Ozone therapy for musculoskeletal disorders: Current concepts

Background

Chronic pain from musculoskeletal disorders - including low back pain, disc herniation, knee osteoarthritis and various joint injuries - is common, and a substantial proportion of patients do not respond adequately to standard treatments such as rest, physiotherapy and anti-inflammatory medication. This narrative review, published in Acta Biomedica Atenei Parmensis, examines medical oxygen-ozone (O2-O3) therapy as a minimally invasive option for these conditions, summarising its proposed mechanisms of action and the clinical evidence available up to the time of publication.

Study design

This is a narrative review rather than a new clinical trial. The author, an orthopaedic surgeon, drew on previously published clinical trials, meta-analyses and case reports covering a range of musculoskeletal conditions, including low back pain, lumbar and cervical disc herniation, knee osteoarthritis, meniscal injury, sacroiliitis, plantar fasciitis and carpal tunnel syndrome. The review covers ozone delivered by intradiscal, intra-articular, periradicular, periganglionic and intramuscular injection, with a stated therapeutic dose range of up to 40 micrograms of ozone per millilitre of oxygen.

Findings

Across the studies summarised, oxygen-ozone injections were linked to meaningful pain reduction in most of the conditions reviewed. For low back pain and disc herniation in patients who had not responded to conservative treatment, reported success rates ranged from 70-80%, with one meta-analysis describing outcomes broadly comparable to surgical discectomy but with a much lower complication rate (under 0.1%). Long-term follow-up in some of the studies cited showed sustained improvement at five and ten years. For cervical pain and cervical disc herniation, individual studies reported reductions in pain scores of around 73%, with pain reported as fully resolved in close to 80% of some patient groups. In knee osteoarthritis, ozone injections performed better than placebo and were reported as comparable to, or in some studies better than, corticosteroid injections, with effects described as more persistent over time. Plantar fasciitis responded better to ozone than to corticosteroid injection at twelve weeks, and combining ozone with splinting improved outcomes in carpal tunnel syndrome compared with splinting alone. Reported adverse events across the literature reviewed were rare, at around 0.1%, with serious but uncommon complications including air embolism, spinal cord problems, stroke and infection, generally linked to technique errors or individual risk factors such as a patent foramen ovale.

What the authors concluded

The author concluded that oxygen-ozone therapy has been shown to reduce pain across a range of musculoskeletal disorders, with a low rate of adverse effects when used according to well-defined protocols - a properly calibrated ozone generator, a precise gas volume and an appropriate ozone concentration for the condition being treated. The review frames ozone therapy as an option for patients who have not responded to standard conservative treatment, rather than as a universal first-line therapy.

Limitations of this study

As a narrative review rather than a systematic review or meta-analysis, this paper does not apply a standardised search strategy or formal quality assessment to the studies it summarises, so selection and reporting bias cannot be ruled out. The underlying studies varied widely in design, sample size, ozone dose and outcome measures, which makes direct comparison between conditions difficult. Most of the evidence cited focuses on short to medium-term outcomes (three to six months), with fewer studies following patients over the long term. The precise biological mechanism behind ozone's pain-relieving and anti-inflammatory effects is not yet fully established, and the review does not set out clear criteria for which patients are most likely to benefit. The reported success rates should be read as a summary of existing literature rather than as new experimental findings.