Efficacy of Lumbar Transforaminal Epidural Steroid Injection with or without Ozone Therapy on Radicular Pain

Nader Ali Nazemian; Alireza Khajehnasiri; Mehdi Sanatkar; Mohammadreza Samavatian; Mohammad Reza Nikoo

doi:10.18502/aacc.v10i4.16267

Nader Ali Nazemian Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Khajehnasiri Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mehdi Sanatkar Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mohammadreza Samavatian Department of Anesthesiology and Pain, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Reza Nikoo Physical Medicine and Rehabilitation Reseaech Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v10i4.16267

Keywords: Radicular pain; Steroid; Transforaminal; Ozone; Epidural

Abstract

Background: The effect of ozone therapy in reducing inflammation and radicular pain with lumbar transforaminal epidural steroid has not been sufficiently investigated. This study compares the effectiveness of transforaminal steroid injection with or without ozone therapy on radicular (leg) pain.

Methods: In a double-blind clinical trial, 40 patients with chronic radicular pain whose pain did not respond to conservative treatments were selected and randomly assigned to two treatment groups of A and B. Group A underwent transforaminal epidural steroid injection with ozone and group B underwent transforaminal epidural steroid injection without ozone. The intensity of pain with the Numerical Rating scale (NRS) scale and the degree of disability with the Oswestry Disability Index (ODI) questionnaire were compared in both groups of patients before treatment, 24 hours after treatment, 1 and 3 months after treatment.

Results: Both groups of A and B were similar in terms of age, gender, pain duration, pain intensity and disability before treatment (P>0.05). In treatment groups of A and B the mean of pain score 24 hours after treatment was 6.95±2.50 and 6.15±3.50 (P=0.495), one month after treatment it was 4.10±2.59 and 3.25±2.32 (P=0.355) and the third month of treatment was 3.85±3.01 and 3.55±3.25 (P=0.429). respectively. The mean of ODI 24 hours after treatment was 22.50±10.78 and 18.95±15.24 (P=0.401), one month after treatment it was 19.40±7.76 and 7.95±5.42 (P <0.001) and three months after treatment it was 17.40±7.26 and 13.55±8.70 (P=0.137).

Conclusion: It seems that adding ozone to corticosteroids has very little effect in reducing pain, and it did not have a significant effect at least in the study. One of the reasons may be the limitation of the sample size in the study, so it is suggested to conduct more studies in this field.