The use of medical ozone in the treatment of chronic pain is progressively expanding in Spain and today it is used both in public and private medical centers. However, there is a great lack of knowledge about this technology not only in primary care but also in medical specialties. Although its biochemical bases are well determined and there are various systematic reviews and meta-analyses in the literature that justify its use in pain medicine, some professionals still are prejudiced against it. The evidence level of using medical ozone according SIGN (Scotish Intercollegiate Guideline Network) criteria is similar or superior to most of the techniques used in a Pain Unit. In this paper, we have done a review on ozone therapy in pain medicine, compiling the evidence published about it.

In the last sixty years, publications in reputed journals have shown the preclinical positive effect of ozone gas in cancer cells. However, the translation of these results into clinical practice is far away from success. A comprehensive approach is necessary for this, and oncologists and researchers need guidance from medical specialists with in-depth knowledge of ozone in medicine. In this article, we review the evidence around this question and suggest different potential research lines to those interested in this exciting field.

Introduction. Reading reference ozone books from Dra. Menendez, Dra. Viebhan, Dra. Borrelli and Dr. Bocci, proper timing for mixing ozone in blood during autohemotherapy is not calculated in a scientific way, having only an estimation of it based on changes in the blood color, more related to oxygen absorption than on ozone itself. Material and methods. We decided to reproduce a reduced model of great autohemotherapy or recently renamed as systemic indirect endovenous ozonotherapy (SIEVO) by the World Federation of Ozone Therapy – WFOT, using syringes to simplify the experiment. Our model consisted of a 20 mL syringe filled with 10 mL of blood withdrawn from healthy volunteers and mixed it gently but in controlled way with 10 mL medical ozone at different concentrations; after 5 and 8 seconds, the remaining gas was analyzed by an spectrophotometer based ozone detector to check the amount of ozone. Data were analyzed using a linear regression model. Results. Results show that even for 60 mcgr/mL ozone concentration, 8 seconds is enough to let all ozone absorbed in blood. Discussion and Conclusions. The experiment shows how quick ozone reacts with blood and claims for a trial with real SIEVO devices to achieve a real timing.

The safety and efficacy of ozone injections in the spine for lumbar disc herniation has been proved in two systematic reviews with one metaanalysis. Many other papers with lower evidence level were published before encouraging its use for this pathology and other degenerative spinal diseases. Fail back surgery syndrome (FBSS) is a terrible situation with no clear treatment option presently. Some authors have dared to use ozone injections in these patients, based on its antiinflammatory action and its highly save portfolio. Due to the great disability and dramatic situation of FBSS patients, a systematic review is mandatory in order to clarify the potential role of ozone in this pathology.

Injuries associated with the hamstring muscles in the running athlete are increasingly investigated due to the economic and functional consequences associated with them. Although hardly used in the treatment of sports injuries, medical ozone is effective and very well tolerated in the treatment of musculoskeletal pain, it was decided to add a series of medical ozone infiltrations to the treatment. The evolution of the case was recorded by medical thermography, in addition to measuring pain intensity (visual analog scale) and functional capacity (toe touch test). Pain intensity (visual analog scale) decreased from seven at baseline to two at the end of treatment (after two ozone infiltrations, one weekly). Mobility of the damaged area (toe touch test) improved from a distance of 8 cm at baseline to 0 cm at the end of treatment. Regarding medical thermography, after the first and second infiltration of ozone, the temperature rose to a significant increase in perfusion from baseline from 31.2 to 31.8 °C and from 31.2 to 32 °C, respectively. These results suggest the possible interest of medical ozone as an adjuvant treatment for the recovery of sports tendinopathies and encourage us to carry out further studies.