Ozone

Ozone treatment for pain or ozone therapy (oxygen-ozone) is a minimally invasive technique we use to reduce inflammation and pain in joints, tendons, muscles and, in selected cases, intervertebral discs. We always apply it with image control (ultrasound or X-rays) and with solutions tailored to each patient.

Ozone (O₃) is a molecule consisting of three oxygen atoms. In pain medicine we use medical ozone, which is instantly generated from medical oxygen by certified equipment. It is not “air” nor is it injected blindly: it is a precise O₂-O₃ mixture that we administer locally (intra-articular, periarticular or intradiscal) and always image-guided.

Key concepts

• Therapeutic concentration: expressed in µg/mL (“gamma”). For musculoskeletal infiltrations we usually work in low-moderate ranges (≈10-40 µg/mL), adjusted to the tissue and indication. In intradiscal we use specific ranges published in the literature and internal protocols.
• Local mechanism of action: ozone reacts rapidly in tissue and generates biochemical signals (ROS and LOPs) that modulate inflammation (↓ NF-κB) and activate endogenous antioxidant pathways (↑ Nrf2). Together, this may reduce pain and improve tissue function.
• Additional intradiscal effect: in disc herniation/protrusion, the O₂-O₃ mixture favors mild chemonucleolysis (dehydration/contraction of the nucleus pulposus) and decreases pressure on the nerve root in selected cases.

At MIVI we do not use intravenous ozone or other systemic routes. Our indications are local and with image control.

We indicate ozone therapy when, after a complete assessment, we consider that it can provide benefit within an overall treatment plan. It is especially useful in:

• Myofascial syndromes
• Discogenic pain
• Hip osteoarthritis pain
• Knee osteoarthritis pain
• Shoulder osteoarthritis pain
• Back pain
• Low back pain
• Tendinopathies (selected cases) as part of a plan that includes rehabilitation.
• Myofascial syndrome (trigger points, chronic muscle pain).

The specific indication (intra-articular, periarticular, paravertebral or intradiscal) is defined after clinical history, examination and review of tests.

• Diagnosis and planning. Medical assessment, objectives and informed consent.
• Guidance by image.
  • Ultrasound for joints, tendons and muscle planes.
  • Fluoroscopy (X-ray) for spinal or intradiscal approaches.
• Local anesthesia and, if necessary, light sedation.
• Infiltration of the gas in the target point. Outpatient procedure (≈10-20 min).
• Same day discharge with activity and physical therapy recommendations.

Many patients notice pain relief and improved function within weeks. The duration of the effect depends on the pathology and personal factors; in osteoarthritis, the benefit is usually temporary and may require reinforcement combined with therapeutic exercise/physiotherapy. Not all people respond equally; that is why we integrate ozone therapy into an overall plan and review the response in a structured way.

Ozone therapy is, in general, well tolerated when performed with medical equipment and image control. Even so, they may appear:

• Transient pain or pressure sensation in the infiltrated area.
• Hematoma or local irritation.
• Dizziness/vasovagal dizziness, rare.
• Infection or injury of nearby structures (very infrequent with guided technique and rigorous asepsis).

Important: at MIVI we do not perform intravenous ozone or non-validated routes of administration for the treatment of pain. We only use local and intradiscal infiltrations in specific indications and standardized protocols.

• Active infection in the area to be treated.
• Uncontrolled coagulation disorders or anticoagulation without prior adjustment.
• Known allergy to local anesthetics.
• Pregnancy (individual assessment).
• Pain without clear diagnosis or specific indication.

• Tell us if you take anticoagulants or antiaggregants.
• Come with comfortable clothes; you will be able to leave on your own.
• Avoid intense exercise the day of the procedure. Resume progressively according to the guideline.
• Maintain the prescribed physical therapy/exercise plan.