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Ozone Therapy

At the forefront of innovative pain management techniques lies ozone therapy, a promising modality that harnesses the power of oxygen to alleviate discomfort and promote healing. In this detailed exploration, we delve into the intricacies of ozone therapy, its mechanisms of action, applications in pain management, safety considerations, and the burgeoning body of research supporting its efficacy.
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Understanding Ozone Therapy
Ozone therapy involves the administration of ozone, a naturally occurring triatomic form of oxygen, into the body to stimulate healing processes and alleviate pain. Ozone, composed of three oxygen atoms (O3), exhibits remarkable therapeutic properties due to its strong oxidizing potential and ability to modulate the body’s immune response. Ozone is a gas that normally exists in the atmosphere and is produced by the effect of UV rays of sun’s light on the oxygen. Medical ozone is a mixture of oxygen and ozone obtained from medical oxygen by using a medical device – a medical ozone generator. Ozone therapy is the use of medical ozone as a therapeutic substance in pathologies with chronic hypoxia, inflammation, and redox imbalance in which ozone has proven to be effective. The proportion of ozone –oxygen to be used is decided according to the pathologies and site of application. Ozone is a molecule composed of three oxygen atoms (O3) instead of the two oxygen atoms found in the oxygen molecule (O2).  It is highly unstable and starts degrading after 20 seconds. Ozone has a half-life of 40 min at 20°C and for this reason, it cannot be stored and must be produced “in situ” for each application.
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Mechanism Of Action
  • Oxygenation:Ozone therapy enhances oxygen delivery to tissues by facilitating the release of oxygen from hemoglobin and improving blood flow to oxygen-deprived areas. Ozone increases the vascularity by enriching the tissues with oxygen thus creating a favourable environment for neoangiogenesis.  This oxygen-rich environment promotes cellular metabolism and tissue repair.
  • Anti-inflammatory Effects: The Oxidizing property of ozone as a soluble gas is greatly responsible for its therapeutic action. Ozone, on contact with biological fluids leads to the formation of Reactive oxygen species (ROS) and Lipid oxidation products.(LOP)  The result of these reactions is increased oxygen supply in the tissue. Ozone exerts potent anti-inflammatory effects by inhibiting the production of pro-inflammatory cytokines and modulating immune responses. The molecules of ROS and LOP, at physiological concentrations help in the biochemical regulation of Inflammation. This reduces swelling, alleviates pain, and fosters a conducive environment for healing.
  • Analgesic Properties:Ozone therapy works by raising the pain threshold via activation of the antinociceptive apparatus which in turn is governed by serotonin and endogenous opioids. Ozone therapy interrupts pain signaling pathways by stimulating the release of endorphins and other neurotransmitters, resulting in analgesia and enhanced pain tolerance. LOPs bring about a sense of wellbeing as they stimulate the CNS and the Endocrine system to boost neurotransmitter release, hormonal production and metabolism.
  • Antimicrobial Action:Ozone’s oxidative properties make it effective against bacteria, viruses, fungi, and other pathogens. By targeting microbial invaders, ozone therapy helps prevent infections and supports the body’s immune defences.
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    APPLICATIONS OF OZONE IN PAIN MANAGEMENT
    Pulsed Electromagnetic Field Therapy involves the application of electromagnetic pulses to targeted areas of the body experiencing pain or injury. These pulses generate low-frequency electromagnetic fields that penetrate deep into tissues, stimulating cellular activity and facilitating healing processes. By modulating cellular metabolism, reducing inflammation, and promoting tissue regeneration, PEMF effectively addresses the underlying causes of pain and accelerates recovery.  
  • HERNIATED DISC– Intra discal or periforaminal Ozone therapy has a direct (mechanical) and indirect (anti-inflammatory) effect (1). The direct effect consists in the lysis of the proteoglicans composing the disc’s nucleus pulposus, thus reducing the osmotic pressure and bringing about shrinkage of the disc. The reduced osmotic pressure in turn improves the local blood circulation. The indirect effect is realized by altering the breakdown of arachidonic acid to inflammatory prostaglandins. As result, by reducing the inflammatory components, there is a subsequent decrease in pain O3 is administered at a nontoxic concentration of 1 to 40 µg of O3 per milliliter of oxygen. The therapeutic effect is usually brought about by freeing of the nerve root owing to the shrinkage produced due to ozonolysis.
  • OSTEOARTHRITIS OFKNEE – Ozone infiltration into an arthritic knee accelerates anabolism leading to improved vascularisation of the cartilage and bone. Ozone also brings about inhibition of chondrocytes, stem cells, inflammatory cytokines, nitric oxide, and mineral metalloproteinases. It has also seen to improve the range of motion. Rout of administration can be intrarticular, periarticular or subcutaneous. Combination with other agents like hyaluronic acid, PRP, Steroids and hypertonic dextrose have the synergistic effects on therapeutic outcome.
  • ADHESIVE CAPSULITIS OF THE SHOULDER– Ozone infiltration for the treatment of adhesive capsulitis/frozen shoulder can bring about reduction in both pain and inflammation. Ozone destroys pain inducing/algogenic substances, regulates serotonin levels and also brings about inactivation of bradykinin. It also aids the physical therapy programme to regain the desired range of motion.
  • GLENOHUMERAL ARTHRITIS/ ROTATOR CUFF TENDENOPATHY/ SUBACROMIAL BURSITIS–Ozone infiltration has shown to bring about marked improvement in the pain scores and also helps in improving the range of motion of the arthritic joint. Patients with SUBACROMIAL BURSITIS and PARTIAL SUPRASCAPULARIS TEARS have also benefitted with image guided ozone interventions
  • TEMPEROMANDIBULAR JOINT DYSFUNCTION– As this joint connects the jaw bone to the skull, disorder of the temperomandibular joint (often found as a part of myofascial pain syndromes). Ozone therapy has been found to be more effective in significantly improving the pain scores and increasing the interincisal mouth opening values. Ozone is believed to stimulate fibroblastic activity which brings about joint repair when injected into the joint capsule. On splitting into separate oxygen atoms, O3 is able to react when in contact with a contaminant. A study has shown 87% of the patients treated with Ozone had marked improvement or complete resolution of symptoms.
  • HIP/TROCHANTERIC BURSITIS– Ozone given via a Pertrochanteric route for hip bursitis has seen to bring about reduction in inflammation, reduction in both daytime and night time pain as well as complete resolution of bursitis and the resulting limp in some patients.
  • RHEUMATOID ARTHRITIS –Studies have indicated that O3 can reduce the activity of TNF-α in the inflammatory tissues and suppress synovial hyperplasia and joint swelling in rheumatoid arthritis. This is often used along with Disease Modifying Anti Rheumatic drugs in the management of Rheumatoid Arthritis.
  • FIBROMYALGIA – Weekly or biweekly intravenous Ozone administration in fibromyalgia patients has shown to decrease pain, improve asthenia and bring about a general sense of wellbeing. Duration and frequency of treatments are usually decided by the clinician depending on the response observed.
    • Safety Considerations: While ozone therapy is generally safe when administered by trained healthcare professionals, it’s essential to consider potential risks and contraindications:
  • Administration Technique:Proper administration techniques, including precise dosing and sterile procedures, are critical to ensure the safety and efficacy of ozone therapy.
  • Patient Selection:Healthcare providers must carefully assess patients for contraindications such as severe thrombocytopenia, active bleeding disorders, and glucose-6-phosphate dehydrogenase (G6PD) deficiency before recommending ozone therapy.
  • Adverse Effects:Although rare, adverse effects such as local irritation at the injection site, transient flu-like symptoms, and oxygen toxicity may occur. Patients should be monitored closely during and after treatment to mitigate potential risks.
  • Regulatory Compliance:Practitioners should adhere to regulatory guidelines and standards of practice governing the use of ozone therapy to ensure patient safety and ethical conduct.
    • Evidence-Based Support: A growing body of scientific evidence supports the efficacy of ozone therapy in pain management across various clinical conditions. Numerous clinical trials, systematic reviews, and meta-analyses have demonstrated the therapeutic benefits of ozone therapy, paving the way for its integration into mainstream healthcare practices. Ozone therapy represents a promising frontier in pain management, offering a safe, effective, and minimally invasive approach for alleviating pain, reducing inflammation, and promoting tissue healing. As research continues to elucidate its mechanisms of action and clinical applications, ozone therapy holds immense potential for improving patient outcomes and enhancing quality of life for individuals suffering from acute and chronic pain conditions.