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Neuromodulators for atypical facial pain and neuralgias: a systematic review and meta-analysis.

Dolor Orofacial y Cefaleas

Triet M Do, Graham D Unis, Nrusheel Kattar, Ashwin Ananth, Edward D McCoul.

Laryngoscope. 2021 Jun;131(6):1235-1253.

doi: 10.1002/lary.29162.

Abstract.

Objective: To evaluate the effectiveness of neuromodulating agents for the management of atypical facial pain and primary facial neuralgias.

Methods: We searched MEDLINE, Embase, CINAHL, and ClinicalTrials.gov databases for original research articles that examine the effectiveness and adverse reactions of pharmacologic therapy for the treatment of trigeminal neuralgia and atypical facial pain. Studies that included surgical interventions for atypical facial pain or facial pain secondary to other causes were excluded. Meta-analysis was conducted for reductions in symptom scores and adverse effects.

Results: Of 3,409 articles screened, 73 full-text articles were included, consisting of 45 observational studies and 29 randomized controlled trials. Twenty-four different pharmacological agents were assessed; carbamazepine was the most frequently studied while botulinum toxin A demonstrated the highest consistency in reduction of symptom scores. Pooled estimate of three randomized controlled trials revealed that patients with trigeminal neuralgia who received botulinum toxin A had higher odds (odds ratio 7.46; 95% CI 3.53-15.78) of achieving a ≥50% reduction in visual analogue scale scores compared to controls. Pooled estimate of 15 observational studies
showed that three-fourths of patients with trigeminal neuralgia who received carbamazepine experienced clinically significant pain reduction (prevalence proportion 0.75; 95% CI 0.66-0.83).

Conclusions: : Patients receiving botulinum toxin A for trigeminal neuralgia had higher odds of achieving ≥50% reduction in pain scores. A significant proportion of patients with trigeminal neuralgia experienced positive response to carbamazepine. There was moderate evidence for amitriptyline in patients with atypical facial pain. Standardization of outcome reporting would facilitate future quantitative comparisons of therapeutic effectiveness.

Reviewer’s comment:

Facial neuralgia and atypical facial pain (persistent idiopathic facial pain) are disorders that have an enormous impact on patients’ quality of life. Both clinical entities can coexist, and recent studies suggest that they share similar mechanisms, being distinct manifestations of the same neuroexcitatory phenomenon. The differential diagnosis is often complex, requiring the intervention of different specialists and the implementation of multimodal treatment plans. In this area, among the various therapeutic options, the first treatment of choice is neuromodulatory drugs.

  • The authors of this paper review the efficacy of these drugs in facial neuropathic pain. They review 73 studies (45 observational and 29 randomised clinical trials), with a total of 2,807 patients using a total of 24 different psychotropic drugs. The methodological diversity among the studies limits the results, but it is concluded that:

1. Carbamazepine is effective in three quarters of trigeminal neuralgias. It could be considered the first choice.

2. Botulinum toxin type A would also be effective in trigeminal neuralgia, with a ≥50% reduction in pain, according to Visual Analogue Scale recordings. It would facilitate central and peripheral desensitisation.

3. As for the other drugs, only Amitriptyline is moderately effective for atypical facial pain.

Neuropathic pain phenomena alter nociception, both centrally and peripherally. It has been suggested that central and peripheral excitability may enhance each other, justifying simultaneous action on different targets. From this point of view, peripheral blockades in patients refractory or intolerant to pharmacological treatments could benefit from more or less invasive infiltrative techniques. This is why, according to the authors, coadjuvant peripheral blocks with Lidocaine or Ropivacaine are increasingly used in the treatment of these patients.

Reviewer: Fco. Javier Hidalgo Tallón (MD, Phd. DDS). Clinical Neurosciences.


Theoretical Basements for a Clinical Trial on COVID-19 Patients with Systemic Ozone Therapy

Category : Clinalgia Pain

Francisco Javier Hidalgo Tallón1,4*, Silvia Menendez-Cepero2, José Baeza-Noci3 and GonzaloGea Carrasco5

1Institute of Neuroscience, University of Granada, Spain
2Scientific Advisor, 1350 Asturia Ave. Coral Gables, 33134-Florida, USA
3School of Medicine and Surgery, University of Valencia, Spain
4Department of Ozone Therapy and Chronic Pain, Catholic University San Antonio of Murcia (UCAM), Spain
5Catholic University San Antonio of Murcia (UCAM), Spain
*Corresponding author: Francisco Javier Hidalgo Tallón, Institute of Neuroscience, University of Granada, and Department of Ozone Therapy and Chronic Pain, Catholic University San Antonio of Murcia (UCAM), Spain; E-mail: fjht63@gmail.com
Received: January 12, 2021; Accepted: January 21, 2021; Published: February 12, 2021


Abstract

Systemic ozone treatment has proved, in different clinical studies, to enhance exchange of gases and blood circulation, improve lung function in chronic pulmonary diseases, reduce viral load in patients infected by Herpes virus, Hepatitis B and C virus, Human Immunodeficiency virus and reduce significantly IL-6 and other proinflammatory cytokines in chronic inflammation diseases. All these results support the rationale to set up a clinical trial for patients suffering COVID-19 as an adjuvant treatment until we found an eventual cure.
Keywords: COVID-19, Ozone therapy, SARSCoV2, Systemic ozone treatment


Proposed Hypothesis

Due to the extreme world situation caused by COVID19 pandemic we consider unethic not to try any treatment option with a justified rationale. We have explained that medical ozone therapy has a clear scientific basement thanks to all preclinical investigation already published. It can be classified as chemical stressor that produces a modulation of the redox balance and immunity. Moreover, it is easy and safe to administer [1]. The efficacy in viral diseases have been published together the modulation of IL-6 and other proinflammatory cytokines that could potentially help in COVID19 patients. We proposed to carry out a randomized control trial to evaluate the safety and efficacy of systemic ozone (indirect endovenous and rectal) in these patients.

Introduction
Coronavirus

The new Severe Acute Respiratory Syndrome (SARS) produced by the new coronavirus, SarsCoV2, has been expanding since past December and declared by WHO as pandemic. Today (March, 27th, 2020) there are 465915 confirmed patients and in Spain the number of cases is 65719 [2]. Mortality rate is around 3.7% and there is no proved treatment [3]. From a clinical point of view, it produces an acute respiratory distress with hemophagocytic lymphohystiocytosis that induces a fatal increase of blood cytokines. The patients also show increased ferritin, interleukyne 6 (IL-) and decrease of platelets as markers of a starting huge inflammation process that can lead to heart failure [4]. In severe ill patients, we found increased prothrombin time, partial thromboplastin time, D-dimer, lactate-dehydrogenase, procalcitonine, albumin, C-reactive protein and aspartate aminotransferase [5].

Medical Ozone Therapy

Medical ozone is a mixture of ozone and medical oxygen produced by a trustable and accurate medical device. Ozone therapy is the use of medical ozone, a safe therapeutic agent, to treat pain and other diseases. Due to the growing interest on these techniques, the World Federation of Ozone Therapy – WFOT published in 2015 a scientific review devoted to health professionals interested in knowing and understanding the biochemistry, pharmacology and indications of medical ozone [6].

Ozone Germicidal Effect

Ozone has proved its efficacy against virus, bacteria (gram positive as well as gram negative), fungus and spores. This is due to its high oxidant capacity that cannot be handled by the classical microbial resistance mechanisms and damages the microbial membranes irretrievably [7]. Its effect is universal but selective. Universal, because it is effective in all microbes, even for Pseudomonas aeruginosa and Escherichia coli, both with a high antibiotic resistance. Selective, because it respects eukaryot healthy cells, due to the huge antioxidant capability of them and their environment. We can find papers about this effect on MS2 bacteriophage virus, Norwalk Virus, poliovirus 1, hepatitis A and Coxsackievirus [8-11].

The inner mechanism of germicidal effect is due to:

• Double bounds in polyunsaturated fatty acids (PUFA) of the membrane being broken by ozone.
• Amino acids (cysteine, methioine, histidine) reacting with ozone in their thiols groups.

Over viruses, apart from the membrane damage, lipid peroxides from the membrane reaction interfere the reverse transcriptase, basic for the virus replication [12]. This antimicrobial effect has nothing to do with the in vivo mechanisms of action that contribute to the infection cure and that could be useful for COVID-19 patients.

Bilological Effects of Medical Ozone

The administration of medical ozone in order to protect and repair organic damage has demonstrated to be an effective and safer stress than the ischemic one. Ozone has proved to be effective against hepatic damage induced by ischemia/reperfusion [13-17], partial hepatectomy [18] or toxicity by carbon tetrachloride [19] or methotrexate [20]. It has also been proved that ozone enhances the ketamine hepatoprotection in septic rats [21]. Similar findings have been reported for renal damage in ischemia/reperfusion models [22-28], toxicity due to radiological contrast [29], adriamicine [30], partial nephrectomy [31], diabetes [32] or methotrexate [33].

Also, in heart and skeletal muscle damage due to ischemia/reperfusion or toxicity by doxorubicin [34-38]. Intestinal damage induced by methotrexate [39], lung irradiation damage [40], fecal peritonitis [41] and endotoxic shock [42]. From these papers about ozone oxidative preconditioning, we know the biological mechanisms underneath the tissue restoration induced by the ozone mild controlled oxidative process. The biochemical reaction of medical ozone on the PUFA transported by albumin generates (Criegee’s reaction) alpha-hydroxy-hydroperoxydes, hydrogen peroxide, and aldehydes, like 4-hydroxynonenal. These last are well known signaling molecules modulating inflammation, proliferation, growing and cellular death (necrotic or apoptotic) [43,44].

The mild acute oxidative stress induced by ozone also modulates the activation of different nuclear transcription factors (NF) [45]: Nuclear Factor of Activated T-cells and Activated Protein-1, Goth related with immunity, Hypoxia Inducible Factor-1a, related with vascular degeneration and NRF2 (Nuclear factor Erythroid-2-Related Factor-2), that regulates the synthesis of mediators of inflammation and antioxidant enzymes (SOD, GPx, GSTr, CAT, HO-1, NQO-1, NADPH). Also modulates the release of heat shock proteins (HSP) that have a protective effect [46] especially in oncological [47,48] and infectious diseases [49]. Pecorelli and Bocci checked an increase of NRF2 in plasma from healthy volunteers after ozone administration to cell cultures. The increase was dose related with a positive increase as ozone dose increased from 20 to 80 μg/mL [50,51]. Similar results were published by Re and cols. that also observed an increase in several heat shock proteins: HSP-60, HSP-70 y HSP-90 [52]. Related with this NRF2 modulation, a decrease in proinflammatory cytokines in multiple sclerosis patients has been published [53].

In erythrocytes, mainly through hydrogen peroxide that accelerates intra erythrocytes glycolysis and so, produces more ATPand an increase of 2, 3-DPG, two changes are induced that help to improve blood circulation:

1. The increase of 2, 3-DPG produces a shift to the right in the oxygen/hemoglobin dissociation’s curve (Bohr effect) [54]. There is an increase in the exchange of gases in lungs and peripheral tissues because of this.
2. Improvement of the Na/K2+ membrane pump, ATP dependent, that restores the membrane function usually affected in chronic illness [55]. This effect improves the blood rheology and microcirculation.

Moreover, ozone lipid peroxides induce the release of endothelial nitric oxide and nitrosotyhyols [56] that induce local and remote vase dilatation, antithrombosis and regulation of heart contractility [57,58].
All these effects produce a great improvement of peripheral tissues oxygenation [59].

Clinical Studies

Clinical applications of medical ozone started at the beginning of the last century. In 1911 Dr. Noble Eberhart, chief of the department of physiology in University of Loyola (Chicago, Illinois, USA) published the book “A Working Manual of High Frequency Currents” that promotes the use of medical ozone for TBC, anemia, asthma, bronchitis, diabetes and others [60]. Today, in PubMed we can find more than 3000 papers on ozone therapy and more than 1200 are clinical studies [61]. Medical ozone therapy is used in Pain Medicine since 80s [62,63] having presently the highest level of evidence for specific indications; also, some dental applications have also a high level of evidence, mainly due the germicidal effect already commented.

Cardio and Cerebrovascular Diseases

The generic improvement of the blood circulation caused by medical ozone and the specific effect on the atheromatous plaque will be especially useful for this kind of diseases [64-66]. Giunta and cols. checked that 27 patients suffering of peripheral occlusive arterial disease treated with systemic medical ozone improved, not also the antioxidant capability but also the blood’s perfusion and viscosity, hematocrit and fibrinogen, with no side effect [67]. A Cuban study recruited 120 patients with risks factors for heart attack and randomized them in 2 groups: control and treatment (ozone rectal insufflation). During one year, each 3 months, several clinical and biochemical parameters were registered. Ozone group was quite more stable both clinical and biologically. No side effects were found [68]. Other Cuban team treated 22 patients post heart attack with systemic indirect endovenous ozone application daily for 3 weeks and showed an improvement in the lipid metabolism and antioxidant capability. No side effects were detected [69]. The same team treated 120 patients with acute, subacute and chronic cerebrovascular disease. After 20 applications of rectal ozone, 86% of the patients improved clinically, specially the acute ones [70].

Neumology

A published clinical trial proved the efficacy of systemic ozone at different doses and ways of administrations in asthmatic patients. Improved in Ig E and antioxidant status together a decrease in inflammation markers. Indirect endovenous ozone was more effective at the same dose [71]. These findings were also found in a group of patients with emphysema treated with 2 cycles of 20 applications of rectal ozone insufflation. They found no side effect [72]. Borrelli and Bocci randomized 50 patients suffering chronic obstructive pulmonay disease in 2 groups: control and treatment with systemic indirect endovenous ozone. There found no improvement in basal oxygenation or lung function but they found improvement in effort tests: 6MWT, Borg dyspnoea scale, SGRQ, concentration and memory capability. No side effects were observed [73].

Immunomodulation

In 1990, Bocci and Paulesu studied the in vitro effects of ozone on human blood’s leukocytes in concentrations from 2.2 and 108 mcg/mL for 30 seconds. These authors found that concentrations around 42 mcg/mL were optimal for increasing interferon [74]. Years later, another in vitro studies showed that 40mcg/mL produced optimal modulation on NFKβ and pro inflammatory cytokines without any side effect [75,76]. Primary IgA deficiency patients found more improvement with systemic ozone that with Transfer Factor 1 [77]. In secondary immunodeficiency pediatric patients treated with systemic ozone also improved clinically with a decrease in the infection rate and without side effects [78].

Chronic Inflammation and Autoimmune Diseases

Medical ozone has shown efficacy and safety in the treatment of chronic inflammatory intestinal diseases [79,80] and rheumatoid arthritis [81,82]. All parameters improved in the groups treated also with systemic ozone.

Clinical trials have validated a decrease in IL-6 and other proinflammatory cytokines in diabetes mellitus [83], multiple sclerosis [53] and lumbar disc herniation patients [84]. This decrease was correlated with a clinical improvement and a stabilization in the course of the diseases.

Viral Infections

Herpes Virus. Medical ozone has found to be effective for herpes virus through local injections, topical ozonized oil and water and also in systemic administration. In postherpetic neuralgia, clinical enhancement has been detected through clinical studies with control groups using injected ozone around the dorsal root ganglium alone [85], combined with pregabaline [86] or with retrovirals and acupuncture [87] and epidural injected [88]. Also, ozone injections have been tested with and without pulsed radiofrequency showing the superiority of combining both treatments [89]. Trigeminal postherpetic neuralgia also improved with local injections of ozone around Gasser ganglium [90]. In mouth pathology, ozonized oil has found to be useful for cold sores [91]. Other studies have been published about topical ozonized oil and water in cutaneous herpetic neuralgia with positive results [92,93].

Systemic ozone has proved to reduce significantly viral load in Herpes 1, 2 and Citomegalovirus [94]. Other controlled trials showed improvement not only for viral load but also for pain and quality of life. No side effects were found [95].

HIV. Based on in vitro preclinical studies [96] some authors have proposed and tried the efficacy and safety of systemic ozone in HIV. Bocci tested indirect endovenous approach [97] in 12 patients; after 7 months with 50 applications for patient and no side effect, he found no change in viral load [98]. Garber did 2 clinical studies (phase I and II) using indirect endovenous ozone in 10 HIV patients. Ozone therapy was well tolerated but did not improve either any analytic parameter; although some clinical improvement was found for concomitant pathologies [99]. We want to mention Carpendale publication that obtained good results in reducing the diarrhea of these patients with rectal ozone insufflations [100]. Recently, Cespedes and cols. have published good results with a significant decrease of viral load and increase in CD4 and CD8 in 32 patients with 15 applications of systemic indirect endovenous ozone. No side effects were reported and quality of life improved [101].

Viral Hepatitis. Both, systemic indirect endovenous or rectal insufflation application of ozone have found to be effective. In 2009, Neronov published his experience on chronic B hepatitis. He concluded that there was an improvement in clinical and biochemical parameters and a decrease in gallstone rate [102]. These results were confirmed later by Chemishev [103]. A randomized control trial was published in 2008 treating 40 hepatitis B patients with conventional treatment and 20 of them also with systemic endovenous ozone. The improvement was significantly greater in the ozone group [104]. Last study on hepatitis B showed that 28 patients with clinical stability under retroviral treatments were submitted for systemic indirect endovenous ozone treatment. After 15 applications, HBs Ag and viral load decreased [105]. For hepatitis C, a similar study was done founding a greater decrease in ALT, AST and viral load; the decrease was proportional to the number of applications [106].

Gu and cols studied patients with severe chronic hepatitis C and renal failure. The randomized trial showed an improvement in liver and renal function with also an increase survival rate in the systemic ozone group [107].

Safety of Medical Ozone Therapy
Medical ozone therapy, properly applied, has been found safe thanks to all preclinical toxicological test performed according to Food and Drug Administration (FDA), World Health Organization and Cuban Regulatory Agency rules [108]. Acute and chronic toxicological tests have been carried out for rectal and intraperitoneal administrations. No adverse reaction was related to ozone. For rectal insufflation, also irritation test was performed with no side effect registered neither in acute or chronic administration.

The safety of ozone on blood was thoroughly studied by Bocci and cols [57]. Moreover, no adverse reaction was found for mutagenic, carcinogenic and teratogenic tests, in vitro and in vivo. However, ozone breathing was found to be extremely toxic, due to the minimal antioxidant capability of the alveolar fluid [109].

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Cita:
Hidalgo Tallón FJ, Menendez-Cepero S, Baeza-Noci J, Carrasco GG (2021) Bases teóricas para un ensayo clínico en pacientes COVID-19 con ozonoterapia sistémica.
J Neurol Neurocrit Care Volumen 4(1): 1-6.

J Neurol Neurocrit Care, Volume 4(1): 6–6, 2021


Dr. Francisco Javier Hidalgo Tallón, expert in chronic pain and ozone therapy.

Category : Clinalgia Pain

 

 

 

 

 

 

 

Today we would like you to learn more about the professional career of Dr. Francisco Javier Hidalgo Tallón, a doctor specialising in Stomatology, expert in Ozone Therapy and Pain Medicine, director of Clinalgia, doctor at the Institute of Neurosciences of the University of Granada and director of the Chair of Ozone Therapy and Chronic Pain at the UCAM, he is one of the world authorities in the knowledge of medical ozone. A renowned researcher, he provides innumerable scientific evidences of the benefits of ozone on the body’s defences and offers a range of therapeutic possibilities that are worth investigating and applying.

Dr. Francisco Javier Hidalgo is a doctor with extensive experience in the field of chronic pain treatment and a pioneer in Spain in the scientific study of ozone applied to medical treatments for fibromyalgia and other chronic pain-related ailments.

Abbreviated CV of Dr. Francisco Javier Hidalgo Tallón

    • Degree in Medicine (University of Granada),
    • Degree in Dentistry (University of Granada),
    • Specialist in Stomatology (Complutense University of Madrid).
    • Doctor of Medicine (University of Granada, Institute of Neurosciences).
    • Postgraduate stay in implantology and periodontology at the New York College of Dentistry, at the Department of Orofacial Pain at the University of Kentucky and at the Ozone Therapy Research Centre in Havana.
    • Master’s degree in implantology, oral rehabilitation and biomaterials (Paris XV University).
    • University expert in anti-ageing medicine (University of Seville).
    • Expert in musculoskeletal ultrasound (International University of La Rioja).
    • Expert in anaesthesiology and pain therapy (CEU Cardenal Herrera University).
    • Teaching collaborator, mainly on subjects related to pain medicine, at the universities of Granada, País Vasco, CEU San Pablo, Complutense de Madrid, Juan Carlos I, Alcalá de Henares, Miguel Hernández, Valencia, Seville, Cádiz and Paul Sabatier (Toulouse III).
    • Associate researcher at the Institute of Neurosciences of the University of Granada and coordinator of practices of the Master’s Degree in Basic, Applied and Pain Neurosciences.
    • Co-author of 25 articles in high-impact scientific journals. Co-director of two doctoral theses. Author of 4 book chapters.
    • President of the XXIX National Congress of the Spanish Society of Craniomandibular Dysfunction and Orofacial Pain (SEDCYDO).
    • 1st Vice-President of the Spanish Society of Ozone Therapy (SEOT).
    • Lecturer at more than 100 national and international congresses.
    • Currently working as director of two private pain units (Clinalgia).
    • Director of the Company/University Chair of ozone therapy and chronic pain at the University of San Antonio de Murcia. Coordinator of the Ozone Therapy in Pain Medicine workshop at the International Pain Forum of Menorca.

Improving the quality of life of our patients

Dr. Francisco Javier Hidalgo Tallón explains in a few words what is done in his clinics: “We apply treatments with our own medical protocols, which are simple, safe and cutting-edge, scientifically backed by the most advanced scientific advances. We rely on our own lines of research that have allowed us to assemble a team that develops unique protocols.

Our main objective is to improve people’s quality of life through the application of therapies and the implementation of changes in lifestyle habits”.

“We can change the patient’s quality of life dramatically from the fourth week onwards. We slow down the evolution of many chronic processes that limit the quality of life day by day.”

“We really bring 21st CENTURY medicine, with very well tolerated treatments, with surprising effects, which will give our patients quality of life at the highest level.”

 

Dr. Francisco Javier Hidalgo Tallón, experto en dolor crónico y antienvejecimiento.
Dr. Francisco Javier Hidalgo Tallón, expert in chronic pain and anti-aging..

Support for fibromyalgia

Another activity that has been important to Dr. Fco. Javier Hidalgo for some time is his dedication to fibromyalgia patients.

The aim is to coordinate resources and to be a facilitator of the different projects and activities that can be planned and organised around fibromyalgia and to involve the population affected by the disease in order to support them:

¬ From the clinical point of view, facilitating the access of these patients to multidisciplinary and effective treatment plans, which might otherwise be inaccessible to a large part of them.

¬ In the social sphere, by facilitating the relationships of those affected with those entities that could be of interest to them in relation to their illness.

¬ Thirdly, to establish training-educational models of action and to disseminate the problems of these patients, helping to make the disease known and understood.

¬ And lastly, to carry out research projects that allow the development of new therapeutic alternatives, as well as a greater knowledge of the disease.

Its research and training work

Another important part is dedicated to research and training.

Training and research are important assets for Clinalgia, so that numerous training activities are carried out, led personally by Dr. Fco. Javier Hidalgo Tallón, both at the university and in the clinics, as well as continuous training.

Director de la Cátedra de Ozonoterapia y Dolor Crónico de la U.C.A.M
The UCAM and Clinalgia have created a chair in ozone therapy and chronic pain, directed by Dr. Fco. Javier Hidalgo Tallón, which will investigate ozone therapy in sports medicine, oncology, dentistry and processes related to oxidative stress.

ith this training project, monographic courses on pain are given with the aim of transmitting knowledge, generating interest in the model and obtaining official publications.

Sports Physician

Finally, Dr. Fco. Javier Hidalgo reminds us that sports medicine has a long way to go with ozone and its treatments, athletes obtain surprising benefits, as in the case of the Pérez Moreno brothers, who after injuries that were going to take them away from sport for good, have returned and beaten their own records.

“We really bring 21st CENTURY medicine, with very well tolerated treatments, with surprising effects, which will give our patients quality of life at the highest level”.

For more information about Dr. Hidalgo Tallón: LinkedIn Professional Profile 


OZONE HERNIATED DISC STUDY

Category : Clinalgia Pain

Research study demonstrates the efficacy of ozone therapy in the treatment of herniated discs.

Percutaneous ozone treatment for herniated lumbar discs:

1-year follow-up of a multicenter pilot study of a disposable hand-held device that generates ozone in disc herniation.

Purpose

To evaluate the safety and efficacy of oxygen-ozone treatment delivered via a new hand-held ozone-generating device to improve pain and function in patients with herniated discs.

Materials and Methods.

A total of 39 patients with herniated lumbar discs received oxygen-ozone treatment at 1 of 3 centers.

Treatment consisted of 2% ozone injection (10 ml): 3 ml administered into the nucleus pulposus and 7 ml administered into the adjacent paravertebral tissues.

The first 8 patients received ozone injections only, while subsequent patients also received periganglionic methylprednisolone (40 mg) and 0.5% bupivacaine injections (1 ml).

Patients were assessed at baseline and at 1 month, 6 months, and 12 months after treatment using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for leg pain and back pain.

Analgesic medication use was also assessed at each time point.

Results

Overall, 91% (32/35) of patients per protocol (those who completed follow-up and had no significant deviations from protocol) showed detectable improvement in ODI at 1-month follow-up; this increased to 93% (26/28) of patients at 12-month follow-up.

1 month after treatment, 60% (21/35) of patients showed significant improvement in ODI scores ( p = .01); 54% (19/35) showed significant improvement in VAS scores for leg pain ( p = .05); and 49% (17/35) showed significant improvement in VAS scores for back pain ( p = .12).

At 6 months after treatment, 67% (22/33) of patients showed significant improvement in ODI scores ( P = .02); 64% (21/33) showed significant improvement in VAS scores for leg pain ( P = .01); and 52% (17/33) showed significant improvement in VAS scores for back pain ( P = .12).

At 12 months after treatment, 68% (19/28) of patients showed significant improvement in ODI scores ( P < .01); 64% (18/28) showed significant improvement in VAS scores for leg pain ( P < .01); and 61% (17/28) showed significant improvement in VAS scores for back pain ( P = .09).

Leg pain generally decreased more rapidly than back pain.

Analgesic medication use also decreased significantly at all follow-up time points compared to baseline ( p <0.01). There were no adverse events or device-related problems.

Conclusions

At 1, 6, and 12 months after treatment, patients experienced significant improvements in pain and function, as well as a significant decrease in analgesic use.

Taken together with the absence of adverse events at 1-year follow-up, these data suggest that oxygen-ozone treatment is a safe and effective therapy for discs with contained herniation.

Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.

Author information.

Department of Anesthesia, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.

Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.

Department of Radiology, London Health Sciences Centre, University of Western Ontario, London, Canada.

Joint Department of Medical Imaging, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.

Joint Department of Medical Imaging, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8. E-mail address: kieran.murphy@uhn.ca.

Original article at: https://bit.ly/2IkRwkR

 


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Sobre Nosotros

MARIA DEL MAR MARTIN
MARIA DEL MAR MARTIN
20:16 18 Feb 20
Equipo muy profesional, alta capacidad de escucha para solucionar tus problemas, tecnología innovadora. Realmente me... están ayudando, tanto emocional o físicamente. Personal muy humanoread more
Cecilia Llantada Zapiain
Cecilia Llantada Zapiain
12:07 06 Feb 20
Hace 23 años que vine a Clinalgia, tenía dolores en distintas partes del cuerpo y de la cabeza, acudí a tres... especialistas que después de hacerme distintas pruebas me recomendaron acudir con el Dr. Hidalgo, hasta la tercera valoración me decidí a ir, menos mal que lo hice, desde entonces veo las cosas desde otro prisma, me enseñaron que no tenemos por qué creer que el dolor es normal. Existe la vida sin dolor! Gracias al Dr. Hidalgo y a su equipo por su cariño y su paciencia. Hace tiempo me trasladaron a Madrid y sigo viniendo para continuar mi estado saludable. Aun cuando mi enfermedad no tiene cura definitiva, me dan calidad de vida, que ya es mucho. Muchas gracias!read more
Encarna Box Casales
Encarna Box Casales
12:24 03 Feb 20
Llevo un año, y estoy encantado, ahora tengo calidad de vida. Y el personal y el medico genial y el trato excelente
Natalia Mora
Natalia Mora
16:23 31 Jan 20
Un equipo profesional, capaces de acertar en el diagnóstico y proporcionar un tratamiento muy efectivo. Siempre... dispuestos a escuchar y solucionar con amabilidad cualquier tipo de dolenciaread more
Juani Navarro Lopez
Juani Navarro Lopez
14:22 31 Jan 20
Cuando empecé a ir a Clinalgia, y a ponerme el tratamiento de ozonoterapia, junto con una dieta antiinflamatoria, que... me mandó el Dr.Fr.Javier Hidalgo Tallón, antes de la cuarta sesión, podía andar deprisa y sin dolor, no me lo podía creer, yo estaba rabiando, tengo Fibromialgia severa y a diario, no por brotes, pero desde que me empecé a poner éste tratamiento de ozonoterapia, y todo lo que me manda el Dr.Fr.Javier Hidalgo Tallón, tengo más calidad de vida, que antes no tenía, Aunque es una enfermedad, con muchos síntomas, y siguen investigando......read more
Maria Isabel Zuazu Jausoro
Maria Isabel Zuazu Jausoro
18:17 29 Jan 20
Para mí el resultado excelente El Dr Hidalgo es un gran profesional al igual que su equipo. Hace catorce años que... recibo tratamientos con ellos y estan a la vanguardia del tratamiento del dolor.read more
Julia Cañizares
Julia Cañizares
12:29 28 Jan 20
Una clínica única en el tratamiento del dolor crónico. Sus especialistas no sólo tratan el dolor, sino las Causas del... dolor, con un enfoque multidisciplinar ejemplar, y un trato humano difícil de encontrar actualmente.read more
Antonia Rodriguez Lopez
Antonia Rodriguez Lopez
16:49 27 Jan 20
Bueno que voy a decir yo de esta clínica los conozco quince años para mi es lo mejor que hay .. los profesionales son... geniales el doctor Javier Idalgo es no tengo palabras para describirlo es de lo mejor que existe sus tratamientos súper efectivos mi hijo empezó con ellos que no hera persona y gracias a este gran equipo pude ser alguien que puede levantarse de la cama y ahora tener una vida normal.. Y podría seguir y seguir diciendo cosas buenas de todos ellos pero lo mejor esque lo haberigueis por vosotros mismo un gran saludo a todos...read more
Santi Hernandez Martinez
Santi Hernandez Martinez
17:19 02 Dec 19
Podría decir muchas cosas, pero lo más importante es q comprenden a las personas q como yo , tienen dolor crónico y... eso, es muy difícil de encontrar, esta enfermedad es difícil porque preocupa a tus familiares y aburre a tus amigos, tienes q ser fuerte ponerte una careta y parecer q estás bien. Yo sé q no me voy a curar pero cuando hablo con Javier parece q estoy mejorando cada vez mas, me anima y me hace sentirme mucho mejor. Él restos de las personas q forman la clínica, a mí, me tratan con un cariño infinito q no sé si me lo merezco, siempre me encuentran solución cuando tengo una crisis o un problema de horario. Como verán todo son palabras de agradecimiento a unas personas q forman en conjunto un gran grupo humano, pienso seguir apoyándome en vosotros mucho tiempo, me hacéis un gran bien.read more
Francisco Martinez Rodenas
Francisco Martinez Rodenas
19:00 29 Nov 19
De estar con un fuerte y punzante dolor en las rodillas he pasado a poder agacharme y levantarme. Un diez para este... gran equipo.read more
mari carmen mc
mari carmen mc
16:59 28 Nov 19
Muy bien a mí me fue fenomenal, empecé con mucho dolor y después del tratamiento estoy muy bien hace tiempo que no... necesito volver a ir.le doy las gracias a todo el equipo que se portó fenomenalread more
DAVID PALACIO
DAVID PALACIO
21:23 07 Nov 19
Tenia una lesión en el tendón de Aquiles que nadie me recuperaba. Tras varios meses de tratamiento por completo, las... molestias desaparecieron por completo y ahora estoy en el mejor momento de mi carrera deportiva. Trato muy profesional y totalmente individualizado.read more
gustavo piñero
gustavo piñero
16:54 06 Nov 19
Buenos profesionales, trato humano y mucha atención a la persona. Buena actitud hacia la enfermedad. Lo recomiendo.
Alberto S De la Torre
Alberto S De la Torre
07:18 05 Nov 19
Hace 14 años que me estan tratando, de querer darme la incapacidad a seguir trabajando y haciendo deporte. Un trato... espectacular, amables, siempre atentos y cercanos. Una persona no puede estar en mejores manos que en las suyas especialmente las del Dr. Hidalgo Tallón. Recomendable 100%read more
Mar Gómez nicolas
Mar Gómez nicolas
20:43 04 Nov 19
Conozco Clinalgia desde hace más de 2 años, soy deportista de élite y pasar por sus manos dio un salto de calidad... enorme en mis resultados, recuperaciones y mantenimiento. El trato humano es especial, se implican al máximo con cada paciente y con cada tratamiento, buscando y dando siempre con la mejor respuesta. He recomendado a compañeros deportistas y a los que no lo son por que tratan el dolor y las molestias a todos en general. Con el doctor Javier Hidalgo a la cabeza son un equipo fantástico a los que siempre estaré agradecida .read more
Loli Carmona Gonzalez
Loli Carmona Gonzalez
18:59 04 Nov 19
Clinalgia es para mí una Clínica dónde la profesionalidad, el trato y las atenciones por parte de todo el equipo son... extraordinarias. Gratitud, gratitud y gratitud hacia todos y muy especialmente al Dr. Javier Hidalgo. Hablar de esta clínica es hablar de calidad de vida.read more
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