Abril - 2017

arbosa

358

ssoc

ras

2017; 63(4):355-360

eral enzymatic and non-enzymatic buffering systems, with

anti-inflammatory and analgesic action.

31-33

Ozone’s mechanism of action in the treatment of

FBSS is little known. Current hypotheses suggest that its

effect could occur through chemical adhesiolysis of scar

fibrosis associated with pain and dehydration of the her-

niated disc contents,

as well as the activation of cytokines

that would inhibit proinflammatory factors associated

with chronic pain.

It is believed that ozone may cause

local vasodilation, favoring the neutralization of acidosis

and the induction of antioxidant enzymes associated with

analgesia, as well as stimulating the activation of the

descending antinociceptive system, blocking the transmis-

sion of pain to the thalamus and cortex.

Interest in the effects of ozone therapy to treat FBSS

has been growing in the last two decades. Intradiscal

and paravertebral ozone injection associated with a ste-

roid and local anesthetics have presented significant

results. Gallucci et al.

compared the effect of adding

ozone to a mixture of steroid and anesthetic in 159 pa-

tients. They reported that the ozone-treated group showed

more improvement than the patients who did not receive

it within six months of follow-up. In addition to the role

of ozone in FBSS, Bonetti et al.

suggest that its anal-

gesic action is also reproducible in chronic LBP and lum-

bago with sciatica.

When evaluating the intraforaminal effect of ozone

versus steroidal infiltration in 306 patients, the authors

observed that those treated with the oxygen-ozone mixture

showed more improvement than the group treated with

corticosteroids alone. In a meta-analysis by Magalhães et

al.,

the level of evidence attributed to long-term pain

relief was II-3 in the case of intradiscal ozone and II-1 for

paravertebral ozone. Although the evidence corroborates

the efficacy of intradiscal and paravertebral ozone injec-

tion, there is still little data on epiduroscopy-assisted use.

In a pilot study with 13 patients published by Magalhães

et al.,

the effect of the ozone-oxygen mixture versus

oxygen in the epidural space was compared after adhe-

siolysis. Patients with PNNP presented a significant reduc-

tion in pain and disability according to ODI, whereas in

the PNP group this reduction was not significant, which

TABLE 2

Mean of results obtained from the scales applied before and 21 days after the procedure (n=19).

Scales

Pre-surgery*

21 days*

p**

Visual Analogue Scale (VAS)

8.47 (± 1.12)

7.05 (± 2.68)

0.029

Neuropathic Pain Symptom Inventory (NPSI)

62.74 (± 20.99)

54.21 (± 28.50)

0.034

Oswestry Disability Index (ODI)

37.58 (± 5.58)

35.84 (± 7.62)

0.217

Roland-Morris Disability Questionnaire

14.47 (± 5.08)

13.84 (± 6.32)

0.438

Brief Pain Inventory (BPI)

Intensity

7.86 (± 1.11)

6.58 (± 2.15)

0.005

Interference

7.63 (± 1.54)

6.71 (± 2.45)

0.054

*Scale values expressed as mean and standard deviation; **Student’s paired t-test.

Pre

Post

Predominantly

neuropathic pain

Predominantly

non-neuropathic pain

FIGURE 1

A. Statistical analysis of VAS after epiduroscopy with ozone injection, evidencing a significant reduction in scores (Student’s paired

t-test with p<0.05). B. Comparison of VAS in patients with PNP and PNNP pain (Repeated Measures ANOVA with p>0.05).