Background: Disk herniation (DH) is one of the most common disk lesions, inducing low back pain (LBP). Various therapeutic options have been proposed for treatment of disk herniation (DH). Intradiscal injection of ozone has been suggested for treatment of DH. Objectives: To determine the effect of intradiscal ozone injection on pain score and disability in patients with LBP from disk prolapsed. Patients and Methods:Patients with LBP diagnosed with DH were enrolled in this clinical trial study. After prep and drape the area and under the fluoroscopy guide (c-arm), intradiscal injection of ozone/oxygen mixture (4 mL, 40 µg/mL) was performed. Pain score and functional ability of the patients according to Oswestry Disability Index (ODI) were measured prior to the injection (baseline) and then at 2 and 4 weeks and then at 3 and 6 months after the injection. Results: Thirty patients (17 females, 13 males) with the mean age of 58.6 y (range, 42-73 y) enrolled in the study. The mean ± standard deviation (SD) of pain score before intervention was 8.1 ± 0.8. After two weeks, it was reduced to 3.2 ± 0.6 (P < 0.001) and finally dropped to 2.0 ± 0.6 sixth months after intervention (P = 0.0001). Functional status of ODI was 28.5 ± 2.1 before intervention and showed significant reduction after two weeks (with the mean of 12.3), and it was almost sustained till sixth months after intervention, with the mean of 11.4 (P = 0.001). Conclusions: Altogether, ozone had significant positive effects on patients with disk herniation unresponsive to other conservative and minimally invasive treatments.

Introduction: Myofascial pain syndrome (MPS) treatment is challenging with a high recurrence rate and still lacks a clear treatment frame. Therefore research on new, more efficient and long lasting effect treatment modalities is necessary. This study looked at the effects of intravenous laser therapy (IVL) and percutaneous low level laser (PLLL) in the management of shoulder MPS. Methods: In this randomized controlled trial, 30 patients fulfilling inclusion criteria were randomly equally allocated to 3 groups, control, IVL and PLLL. Control group received 12 sessions of placebo low level laser, IVL group received 12 sessions of IVL therapy, and PLLL group received 12 sessions of PLLL therapy. All patients were trained for better body posture, body mechanics, gentle massage of trigger points, stretching exercises of affected muscle (trapezius), and received 10 mg of oral nortriptyline regimen every night for 3 months. Outcomes included pain severity, functional disability, and quality of life. Patients were assessed using Numeric Rating Scale (NRS), Pain Disability Index (PDI), and Short Form Health Survey (SF-12). Data collected were analyzed using analysis of variance (ANOVA), Mann-Whitney and t tests. Results: The mean of PDI and maximum pain intensity during day and night significantly reduced in both PLLL and IVL groups compared to control group. Although pain severity and PDI reduction was more pronounced in IVL group compared to PLLL group, the differences were not statistically significant. Also, quality of life statistically significantly improved in both IVL and PLLL groups compared to control group was more, and although higher in IVL group, the difference was not statistically significant when compared to PLLL group. No side effects were observed in the intervention groups. Conclusion: Intravenous laser and PLLL therapy had a positive effect on pain severity and PDI reduction, and quality of life in this study. Also no adverse event was recorded. Thus, intravenous lasers and PLLL therapy seem to be effective complementary modalities in managing patients with shoulder MPS.

The origin of 16% to 30% of low back pain is sacroiliac joint. It is difficult to distinguish the sacroiliac joint pain from other types of low back pain using history and physical examination. Radiological imaging has little role in diagnosis of the sacroiliac joint pain and diagnostic blocks are the gold standard in these patients. The main objective of this study is to evaluate the accuracy and safety of diagnostic sacroiliac joint block (DSJB) under sonographic guidance. Materials and Methods: This analytic cross sectional study was conducted on 65 patients. DSJB under sonographic guidance was done for all patients with 1 ml radiographic contrast material and 1 ml local anesthetic (2% lidocaine). In order to confirm intra-articular injection by sonographic guidance, fluoroscopic spot images were considered. The side effect and positive predictive value of physical provocative tests of sacroiliac joint were evaluated. Results: Of 65 diagnostic blocks, after fluoroscopic confirmation, 62 injections were intra-articular and only 3 were peri-articular. There was a significant statistical correlation between procedure time and patients' body mass index. 3 and 4 to 6 positive provocative tests of sacroiliac joint resulted in a positive predictive value of 83.3% and 93.3%, respectively. The procedure had no side effect and complication. Conclusion: Based on the obtained results, diagnostic block of sacroiliac joint under sonographic guidance has reasonable accuracy without side effects. If performed by experienced clinicians in nerve block under sonographic guidance, it can be valuable alternative method for other guidance modalities in diagnosis of patient with sacroiliac joint pain.