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Hyperbaric Oxygen as an Off-Label Treatment for Lyme Disease

Lyme disease – a tick-borne illness – is caused by a single strand of bacteria. It can lead to a wide range of symptoms, from fever and rash to more severe neurological and cardiac issues. While antibiotics are the standard treatment, some patients continue to experience symptoms long after the infection is cleared. This condition is so popular, that it has its own name: Post-Treatment Lyme Disease Syndrome (PTLDS). 

In the quest for effective treatments, one innovative off-label approach has garnered attention: Hyperbaric Oxygen Treatment (HBOT). Traditionally not approved for Lyme disease, this treatment is being explored off-label, piquing the curiosity of those affected with persistent symptoms.

What is Hyperbaric Oxygen Treatment?

Hyperbaric Oxygen Treatment is a medical therapy that enhances the body's natural healing processes through the inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is increased and controlled. It is based on the principle that oxygen is transported not o

nly by red blood cells but also dissolved in plasma. Under increased pressure, more oxygen can be dissolved into the bloodstream, which can reach areas with reduced or blocked circulation, and support the healing of damaged tissues.

How it Works

In a typical HBOT session, the patient enters a hyperbaric oxygen chamber, either a monoplace (for one person) or a multiplace chamber (accommodating more than one person). The pressure inside the chamber is gradually increased to about 2.5 times the normal atmospheric pressure. This is the equivalent of diving to 33 feet below sea level. 

This high-pressure environment has potent physiological effects on the body. It causes the lungs to gather more oxygen than would be possible breathing pure oxygen at normal air pressure. This oxygen-rich blood circulates throughout the body, promoting healing by stimulating the release of growth factors and stem cells, reducing inflammation, and inhibiting bacterial growth.

HBOT is being used for several medical conditions, including, but not limited to:

  • Wounds that fail to heal (for example as a result of diabetes or radiation injury) [1]

  • Acute traumatic ischemias

  • Certain types of brain abscesses [2]

  • Skin grafts and flaps that are at risk of tissue death

  • Decompression sickness experienced by divers [3]

  • Serious infections where tissues are oxygen-starved

  • Carbon monoxide poisoning [4]

It was even used as a therapy to treat the death of soft tissue in a diabetes patient following a bite from a centipede. [5]

HBOT for Lyme Disease

The leap from treating wounds and infections to targeting Lyme disease with HBOT is based on the therapy's underlying mechanisms. Lyme disease bacteria thrive in low-oxygen environments, and the persistent symptoms some patients experience may be partly due to the bacteria's survival in these conditions. Some researchers hypothesize, that by saturating tissues with oxygen, HBOT may create an inhospitable environment for these bacteria, potentially reducing their numbers and the symptoms they cause.

Additionally, the anti-inflammatory effects of HBOT might help alleviate symptoms associated with chronic Lyme disease, such as joint pain and neurological issues. 

What Does the Research Say?

In a notable case from Taiwan, a middle-aged man who enjoyed hiking and had potential tick exposures, developed symptoms consistent with Lyme disease, including fever, fatigue, and bone pain, followed by skin lesions and joint pain. Despite a positive test for Lyme disease and initial treatment with antibiotics, he experienced a variety of persistent symptoms affecting his nervous, cardiovascular, and musculoskeletal systems, significantly impacting his quality of life. [6]

After years of enduring these symptoms and undergoing various antibiotic treatments without significant improvement, the patient sought HBOT in 2011. The treatment involved 30 sessions of breathing 100% oxygen in a pressurized chamber, which led to a remarkable improvement. The therapy not only alleviated symptoms related to the nervous system, such as memory loss and sleep disorders, but also resolved musculoskeletal issues like joint pain. [6]

This case underscores, that while the primary treatment remains antibiotics, for some, this may not be enough. HBOT may be considered as a potential adjunctive therapy, particularly for those who have exhausted conventional treatments. [6]

Research from another publication involved treating a group of patients suffering from Lyme disease with HBOT, resulting in a remarkable improvement in symptoms for the majority. Patients reported alleviation in pain, cognitive dysfunctions, and other Lyme-associated symptoms. The findings are supported by brain imaging before and after the treatment, showing noticeable improvements that correspond with the patients' reports of symptom relief. However, to the best of our knowledge, this is an informal publication that may not have undergone the peer-review process. [7]

However, a review article, that was published in the Journal of Chemotherapy, addressed treatment options for Lyme disease. It states, that HBOT has been recommended for patients who have received antibiotics, but still suffer from symptoms. It also suggested, that HBOT can be especially effective against anaerobic bacteria. While the responsible bacteria – B. burgdorferi –  is not strictly anaerobic, it tends to prefer low oxygen environments. [8]


The three publications mentioned above suggest that HBOT, when used in conjunction with antibiotic therapy, may be an effective treatment for Lyme disease, particularly in cases where conventional antibiotic treatment alone does not lead to adequate symptom resolution. 

However, despite research underscoring its effectiveness, the volume of research on this topic has been very limited. As of now, HBOT remains an off-label treatment option for Lyme disease, as it has yet to receive FDA approval.


  1. Ortega MA, Fraile-Martinez O, García-Montero C, Callejón-Peláez E, Sáez MA, Álvarez-Mon MA, García-Honduvilla N, Monserrat J, Álvarez-Mon M, Bujan J, Canals ML. A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities. Medicina (Kaunas). 2021 Aug 24;57(9):864. doi: 10.3390/medicina57090864. PMID: 34577787; PMCID: PMC8465921.

  2. Bartek J Jr, Jakola AS, Skyrman S, Förander P, Alpkvist P, Schechtmann G, Glimåker M, Larsson A, Lind F, Mathiesen T. Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir (Wien). 2016 Jul;158(7):1259-67. doi: 10.1007/s00701-016-2809-1. Epub 2016 Apr 25. PMID: 27113742.

  3. Moon RE, Mitchell S. Hyperbaric treatment for decompression sickness: current recommendations. Undersea Hyperb Med. 2019 Sep - Dec - Fourth Quarter;46(5):685-693. PMID: 31683368.

  4. Sethuraman K, Thom SR. Hyperbaric oxygen should be used for carbon monoxide poisoning. Br J Clin Pharmacol. 2023 Mar;89(3):939-941. doi: 10.1111/bcp.15605. Epub 2022 Dec 1. PMID: 36457237.

  5. Özer EE, Aksam B, Sönmez U, Özdemir HÖ. Hyperbaric oxygen therapy of soft tissue necrosis due to centipede bite in a patient with diabetes. J Wound Care. 2022 Jul 2;31(7):586-588. doi: 10.12968/jowc.2022.31.7.586. PMID: 35797257.

  6. Huang CY, Chen YW, Kao TH, Kao HK, Lee YC, Cheng JC, Wang JH. Hyperbaric oxygen therapy as an effective adjunctive treatment for chronic Lyme disease. J Chin Med Assoc. 2014 May;77(5):269-71. doi: 10.1016/j.jcma.2014.02.001. Epub 2014 Apr 13. PMID: 24726678.

  7. Hyperbaric Oxygenation for Lyme Vasculitis W. P. Fife, Ph. D. R. A. Neubauer, M. D.

  8. Taylor RS, Simpson IN. Review of treatment options for lyme borreliosis. J Chemother. 2005 Sep;17 Suppl 2:3-16. doi: 10.1179/joc.2005.17.Supplement-2.3. PMID: 16315580.


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