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E
ffects
of
ozone
on
the
pain
and
disability
in
patients
with
failed
back
surgery
syndrome
R
ev
A
ssoc
M
ed
B
ras
2017; 63(4):355-360
355
ORIGINAL ARTICLE
Effects of ozone on the pain and disability in patients with failed
back surgery syndrome
D
anilo
C
osta
B
arbosa
1,2
, J
airo
S
ilva
dos
Â
ngelos
1
, G
leica
M
aria
J
osino
de
M
acena
2
, F
rancisco
N
êuton
de
O
liveira
M
agalhães
1
,
E
rich
T
alamoni
F
onoff
1
*
1
Division of Functional Neurosurgery, Department of Neurology, Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
2
Medical School, Universidade Anhembi Morumbi, São Paulo, SP, Brazil
S
ummary
Study conducted under the protocol
0267/09, Capes / Hospital das Clínicas,
Faculdade de Medicina da Universidade
de São Paulo (HC-FMUSP), as open trial,
São Paulo, SP, Brazil
Article received:
8/1/2016
Accepted for publication:
10/4/2016
*Correspondence:
Address: Rua Dr. Ovídio Pires
de Campos, 785
São Paulo, SP – Brazil
Postal code: 01060-970
fonoffet@usp.br http://dx.doi.org/10.1590/1806-9282.63.04.355Introduction:
Low back pain is one of the painful disorders of higher prevalence.
It has several etiologies and surgery may be indicated in the presence of
neurological deficits or compression syndromes. However, in up to 40% of cases,
patients develop worsening of pain and failed back surgery syndrome (FBSS),
which is an important cause of chronic pain with high morbidity and disability.
In the last two decades, ozone has been shown to be a new therapeutic option
for FBSS due to its analgesic and anti-inflammatory properties.
Objective:
To evaluate the effect of ozone therapy on pain and disability in
patients with failed back surgery syndrome.
Method:
We selected 19 patients undergoing epiduroscopy and injection of
ozone. Patients were evaluated preoperatively and 21 days after the procedure,
using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory,
Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI),
Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4.
Results:
The patients showed significant pain relief, but no improvement was
observed in the functional scales.
Conclusion:
Our results suggest that epidural ozone therapy can be a treatment
option in FBSS to reduce the intensity of the pain.
Keywords:
low back pain, chronic pain, failed back surgery syndrome, ozone,
epiduroscopy, Visual Analogue Scale.
I
ntroduction
Low back pain (LBP) is one of the most prevalent pain
disorders,
1
and a frequent cause of morbidity and dis-
ability. It is estimated that about two-thirds of the popu-
lation experience LBP at some point in their life, which
is an important cause of sick leave in working-age adults.
1,2
In the US, the prevalence of chronic LBP can reach 30%,
costing the country approximately US$ 90 billion. In
Brazil, there are no national statistics. A cross-sectional
study conducted in Rio Grande do Sul found a prevalence
of 4.2% for chronic LBP.
3
LBP may be primary or secondary, and either present
or not neurological impairment. The origin of the pain
can be mechanical-degenerative, traumatic, congenital,
neoplastic, inflammatory, infectious or metabolic,
1,4,5
the
first being more frequent. Many patients with LBP have
musculoskeletal or degenerative changes that do not need
specific treatment and are usually self-limiting. In more
than 85% of LBP cases, there is no specific cause.
6
Most
cases of LBP are acute (also known as lumbago), have a
good prognosis and usually resolve within four weeks.
Some patients may have persistent symptoms and the
improvement period may extend up to 12 weeks (subacute
LBP).
1,7
However, a minority of patients develop persistent
pain for more than 12 weeks (chronic LBP), and pain and
disability may persist relatively constantly.
1,8
Several factors may contribute to the aggravation and
chronification of LBP syndromes, such as smoking, obe-
sity, chronic diseases, educational level, posture habits
and other conditions that compromise quality of life.
4,9
Imaging studies of the spine may reveal abnormalities
such as disc degeneration, vertebral disc herniation and