Hyperbaric oxygen therapy is used 'off label' to treat brain injuries, but questions remain
Gordon Brown used to be a licensed psychologist and U.S. Navy petty officer 1st class. But a severe blow to the head caused bleeding on the brain and led to surgery in 2002 that left him struggling to read and speak.
Brown said he’s now mostly recovered, and he credits hyperbaric oxygen therapy, known as HBOT, which most commonly is used in hospitals to treat burn victims and severe skin and bone infections. Patients are placed in pressurized chambers and breathe pure oxygen.
“I couldn’t have done this interview prior to the dives (therapy sessions),” said Brown, now 68.
HBOT of Arizona uses the therapy to treat thousands of brain injury patients – roughly 2,000 this year – although the Food and Drug Administration has not approved hyperbaric oxygen for that purpose. However, “off-label prescribing” is allowed for all drugs or treatments the FDA has approved for any condition.
“The risks and benefits of HBOT when used for off-label have not been established,” an FDA spokesperson told Cronkite News. “At this time, the FDA has not approved, cleared or authorized the use of HBOT for cognitive improvement.”
The FDA has approved HBOT treatment only for certain conditions, and it notes on its website that “some claims of what it can do are unproven.” Further clinical trials are underway or completed for use of the therapy for traumatic brain injury, PTSD and long COVID, according to the FDA and clinicaltrials.gov.
But that doesn’t stop patients from trying off-label treatments.
The FDA says hyperbaric chambers vary in size, shape and material, but all are pressurized to an atmospheric pressure below sea level while patients breathe 100% medical-grade oxygen through a mask.
When they’re in the chamber, HBOT of Arizona patients can read books or watch TV through a window of the chamber, but they can’t bring in electronic devices due to the pressure change, which can ruin electronics, the for-profit clinic says on its website.
According to HBOT of Arizona, the oxygen and pressure combined promote faster healing by increasing oxygen in tissue, which leads to the growth of new capillaries. The company has a certified hyperbaric technologist present for all sessions.
Brown said he suffered two grand mal seizures after the surgery in 2002 “and flatlined both times. I died twice.”
In addition to post-operative challenges in reading and speaking, Brown had anger issues, memory loss and trouble with balance after his injury.
The Navy veteran and scuba diver was familiar with HBOT because it’s used to treat divers with decompression sickness. He started the therapy in 2015 at HBOT of Arizona.
“As I went through the days,” he recalled, “I started noticing that a lot of memories started coming back, and they weren’t coming back in a linear fashion. They were just memories that were popping up and I didn’t know what they were.”
Toward the end of his 40 treatments, known as dives, over the course of two months, his friends started noticing his speech improving, he could read again and his memory started returning.
A typical regimen at HBOT of Arizona consists of 40, hour-long dives, said general manager Lori Klauber, but it may take more sessions to reach a plateau. Treatments may vary depending on the condition but averages $200 or more per session without insurance, she said.
“We take on-label and off-label (patients),” Klauber said, noting the company uses HBOT to treat conditions hospitals typically don’t, including post-traumatic stress disorder, “TBI, (COVID-19) long-haulers, autism, cerebral palsy.”
When it comes to off-label uses of HBOT, the risks and benefits are not established. HBOT risks for all uses include ear and sinus pain, middle ear injuries, temporary vision change and lung collapse, according to an FDA spokesperson. Oxygen tank fire is also a potential risk when using the chamber.
Regardless of FDA approval, Brown said, HBOT has worked for him and other brain trauma patients he has sponsored for the therapy.
Before the therapy, Brown spoke haltingly and was embarrassed to talk to people.
“I knew I had a brain at one time. It was very frustrating, but by the time I finished my 40th dive, I felt like I was about 85 to 90% back.”