Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials
Magalhaes FN, Dotta L, Sasse A, et al. Pain Physician, 2012.
- Study type
- Systematic review / meta-analysis
- People studied
- Total not recorded
- Population
- Patients with chronic low back pain secondary to herniated disc
- Published
- 2012, Pain Physician
- Identifiers
- PMID 22430658
What the authors reported
A systematic review of 8 observational studies and meta-analysis of 4 randomized trials found percutaneous ozone injection (intradiscal or paravertebral) associated with positive pain outcomes and low morbidity, graded as evidence level II-1 to II-3 depending on route of injection.
What limits this result
The authors themselves note a lack of precise diagnostic criteria and frequent use of mixed therapeutic agents across studies, that included trials were mainly active-control, and that no placebo-controlled trial was found.
Other ozone methods, such as major autohemotherapy, that clinics cite in support of EBO2. A result for one method does not transfer automatically to another. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Systematic review and meta-analysis of randomized controlled trials
- Setting
- Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil (author affiliation)
- Read from
- Read from the full text of the paper. Read on September 28, 2026.
Sources: Abstract on PubMed, The paper at painphysicianjournal.com
What it measured
- Studies included
- Eight observational studies in the systematic review and 4 randomized trials in the meta-analysis
- Pooled result of the randomized studies (Fig. 2)
- Intervention superior to the control: OR 2.66 (95% CI 1.94 to 3.63), P < 0.00001
- Observational studies
- Positive results for short- and long-term relief of pain
- Level of evidence for long-term pain relief
- II-3 for ozone applied intradiscally; II-1 for ozone applied paravertebrally
- Grading of recommendation
- 1C for intradiscal ozone therapy; 1B for paravertebral ozone therapy
- Control groups in the randomized trials selected
- 3 trials used an active control (steroid or steroid with local anesthetic); one used a sham procedure
Among the selected RCTs, 3 of them compared ozone treatment with an active control group (steroid or steroid with local anesthetic) and one study compared ozone injection with a sham procedure.
- Complications found in the literature reviewed
- Predominantly case reports of 5 different types of complications
In this review, regarding ozone therapy for low back pain, we encountered predominantly case reports of 5 different types of complications.
- Infection
- A case report of fatal septicemia secondary to Escherichia coli infection after ozone therapy for lumbar disc herniation
Sources: Abstract on PubMed, The paper at painphysicianjournal.com
Safety as reported
6 reports of side effects related to ozone infusion were found in the review
Follow-up
Studies were reviewed if they had outcome evaluations at 6 months or longerAll studies providing appropriate management with outcome evaluations at 6 months or longer and statistical evaluations were reviewed.
Funding and conflicts
Partially funded by F APESP - Grant #2011/08529-5 (as printed); conflict of interest: none
Where we cite this study
Does EBO2 (EBOO) Work? The Evidence, Study by Study
Every study in our EBO2 (EBOO) library in one place: design, size, what was measured and found, its limits, and a check for any study a clinic cites.