Title : Novel treatment in pain management
Abstract:
Introduction: Ozone (O3) is an unstable allotropic form of oxygen that imparts an oxidizing activity with various biological components. It can generate its immune-modulating, anti-inflammatory, antibacterial, virucidal, fungicidal, analgesic, and other properties depending on the therapeutic dose chosen.
Objectives: Ozone therapy has various therapeutic uses including topical applications for wound healing, treatment of periodontitis, cancer, AIDS, severe acute respiratory syndrome, neurodegenerative diseases and diabetic foot.
Methods: Clinical trials using ozone therapy showed that when this therapy is used alone or in combination it is safe and effective in pain relief and function improvement. Ozone therapy is indicated in lumbar herniated disc. Lumbar herniated disc causes symptoms of sciatica and possible foot pain, numbness or weakness. Ozone is administered in the form of an oxygen-ozone gas mixture, at nontoxic concentrations varying from 1 to 40 μg of ozone per milliliter of oxygen. The optimal concentration of ozone per milliliter of oxygen for intradiscal administration is 27μg. Several clinical studies on the efficacy of the use of O2-O3 in treatment of lumbar disc herniations have been reported in the literature. Patients with neck pain and or radiculopathy corresponding to disc herniation without cervical cord compression are most suitable for ozone therapy. Ozone therapy is a minimally invasive treatment that provides antiinflammatory effects and pain relief by oxidizing proteoglycan in the nucleus pulposus leading to shrinkage of the disc which compresses the nerve roots. A powerful stimulus to the activation of antioxidant defense is the result of O3 injected in the peridural space of the conjugation foramen and disc.
Result & Discussion: The overall procedural complications rate is estimated around 0.1%. Steppan J et al (2010) determined that the complication rate was much lower (<0.1%) and the recovery time was significantly shorter with ozone therapy. Magalhaes FN et al indicated the level of evidence in the systematic meta- analysis of therapeutic results of percutaneous injection of ozone for low back pain secondary to disc herniation for long-term pain relief was found to be II-3 for ozone therapy applied intradiscally and II-1 for ozone therapy applied paravertebrally. The grading of recommendation was 1C for intradiscal ozone therapy and 1B for paravertebral ozone therapy.
Conclusion: The literature confirms that minimally invasive therapy with oxygen-ozone is safe to use through percutaneous injections for the treatment of lumbar and cervical pain, particularly when compared to surgery and drug therapy. O3 therapy is becoming an effective treatment option as it promotes tissue hyper oxygenation as well as treating painful syndromes affecting muscles, tendons, and joints.Though O3 has indicated great success in most indications mentioned, there still needs to be further research conducted to determine its activity.
