical Research, conducted a double-blind, randomized, and placebo-controlled study looking at the effectiveness of hyperbaric oxygen and HBOT on patients with chronic regional pain syndrome (RSD/CRPS). The study had 71 patients, with 37 in the HBOT group and 34 in the control group, which received normal air.

Before the study began, the patients were evaluated for pain, edema, and range of motion. After 15 treatment sessions of 90 minutes each, those patients that received the HBOT treatments showed a significant change over those that did not. A reduction in pain was documented after the first session and all patients showed a significant reduction in pain after all 15 treatments. There was also a significant reduction in edema levels and an increase in a range of motion.

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HBOT Reduces the Risk of Amputation
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The longer a person has RSD/CRPS, the greater they are at risk for tissue and skin changes in the area affected. These changes can include ulceration, opens sores, and cellulitis. In these cases, the tissue changes can result in permanent damage, often requiring amputation of the affected limb. In these cases, HBOT has proven to reduce the need for amputation.

A 2016 study published in Neurology looked at the use of hyperbaric oxygen and HBOT in patients with severe chronic regional pain syndrome (RSD/CRPS) and these skin complications. It showed that HBOT reduced the risk of amputation and effectively treated cellulitis, skin ulcerations, and weeping wounds.
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A Case Study Shows Significant Improvement with HBOT

A case study from 2015 looked at a 41-year-old male with type II CRPS of the left foot following a left ankle fracture. The patient experiences severe pain, swelling, allodynia, reduced range of motion and changes in skin color. Tasks as simple as putting on socks and shoes caused severe pain. Initial pain chart baseline was 7-8/10. The patient underwent 15 90-minute HBOT treatments over the course of three weeks.

After the treatments, the patient reports a 30 percent reduction in pain and a 57 percent mood improvement. They also reported a 44 percent increase in walking ability and a 30 percent increase in the enjoyment of life. Swelling and skin discoloration were reduced as well. At a 6-month post-treatment exam, the patient reported intermittent pain in the left foot, but only at a 3/10 pain scale level. He was able to return to work full-time as a firefighter and was back to jogging a couple of times a week.

Dr. Spiegel and His Success with HBOT

After treating a couple of patients for other conditions, these patients let Dr. Spiegel know that in addition to the treatment being successful for their wounds, they also noticed relief of their RSD/CRPS symptoms improve.

After discovering this, he contacted previous RSD patients he had treated as a neurologist and sent to traditional pain management and had them return for HBOT treatments. He now finds that after the first or second treatment with HBOT, 50 to 75 percent of chronic regional pain syndrome (RSD/CRPS) patients get their normal sleep patterns back. By the fourth or fifth treatment, skin color returns to normal and swelling reduces in the affected limb. By the 10th treatment, most patients begin to see a reduction in pain levels.

With 20 to 30 treatments being the norm, most patients find their pain after treatment is gone or down to a two out of 10 on the standard pain scale. Dr. Spiegel has had patients come in for treatment in wheelchairs and leave able to walk to some degree.

Many of his patients report significant improvement. Brain fog lifts and cognitive function improves, as does their mood. Swelling and edema levels return to normal and, after physical therapy, most patients regain range of motion and muscle strength. Many can return to regular work once again. Hyperbaric oxygen and HBOT treatments help improve the quality of life in patients with RSD/CRPS.

If you would like to see how HBOT can help your chronic regional pain syndrome (RSD/CRPS), contact our office today to set up an initial consultation. You can also click HERE to fill out our contact form and our staff will contact you.

What is RSD/CRPS?

RSD/CRPS is a chronic pain condition that typically surfaces after an injury, surgery, stroke or heart attack. It is believed to be a malfunction of the peripheral and central nervous system. The condition causes severe pain usually affecting an arm or leg. The pain associated with chronic regional pain syndrome (RSD/CRPS) far exceeds what would be normal for any potential injury. It is a condition that sits at the top of the McGill University Pain Scale with a 42 out of a possible 50. This ranks higher in pain than that of amputation. RSD/CRPS tops the pain scale as the most intense pain experienced. For this reason, RSD/CRPS is often referred to as the “Suicide Disease”, as many patients struggle to live with the pain.

With the name change from Regional Sympathetic Dystrophy to Complex Regional Pain Syndrome, the condition was also divided into two categories: CRPS-I (the category previously considered RSD) and CRPS-II (previously known as causalgia). If there is a confirmed and connected nerve injury, patients are classified with CRPS-I. When symptoms occur without a connection to a nerve injury, they are diagnosed with CRPS-II.
While the main names for these conditions are RSD/CRPS, it can also be referred to as Algodystrophy, Algoneurodystrophy, Causalgia Syndrome, Reflex Neurovascular Dystrophy and Sudeck’s Atrophy.

What Causes Chronic Regional Pain Syndrome or RSD/CRPS?

The true cause of RSD/CRPS is unclear. In more than 90 percent of cases, it is triggered by an injury or trauma. However, what makes someone get the condition while others do not is still a question. The most common conditions that trigger RSD/CRPS are fractures, sprains and strains, soft tissue injuries (burns, simple cuts, and bruises), and surgery. However, even simple medical procedures, such as a shot or needle stick, can trigger RSD. When a recorded trauma cannot be pinpointed, it is believed the underlying cause may be an infection, blood vessel abnormalities, or nerve entrapments.

What Causes the Pain Associated with RSD?

The response to these traumas or conditions is abnormal and greatly magnified. The cause of the pain is damage or abnormal function in the small unmyelinated and thinly myelinated sensory nerve fibers. These fibers transmit pain messages to the blood vessels in the body. This miscommunication results in inflammation and blood vessel abnormalities. That, in turn, triggers damage to the spinal cord and brain.

Miscommunication to the blood vessels can result in vessel dilation or constriction, which can starve muscles and tissue from necessary oxygen and nutrients. One study suggests the RSD/CRPS may be caused by a small blood vessel disease that affects the oxygen supply to muscle cells in the body. This possible lack of oxygen is where HBOT has been shown to play a role in treatment.

How is RSD/CRPS Diagnosed?

There is no single test to diagnose RSD/CRPS and a diagnosis is mostly based on a physical exam and medical history. Doctors may order a variety of tests to rule out other conditions as well as look for clues that can point to RSD/CRPS. Some of these tests include:

• Rule Out Other Conditions – Testing may begin by ruling out other conditions that can cause similar symptoms, such as arthritis, Lyme disease, various muscle diseases, small fiber neuropathies or clotted and blocked veins.
• Sympathetic Nervous System Tests – These are tests that look for changes in the sympathetic nervous system. Tests will measure skin temperature changes in affected areas. They look for sweat amounts in affected areas compared to normal areas and monitor blood flow changes and blood pressure.
• Bone Scans – This test looks for changes in the bone of an affected area. There is an association between RSD/CRPS and excess bone resorption, where cells break down the bone and release calcium into the blood. A bone scan will show bone changes and can confirm suspected RSD/CRPS. In later stages of the disease, these bone changes can show up on standard x-rays as well.
• Magnetic Resonance Imaging (MRI) – MRIs can show abnormal signals in the skin, soft tissue, joints, muscles, bone, and bone marrow.

Signs and Symptoms of RSD/CRPS

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The main symptom present with RSD/CRPS is severe pain that can be intermittent or constant. Patients describe the pain in many ways, including burning, throbbing, pins and needles, intense squeezing or crushing. In many cases, the skin over the infected area is painful to the touch. Symptoms can come and go. In addition to pain, RSD/CRPS can cause a variety of different symptoms including:

• Changes in skin temperature over the affected area, alternating between sweaty and cold.
• Changes in skin appearance, such as a shiny or thin look or color changes (white and mottled, red or blue)
• Sensitivity to touch or cold temperatures
• Swelling of the affected area
• Changes in hair and nail growth
• Stiffness, swelling, and damage to joints
• Decreased mobility of the affected area
• Muscle spasms, tremors, weakness and muscle atrophy

Traditional Treatment Options for RSD/CRPS

Traditional treatment for RSD/CRPS ranges from medications to various forms of therapy and even surgery. Early treatment is often more effective and can often slow down the progression of symptoms.

Some common medications include:

• Non-Steroidal Anti-Inflammatories (NSAIDs) – These include medications such as over-the-counter aspirin, ibuprofen, and naproxen to help relieve pain and inflammation
• Corticosteroids – Medications, such as prednisolone and methylprednisolone work to treat inflammation, swelling, and edema in early stages of RSD/CRPS
• Bisphosphonates – These medications work to inhibit osteoclast activity and have shown promise in treating cases of RSD/CRPS
• Antidepressants and Anticonvulsants – Medications, such as gabapentin, amitriptyline, and nortriptyline are effective in treating nerve pain.
• Opioids – Pain medications, such as oxycodone, morphine, fentanyl, and hydrocodone, help manage pain.
• Intravenous Ketamine – This strong anesthetic can provide substantial pain relief but will not help to improve function.

No drug has specific FDA-approval for the treatment of RSD/CRPS. Not all available medications will work with all patients. And it becomes a trial and error to find a combination that may benefit.

Other Treatment Options for RSD/CRPS

• Physical Therapy – Focuses on improving movement and range of motion, increasing muscle strength, reducing pain, and improving blood flow.
• Topical Analgesics –  various topical anesthetic creams and patches, such as lidocaine, can reduce pain levels and hypersensitivity
• Transcutaneous Electrical Nerve Stimulation (TENS) – A TENS unit applies electrical impulses to nerve endings.
• Mirror Therapy –  Designed to trick the brain. The patient sits in front of a mirror and moves the healthy limb. But because of the mirror, the brain perceives it as the RSD/CRPS affected limb.
• Psychotherapy –  The pain and disability that RSD/CRPS causes often lead to depression, anxiety or even PTSD. These conditions, in turn, can heighten the perception of pain. Treating any secondary conditions is essential for overall therapy.
• Spinal Cord Stimulation –  Spinal cord stimulation uses stimulating electrodes placed into the spine, near the spinal cord. The tingling sensation they provide helps to reduce pain levels.
• Sympathetic Nerve Block –  This injects an anesthetic next to the spine. The nerve block essentially blocks the activity of the sympathetic nerves and improving blood flow. This, however, does not provide long-term benefits.
• Surgical Sympathectomy –  This is a surgical procedure that destroys the nerves in the affected area. The use of this procedure is controversial.
• Intrathecal Drug Pumps –  This is a pump that delivers medication directly into the fluid surrounding the spinal cord. Medications can include opioids, anesthetic agents, and baclofen. The targeted administration allows for smaller doses of medication while increasing effectiveness and reducing side effects.
• Biofeedback –  Biofeedback and relaxation techniques enable a better connection and awareness of your body. This allows for better muscle relation and reduction of pain.

Take the Next Step!

If you would like to learn more about how HBOT can help treat your RSD/CRPS and help you regain your quality of life, give our office a call today and set up an initial consultation. Dr. Spiegel will meet with you, go over your medical charts and discuss how HBOT may be able to help. Contact us today at 727.787.7077. You may also fill out our online information for HERE.