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Can pressure cure pain?

Ask any diver what the treatment is for the bends, and you will hear the words 'recompression chamber'.

Ask a sufferer of chronic and excruciating pain what their treatment might be, and you could soon be hearing the same words. That is if the promising early results of a trial being carried out in Merseyside are anything to go by.

When Adrian Morris, 55, was trimming his hedge last May, he fell off a stepladder and broke his left arm. After it was pinned, plated and reset, it stayed in plaster for five weeks.

In many cases that would have been the end of the matter, apart from physiotherapy to restore mobility and muscle strength - but not for Adrian.

He developed Complex Regional Pain Syndrome (CRPS Type 1) - a complication that can happen after a wrist or forearm injury. 'It was like having an alligator biting your arm 24 hours a day. It produced a feeling of enormous heat, and there were colour changes in the skin. It was unbearable.'

It prevented Adrian, a physics teacher from the Wirral, from working and from enjoying his hobby as a cyclist - and it grew so intense it drove him to the brink of suicide.

'I was being treated at a pain clinic, but nothing worked. I was taking a phenomenal amount of pills, but they made my brain feel like a lump of mince.

'I couldn't think straight. I used to sit on the edge of the bed at night, rocking back and forth with the pain. By August I became depressed and started contemplating suicide.'

But then the clinic told Adrian about a trial of an experimental treatment to relieve CRPS - using hyperbaric, or 'recompression' chambers.

Originally developed to treat divers with the bends (a condition that occurs when they come up too quickly and nitrogen bubbles form in the blood) the chambers have also been used to treat carbon monoxide poisoning.

Then a doctor in Baltimore discovered a new use for them. He was treating a patient suffering from acute smoke inhalation using hyperbaric oxygen therapy. She also had CRPS in her foot.

After just a few minutes' therapy, she reported that the treatment was giving her pain relief as well.

Dr John Harrison, consultant in anaesthesia and Medical Director of the Hyperbaric Unit in BUPA's Murrayfield Hospital, read about the incident in a medical journal and was immediately interested.

Last year he launched a pilot study to investigate the possibilities of using hyperbaric chambers to combat pain. Adrian was excited to hear that Dr Harrison was recruiting patients for his study, and that the hospital was just down the road from him.

Last September he became one of the first ten patients in the UK to be treated for CRPS using this technique.

Adrian's treatment involved a daily 90-minute session in the chamber over four weeks, where he breathed pure oxygen at an equivalent pressure of being 46ft (14m) underwater.

'The pain relief was almost immediate,' he says, 'and by the end of it I was virtually pain-free.' And the side-effects? 'Your ears have to be able to withstand the pressure change, but apart from that the worst part of sitting in the chamber was boredom.'

The procedure is relatively simple. The patient enters a chamber that is sealed and then filled with compressed air until a pressure of 2.4 Atmospheres Absolute is reached - the equivalent of 14m of seawater.

The patient breathes 100pc oxygen either through a facemask or a transparent hood. The combination of pressure and oxygen physically dissolves more oxygen into the bloodstream - which may enable cells to take up more and improve their function.

Chronic unremitting pain affects millions of people, and the implications for a drug-free treatment such as hyperbaric oxygen therapy are potentially enormous.

Cancer patients often suffer severe neuropathic pain, and stroke victims can develop 'central post-stroke' pain. Even elderly people who contract shingles are at risk of developing 'post-herpetic neuralgia' - which is similar to CRPS because the pain can be excruciating.

Dr Harrison says, 'We need to expand the trial. Even though we studied only a handful of patients, all seem to have improved.'

To measure the results as objectively as possible, Dr Harrison's patients were assessed before and after treatment by experts at the Pain Research Institute at University Hospital, Aintree, Liverpool, using pain scoring and tests on factors such as sensitivity to cold, heat, sharpness and touch.

'Dr Harrison's patients certainly showed an improvement,' confirms Dr Bowshera, senior medical research scientist at the Institute.

'It is mysterious,' he adds, 'and may well be because the therapy squeezes more oxygen into the cells. In cases of CRPS there's always a lot of swelling which makes cells less able to take up nutrients - including oxygen - and this may hinder recovery.'

There are currently 25 registered hyperbaric units in the UK. But as the demand for hyperbaric medicine increases, this number could easily grow. Dr Harrison says: 'We probably treat about 100 emergency cases every year - half of whom are divers suffering from the bends, and half of whom are suffering from carbon monoxide poisoning.'

Since his treatment, Adrian still remains virtually free of the agony of CRPS. 'Hyperbaric treatment has dramatically reduced my pain.

'I can now cycle for about half an hour on my static cycle and look forward to the day I get out on the open roads again. Things are definitely looking up.'

Pregnant women, poorly controlled epileptics, anyone with claustrophobia or ear problems may not be able to use hyperbaric oxygen therapy. If you believe you may have CRPS Type 1 and are interested in taking part in the trial, send an email to info@hyperbaric-medicine.co.uk