Long-Term Results with Adjuvant Ozone Therapy in the Management of Chronic Pelvic Pain Secondary to Cancer Treatment

Background

Cancer treatments such as pelvic radiotherapy, radical surgery and chemotherapy can leave some patients with long-term, hard-to-treat pelvic pain long after the original cancer has been treated. For a subset of these patients, standard analgesics and interventional pain techniques fail to bring the pain under control, leaving few options. A Spanish research group led by Bernardino Clavo had previously published a preliminary report describing early benefits from adding ozone therapy to the care of these patients, assessed three months after treatment. Following interest from other clinicians who wanted more detail on the treatment schedule and on how patients fared over a longer period, the same authors published this follow-up letter reporting their extended results.

Study design

The report followed six patients with chronic, refractory pelvic pain that had developed as a consequence of prior cancer treatment. Ozone therapy was given as an add-on to each patient's existing pain management, using whichever administration route matched the location of their symptoms: rectal insufflation, intravesical instillation (into the bladder) or intravaginal application. Treatment ran for a median of around 28 weeks, comprising roughly 49 sessions per patient. The authors tracked continuous background pain and acute breakthrough pain episodes using standard pain-rating scales, recorded whether patients were able to reduce or stop their analgesic medication, and monitored associated symptoms such as vaginal dryness, blood in the urine (haematuria) and a persistent sensation of needing to pass a bowel motion (tenesmus). Patients were followed for up to nine months after finishing their course of ozone sessions.

Findings

Average continuous pelvic pain scores fell from 7.8 (on a 0-10 scale) before treatment to 1.8 by the end of the ozone sessions, and this improvement was maintained through the nine-month follow-up period. Acute breakthrough pain episodes also fell markedly. Five of the six patients were able to reduce or completely stop their analgesic medication. The associated symptoms of vaginal dryness, haematuria and tenesmus improved as well.

What the authors concluded

The authors concluded that adjuvant ozone therapy showed promise as a way of managing refractory pelvic pain following cancer treatment, with benefits that were sustained well beyond the end of treatment. They stated that these encouraging results warrant confirmation through larger, randomised clinical trials.

Limitations of this study

This was a small case series of just six patients, reported as a letter rather than a full peer-reviewed research paper, with no control or comparison group and no blinding. As an uncontrolled, single-centre observation, it cannot rule out the influence of other factors on the improvements seen, and the findings need to be confirmed in properly designed randomised controlled trials before firm conclusions can be drawn. This study concerns chronic pelvic pain that developed as a complication of prior cancer treatment. It does not establish ozone as a treatment or cure for cancer itself. Ozone therapy is a complementary approach and should always be discussed with your oncology team.