Efficacy of Medical Ozone for Treatment of Chronic Musculoskeletal Pain with Abnormal Mitochondrial Redox State

Background: Chronic musculoskeletal pain is multifaceted and20% of the adult population lives with severe chronic pain and have negative consequences, intense pain, depression, weakness, sleep problems, loss of enjoyment of life and decreased emotional well-being. This work done to study efficacy of trigger point injections with ozone for treatment of chronic musculoskeletal pain in patients with abnormal mitochondrial redox state compared to standard steroid injection or combination therapy. Methods This is a prospective randomized clinical study conducted on 51 patients with chronic musculoskeletal pain at Medical Research Institute Hospital, Alexandria University from January2019toJanuary2021.Patients randomly using computer-generated random numbers into 3groups,17received ozone injection,17betamethasone injection and17 combined Ozone and betamethasone injection. Groups were compared regarding intensity of pain, correction of mitochondrial redox state and normalizing Lactate/Pyruvate ratio. Results there were differences between 3groups as regard VAS;three days after intervention(p < 0.021)as it was lower in group A compared to group and at one and three weeks after intervention(p < 0.001)where it was lower in groups A,C when compared with groupB.There were differences in lactate/pyruvate ratio(percentage change)between the 3 groups(p < 0.004)as it was lower in groups AandC when compared with groupB.There were differences between 3 groups as regard mitochondrial copy number(p  0.008)as it was higher in groups AandC when compared with group B. Conclusions Trigger point injections with ozone can relief musculoskeletal pain as it had significant effect in reduction of muscle pain and increasing pain free interval. Pain improvement increases with time. Ozone improves muscle oxygenation, mitochondrial function