Does hyperbaric oxygen therapy actually work?

For FDA-approved conditions including diabetic wounds, radiation injury, carbon monoxide poisoning, and decompression sickness, yes — the clinical evidence is strong. For investigational conditions like long COVID and TBI, evidence ranges from promising (long COVID) to mixed (TBI). For conditions like autism, evidence is insufficient.

Should I try HBOT for a condition not on the FDA list?

Consider clinical trials before committing to private-pay HBOT for investigational conditions. Search ClinicalTrials.gov for your condition and 'hyperbaric oxygen.' If you proceed privately, understand that insurance won't cover it and the evidence may be preliminary.

Does Hyperbaric Oxygen Therapy Work? An Honest Look at the Evidence

Q: Is HBOT evidence-based?

HBOT has strong evidence for its 14 FDA-approved indications. Evidence for investigational uses varies widely by condition. The strongest investigational data currently exists for long COVID (Efrati et al., 2022, Nature Communications) and some forms of TBI.

Q: Why do some doctors doubt HBOT?

Skepticism often stems from inconsistent research protocols across trials, marketing of HBOT for conditions with little evidence, and the fact that sham HBOT sometimes shows effects in trials. Skepticism about off-label uses is reasonable. Skepticism about well-established indications like CO poisoning or diabetic wounds is not supported by the evidence.

The answer depends entirely on what you’re treating. For some conditions, the evidence is solid. For others, it’s early and contested. Lumping them together makes the question unanswerable.

Where the Evidence Is Strong

For FDA-approved conditions, HBOT has decades of clinical data behind it.

Diabetic lower-extremity wounds have multiple randomized controlled trials and Cochrane reviews supporting HBOT as an adjunct to standard wound care. Wound healing rates, limb salvage, and reduction in major amputation are the documented outcomes.

Radiation injury, including osteoradionecrosis of the jaw and radiation tissue damage, has strong case series and clinical experience behind it. The Marx Protocol for jaw ORN has been in use since 1985 with well-documented results.

Carbon monoxide poisoning has a clear physiologic mechanism. CO binds hemoglobin about 200 times more tightly than oxygen. HBOT at 2.4-3 ATA dramatically accelerates CO elimination. Thom et al. (1995) showed HBOT reduced delayed neurological syndrome after CO poisoning compared to normobaric oxygen. PMID: 7651459

Decompression sickness has decades of military and diving medicine data. The US Navy Treatment Tables are the standard of care specifically because recompression works. This isn’t contested.

Where the Evidence Is Mixed or Early

For investigational conditions, the picture is more complicated.

Long COVID: Efrati et al. (2022) published a well-designed randomized controlled trial in Nature Communications (PMID: 36329021) showing cognitive and functional improvements after 40 HBOT sessions. This is the best trial to date. More replication is needed.

TBI and concussion: genuinely controversial. Some trials from the Efrati group and others show benefit. US military-funded trials (Cifu et al., Harch et al.) showed more mixed results. The methodology differences between trials make direct comparison hard. The field hasn’t reached consensus.

PTSD: a 2024 RCT by Gottlieb and colleagues showed promising results. The evidence is early but better than for most investigational uses.

Autism: a Cochrane review found insufficient evidence to draw conclusions. The FDA has specifically warned consumers against using HBOT for autism.

Fibromyalgia: one RCT (Efrati 2015) showed meaningful benefit. Needs replication.

Anti-aging and wellness: very early data, no clinical trials with hard endpoints. No basis for clinical claims.

Why There’s Skepticism About HBOT Generally

Skepticism about HBOT as a field is partly fair and partly unfair.

The fair part: trials use different pressures, different oxygen fractions, different treatment durations, and different patient populations. Comparing them is difficult. And “sham HBOT” — slightly pressurized air below therapeutic levels — sometimes shows measurable effects, which raises questions about placebo contribution.

The unfair part: some critics lump FDA-approved conditions and wellness marketing together. The evidence for diabetic wounds is not the same situation as the evidence for autism.

One recommendation: for FDA-approved conditions, find an accredited clinic and get treated. For investigational conditions, look for clinical trials at ClinicalTrials.gov before paying $10,000-18,000 out-of-pocket for a private-pay protocol.

FAQ

Q: Does HBOT actually work? For FDA-approved conditions, yes — the evidence is strong. For investigational conditions, it varies. For conditions like autism, evidence is insufficient.

Q: Is HBOT evidence-based? For its 14 FDA-approved indications, yes. For off-label uses, it depends heavily on the specific condition.

Q: Why do some doctors doubt HBOT? Inconsistent trial protocols, off-label marketing, and mixed results in some investigational areas. Skepticism of off-label uses is reasonable. Skepticism of CO poisoning or diabetic wound treatment is not.

Q: Should I try HBOT for an off-label condition? Search ClinicalTrials.gov first. Trials let you access treatment without paying out-of-pocket. If you proceed privately, go in with clear eyes about the evidence level.

Medical Disclaimer: This content is for informational purposes only and does not constitute medical advice. Hyperbaric oxygen therapy must be prescribed and supervised by a licensed physician. Always consult your care team about your specific situation. This site does not establish a doctor-patient relationship.