Background: Low back pain (LBP) is one of the most common and important health
problems affecting the population worldwide and remains mostly unsolved. Ozone therapy
has emerged as an additional treatment method. Questions persist concerning its clinical
efficacy.
Objective: The purpose of our study was to evaluate the therapeutic results of
percutaneous injection of ozone for low back pain secondary to disc herniation.
Study Design: A systematic review and meta-analysis of randomized controlled trials.
Methods: A comprehensive literature search was conducted using all electronic databases
from 1966 through September 2011. The quality of individual articles was assessed based
on the modified Cochrane review criteria for randomized trials and criteria from the
Agency for Healthcare Research and Quality.
Outcome Parameters: The outcome measure was short-term pain relief of at least 6
months or long-term pain relief of more than 6 months.
Results: Eight observational studies were included in the systematic review and 4
randomized trials in the meta-analysis. The indicated level of evidence for long-term pain
relief was 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.
Limitations: The main limitations of this review are the lack of precise diagnosis and the
frequent use of mixed therapeutic agents. The meta-analysis included mainly active-control
trials. No placebo-controlled trial was found.
Conclusions: Ozone therapy appears to yield positive results and low morbidity rates
when applied percutaneously for the treatment of chronic low back pain.
Key words: Low back pain, oxygen-ozone, ozone therapy, chronic pain, failed back
surgery syndrome.
Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials