Potencial terapéutico de la ozonoterapia como coadyuvante en la rehabilitación del dolor lumbar
DOI:
https://doi.org/10.33448/rsd-v11i4.27372Palabras clave:
Lumbalgia crónica; Tratamiento; Ozono; Rehabilitación; Dolor.Resumen
El dolor lumbar crónico (DLC) es uno de los trastornos musculoesqueléticos más comunes, prevalente a nivel mundial y una de las principales causas de discapacidad y deterioro de la calidad de vida, representando una importante carga económica. La ozonoterapia (OT) ha sido sugerida en la práctica clínica como una terapia adjunta a la rehabilitación y prometedora debido a los resultados positivos para el tratamiento de varias enfermedades crónicas, incluida la DLC. Por lo tanto, el propósito de este estudio es presentar y comprender, a través de una revisión narrativa, la evidencia actual disponible sobre el potencial terapéutico de la TO en el tratamiento del CLBP. Se utilizaron las bases de datos bibliográficas de PubMed/MEDLINE, Biblioteca Virtual en Salud (BVS), Web of Science y SciELO. Con base en los estudios revisados por pares, los estudios analizados demuestran que la TO es un enfoque prometedor ya que ejerce efectos positivos en la reducción del nivel de dolor, la discapacidad y la calidad de vida de los pacientes con EPC a corto y mediano plazo, ya que el gas es capaz de modular los procesos inflamatorios, tiene acción antioxidante e influye en las vías opioides endógenas. Además, los autores respaldan su uso como terapia adyuvante en el tratamiento de la EPC y que la terapia podría ser particularmente relevante para los pacientes que no responden a la terapia con medicamentos, experimentan efectos adversos de la terapia con medicamentos y/o que no son candidatos para la cirugía. Por lo tanto, la TO puede sugerirse como un método complementario a la rehabilitación en el tratamiento del CLBP, ya que es una técnica que tiene costos relativamente bajos, además de ser mínimamente invasiva y bien tolerada. Sin embargo, se necesitan ensayos clínicos controlados y aleatorizados para dilucidar los protocolos ideales de aplicación, ya que la literatura aún es escasa en este escenario.
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Akkawi I. (2020). Ozone therapy for musculoskeletal disorders Current concepts. Acta bio-medica : Atenei Parmensis, 91(4), e2020191. https://doi.org/10.23750/abm.v91i4.8979
Alayat, M. S., Atya, A. M., Ali, M. M., & Shosha, T. M. (2014). Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial. Lasers in medical science, 29(3), 1065–1073. https://doi.org/10.1007/s10103-013-1472-5
Apuzzo, D., Giotti, C., Pasqualetti, P., Ferrazza, P., Soldati, P., & Zucco, G. M. (2014). An observational retrospective/horizontal study to compare oxygen-ozone therapy and/or global postural re-education in complicated chronic low back pain. Functional neurology, 29(1), 31–39.
Arena, M., Savoca, G., Lednyiczky, G. Percutaneous Paravertebral Infiltration of O2-O3, Bioresonance Magnetotherapy, Transcutaneous Electrical Nerve Stimulation and Psychosomatic Postural Rehabilitation in the Treatment of Degenerative Joint Disease of the Lumbar Spine with Functional Insufficiency of the Vertebral Motor Unit. Int J Ozone Therapy 2008; 7: 29-36.
Babaei-Ghazani, A., Fadavi, H. R., Eftekharsadat, B., Ebadi, S., Ahadi, T., Ghazaei, F., & Khabbaz, M. S. (2019). A Randomized Control Trial of Comparing Ultrasound-Guided Ozone (O2-O3) vs Corticosteroid Injection in Patients With Shoulder Impingement. American journal of physical medicine & rehabilitation, 98(11), 1018–1025. https://doi.org/10.1097/PHM.0000000000001240
Barbosa, D. C., Ângelos, J., Macena, G., Magalhães, F., & Fonoff, E. T. (2017). Effects of ozone on the pain and disability in patients with failed back surgery syndrome. Revista da Associacao Medica Brasileira (1992), 63(4), 355–360. https://doi.org/10.1590/1806-9282.63.04.355
Barragán-Mejía, M. G., Castilla-Serna, L., Calderón-Guzmán, D., Hernández-Islas, J. L., Labra-Ruiz, N. A., Rodríguez-Pérez, R. A., & Angel, D. S. (2002). Effect of nutritional status and ozone exposure on rat brain serotonin. Archives of medical research, 33(1), 15–19. https://doi.org/10.1016/s0188-4409(01)00345-9
Bellomo, R. G., Paolucci, T., Giannandrea, N., Pezzi, L., & Saggini, R. (2020). Ozone Therapy and Aquatic Rehabilitation Exercises to Overcome the Lumbar Pain Caused by Facet Joint Syndrome - Case Report. International medical case reports journal, 13, 171–176. https://doi.org/10.2147/IMCRJ.S247697
Bhatia, A., Munk, P., Lee, D., Elias, G., Murphy, K.(2019) Percutaneous Ozone Treatment for Herniated Lumbar Discs: 1-Year Follow-up of a Multicenter Pilot Study of a Handheld Disposable Ozone-Generating Device. J. Vasc. Interv. Radiol, 30, 752–760.
Bidonde, J., Busch, A. J., Schachter, C. L., Overend, T. J., Kim, S. Y., Góes, S. M., Boden, C., & Foulds, H. J. (2017). Aerobic exercise training for adults with fibromyalgia. The Cochrane database of systematic reviews, 6(6), CD012700. https://doi.org/10.1002/14651858.CD012700
Bocci, V.(2012) How a calculated oxidative stress can yield multiple therapeutic effects. Free Radic. Res, 46, 1068–1075.
Bocci, V.(2002) Oxygen-Ozone Therapy: A Critical Evaluation; Kluwer Academic Publishers: Dordrechit, The Netherlands.
Bocci V. A. (2006). Scientific and medical aspects of ozone therapy. State of the art. Archives of medical research, 37(4), 425–435. https://doi.org/10.1016/j.arcmed.2005.08.006
Bocci, V., & Valacchi, G. (2013). Free radicals and antioxidants: how to reestablish redox homeostasis in chronic diseases?. Current medicinal chemistry, 20(27), 3397–3415. https://doi.org/10.2174/0929867311320270005
Bonetti, M., Zambello, A., Princiotta, C., Pellicanò, G., Della Gatta, L., & Muto, M. (2020). Non-discogenic low back pain treated with oxygen-ozone: outcome in selected applications. Journal of biological regulators and homeostatic agents, 34(4 Suppl. 1)
Carey, T. S., Garrett, J. M., & Jackman, A. M. (2000). Beyond the good prognosis. Examination of an inception cohort of patients with chronic low back pain. Spine, 25(1), 115–120. https://doi.org/10.1097/00007632-200001010-00019
Carter, I. R., & Lord, J. L. (2002). Clinical inquiries. How effective are exercise and physical therapy for chronic low back pain?. The Journal of family practice, 51(3), 209.
Chenot, J. F., Greitemann, B., Kladny, B., Petzke, F., Pfingsten, M., & Schorr, S. G. (2017). Non-Specific Low Back Pain. Deutsches Arzteblatt international, 114(51-52), 883–890. https://doi.org/10.3238/arztebl.2017.0883
Chiarotto, A., Maxwell, L. J., Ostelo, R. W., Boers, M., Tugwell, P., & Terwee, C. B. (2019). Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review. The journal of pain, 20(3), 245–263. https://doi.org/10.1016/j.jpain.2018.07.009
Clavo, B., Pérez, J. L., López, L., Suárez, G., Lloret, M., Rodríguez, V., Macías, D., Santana, M., Morera, J., Fiuza, D., Robaina, F., & Günderoth, M. (2003). Effect of ozone therapy on muscle oxygenation. Journal of alternative and complementary medicine (New York, N.Y.), 9(2), 251–256. https://doi.org/10.1089/10755530360623365
Corp, N., Mansell, G., Stynes, S., Wynne-Jones, G., Morsø, L., Hill, J. C., & van der Windt, D. A. (2021). Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European journal of pain (London, England), 25(2), 275–295. https://doi.org/10.1002/ejp.1679
Costa, L. O., Maher, C. G., Latimer, J., Ferreira, P. H., Ferreira, M. L., Pozzi, G. C., & Freitas, L. M. (2008). Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: which one is the best?. Spine, 33(22), 2459–2463. https://doi.org/10.1097/BRS.0b013e3181849dbe.
Dal Fior, S., Gaido, C., Carnino, I., Gamna, F., Busso, C., Massazza, G., & Minetto, M. A. (2020). Clinical predictors of response to ozone therapy for treatment of discogenic and non-discogenic low back pain. Journal of biological regulators and homeostatic agents, 34(3), 1223–1228. https://doi.org/10.23812/19-564-L-36
de Sire, A., Baricich, A., Minetto, M. A., Cisari, C., & Invernizzi, M. (2019). Low back pain related to a sacral insufficiency fracture: role of paravertebral oxygen-ozone therapy in a paradigmatic case of nociplastic pain. Functional neurology, 34(2), 119–122.
de Sire, A., Agostini, F., Lippi, L., Mangone, M., Marchese, S., Cisari, C., Bernetti, A., & Invernizzi, M. (2021). Oxygen-Ozone Therapy in the Rehabilitation Field: State of the Art on Mechanisms of Action, Safety and Effectiveness in Patients with Musculoskeletal Disorders. Biomolecules, 11(3), 356. https://doi.org/10.3390/biom11030356
Di Filippo, M., Sarchielli, P., Picconi, B., & Calabresi, P. (2008). Neuroinflammation and synaptic plasticity: theoretical basis for a novel, immune-centred, therapeutic approach to neurological disorders. Trends in pharmacological sciences, 29(8), 402–412. https://doi.org/10.1016/j.tips.2008.06.005
Di Paolo, N., Bocci, V., Gaggiotti, E. Ozone therapy. Int J Artif Organs. 2004 Mar;27(3):168-75. doi: 10.1177/039139880402700303. PMID: 15112882.
Dixit, S., Maiya, A., & Shastry, B. (2014). Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 23(5), 1629–1640. https://doi.org/10.1007/s11136-013-0602-7
Elvis, A. M., & Ekta, J. S. (2011). Ozone therapy: A clinical review. Journal of natural science, biology, and medicine, 2(1), 66–70. https://doi.org/10.4103/0976-9668.82319
GBD 2016 Brazil Collaborators (2018). Burden of disease in Brazil, 1990-2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet (London, England), 392(10149), 760–775. https://doi.org/10.1016/S0140-6736(18)31221-2
GBS 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [published correction appears in Lancet. 2019 Jun 22;393(10190):e44]. Lancet. 2018;392(10159):1789-1858.
Giunta, R., Coppola, A., Luongo, C., Sammartino, A., Guastafierro, S., Grassia, A., Giunta, L., Mascolo, L., Tirelli, A., & Coppola, L. (2001). Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Annals of hematology, 80(12), 745–748. https://doi.org/10.1007/s002770100377
Hayden, J. A., van Tulder, M. W., Malmivaara, A. V., & Koes, B. W. (2005). Meta-analysis: exercise therapy for nonspecific low back pain. Annals of internal medicine, 142(9), 765–775. https://doi.org/10.7326/0003-4819-142-9-200505030-00013
Kirkley, A., Birmingham, T. B., Litchfield, R. B., Giffin, J. R., Willits, K. R., Wong, C. J., Feagan, B. G., Donner, A., Griffin, S. H., D'Ascanio, L. M., Pope, J. E., & Fowler, P. J. (2008). A randomized trial of arthroscopic surgery for osteoarthritis of the knee. The New England journal of medicine, 359(11), 1097–1107. https://doi.org/10.1056/NEJMoa0708333
Li, W., Khor, T. O., Xu, C., Shen, G., Jeong, W. S., Yu, S., & Kong, A. N. (2008). Activation of Nrf2-antioxidant signaling attenuates NFkappaB-inflammatory response and elicits apoptosis. Biochemical pharmacology, 76(11), 1485–1489. https://doi.org/10.1016/j.bcp.2008.07.017
Macedo, L. G., Maher, C. G., Latimer, J., & McAuley, J. H. (2009). Motor control exercise for persistent, nonspecific low back pain: a systematic review. Physical therapy, 89(1), 9–25. https://doi.org/10.2522/ptj.20080103
Magalhaes, F. N., Dotta, L., Sasse, A., Teixera, M. J., & Fonoff, E. T. (2012). Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials. Pain physician, 15(2), E115–E129.
Melchionda, D., Milillo, P., Manente, G., Stoppino, L., & Macarini, L. (2012). Treatment of radiculopathies: a study of efficacy and tollerability of paravertebral oxygen-ozone injections compared with pharmacological anti-inflammatory treatment. Journal of biological regulators and homeostatic agents, 26(3), 467–474.
Migliorini, F., Maffulli, N., Eschweiler, J., Bestch, M., Tingart, M., & Baroncini, A. (2020). Ozone injection therapy for intervertebral disc herniation. British medical bulletin, 136(1), 88–106. https://doi.org/10.1093/bmb/ldaa032
Momenzadeh, S., Kiabi F. H., Moradkhani, M, et al.(2012) Low level laser therapy (LLLT) combined with physical exercise, a more effective treatment in low back pain. J Lasers Med Sci 3:67–70.
Moreno-Fernández, A., Macías-García, L., Valverde-Moreno, R., Ortiz, T., Fernández-Rodríguez, A., Moliní-Estrada, A., & De-Miguel, M. (2019). Autohemotherapy with ozone as a possible effective treatment for Fibromyalgia. Autohemotherapy with ozone as a possible effective treatment for Fibromyalgia. Acta reumatologica portuguesa, 44(3), 244–249..
Nguyen, C., Lefèvre-Colau, M. M., Poiraudeau, S., & Rannou, F. (2016). Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review. Annals of physical and rehabilitation medicine, 59(3), 190–195. https://doi.org/10.1016/j.rehab.2016.02.010
Nijs, J., Apeldoorn, A., Hallegraeff, H., Clark, J., Smeets, R., Malfliet, A., Girbes, E. L., De Kooning, M., & Ickmans, K. (2015). Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain physician, 18(3), E333–E346.
Niu, T., Lv, C., Yi, G., Tang, H., Gong, C., & Niu, S. (2018). Therapeutic Effect of Medical Ozone on Lumbar Disc Herniation. Medical science monitor : international medical journal of experimental and clinical research, 24, 1962–1969. https://doi.org/10.12659/msm.903243.
Owen, P. J., Miller, C. T., Mundell, N. L., Verswijveren, S., Tagliaferri, S. D., Brisby, H., Bowe, S. J., & Belavy, D. L. (2020). Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British journal of sports medicine, 54(21), 1279–1287. https://doi.org/10.1136/bjsports-2019-100886
Paoloni, M., Di Sante, L., Cacchio, A., Apuzzo, D., Marotta, S., Razzano, M., Franzini, M., & Santilli, V. (2009). Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection. Spine, 34(13), 1337–1344. https://doi.org/10.1097/BRS.0b013e3181a3c18d
Peralta, C., Xaus, C., Bartrons, R., Leon, O. S., Gelpi, E., & Roselló-Catafau, J. (2000). Effect of ozone treatment on reactive oxygen species and adenosine production during hepatic ischemia-reperfusion. Free radical research, 33(5), 595–605. https://doi.org/10.1080/10715760000301121
Petersen, T., Laslett, M., & Juhl, C. (2017). Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC musculoskeletal disorders, 18(1), 188. https://doi.org/10.1186/s12891-017-1549-6
Raeissadat, S. A., Rayegani, S. M., Sadeghi, F., & Rahimi-Dehgolan, S. (2018). Comparison of ozone and lidocaine injection efficacy vs dry needling in myofascial pain syndrome patients. Journal of pain research, 11, 1273–1279. https://doi.org/10.2147/JPR.S164629
Rahimzadeh, P., Imani, F., Ghahremani, M., & Faiz, S. (2018). Comparison of percutaneous intradiscal ozone injection with laser disc decompression in discogenic low back pain. Journal of pain research, 11, 1405–1410. https://doi.org/10.2147/JPR.S164335
Rajeevan, M. S., Dimulescu, I., Murray, J., Falkenberg, V. R., & Unger, E. R. (2015). Pathway-focused genetic evaluation of immune and inflammation related genes with chronic fatigue syndrome. Human immunology, 76(8), 553–560. https://doi.org/10.1016/j.humimm.2015.06.014
Rice, D., Nijs, J., Kosek, E., Wideman, T., Hasenbring, M. I., Koltyn, K., Graven-Nielsen, T., & Polli, A. (2019). Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. The journal of pain, 20(11), 1249–1266. https://doi.org/10.1016/j.jpain.2019.03.005
Sagai, M., & Bocci, V. (2011). Mechanisms of Action Involved in Ozone Therapy: Is healing induced via a mild oxidative stress?. Medical gas research, 1, 29. https://doi.org/10.1186/2045-9912-1-29.
Schwartz-Tapia, A., Martínez-Sánchez, G., Sabah, F..Madrid Declaration on Ozone Therapy. Madrid: International Scientific Committee of Ozone Therapy; Aepromo: vol.50, Madrid, Spain,2015.
Sconza, C., Leonardi, G., Kon, E., Respizzi, S., Massazza, G., Marcacci, M., & Di Matteo, B. (2021). Oxygen-ozone therapy for the treatment of low back pain: a systematic review of randomized controlled trials. European review for medical and pharmacological sciences, 25(19), 6034–6046. https://doi.org/10.26355/eurrev_202110_26881
Seyam, O., Smith, N. L., Reid, I., Gandhi, J., Jiang, W., & Khan, S. A. (2018). Clinical utility of ozone therapy for musculoskeletal disorders. Medical gas research, 8(3), 103–110. https://doi.org/10.4103/2045-9912.241075
Smith, N. L., Wilson, A. L., Gandhi, J., Vatsia, S., & Khan, S. A. (2017). Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Medical gas research, 7(3), 212–219. https://doi.org/10.4103/2045-9912.215752
Ulusoy, G. R., Bilge, A., & Öztürk, Ö. (2019). Comparison of corticosteroid injection and ozone injection for relief of pain in chronic lateral epicondylitis. Acta orthopaedica Belgica, 85(3), 317–324.
Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., Viswanath, O., Jones, M. R., Sidransky, M. A., Spektor, B., & Kaye, A. D. (2019). Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Current pain and headache reports, 23(3), 23. https://doi.org/10.1007/s11916-019-0757-1
Vallone, F., Benedicenti, S., Sorrenti, E., Schiavetti, I., & Angiero, F. (2014). Effect of diode laser in the treatment of patients with nonspecific chronic low back pain: a randomized controlled trial. Photomedicine and laser surgery, 32(9), 490–494. https://doi.org/10.1089/pho.2014.3715
Van Tulder, M. W., Koes, B. W., Metsemakers, J. F., & Bouter, L. M. (1998). Chronic low back pain in primary care: a prospective study on the management and course. Family practice, 15(2), 126–132. https://doi.org/10.1093/fampra/15.2.126
Van Middelkoop, M., Rubinstein, S. M., Verhagen, A. P., Ostelo, R. W., Koes, B. W., & van Tulder, M. W. (2010). Exercise therapy for chronic nonspecific low-back pain. Best practice & research. Clinical rheumatology, 24(2), 193–204. https://doi.org/10.1016/j.berh.2010.01.002
Vélez, B.P.(2014). Ozone therapy, a supplement for patients with fibromyalgia. Ozone Ther. Glob. J, 4, 39–49.
Vlaeyen, J., Maher, C. G., Wiech, K., Van Zundert, J., Meloto, C. B., Diatchenko, L., Battié, M. C., Goossens, M., Koes, B., & Linton, S. J. (2018). Low back pain. Nature reviews. Disease primers, 4(1), 52. https://doi.org/10.1038/s41572-018-0052-1
Wewege, M. A., & Jones, M. D. (2021). Exercise-Induced Hypoalgesia in Healthy Individuals and People With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. The journal of pain, 22(1), 21–31. https://doi.org/10.1016/j.jpain.2020.04.003
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