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Abstract

Objective

Chronic discogenic low back pain (LBP) is one of the most prevalent musculoskeletal disorders. Despite numerous studies, the effectiveness of paraspinal ozone therapy continues to be uncertain, partly because of the methodological shortcomings. This study evaluates the effectiveness of para-spinal ozone-oxygen mixture injection compared to pure oxygen in chronic discogenic low back pain.

Design

In this double-blind RCT, 30 patients with MRI-confirmed chronic discogenic LBP were randomized into intervention (20 μg/mL ozone-oxygen mixture) or control (pure oxygen) groups. Every patient underwent a series of three ultrasound-guided para-spinal injections administered weekly in combination with exercise. Pain intensity (Visual Analog Scale, VAS) and functional status (Oswestry Disability Index, ODI) were assessed at baseline, one month, and three months post-intervention.

Results

Both groups exhibited notable enhancements in VAS and ODI scores; however, the ozone group revealed more favorable results (P < 0.001). The ozone group exhibited significantly higher mean reductions in VAS (5.6 compared to 2.4) and ODI (19.07 compared to 7.8). (P < 0.001)

Conclusion

Para-spinal ozone-oxygen injection was significantly superior to pure oxygen in alleviating pain and enhancing functional scores. Despite limitations such as a small sample size, this research offers insights into ozone therapy as a promising minimally invasive alternative for chronic discogenic low back pain.

Keywords

back pain < B interventional pain medicine < I low back pain < L musculoskeletal < M physical medicine and rehabilitation < P spine < S ultrasonography

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References

Kahere

Hlongwa

Ginindza

. A scoping review on the epidemiology of chronic low back pain among adults in Sub-Saharan Africa. Int J Environ Res Public Health 2022; 19: 3–10.

Mohd Isa

, et al. Discogenic low back pain: Anatomy, pathophysiology and treatments of intervertebral disc degeneration. Int J Mol Sci 2022; 24: 5–12.

Peh

. Provocative discography: current status. Biomed Imaging Interv J 2005; 1: e2.

Lin

, et al. Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review. Eur Spine J 2011; 20: 1024–1038.

Carreon

, et al. Cost-effectiveness of lumbar epidural steroid injections. Spine (Phila Pa 1976) 2018; 43: 35–40.

Matteo

, et al. Treatment of low-back pain with oxygen-ozone therapy. In: Selim

(eds) Hernia updates and approaches. IntechOpen: Rijeka, 2023, pp.Ch. 17.

Sconza

, et al. Oxygen-ozone therapy for the treatment of low back pain: a systematic review of randomized controlled trials. Eur Rev Med Pharmacol Sci 2021; 25: 6034–6046.

Karagül

Kartaloğlu

. Retrospective observational study of paravertebral intramuscular ozone/oxygen injection in the treatment of chronic nonspecific low back pain. J Turkish Spinal Surg 2023; 34: 31–35.

Borrelli

. Mechanism of action of oxygen ozone therapy in the treatment of disc herniation and low back pain. Acta Neurochir Suppl 2011; 108: 123–125.

10.

Mousavi

, et al. The Oswestry disability Index, the Roland-Morris disability questionnaire, and the Quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine (Phila Pa 1976) 2006; 31: E454–E459.

11.

Dworkin

, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005; 113: 9–19.

12.

Holden

, et al. Pain patterns during adolescence can be grouped into four pain classes with distinct profiles: a study on a population based cohort of 2953 adolescents. Eur J Pain 2018; 22: 793–799.

13.

Collaborators

GBDLBP

. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the global burden of disease study 2021. Lancet Rheumatol 2023; 5: e316–e329.

14.

Kumar

, et al. How effective is ozone therapy in treatment of lumbar disc disease: a systematic review of prospective studies. Maedica (Bucur) 2024; 19: 816–822.

15.

Yalcin

. Paravertebral intramuscular ozone therapy in lumbar disc hernia: a comprehensive retrospective study. J Back Musculoskelet Rehabil 2021; 34: 597–604.

16.

Parvin

, et al.

Comparative effectiveness of paravertebral Ozone injection and caudal epidural steroid-hyaluronidase injection in lumbosacral spinal stenosis

Br J Neurosurg 2021; 38(2): 451–456.

17.

Latini

, et al. Intramuscular paravertebral oxygen-ozone therapy for chronic neck pain and low back pain: evaluation of 6-month clinical outcomes. Med Gas Res 2024; 14: 6–11.

18.

Sagai

Bocci

. Mechanisms of action involved in ozone therapy: is healing induced via a mild oxidative stress? Med Gas Res 2011; 1: 29.

19.

Bocci

. Biological and clinical effects of ozone. Has ozone therapy a future in medicine? Br J Biomed Sci 1999; 56: 270–279.

20.

Akkawi

. Ozone therapy for musculoskeletal disorders current concepts. Acta Biomed 2020; 91: e2020191.

21.

Rodriguez

, et al. Human disc nucleus properties and vertebral endplate permeability. Spine (Phila Pa 1976) 2011; 36: 512–520.

22.

Van den Heuvel

SAS

, et al. 3. Pain originating from the lumbar facet joints. Pain Pract 2024; 24: 160–176.

23.

Latini

, et al. Medical ozone therapy in facet joint syndrome: an overview of sonoanatomy, ultrasound-guided injection techniques and potential mechanism of action. Med Gas Res 2021; 11: 145–151.

24.

Yang

, et al. The clinical efficacy of ozone combined with steroid in the treatment of discogenic low back pain: a randomized, double-blinded clinical study. Front Neurol 2023; 14: 1078111.

25.

Sucuoglu

Soydas

. Does paravertebral ozone injection have efficacy as an additional treatment for acute lumbar disc herniation? A randomized, double-blind, placebo-controlled study. J Back Musculoskelet Rehabil 2021; 34: 725–733.

26.

Paoloni

, et al. Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection. Spine (Phila Pa 1976) 2009; 34: 1337–1344.

27.

Dunning

, et al. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev 2014; 19: 252–265.

28.

Kiralp

, et al. A novel treatment modality for myofascial pain syndrome: hyperbaric oxygen therapy. J Natl Med Assoc 2009; 101: 77–80.

29.

Lund

Bengtsson

Thorborg

. Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol 1986; 15: 165–173.

30.

Ashar

, et al. Open-Label placebo injection for chronic back pain with functional neuroimaging: a randomized clinical trial. JAMA Netw Open 2024; 7: e2432427.

31.

D-H

. Effects of williams exercise and McKenzie exercise on pain level and oswestry disability Index in chronic low back pain patients. kjsm 2022; 40: 170–178.

32.

Sukmajaya

, et al. Williams flexion exercise for low back pain: a possible implementation in rural areas. Open Access Maced J Med Sci 2020; 8: 1–5.

Ultrasound guided paravertebral ozone-oxygen injection versus pure oxygen for chronic discogenic low back pain: A double-blind randomized controlled trial