Abstract
Background
Many studies have been done on paravertebral–intramuscular ozone therapy in the management of chronic mechanical low back pain and found that it is effective in pain and function improvement, but none of the studies were done to assess the benefit of addition of paravertebral–intramuscular ozone therapy to the traditional physical therapy in the management of chronic low back pain.
Patients and methods
The study included 160 patients who were diagnosed with chronic mechanical low back pain, and they were divided into two groups: group I included 80 patients treated with paravertebral oxygen–ozone (O2O3), infrared lamp therapy, and exercises, and group II included 80 patients treated with infrared lamp therapy and exercises. They were assessed by pain intensity measures such as visual analog scale (VAS) and verbal rating scale (VRS) and functional status measures such as the disability questionnaire - Roland Morris Disability Questionnaire (RMQ) - and the Revised Oswestry Disability Index (ODI). Patients were assessed before treatment, at the end of the treatment (after 4 weeks), and at a follow-up of 24 weeks.
Results
Improvement was achieved in all patients of both groups at 1 month, with statistically highly significant differences between the patients of group I regarding VAS, VRS, RMQ,andODIscales(P<0.001).Wefoundhighlysignificantdifferencesbetweenthe patients of group II regarding RMQ and ODI scales (P<0.001) and statistically significant difference between patients of the same group as regarding VAS and VRS (P<0.05) at 6 months. Group I showed continuous improvement in all variables with highly statistically significant difference (P<0.001) when comparing these with the pretreatment variables at all time points, whereas improvement did not continue with group II at the end of the 24 weeks, as no statistically significant differences were found regarding all measures of outcome scales (P>0.05).
Conclusion
O2O3 paravertebral injections combined with physical therapy in patients with chronic mechanical low back pain can offer significantly longer improvement in pain management and functional status in these patients.
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References
Di Cesare A, Giombini A, di Cesare M, Ripani M, Vulpiani M, Saraceni V. Comparison between the effects of trigger point mesotherapy versus acupuncture points mesotherapy in the treatment of chronic low back pain: a short term randomized controlled trial. Complement Ther Med 2011; 19:19–26
Sostres C, Gargallo C, Arroyo M, Lanas A. Adverseeffects of non-steroidal anti-inflammatory drugs NSAIDs, aspirin and coxibs) on upper gastrointestinal tract. Best Pract Res Clin Gastroenterol 2010; 24:121–132
Kamali F, PanahiF, EbrahimiS, Abbasi L. Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. J Back Musculoskelet Rehabil 2014; 27:475–480
Atalay N, Sahin F, Atalay A, Akkaya N. Comparison of efficacy of neural therapy and physical therapy in chronic low back pain. Afr J Tradit Complement Altern Med 2013; 10:431–435
Nadler S, Steiner D, Erasala G, Hengehold D, Hinkle R, Beth M, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine 2002; 27:1012–1017
Mayer J, Ralph L, Look M, Erasala G, Verna J, Matheson L, Mooney V. Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. Spine J 2005; 5: 395–403
Apuzzo D, Giotti C, Pasqualetti P, Ferrazza P, Soldati P, Zucco G. An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain. Funct Neurol 2014; 29:31–39
Magalhaes F, Dotta L, Sasse A, Teixera M, Fonoff E. Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain Physician 2012; 15:E115–E129
Zambello A, Fara B, TabaraccI G, Bianchi M. Epidural steroid injection vs paravertebral O2O3 infiltration for symptomatic herniated disc refractory to conventional treatment. A prospective randomized study. Rivista Italiana di Ossigeno-Ozonoterapia 2006; 5:123–127
Roland MO, Moris RW. A study of the natural history of back pain. Part 1: development of a reliable and sensitive measure of disability in low back pain. Spine 1983; 8:141–144
Fairbank JC. Physiotherapy 1981; 66(8): 271–273, Hudson-Cook. In: Jenner R, editors. Back pain: new approaches to rehabilitation & education. Manchester, UK: Manchester University Press; 1989. pp. 187–204
Morelli L, Bramani S, Cantaluppi M, Pauletto M, Scuotto A. Comparison among different therapeutic techniques to treat low back pain:a monitored randomized study. Ozone Ther 2016; 1:17–20
Paoloni M, di Sante L, Cacchio A, Apuzzo D, Marotta S, Razzano M, 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 2009; 34:1337–1344
Melchionda D, Milillo P, Manente G, Stoppino L, Macarini L. Treatment of radiculopathies: a study of efficacyand tolerability of paravertebral oxygen-ozone injections compared with pharmacological anti-inflammatory treatment. J Biol Regul Homeost Agents 2012; 26:467–474
Biazzo A, Corriero A, Confalonieri N. Intramuscular oxygen-ozone therapy in the treatment of low back pain. Acta Biomed 2016; 87:1–6
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Alyan, S., Zaghlol, R. & Mustafa, S.A. Efficacy of combined paravertebral ozone (O2O3) therapy with physiotherapy in patients with chronic mechanical low back pain. Egypt Rheumatol Rehabil 45, 106–111 (2018). https://doi.org/10.4103/err.err_43_17
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DOI: https://doi.org/10.4103/err.err_43_17