Hyperbaric Oxygen Therapy: an effective treatment for chronic pain and inflammation.

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Written by Julie Howell

8/2026

Many disease processes have chronic pain and inflammation as symptoms. With the rise of medication addiction, nonpharmacological means and adjunct therapy for symptom management are necessary. This paper aims to examine the effectiveness of hyperbaric oxygen therapy in treating chronic pain and inflammation. The reviewed literature used HBOT to treat many different disease processes with pain and inflammation symptoms in humans and animals. A variety of study designs were reviewed, as well as the history and background of HBOT. The literature also compared HBOT to standard forms of treatment, either by itself or as an adjunct treatment. HBOT is just as effective or better than the standard treatments and medications.

Chronic pain and inflammation are common symptoms of many disease processes, and the standard treatments do not always manage them effectively. Many pharmacological treatments have unwanted side effects, resulting in treatment noncompliance and becoming reliant on or addicted to pain medications. Aadil et al. (2021) explain that opioid overdose-related deaths are on the rise and that there has been a 5% increase in death rates in the United States between 2018 and 2019. There is a need for non-invasive and non-pharmacological means to treat these symptoms. Wilson et al. (2022) implicated HBOT as an effective treatment for pain and opioid withdrawal symptoms. HBOT has been noted to treat various medical diagnoses with inflammation and pain symptoms, as indicated in the cross-sectional study by Van Damme et al. (2022). As discussed by Harnanik et al. (2020), at the cellular level, HBOT is proving to be effective in the treatment of pain and inflammation process of diseases.

HBOT is composed of sitting in a chamber where oxygen percentage and absolute atmospheric pressures (ATA) are manipulated to therapeutic levels. Normal room air is 21% oxygen, and regular ATA is 1.3. Oxygen and ATA can be adjusted to varying degrees to accommodate study parameters. Krishnamurti (2020) gives us some background on HBOT, which was initially created and used for the safety of deep-sea diving but quickly became an option for medical treatment, modified many times over the years, with the first documented use of HBOT in 1662. Since 1662, safety and advisory boards have been implemented to ensure HBOT is used responsibly, like the American College of Hyperbaric Medicine, which was formed to advance hyperbaric medicine ethically and founded in 1980, and the International Society of Hyperbaric Medicine, which was founded in 1988. The American Board of Medical Specialties, as a sub-specialty of emergency and preventative medicine, approved HBOT as a medical treatment in 2000.

            Krishnamurti (2020) explains that hyperbaric chambers have many names, such as pneumatic chambers, compressed air baths, and decompression chambers. Compressed air therapy was first introduced into the United States in 1871 to treat the Spanish influenza epidemic, and Brazilians used HBOT to treat leprosy in 1937. Ite Boerema, a cardiac surgeon from the Netherlands, used HBOT in the 1950s to over-oxygenate the body’s tissues in his practice. With recent medical technology and research, HBOT is getting evidence-based recognition (Krishnamurti, 2020). Hyperbaric chambers are effective for chronic pain management and inflammation. This paper will focus on the effectiveness of chronic pain and inflammation with HBOT.

Methods

Clinical studies were needed to show that hyperbaric oxygen therapy chambers were used for chronic pain and inflammation. The search terms were reworded several times to see if the database would pull different articles. Search terms included “hyperbaric chamber oxygen therapy and chronic pain,” “hyperbaric chamber oxygen therapy and chronic inflammation,” “hyperbaric oxygen therapy and chronic pain or inflammation,” “hyperbaric oxygen therapy and rheumatoid arthritis,” and “history of hyperbaric chambers.” A background was needed on how hyperbaric chambers first started with use for medical needs. Once it was found how HBOT affected pain management and was used for Opioid withdrawal, articles on Opioid use and the rise of overdosing were searched for using the term “opioid use” and “hyperbaric oxygen therapy and opioids” to see how effective hyperbaric chambers can be in all realms of pain management.

All the searches included were scholarly, full-text, published in English, and within the last five years, 2018-2023. Most sources were located in the American College of Healthcare Sciences library database. Then the abstracts were scanned to see if they were clinical studies or research reviews, and compared hyperbaric therapy and pain or inflammation treatment effects, or compared hyperbaric therapy to standard pain and inflammation treatments. Then the full text of articles were pulled from the recommended individual database sites: Ebsco, Science Direct, ProQuest, and PubMed. The article containing HBOT’s background and history was obtained by searching the history of hyperbaric chambers on Google. The article obtained from this search was not a clinical study but is being used as a supportive resource for this paper.

Results

This literature review was completed to investigate the effectiveness of HBOT as a treatment for chronic pain and inflammation management. This review located articles that compared hyperbaric oxygen therapy treatment to standard medications, hyperbaric chamber therapy compared to physical exercise for fibromyalgia pain and inflammation treatment, hyperbaric oxygen therapy for pain control, and hyperbaric oxygen therapy for inflammation processes. Some of the studies included in this research also discuss the changes in inflammatory markers and red blood cell characteristics with HBOT.

Hyperbaric Oxygen Therapy Compared to Medications

The study by Ablin et al. (2023) is a randomized, single-blind, controlled trial conducted on patients who were healthy until they recently suffered a traumatic brain injury that triggered fibromyalgia. This study aimed to determine if HBOT was equivalent to or better than standard medication therapy for fibromyalgia patients. The study had 29 randomly grouped participants to receive HBOT or medication treatment. The HBOT group was provided with daily sessions for 60 days, five sessions per week, for three months. The sessions were 90 minutes and included breathing 100% oxygen by mask at 2 ATA. The medication group was assigned to receive medication intervention for three months, with one of the two medications: Duloxetine or Pregabalin. A bedtime dose of 75 mg of Pregabalin or a morning dose of 30 mg of Duloxetine was provided. Doses of the medications were adjusted as necessary based on lab levels and tolerance during a 6-week follow-up. The results showed that there were improvements in symptoms and pain thresholds as well as quality of life. The brain scans noted improvements and showed increased brain activity. At the beginning of the treatment, all participants had positive fibromyalgia diagnosis criteria. After HBOT, 11 participants no longer met fibromyalgia diagnostic criteria. The outcome of this study shows that HBOT decreases pain more than standard treatment medications and even removes patients from the fibromyalgia diagnosis due to decreased symptoms.

Hyperbaric Oxygen Therapy Compared to Exercise

In a randomized clinical trial, Izquierdo et al. (2020) included 49 women with fibromyalgia and randomly divided them into three groups: a physical exercise group (16), a low-pressure HBOT group (17), and a control group (16). The study wanted to compare HBOT to physical exercise and assess baseline and post-treatment symptoms. The assessed symptoms included induced fatigue, perceived pain, pressure pain threshold, endurance, functional capacity, physical performance, and cortical excitability. Overall, the results showed that perceived pain and induced fatigue only improved in the HBOT group. Improvement was noted for pressure pain threshold, endurance, functional capacity, and physical performance for both HBOT and the physical exercise group. The cortical excitability measured with the resting motor threshold did not improve in any of the treatments. The results show that HBOT reduced pain and fatigue more than standard physical exercise treatment, and the pain threshold and endurance were just as effective as those of the physical exercise group with HBOT.

Hyperbaric Oxygen Therapy for Pain and Opioid Withdrawal

Opioid use is a growing pandemic in the United States. From 2018 to 2019, a 5% increase (72,000 people) in the United States died from a drug overdose (Aadil et al., 2021). HBOT is a potential non-medication treatment to address poorly managed pain and opioid withdrawal symptoms. Wilson et al. (2022) explored hyperbaric therapy use with poorly managed pain and opioid withdrawal. This randomized, double-blind, controlled trial used eight adults who were randomly placed into two groups to receive either a 90-minute HBOT dose in a pressurized chamber with 100% oxygen at 2.0 ATA or a placebo receiving 21% oxygen (room air) at a minimal pressure of ≤1.3 ATA. Assessed data included study retention, treatment satisfaction, and pre-and post-intervention effects for opioid withdrawal symptoms, drug cravings, pain intensity and interference, sleep quality, and mood. All assessed areas showed improvement for participants receiving HBOT than those receiving placebo treatment, except for clinically observed withdrawal symptoms. Pain intensity and drug cravings were the areas with the most improvement. The results suggested that a study should be completed using HBOT as a potential adjunct treatment for adults receiving methadone for opioid use disorder. Positive trends toward symptom improvements were detected post-HBOT versus placebo. HBOT is showing effectiveness in pain management to avoid opioid use. Concerns for this study were that it was such a small trial size.

Effects on Inflammation Processes

Kjellberg et al. (2022) used a randomized, placebo-controlled, double-blind trial that discussed the inflammatory process in the body related to Covid 19 infection. The study was completed to see if HBOT had any physiological effects on body processes and if an increase in quality of life was obtained. The trial used 80 participants from the same post covid unit who were previously healthy until debilitated by long COVID-19 and have a low quality of life. Clinical data, quality of life questionnaires, blood samples, objective tests, and activity data were collected at the start of the study. Participants were randomized into two groups: a treatment group that received HBOT and a placebo group. The groups received 10 HBOT treatments or placebo treatments. The HBOT treatment included 90 minutes of breathing 100% oxygen at 2.4 ATA with two breaks for air. All 10 HBOT treatments were done within a 6-week time frame. The Placebo group also completed ten sessions within a 6-week time frame, but their sessions were only at 1.34 ATA with room air and will have up to 2 breaks to simulate the treatment group. Data will be collected at the end of the initial 6-week treatment and again at 13, 26, and 52 weeks. The results appear to be pending as it is a long-term study based on a 4-year trial; results should be available once published in 2026. Bias was noted since participants were all selected from the same post covid unit. The limitations noted were that this study is novel as long-term covid 19 has unknown long-term effects and has been found to affect multiple body systems. The study did note that typical HBOT dosing is five days a week, with 30–40 sessions over 6–8 weeks, versus the studies’ 10 total treatments over six weeks at 90-minute sessions.

Another study about inflammation due to a disease process is done by Gouveia et al. (2022). Gouveias’ study was focused on systemic inflammatory response syndrome (SIRS) in dogs and using HBOT as a treatment for inflammation. This study included 49 dogs with two or more symptoms of SIRS and then placed into two groups: a traumatic-induced study group (32) and a non-traumatic study group (17). All dogs received HBOT with 2.4–2.8 ATA for 60 to 90-minute sessions. Results showed that 73.5% of dogs had improved after treatment. The data also showed that the days from SIRS diagnosis to treatment played an essential role in the treatment outcome. The study concluded that HBOT should be applied as early as possible. There are concerns that the groups were not equal; however, the study indicates promising results for using HBOT to treat diseases with inflammation processes.

Changes in Red Blood Cells and Inflammatory Markers

A study done by Steenebruggen et al. (2023) discusses how red blood cell structure is altered during specific inflammatory disease processes and how HBOT can change the structure to improve the disease process. The study had three groups: patients with acute or chronic inflammation (10), patients with acute carbon monoxide poisoning (10), and healthy volunteers (10). Before HBOT, red blood cell elongation was significantly lower in patients with acute or chronic inflammation than in healthy volunteers and patients with acute carbon monoxide poisoning. After one session of HBOT, the red blood cell elongation was higher than before. Red blood cell elongation continued and remained constant after 10 HBOT sessions. There were no differences before and after HBOT in protein or amino acid oxidation from oxidated stress. Implications of the results show that the red blood cell elongated after each hyperbaric therapy session, positively impacting the inflammation process.

Bosco et al. (2018) investigated how HBOT modulates inflammatory markers and reactive oxygen species (ROS) in patients with avascular necrosis of the femoral head (AVNFH). Twenty-three male patients were treated with two rounds of HBOT, 30 sessions each round, and a 30-day break between the two rounds. Each HBOT treatment lasted 90 minutes at 2.5 ATA at 100% oxygen. Before the treatment, baseline plasma levels of tumor necrosis factors were measured again after 15 and 30 treatments, after the 30-day break, and after 60 treatments. There was a reduction in plasma levels over the treatment period. The decreased inflammatory markers confirmed the reduction in bone marrow edema and patient self-reported pain. The results imply that HBOT positively impacts inflammation markers.

Another study shows changes to the T helper cells, which regulate inflammation, performed on mice by Harnanik et al. (2020). This study was used to confirm the effect of HBOT on T helper 17 /T (Treg) cell polarization by looking at the changes in hypoxia-inducible factor-1 alpha (HIF-1α) expression in rheumatoid arthritis. They used antigen and collagen-induced arthritis. The sample consisted of 16 male mice and was split into two groups: a non-HBOT group as the control group (8) and the HBOT group as the treatment group (8). The histological assessment of inflammation markers in the tissue from the left knee was obtained.

Superoxide dismutase (SOD) levels were used to assess oxidative stress and systemic inflammation. Enzyme-linked immunoassay was used to determine Interleukin 17a, C-reactive protein (CRP), and rheumatoid factor. Paw swelling was evaluated to determine the degree of rheumatoid arthritis. Results showed a decrease in inflammatory marker expression and a reduction in paw swelling; however, when comparing both groups, the CRP levels remained unchanged. Result implications show that while swelling and cell expression were improved, the CRP levels remained the same. The study advised that HBOT would be an excellent adjunct therapy with drug therapy for Rheumatoid arthritis.

Discussion

This paper has looked at the effectiveness of HBOT on chronic pain and inflammation. The goal was to assess whether HBOT was as effective or better than standard treatments. There is plenty of literature on the use of HBOT on various disease processes in human and animal research. In the articles reviewed, HBOT has been used to treat Covid-19, Rheumatoid arthritis, SIRS, and fibromyalgia. Krishnamurti (2020) noted that in 2002, the U.S. Army completed a study and confirmed that HBOT repairs white matter damage in children with cerebral palsy and has even been used to treat fetal alcohol syndrome. In 2010, it was discovered that HBOT activated 8101 genes, resulting in the reduction of inflammation and reducing pain. Izquierdo-Alventos et al. (2020) also indicated that HBOT is effective for inflammation related to fibromyalgia. The study by Gouveia et al. (2022) was completed on dogs, and another study was done on mice by Harnanik et al. (2020). All of the data viewed showed an improvement in quality of life, a decrease in inflammation and inflammation markers, and showed improvement in pain, decreasing the need for pain medication. Steenebruggen et al. (2023) noted red blood cell changes after HBOT treatment. HBOT treatments will help curb opioid drug use and addiction, which, as pointed out in the article by Wilson et al. (2022), is at an all-time high. Ablin et al. (2023) saw an improvement in analyzed brain scans pre- and post-HBOT treatment, which noted increased activity in the emotional processing part of the brain: the frontal cortex. With the improvements in the disease process, pain and inflammation symptoms, it is promising that HBOT is effective as a treatment.

Limitations

Harnanik (2020) noted decreased paw swelling with HBOT treatment but did not see a reduction in the C- reactive protein inflammatory marker. Results from Ablin et al. (2023) did note that HBOT did get participants out of fibromyalgia diagnosis, but there was no information on the follow-up of these patients for the long term. While all the studies met the group testing size requirements, most trials were small. The studies were also short in length, so there needs to be data on how long the effects of the treatments are effective. There needed to be more information on the recommendations for treatment maintenance. The study by Kjellberg et al. (2022) is incomplete and is still following up post-treatment, which should provide information to address the concern for maintenance therapy and how long treatment effects last. This article noted concern for their initial efficacy calculation for the placebo treatment. This may have set their clinically relevant estimation too high, possibly resulting in a type II error. It will be interesting to see the outcomes of this study to see if the resulting data is reliable and collaborates with the effective use of HBOT. There were some decreased inflammation markers and decreased pain, but they were not completely gone. All the data showed some improvement, supporting the hypothesis that HBOT effectively treats chronic pain and inflammation. The research indicates HBOT is a good treatment option as a stand-alone or adjunct treatment for pain and inflammation, allowing symptom relief and a higher quality of life.

Conclusions

In summary, all of the literature reviewed has implicated HBOT as an effective treatment for diagnoses with chronic pain and inflammation symptoms. From the cellular level changes that happen to the patients’ self-report of symptoms, pain, and quality of life, HBOT is proving effective as a stand-alone or adjunct treatment. Although many of the studies were small, the results were consistent. HBOT has and will continue to gain reputability, and future studies should focus on replication, but with larger study groups to confirm the effects of HBOT. The more it is studied, the more we can understand how it works and get a standardization for dosing, treatment maintenance, and its long-term effects.

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