الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Pain and functional loss are common musculoskeletal problems. A variety of diseases
can cause musculoskeletal pain. Musculoskeletal disorders are recognized by the world health
organization and the centers for disease control and prevention as a problem of global
proportions. A musculoskeletal disease affects an estimated 1.7 billion individuals globally.
Chronic or recurrent musculoskeletal pain was experienced by one out of every two people.
Muscle Pain is supposed to happen via two main mechanisms: peripheral and central.
Trauma, disordered deep-tissue microcirculation, altered muscle metabolism, and
mitochondrial dysfunction are examples of peripheral factors. Mitochondrial content affects a
muscle’s aerobic capacity, which is reduced in chronic musculoskeletal pain, resulting in a
reduction in ATP, which propagates contracture compressing capillary circulation, leading to
hypoxic environment. The majority of confirmed mitochondrial oxidative abnormalities
associated with an increased blood lactate and this is often associated with elevated
lactate/pyruvate ratio, which means a change in the cellular redox state.
The rising musculoskeletal pain prevalence has prompted the search for non-surgical
treatments such as physical therapy, pharmacological treatment, and injection-based
treatment. Injection therapies can be introduced when pain or functional limitations are
significant despite oral medication or exercise.
The most frequent treatment for musculoskeletal problems is corticosteroid injections.
They’re anti-inflammatory, which is why they’re so widely utilized in pain treatment. Since
the 1930s, a combination of oxygen and ozone gases has been used in medicine, recently
utilized to alleviate pain. Surprisingly, researchers have discovered that the brief, calculated
oxidative stress obtained by ozone therapy may correct permanent imbalances induced by
persistent or severe oxidative injury, and it is becoming evident that modest, repeated ozone
treatment boosts the activity of superoxide dismutase, catalase, and glutathione peroxidase,
producing a state of oxidative stress adaptation with major benefits. When injected into
trigger points, ozone-oxygen expands and disrupts the tissue and fascia, perhaps correcting
the trigger point pathology.
The present prospective randomized trial was carried out at the Medical Research
Institute Hospital, Anesthesia and Pain Management Department, Alexandria University.
The study was conducted on 45 patients, presented with musculoskeletal pain to study
efficacy of trigger point injection with medical ozone for treatment of chronic
musculoskeletal pain in patients with abnormal mitochondrial Redox state compared to
standard steroid injection or combination therapy. According to the department of
Biostatistics of the Medical Research Institute. They have been allocated randomly into
three groups
group A: (n. 15) will receive a trigger point injection of 5 ml of 12 μg/ml ozone using
EXT50 ozone generator (Longevity resources, Canada) for each point.
group B: Controlled group (n. 15) will receive a trigger point injection 0.5 mg
betamethasone injectable suspension diluted in 2 ml sterile water for each point.
Summary, Conclusion & Recommendation
73
group C: (n. 15) will receive a trigger point injection of 5 ml of 12 μg/ml ozone using
EXT50 ozone generator and 0.5 mg betamethasone injectable suspension diluted in 2 ml
sterile water for each point.
Result:
Demographic data, there was no significant difference between the three groups in
age, gender, weight, height and BMI.
There was no statistically significant difference in number of injected points among
the three studied groups.
Pain assessment, before intervention, there was no statistically significant difference
in VAS among the three studied groups. Three days after intervention there was
statistically significant difference in VAS where group A showed statistically
significantly more reduction when compared with group B but there was no
statistically significant difference when group A and group B compared with group C.
One and three weeks after intervention there was statistically significant difference
in VAS where group A and C showed statistically significantly more reduction when
compared with group B but not when group A compared with group C.
Serum lactate level measured 3 days after intervention was statistically significantly
lower when compared with before intervention in the three studied groups while serum
pyruvate level measured 3 days after intervention showed no statistically significant
difference compared with before intervention in the three studied groups. In the
comparison between 3 groups, showed no statistically significant difference in serum
lactate and pyruvate among the three studied groups neither before nor 3days after
intervention.
Lactate/pyruvate ratio (L/P ratio) after intervention was statistically significantly
lower when compared with before intervention in the three studied group. Comparing
the three groups; there was no statistically significant difference in L/P ratio among the
three studied groups before and after intervention while there was statistically
significant difference in percentage change of L/P ratio among the three studied groups
where the percentage change of L/P ratio in group A and C showed statistically
significantly more reduction when compared with group B respectively and showed no
statistically significant reduction when group A compared with group C.
According to Mitochondrial DNA (mtDNA) copy number, mtDNA after
intervention was statistically significantly higher when compared with before
intervention in the group A and C but not in group B. Comparing the three groups,
mtDNA was no statistically significant difference before intervention but was
statistically significant difference after intervention where mtDNA after intervention
was statistically significantly high when group A compared with B while in
comparison of group A with C and B with C was not statistically significantly high.
Plasma redox state, Reduced/Oxidized glutathione (GSH/GSSG) ratio,
GSH/GSSG ratio 3 days after intervention was statistically significantly higher when
compared with before intervention in all of the studied groups. Comparing the three
groups, there was no statistically significant difference in GSH/GSSSG ratio before
intervention but was statistically significant difference 3 days after intervention where
GSH/GSSG ratio after intervention was statistically significantly high when group A
and C compared with group B while not when group A compared with group C.
Summary, Conclusion & Recommendation
74
6.2. Conclusion
from the current study, it was concluded that:
Medical ozone therapy is an effective technique for management of pain as it had
significant effect in reduction of muscle pain and increasing pain free interval in
patients. Pain improvement increases with time. So, it will reduce analgesic demand.
Ozone treatment improves muscle oxygenation. It also enhances the mitochondrial
function and biogenesis.
Ozone has anti-oxidant effect through improve the transcription of antioxidant enzymes.
Corticosteroids have short term symptomatic improvement, they had variable effect on
mitochondrial respiratory function and biogenesis.
6.3. Recommendation
- Future controlled trials for specific musculoskeletal pain conditions are needed to
establish the role of abnormal mitochondrial redox state in their pathogenesis.
- More controlled studies comparing effect of medical ozone versus dry needling and
local anaesthesia in management of specific musculoskeletal painful conditions.
- Also, more controlled clinical trials are required to evaluate the role of ozone therapy in
management of specific musculoskeletal painful conditions.