The use of Ozone in Chronic Joint Pain

Ross Hauser, MD  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C  | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois

The use of Ozone in Chronic Joint Pain

There is a significant amount of research surrounding the use of ozone (o3) in treating various diseases. In this article we will present some of the research that surrounds the use of ozone gas for problems of chronic pain.

Ozone gas started gaining attention as a treatment for chronic joint pain decades ago. A 1989 study from the University of Bologna in Italy (1) examined the effects of oxygen-ozone mixture (called medical ozone) locally injected.

• 156 patients were treated and divided into 3 groups:
  • post-traumatic knee disorders,
  • arthritis without marked bone deformities and
  • arthritis with marked bone deformities.
• In the first two groups optimal results were obtained while for the third other therapies were then added to stop the advancing degenerative process. In conclusion, knee joint disorders can very successfully be treated by means of oxygen-ozone mixture locally administered.

This research is to illustrate the long years that have been dedicated to the research of ozone. We have more recent research that we will be exploring below.

Ozone gas in musculoskeletal disorders

A detailed and precise analysis of ozone gas and musculoskeletal disorders is presented in the journal Medical gas research, September 2018.(2)

Here researchers examined the role of ozone over a myriad of disorders including lumbar facet joint syndrome, subacromial bursitis, carpal tunnel syndrome, hip bursitis, shoulder adhesive capsulitis, herniated disc, and temporomandibular joint disorder. Here are some learning points from that research:

Effectiveness in temporomandibular joint disorder

The researchers found that the use of ozone therapy has been much more effective than medication therapy in patients with temporomandibular joint disorder and high pain scores. Ozone can relieve pain and increases the maximum voluntary interincisal mouth opening values. The researchers speculated that ozone gas promotes new cartilage growth as well as reduce inflammation.

Effectiveness for herniated disc

The use of ozone directly injected into the disc was explored. Among the main findings was that ozone may be beneficial because it dehydrates the disc and as such would lessen the amount of bulge pressing on the nerves. Ozone therapy also had analgesic and anti-inflammatory effects in treating disk herniation. In a 2017 study, researchers in Italy and Canada published findings in the Journal of the Canadian Association of Radiologists (3) where they reported that patients who can benefit the most from ozone are patients with back pain with or without radicular pain but without motor deficits, which have been non-responsive to 4-6 weeks of conservative therapies. They found that short-term results could be achieved by dehydrating or shrinking the disc.

Effectiveness for shoulder pain

Here the researchers reported on a single case history of a 57 year old woman who had shoulder pain reduction and increased range of motion. Next they reported on suggested anti-inflammatory benefits in patients with shoulder adhesive capsulitis.

Effectiveness for hip bursitis

Here the researchers suggested that ozone therapy can be used to alleviate hip pain due to functional overload, trochanteric bursitis, pain caused by initial and late coxarthrosis, and hip tendonitis. It is also helpful to associate oxygen-O3 therapy along with prescribed exercises and a period of rehabilitation.

Comparison of Ozone Therapy and Hyaluronic Acid Injections and dextrose Prolotherapy injections

An October 2018 study in the Journal of pain research (4) compared ozone treatments with Hyaluronic Acid Injections or dextrose Prolotherapy injection as the control group.

Please note that this is not a comparison of Prolozone to the other treatments, this is a comparison of ozone alone.

The reserarchers wrote that “the existing body of evidence had well demonstrated that ozone injection was evidently effective for short-term management (1–3 months) of mild-to-moderate knee osteoarthritis patients (grade I–III KLS). But the main challenge was on longer periods of time in which different studies had declared heterogeneous (or mixed) results.”

The researchers gathered dated from a serious of randomized control trials and made this obeservations:

• Short-term effectiveness of intra-articular ozone is better than placebo (air) and corticosteroids
• Short-term effectiveness of intra-articular ozone is equal to that of dextrose prolotherapy or hyaluronic acid injections.
• However, at 3–6 months after injections, the therapeutic efficacy of ozone decreased to a level, slightly lower than that of dextrose prolotherapy or hyaluronic acid injections.
• After 6 months, ozone therapy was not associated with significant improvement of Range of Motion  and functionality

A 2015 study in the journal Anesthesiology and pain medicine (5) showed that:

• “Prolotherapy with hypertonic dextrose or prolozone (intraarticular ozone injection) can be effectively used in the nonoperative management of patients with knee osteoarthritis. Prolotherapy is an injection therapy for the management of chronic musculoskeletal disorders such as knee osteoarthritis. . . Ozone is a toxic and soluble gas with high oxidative activity.
• Ozone has an antinociceptive (pain blocking) effect
• Sixty-one percent (61%) of patients with lumbar disc herniation treated with intramuscular oxygen-ozone injection became pain free compared with 33% of the control group.

Prolozone is a Prolotherapy technique developed by Frank Shallenberger, MD, that utilizes ozone gas, along with other therapeutic substances to stimulate healing and reduce pain in injured soft tissues and joints. Dr. Shallenberger describes Proloze in a 2011 article in the Journal of Prolotherapy as: “a technique that marries concepts from neural therapy, Prolotherapy, and ozone therapy. It involves injecting various combinations of procaine, anti-inflammatory medications/homeopathics, vitamins, minerals, proliferatives, and a mixture of ozone/oxygen gas into degenerated or injured joints, and into areas of pain. The result of this combination is nothing short of remarkable in that damaged tissues can be regenerated, and otherwise untreatable pain can be permanently cured.”(6)

The ozone gas is produced when oxygen is exposed to an electric spark via a corona discharge ozone generator. The concentration of ozone in the final gas mixture is between 1­3%. Therapeutic injections of ozone into soft tissue structures, such as muscles, tendons and ligaments as well as arthritic joints for the relief of pain has been utilized for decades in medical clinics around the world.

Various case series have been published documenting the analgesic effect of ozone in osteoarthritis. Double ­blind randomized ­controlled studies have also documented the therapeutic effects of Prolozone in the treatment of low back pain with and without sciatica. As a powerful oxidizing agent, ozone has been found to have a pro-­inflammatory as well as an anti-­inflammatory effect, depending on the concentration utilized. Its proposed mechanisms for tissue repair and regeneration include the stimulating of growth factor production and release.

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1 Sanseverino E. Knee joint disorders treated by oxygen-ozone therapy. Europa Medicophysica. 1989;3:163-170. [Google Scholar]
2 Seyam O, Smith NL, Reid I, Gandhi J, Jiang W, Khan SA. Clinical utility of ozone therapy for musculoskeletal disorders. Medical gas research. 2018 Jul;8(3):103. [Google Scholar]
3 Giurazza F, Guarnieri G, Murphy KJ, Muto M. Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation. Can Assoc Radiol J. 2017 May;68(2):171-177. [Google Scholar]
4 Raeissadat SA, Tabibian E, Rayegani SM, Rahimi-Dehgolan S, Babaei-Ghazani A. An investigation into the efficacy of intra-articular ozone (O2–O3) injection in patients with knee osteoarthritis: a systematic review and meta-analysis. Journal of pain research. 2018;11:2537. [Google Scholar]
5 Shallenberger F, HMD A. Prolozone™–Regenerating Joints and Eliminating Pain. Journal of Prolotherapy. 2011 May;3(2):630-8. [Google Scholar]
6 Hashemi M, Jalili P, Mennati S, et al. The Effects of Prolotherapy With Hypertonic Dextrose Versus Prolozone (Intraarticular Ozone) in Patients With Knee Osteoarthritis. Anesthesiology and Pain Medicine. 2015;5(5):e27585. [Google Scholar]

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