Publication: Eficacia del ozono por vía epidural caudal en el tratamiento del dolor lumbar irradiado
Authors
López López, José Miguel
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Escuela Internacional de Doctorado
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Rubio Gil, Enrique
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Introducción
El dolor lumbar es la principal causa de vivir con discapacidad a nivel mundial. La infiltración epidural caudal es una opción terapéutica para el dolor lumbar irradiado. La adición de ozono médico podría potenciar el efecto analgésico y funcional con un perfil de seguridad favorable. El objetivo fue comparar la eficacia de la infiltración epidural caudal con anestésico local y corticoide en tres grupos con estrategias diferentes: sin ozono, con ozono 15 mcg/ml y a 25 mcg/ml.
Material y Método
Se realizó un estudio analítico observacional retrospectivo en la Unidad de Dolor Crónico del Hospital General Universitario Reina Sofía (HGURS) entre los años 2020 y 2022. La muestra incluyó 98 pacientes con dolor lumbar por radiculopatía secundaria a discopatía, con clínica superior a 3 meses y EVA basal > 7. Los pacientes se distribuyeron en tres grupos: No Ozono, Ozono 15 mcg/ml y Ozono 25 mcg/ml.Los pacientes se valoraron antes de la intervención y el seguimiento se realizó a los 15 días, 3 meses y 6 meses. El análisis se centró en la intensidad del dolor (EVA), la discapacidad funcional (ODI), el dolor neuropático (NPSI) y la calidad de vida (cuestionario de salud SF- 36).
Resultados
Los tres grupos mejoraron de forma significativa a corto plazo (15 días) en el EVA y el ODI. Sin embargo, la evolución temporal fue paralela observándose un repunte paulatino de los síntomas en los grupos No Ozono y Ozono 15 mcg/ml, mientras que el grupo Ozono 25 mcg/ml mantuvo una trayectoria más estable del dolor y la discapacidad a 3 y 6 meses.Las diferencias más relevantes se observaron en el dolor neuropático y la calidad de vida. El grupo Ozono 25 mcg/ml mantuvo la disminución de síntomas (NPSI) hasta los 6 meses, con diferencias inferiores estadísticamente significativas al resto de los grupos. Este grupo presentó, a los 3 meses, en el SF-36, una evolución significativamente más favorable en ocho de las nueve dimensiones.
Conclusiones
La ozonoterapia epidural caudal aplicada a 25 mcg/ml se asocia con un efecto dosis- dependiente superior y sostenido. Modula el dolor; mejora la calidad de vida y los síntomas neuropáticos, posicionándose como estrategia terapéutica valiosa en el manejo conservador del dolor lumbar irradiado crónico.Palabras clave: dolor lumbar; radiculopatía; ozonoterapia; epidural caudal; EVA; ODI; NPSI; SF-36; calidad de vida; dolor neuropático.
Introduction Low back pain is the leading cause of years lived with disability worldwide. Caudal epidural injection is a therapeutic option for radiating low back pain. The addition of medical ozone may enhance the analgesic and functional effect with a favourable safety profile. The objective was to compare the efficacy of caudal epidural infiltration with local anaesthetic and corticosteroid in three different strategies: without ozone, with ozone 15 mcg/ml, and with ozone 25 mcg/ml.Material and Methods A retrospective analytical observational study was conducted in the Chronic Pain Unit of Hospital General Universitario Reina Sofía (HGURS) between 2020 and 2022. The sample included 98 patients with lumbar radiculopathy secondary to disc disease, with symptoms lasting more than 3 months and baseline VAS > 7.Patients were allocated into three groups: No Ozone, Ozone 15 mcg/mL and Ozone 25 mcg/ml. Patients were assessed before the procedure, and follow-up evaluations were performed at baseline, 15 days, 3 months, and 6 months. The analysis focused on pain intensity (VAS), functional disability (ODI), neuropathic pain (NPSI), and quality of life (SF-36 health survey). Results All three groups showed significant short-term improvement (15 days) in VAS and ODI. However, their temporal evolution diverged: both the No Ozone and Ozone 15 mcg/ml groups showed a gradual rebound of symptoms, whereas the Ozone 25 mcg/ml group maintained a more stable trajectory of pain and disability at 3 and 6 months. The most relevant differences were found in neuropathic pain and quality of life. The Ozone 25 mcg/ml group maintained the reduction in NPSI symptoms up to 6 months, with statistically significantly lower values compared with the other groups. At 3 months, this group showed a significantly more favourable progression in eight of the nine SF-36 dimensions. Conclusions Caudal epidural oxygen-ozone therapy at 25 mcg/ml is associated with a superior and sustained dose-dependent effect. It modulates pain, improves quality of life, and reduces neuropathic symptoms, positioning itself as a valuable conservative therapeutic strategy for chronic radicular low back pain.Keywords: low back pain; radiculopathy; ozone therapy; caudal epidural; VAS; ODI; NPSI; SF-36; quality of life; neuropathic pain.
Introduction Low back pain is the leading cause of years lived with disability worldwide. Caudal epidural injection is a therapeutic option for radiating low back pain. The addition of medical ozone may enhance the analgesic and functional effect with a favourable safety profile. The objective was to compare the efficacy of caudal epidural infiltration with local anaesthetic and corticosteroid in three different strategies: without ozone, with ozone 15 mcg/ml, and with ozone 25 mcg/ml.Material and Methods A retrospective analytical observational study was conducted in the Chronic Pain Unit of Hospital General Universitario Reina Sofía (HGURS) between 2020 and 2022. The sample included 98 patients with lumbar radiculopathy secondary to disc disease, with symptoms lasting more than 3 months and baseline VAS > 7.Patients were allocated into three groups: No Ozone, Ozone 15 mcg/mL and Ozone 25 mcg/ml. Patients were assessed before the procedure, and follow-up evaluations were performed at baseline, 15 days, 3 months, and 6 months. The analysis focused on pain intensity (VAS), functional disability (ODI), neuropathic pain (NPSI), and quality of life (SF-36 health survey). Results All three groups showed significant short-term improvement (15 days) in VAS and ODI. However, their temporal evolution diverged: both the No Ozone and Ozone 15 mcg/ml groups showed a gradual rebound of symptoms, whereas the Ozone 25 mcg/ml group maintained a more stable trajectory of pain and disability at 3 and 6 months. The most relevant differences were found in neuropathic pain and quality of life. The Ozone 25 mcg/ml group maintained the reduction in NPSI symptoms up to 6 months, with statistically significantly lower values compared with the other groups. At 3 months, this group showed a significantly more favourable progression in eight of the nine SF-36 dimensions. Conclusions Caudal epidural oxygen-ozone therapy at 25 mcg/ml is associated with a superior and sustained dose-dependent effect. It modulates pain, improves quality of life, and reduces neuropathic symptoms, positioning itself as a valuable conservative therapeutic strategy for chronic radicular low back pain.Keywords: low back pain; radiculopathy; ozone therapy; caudal epidural; VAS; ODI; NPSI; SF-36; quality of life; neuropathic pain.
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