Ozone Therapy and Lower Back Pain

We read with interest Bonetti et al’s article “Intraforaminal
O2–O3 Versus Periradicular Steroidal Infiltrations in Lower Back
Pain: Randomized Controlled Study,” which appeared in the May
issue of the AJNR.1 We came across this paper as we were searching
for the possible beneficial effects of ozone therapy in fibromyalgia,
which had been pointed out to us at a recent European meeting.
The conclusions from this paper are that oxygen-ozone treatment
is highly effective in relieving acute and chronic lower back pain
and sciatica and that this treatment can be administered as a first
option rather than epidural steroids. The authors support their
conclusions with percentages and P values noted in the text as well
as in the abstract, but not in the Table. In examining the actual data
shown in the Table, we realized that the statistical analyses performed
were flawed, given that the outcomes (excellent, good, or
poor) are not independent observations. Therefore, the comparisons
cannot be limited to those patients in one category with the
exclusion of those in the others, but rather have to be performed
with the entire data in a classic 2 (treatment type) by 3 (outcome
type) format (2 df). The data would then read as noted in Tables 1
(for the intermediate outcomes) and 2 (for the long-term outcomes)
that accompany this letter. None of the derived 2 values
shown in these tables reached 5.991, which would be the required
value for a significance of 0.05. The conclusions reached in this
paper are, therefore, not supported by the data presented.
In light of the possible implications these data may have in
supporting the role of ozone therapy for the treatment of back pain
(and other painful musculoskeletal disorders), this clarification is
essential.