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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
359
shows that ozone therapy may present better results to
decrease pain and disability in patients with PNNP.
In addition to pain, FBSS causes great incapacity,
insecurity and feelings of disability, conditions that can
compromise the professional and family life of patients,
causing great damage to their overall function and qual-
ity of life. In a cross-sectional study with 177 patients
with chronic LBP, Salvetti et al.
36
found the prevalence of
disability at 68%.
All patients evaluated in our study had a high degree
of disability due to FBSS. During the evaluation 21 days
after epiduroscopy, a significant decrease in pain intensity
on the VAS and BPI scales (intensity field) was observed in
19.34% and 16.28% of patients, respectively. The reduction
in intensity was consistent with the reduction in paroxysm
and duration of pain found on the NPSI scale. However,
this result was not seen in the functional evaluation using
the ODI and Roland-Morris scales, which presented a
non-significant decrease in the scores (Table 2) that evalu-
ated daily activities such as personal care, sleep, social
and sexual function, and mobility. This result may be
related to the homogeneity of the sample, which includes
only patients diagnosed with FBSS who presented mod-
erate to high degree of disability, while other studies
evaluated mixed populations, with other causes of chron-
ic LBP. As the occurrence of litigation was not investi-
gated in these patients, it is not possible to ascertain the
effect of such variable in this population. Epiduroscopy-
-assisted ozone therapy is considered a low risk procedure
with few complications, including accidental dural in-
jury and epidural bleeding. Doses of ozone above the
therapeutic range of 10 to 40 ug/mL may cause vagal
vessel reflex, syncope and gas embolism.
28
No complica-
tions were reported in this series.
C
onclusion
FBSS-related pain is a debilitating condition that is difficult
to treat. Ozone therapy has emerged with a therapeutic
option in the management of pain and disability in these
patients. The results of our study confirm its usefulness
and show a decrease in pain intensity in patients with both
PNP and PNNP. However, double-blind and controlled
studies are needed to understand the long-term effects of
ozone and to determine the effectiveness of the procedure.
R
esumo
Efeitos do ozônio na dor e na incapacidade em pacientes
com síndrome dolorosa pós-laminectomia
Introdução:
A dor lombar é um dos distúrbios dolorosos
de maior prevalência. Tem diversas etiologias e, na pre-
sença de déficits neurológicos ou síndromes compressivas,
pode ser indicada cirurgia. Entretanto, em até 40% dos
casos os pacientes podem evoluir com piora da dor e
síndrome dolorosa pós-laminectomia (SDPL), que se
constitui em uma importante causa de dor crônica com
grande morbidade e incapacidade. Nas últimas duas dé-
cadas, o ozônio tem se mostrado uma nova opção tera-
pêutica para a SDPL em virtude das suas propriedades
analgésicas e anti-inflamatórias.
Objetivo:
Avaliar o efeito da ozonioterapia na dor e na
incapacidade de pacientes com SDPL.
Método:
Foram selecionados 19 pacientes, submetidos
a epiduroscopia e aplicação de ozônio. Os pacientes foram
avaliados no pré-operatório e 21 dias após o procedimen-
to, por meio de Escala Visual Analógica, Inventário Breve
de Dor, Questionário Roland-Morris de Incapacidade,
Oswestry Disability Scale, Inventário de Sintomas de Dor
Neuropática e Questionário de Dor Neuropática.
Resultados:
Os pacientes apresentaram redução signifi-
cante nos escores das escalas de avaliação de dor; porém,
essa redução não foi observada na avaliação da incapaci-
dade funcional.
Conclusão:
Os dados obtidos sugerem que a ozoniote-
rapia epidural pode ser uma opção de manejo da SDPL
na diminuição da intensidade da dor.
Palavras-chave:
lombalgia, dor crônica, síndrome pós-la-
minectomia, ozônio, epiduroscopia, Escala Visual Analógica.
R
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