Ozone Therapy for Herniated Disc

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Ozone Therapy for Herniated Disc

Question:

What is ozone therapy to treat herniated disc in the lower back? What is the rate of success and after effects?

Answer:

Ozone is a gas that combines 3 atoms of oxygen. It's used in disinfectants, deodorant chemicals, and bleaching. It's also present in the atmosphere where it's thought to protect the earth from harmful radiation and excessive heat.

Ozone has been used for a number of medical purposes in a variety of ways for more than 100 years. For example, it can be injected into the blood or into joints, inhaled or introduced into body cavities such as the rectum. Advocates of ozone therapy believe that it can treat disorders ranging from cardiovascular disease to HIV. Unfortunately, high quality studies proving the benefits of ozone therapy are lacking.

A mix of ozone and air can be injected into the spine as a treatment for herniated (slipped) discs. This treatment is popular in many parts of the world but is not approved by the Food and Drug Administration for use in the United States. I was unable to find a study comparing injections of ozone with placebo. (Such a study would be difficult to perform.) There are studies, however, comparing injections of ozone, corticosteroids and an anesthetic with ozone injections alone. For example, a 2002 study in Italy found that 70% of 300 patients receiving ozone injections improved 6 months after treatment. Results were even better for another 300 patients receiving an injection of ozone, steroids and an anesthetic: 78% improved at 6 months. However, patients were not randomly assigned to treatment and there was no control (placebo) group so it's difficult to know how much of the improvement was specifically due to the ozone injections.

There is no clear understanding about why ozone injections should work. Theories about its mode of action include:

• a direct anti-inflammatory effect

• improved blood flow and oxygen delivered to the painful area

• shrinkage of the disc due to a dehydrating effect of ozone

• stimulation of the healing process through the direct effects of ozone on the cells that produce the building blocks of joint tissue (fibroblasts)

None of these is proven, however.

Practitioners advocating ozone therapy describe side effects as rare and of little significance. I did find one report of a fatal infection associated with ozone injections for disc disease. However, such rare complications also can occur with other injection therapies that are commonly performed for spine problems. I could find no reliable data confirming the safety of ozone injections.

Without high quality, reliable studies to rely upon, it is difficult to know whether ozone injections are a good idea for disc disease in the spine. If you are interested in pursuing this option, talk to your doctor about it and be sure you understand all of your treatment options.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Last updated:	July 20, 2009