Hyperbaric Oxygen Therapy and Chronic Fatigue Syndrom1

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Hyperbaric Oxygen Therapy and Chronic Fatigue Syndrome

Treatment: Hyperbaric Therapy in Chronic Fatigue Syndrome

ImmuneSupport.com

11-26-2003 Source: Journal: J of Chronic Fatigue Syndrome, Vol. 11(3) 2003, pp.

37-49

Authors: EIke Van Hoof, Clin Psych; Danny Coomans, PhD; Pascale De Becker, PhD;

Romain Meeusen; Cluydts, PhD; Kenny De Meirleir, MD, PhD

Affiliations:

EIke Van Hoof, Pascale De Becker, and Kenny De Meirleir are affiliated with the

Chronic Fatigue Clinic, Department of Internal Medicine, Faculty of Medicine,

Vrije Universiteit Brussel, Belgium. Danny Coomans is affiliated with the School

of Mathematical and Physical Sciences, Cook University, Australia. Romain

Meeusen is affiliated with the Department of Human Physiology and Sports

Medicine, Vrije Universiteit Brussel, Belgium. Cluydts is affiliated

with the Department of Psychology, Vrije Universiteit Brussel, Belgium. Address

correspondence to: EIke Van Hoof, Vakgroep MFAB/ Sportgeneeskunde, AZ-VUB KRO

gebouw niveau-l, Laarbeeklaan 101, 1090 Brussels, Belgium(E-mail:

mailto:EIke.Van.Hoof@... ).

The authors would like to thank Dr. Neil McGregor for his advice in writing this

article.

ABSTRACT. The aim of this study was to determine if hyperbaric oxygen treatment

(HBOT) could be used as adjunctive therapy and if HBOT could increase the

quality of life in such a way that the functional status would improve in

patients with an infection. A randomized, controlled trial was conducted on 15

Mycoplasma sp. infected CFS (CDC 1994) patients and 14 CFS (CDC 1994) patients

with no evidence of a Mycoplasma infection [who] were enrolled in a convenience

randomization sample from our referral clinic. No statistical differences were

found by use of univariate repeated measures although Bodily Pain as measured by

the SF-36 seems to decrease after hyperbaric therapy (Greenhouse-Geisser: p =

..010).

Trends were found using paired t-testing for Mycoplasma infected CFS patients.

The general perceived fatigue seemed to decrease after hyperbaric therapy

(General Fatigue: p = .06). Directly after one week of hyperbaric therapy

general fatigue improved (p = .03) but there was a reduction of activity

(reduced activity: p = .05) and general perceived health (general health: p =

..04). One month later the physical role increased (Role-Physical: p = .07).

Although more data is required to make firm conclusions, trends were found.

Reduced fatigue, increased levels of activity and an improved reaction time

improved significantly their quality of life and therefore, enhanced also their

functional status and thus could be used as an adjunctive therapy.

KEYWORDS. Chronic systemic infections, hyperbaric oxygen therapy, adjunctive

therapy, quality of life

INTRODUCTION

Chronic Fatigue Syndrome (CFS) was first described in the 1930s and due to its

definition by exclusion, its pathogenesis has been difficult to delineate.

During the last few decades an increasing number of studies have started to

unravel the pathogenesis of CFS. Currently the etiology is not known and no

definite pathological abnormalities have been identified, therefore CFS is still

called a syndrome and not a disease or group of diseases.

The controversy around this syndrome is intense with the overriding theme being

whether its origin is physical or psychological. Interestingly this very same

debate has taken place for many other chronic diseases in which initially no

objective abnormalities were found followed by findings which clearly establish

a physical/organic basis to the disease, leading to their wide acceptance.

Up until now, many therapies have been investigated in this population with

different results (1). One of the most promoted therapies seems to be 'Cognitive

Behavioral Therapy (CBT) with Graded Exercise' (2). The restricted lifestyle of

CFS patients has led to the suggestion that a reduction in exercise capacity

contributes and prolongs their illness. It is for this reason that

exercise-training programs are added to the treatment of CFS-patients (2).

Different ailments, however, inhibits wide spread application. First of all, CBT

has not been adequately assessed for severely affected CFS patients (3). In

fact, CBT seems applicable only when a Karnofsky Performance Score

(KPS)-threshold of 70 is reached (4,5).

The Karnofsky Performance Score indicates functional disability in different

populations and is used as a communication tool in CFS. A KPS of 70 means that

the CFS patient " cares for him/herself but is unable to carry on normal activity

or do active work. " This threshold (70) is in contrast with the overall score of

the CFS population which is 60-65. A person with a KPS of 60-65 " requires

occasional assistance but is able to care for most needs. " Secondly, CBT is

characterized by a high dropout rate (6).

So, in order to bring CFS patients to a threshold of 70 and in order to bring

CFS patients in the ability to start up an exercise program, different

strategies should be used. While CFS patients do have abnormal immune parameters

which indicate infections agents (7), hyperbaric oxygen therapy could be

considered. By applying HBOT, the quality of life should be influenced in those

patients with distorted immune parameters. A higher quality of life suggests a

higher functional status. If patients increase their area of control by more

activity or less fatigability, such as more walking around or leaving the home,

leading to more independence, this implies a higher functional status.

Rationale for the Use of Hyperbaric Therapy in CFS

The immune system, wound healing, and vascular tone are all affected by oxygen

supply. Oxygen alone has little direct antimicrobial effect, even for most

anaerobes (8) like Mycoplasma infections. It is, however, a crucial factor in

immune function. Neutrophils require molecular oxygen as a substrate for

microbial killing. The oxidative burst seen in neutrophils after phagocytosis of

bacteria involves a 10 to I5-fold increase in oxygen consumption (9). Here

oxygen serves as a substrate in the formation of free radicals, which directly

or indirectly initiate phagocytic killing. This endogenous antimicrobial system

virtually ceases functioning under conditions of hypoxia (10). In short,

increasing the oxygen level in tissue can allow restoration of white blood cell

function and thus the return of adequate antimicrobial action. However, whether

this is applicable in a normal physiological system or some other process may be

involved is not known.

History of Hyperbaric Therapy

The use of hyperbaric air therapy was apparently attempted before anyone knew of

the existence of oxygen (11). A physician named Henshaw first attempted to treat

patients in a chamber with altered air pressure about 300 years ago (12).

Hyperbaric oxygen therapy (HBOT) involves intermittent inhalation of 100% oxygen

under a pressure greater than one atmosphere. Initial widespread enthusiasm for

HBOT led to its inappropriate use, resulting in a backlash against the use of

HBOT (12). More recent and reputable studies have demonstrated that the

technique has a role in treating specific illnesses (11).

The Undersea Medical Society that evaluates clinical applications of HBOT has

categorized disorders of which it is or may be useful (11). Table 1 gives an

overview of the different treatment areas suggested for HBOT: category 1 is

widely accepted and category 4 has little evidence to support its use. CFS

patients with chronic bacterial infections are categorized as an adjunctive

therapy by the Undersea Medical Society.

Complications and Side Effects of HBOT

The complications of HBOT are related to. the changes in barometric pressure and

oxygen toxicity. Patients can receive mild inner ear discomfort that may occur

by using certain maneuvers. The most common complication is middle ear or sinus

trauma (9) due to the change in pressure. Any air filled cavity that cannot

equilibrate with ambient pressure, such as the middle ear is subject to

deformity and barotraumas during pressure changes in HBOT. Other complications

sometimes observed at this pressure can include nausea, tooth and sinus pain and

blurred vision (9).

Hypotheses

This controlled pilot study evaluates the utility of HBOT in CFS patients

infected with Mycoplasma hominis. In other words, can HBOT improve the quality

of life of this subgroup of CFS patients as investigated by validated

psychological questionnaires? If the quality of life improves, patients may

reach a KPS-threshold of 70 and additionally, attend CBT and graded exercise to

improve their functional status.

© 2003 by The Haworth Press, Inc. All rights reserved.

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