Efficacy of Medical Ozone for Treatment of Chronic Musculoskeletal Pain with Abnormal Mitochondrial Redox State: Prospective Randomized Clinical Trial

• Published in: Pain physician 2024-05, Vol.27 (4), p.E371-E382
• Main Authors: Eldemrdash, Ayman, Tairy, Taha, Sabry, Lilly, Aelmulla, Ahmed, Kamel, Maher, Yousry, Engi
• Format: Article
• Language: English
• Subjects: Adult; Betamethasone - administration & dosage; Betamethasone - therapeutic use; Chronic Pain - drug therapy; Clinical trials; Female; Humans; Male; Medical research; Middle Aged; Mitochondria - drug effects; Mitochondria - metabolism; Musculoskeletal diseases; Musculoskeletal Pain - drug therapy; Oxidation-Reduction - drug effects; Ozone; Ozone - administration & dosage; Ozone - therapeutic use; Pain; Pain management; Pain Measurement; Prospective Studies
• ISSN: 1533-3159; 2150-1149

Chronic primary musculoskeletal pain is multifaceted and 20% of the adult population lives with severe chronic pain and experience symptoms such as intense pain, depression, weakness, sleep problems, decreased quality of life and decreased emotional well-being. This paper studies the efficacy of trigger point injections with ozone compared to standard steroid injection or combination therapy for the treatment of chronic musculoskeletal pain in patients with abnormal mitochondrial redox state. This is a prospective randomized clinical study conducted with 51 patients experiencing chronic musculoskeletal pain. Medical Research Institute Hospital, Alexandria University. By computer-generated random numbers the 51 patients were divided into 3 groups. Group A (17 patients) received ozone injection, group B (17 patients) received betamethasone injection and group C (17 patients) received combined ozone and betamethasone injections. The groups were compared based on the intensity of pain and correction of mitochondrial redox state of the patients. Three days after intervention, the visual analog scale (VAS) scores reported by patients were lower in group A compared to group B (with a mean difference 1.27, 95% confidence interval (CI) of 0.15-2.39 (P < 0.02). One and 3 weeks after intervention, VAS scores of patients were lower in groups A and C compared to group B. At one week the mean difference between A and B was 1.2, with a 95% CI of 0.15-2.25 (P < 0.02) and the mean difference between C and B was 1.73 with a 95% CI of 0.69-2.78 (P < 0.001). At 3 weeks the mean difference between A and B was 1.5 with a 95% CI of 0.2-2.87 (P < 0.01) and the mean difference between C and B was 2.27 with a 95% CI of 0.93-3.60 (P < 0.0001). The reduced/oxidized glutathione ratio after intervention was higher in groups A and C compared to group B (P > 0.008). The mitochondrial copy number was higher in group A compared to group B (P < 0.002). This study didn't allow for the comparison of the experimental groups with a placebo or control group for musculoskeletal pain conditions in orderto establish the role of an abnormal mitochondrial redox state on the pathogenesis of patients from an ethical view. Ozone therapy or combined ozone and betamethasone treatment are  effective techniques for management of pain since it produced a significant reduction of muscle pain and increase of the pain free interval experienced by patients. Ozone therapy causes pain improvement which increases w