title: Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Low back pain (LBP) is one of the most common and important health problems affecting the population worldwide and remains mostly unsolved. Ozone therapy has emerged as an additional treatment method. Questions persist concerning its clinical efficacy.
  
  
  OBJECTIVE
  The purpose of our study was to evaluate the therapeutic results of percutaneous injection of ozone for low back pain secondary to disc herniation.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials.
  
  
  METHODS
  A comprehensive literature search was conducted using all electronic databases from 1966 through September 2011. The quality of individual articles was assessed based on the modified Cochrane review criteria for randomized trials and criteria from the Agency for Healthcare Research and Quality.
  
  
  METHODS
  The outcome measure was short-term pain relief of at least 6 months or long-term pain relief of more than 6 months.
  
  
  RESULTS
  Eight observational studies were included in the systematic review and 4 randomized trials in the meta-analysis. The indicated level of evidence for long-term pain relief was II-3 for ozone therapy applied intradiscally and II-1 for ozone therapy applied paravertebrally. The grading of recommendation was 1C for intradiscal ozone therapy and 1B for paravertebral ozone therapy.
  
  
  CONCLUSIONS
  The main limitations of this review are the lack of precise diagnosis and the frequent use of mixed therapeutic agents. The meta-analysis included mainly active-control trials. No placebo-controlled trial was found.
  
  
  CONCLUSIONS
  Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.
authors.affiliation: Hospital das Clnicas, Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Francisco N De Oliveira
authors.initials: FN
authors.lastname: Magalhaes
authors.forename: Luciana
authors.initials: L
authors.lastname: Dotta
authors.forename: Andre
authors.initials: A
authors.lastname: Sasse
authors.forename: Manoel J
authors.initials: MJ
authors.lastname: Teixera
authors.forename: Erich T
authors.initials: ET
authors.lastname: Fonoff
mesh_terms: D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D007405:Intervertebral Disc Displacement / Q000503:physiopathology*; D017116:Low Back Pain / Q000188:drug therapy* / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D010126:Ozone / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D010126:Ozone