Preprint Hyperbaric oxygen therapy improves clinical symptoms and functional capacity and restores thalamic connectivity in ME/CFS, 2025, Kim, Scheibenbogen+.

SNT Gatchaman

SNT Gatchaman

Senior Member (Voting Rights)
Staff member
Hyperbaric oxygen therapy improves clinical symptoms and functional capacity and restores thalamic connectivity in ME/CFS
Laura Kim; Guido Cammà; Claudia Kedor Peters; Maron Mantwill; Oliver Müller; Nadège Leprêtre; Cornelia Heindrich; Rebekka Rust; Moritz Krill; Tim J Hartung; Lukas Reeß; Stephan Krohn; Christian von Heymann; Kirsten Wittke; Carsten Finke; Carmen Scheibenbogen

BACKGROUND
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating disorder characterized by profound fatigue, cognitive impairment, autonomic dysfunction, and exertional intolerance with strongly impaired physical functioning. Hyperbaric oxygen therapy (HBOT) has been proposed as a potential treatment, but its effects on ME/CFS patients remain largely unexplored. This study aimed to evaluate the effectiveness and feasibility of HBOT in ME/CFS patients and to investigate its effects on functional brain changes.

METHODS
30 ME/CFS patients (mean age: 42.3 ± 11.7 years; seven males, 23 females) received 40 HBOT sessions each. Outcomes were assessed at baseline, during treatment, and four weeks post-treatment. The primary outcome was change in the Physical Functioning subscale of the Short Form-36 Health Survey (SF-36 PF). Secondary outcomes included severity of core symptoms assessed via questionnaires, exercise capacity, handgrip strength, cognitive performance, orthostatic intolerance, and brain MRI (volumetry and functional connectivity, (FC)). Thirty age-and sex-matched healthy controls (HCs) (mean age: 42.3 ± 11.3 years; seven males, 23 females) were included for MRI comparison.

FINDINGS
In the linear mixed model, SF-36 PF significantly improved during HBOT compared with baseline (g = 0.71, p = 0.006). SF36 pain (p = 0.002, g = 0.79) and CFQ fatigue showed clinically meaningful reductions (p < 0.001, g = -0.87) during HBOT. Exercise capacity (g = 0.66), muscle strength (g = 0.40), and information processing speed (g = 0.52), all improved significantly after HBOT compared to baseline (all p < 0.05). Treatment adherence was high, and tolerability was favorable, with no major side effects reported. Functional MRI analyses revealed increased thalamic FC in ME/CFS patients compared to HCs in bilateral sensorimotor (p < 0.001, t = 5.65, FDR-corrected) and visuo-occipital regions (p < 0.001, t = 5.4, FDR-corrected) at baseline. After HBOT, thalamic hyperconnectivity normalized. Responders (defined as a ≥ 10 point increase in SF-36 PF) showed greater reductions in thalamic hyperconnectivity than non-responders (p < 0.001, t = -4.34 to -5.18, FDR-corrected).

INTERPRETATION
HBOT was well-tolerated and was associated with significant improvements in physical functioning, fatigue, pain, and cognitive performance and provides the rationale for a controlled trial in ME/CFS to confirm therapeutic efficacy. The normalization of thalamic hyperconnectivity following HBOT and its association with clinical response highlights the role of thalamic FC in ME/CFS pathophysiology and underscores the need for larger, controlled trials in ME/CFS to confirm therapeutic efficacy.

FUNDING
Funded by The Federal Ministry of Education and Research (NKSG, 01EP2201), the Klinik Bavaria Kreischa, and the Weidenhammer Zoebele Research Foundation.

Web | PDF | Preprint: MedRxiv | Open Access
 
Why are there so many HBOT trials with no proper control group?

The results are seriously unimpressive:
IMG_0452.jpeg

IMG_0453.jpeg

They also had to be healthy enough to complete 40 session in 8-16 weeks. Seems like it probably was a waste of time.
 
Utsikt said:
They also had to be healthy enough to complete 40 session in 8-16 weeks.
Click to expand...

You'd need to be healthy to do that many dives. It's very noisy and tiring, and as you're not usually in the chamber alone there's a bit of interaction too.

A friend with MS wanted to try it at a local centre, but didn't want to go on her own. I'm always up for novel experiences, so I said I'd go with her (they allowed people with ME/CFS to use the chamber). We did two dives a week until she felt okay about going without me.

The only effect it had on ME/CFS was to cause PEM. It wasn't too bad, but I can't imagine anyone with severe symptoms being able to tolerate it. The effect is similar to sitting in a cramped train carriage going through a tunnel for 40 minutes, while also breathing in a different way to usual—not horrible, but you're quite looking forward to getting out by the end.
 
Last edited:
There isn't always a HBOT chamber close by. I live in a relatively high density population area and still, the nearest one is 20 miles away. It is heavily used by MS patients but they put my name as a patient with ME on their waiting list. I never heard further.

Now, that is too far because I can no longer travel independently and I would not be healthy enough to participate.
 
They excluded the 7/37 participants who dropped out
They do not compare results to a control group
The participants received 40 sessions, which seems quite a lot

And still the improvement was only 6.3 points on the SF-36 PF (a clinically meaningful improvement was defined as 10 points)

So it looks like the trial strongly showed that hyperbaric oxygen therapy probably doesn't work in ME/CFS.
 
ME/CFS Science Blog said:
They excluded the 7/37 participants who dropped out
They do not compare results to a control group
The participants received 40 sessions, which seems quite a lot

And still the improvement was only 6.3 points on the SF-36 PF (a clinically meaningful improvement was defined as 10 points)

So it looks like the trial strongly showed that hyperbaric oxygen therapy probably doesn't work in ME/CFS.
Click to expand...
Do we know whether the SF36-PF scores are normalised or not normalised? An improvement of 6.3 on the normalised scoring system is more impressive than 6.3 on the non-normalised scoring system.
 
Dolphin said:
Do we know whether the SF36-PF scores are normalised or not normalised? An improvement of 6.3 on the normalised scoring system is more impressive than 6.3 on the non-normalised scoring system.
Click to expand...
Suspect it was normalized. Either way, they report the minimal clinically significant improvement to be 10 points. So the mean improvement was lower than this, despite having no control group.
 
Binkie4 said:
There isn't always a HBOT chamber close by. I live in a relatively high density population area and still, the nearest one is 20 miles away. It is heavily used by MS patients but they put my name as a patient with ME on their waiting list. I never heard further.
Click to expand...

A private clinic nearby offers HBOT and I seriously considered it a couple of years ago after the first wave of (ultimately highly dubious) Israeli and Polish case studies came out. But my questions to them regarding COVID safety were met with ghosting. Given the cost ($250CAD/session… we’re looking at 10k for a "maybe") I went with maybe not.
Dolphin said:
A normalised change of 6.3 is around 0.63 x 24 =15.12 on the non-normalised SF 36 PF.
Click to expand...
Which would be great, if true. But the study design has done nothing to assuage my skepticism.

I remember reading about a researcher from Cambridge that was planning a proper study on HBOT for Long COVID. This was well over a year ago. I remember thinking "finally, some rigour".

Clearly, nothing groundbreaking came of it (assuming they ever managed to conduct it).

Anyway "some mild improvement, in some people, we think… hard to tell really" isn’t doing it for me anymore. I need something more before I’ll act on the intel.
 
Jaybee00 said:
What is this?

Do I really want a hyperconnected thalamus?
Click to expand...

Possibly not, it's associated with autism and ADD among other things. If it can so easily be disconnected, it's a bit surprising more people with profound autism aren't treated with HBOT.

Unless it's just another made-up use for an existing term, of course.
 
You must log in or register to reply here.
Back
Top Bottom