Atalay, NS (1), Sahin, F (1), Atalay, A (2) and Akkaya, N (1)
(1) Pamukkale University Medical School, Department of Physical Medicine and Rehabilitation, Denizli, Turkey. (2) Denizli State Hospital, Clinic of Orthopedics and Traumatology, Denizli,
Turkey
Citation: Atalay NS, Sahin F, Atalay A, Akkaya N. Comparison of efficacy of neural therapy and physical therapy in chronic low back pain. Afr J Tradit Complement Altern Med. 2013 Apr
12;10(3):431-5
The aim of this prospective study was to evaluate the effects of neural therapy, and physical therapy on level of pain, disability, quality of life, and psychological
status in patients with chronic low back pain. Patients admitted to the physical therapy and rehabilitation outpatient clinic with the complaint of low back pain of at least 3 months duration. Group
1 (n=27), physical therapy (PT, hotpack, ultrasound, TENS 15 sessions), group 2 (n=33), neural therapy (NT, 1:1 mixture of 20 mg/mL Lidocaine HCl (Jetokain simplex®) and saline for 5 sessions. For
pain, Visual Analogue Scale (VAS), for disability Roland Morris Disability Questionnaire (RMDQ), for quality-of-life Nottingham-Health-Profile (NHP), for depression, and anxiety, Hospital
Anxiety-Depression Scale (HADS) were used before and after the treatment. Mean age was 47.3±11.32 years, symptom time was 13.78±11.98 months. There were no differences for demographic variables
between groups. Significant improvements were detected for VAS, RMDQ, NHP-Pain, NHP-Physical activity, HADS for both of two groups after treatment. In addition to these findings, significant
improvements were found for NHP-Energy, NHP-Social isolation in NT group. The differences of pre- and post-treatment values of parameters were evaluated for each group. Although there were no
differences for VAS, NHP-sleep, NHP-Emotional reaction, HADS between groups, RMDQ, NHP-Pain, NHP-Physical activity, NHP-Social isolation were higher in NT than PT before treatment, the improvements
for these parameters were better in NT than PT. In conclusion both of NT and PT are effective on pain, function, quality of life, anxiety, and depression in patients with chronic low back
pain.
Keywords: chronic low back pain, physical therapy, neural therapy
Hospital das Clnicas,
Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Abstract
BACKGROUND: Low back pain (LBP) is one of the
most common and important health problems affecting the population worldwide and remains mostly unsolved. Ozone therapy has emerged as an additional treatment method. Questions persist concerning its
clinical efficacy.
OBJECTIVE: The purpose of our study was to
evaluate the therapeutic results of percutaneous injection of ozone for low back pain secondary to disc herniation.
STUDY DESIGN: A systematic review and
meta-analysis of randomized controlled trials.
METHODS: A comprehensive literature search was
conducted using all electronic databases from 1966 through September 2011. The quality of individual articles was assessed based on the modified Cochrane review criteria for randomized trials and
criteria from the Agency for Healthcare Research and Quality.
OUTCOME PARAMETERS: The outcome measure was
short-term pain relief of at least 6 months or long-term pain relief of more than 6 months.
RESULTS: Eight observational studies were
included in the systematic review and 4 randomized trials in the meta-analysis. The indicated level of evidence for long-term pain relief was II-3 for ozone therapy applied intradiscally and II-1 for
ozone therapy applied paravertebrally. The grading of recommendation was 1C for intradiscal ozone therapy and 1B for paravertebral ozone therapy.
LIMITATIONS: The main limitations of this
review are the lack of precise diagnosis and the frequent use of mixed therapeutic agents. The meta-analysis included mainly active-control trials. No placebo-controlled trial was found.
CONCLUSIONS: Ozone therapy appears to yield
positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.
Oxygen/ozone treatment of herniateddiscs is an effective and extremely safe procedure. The estimated improvement in pain and function is impressive in view of the broad
inclusion criteria, which included patients ranging in age from 13 to 94 years with all types of disc herniations. Pain and function outcomes are similar to the outcomes for lumbardiscs treated with surgical discectomy, but the complication rate is much lower (<0.1%) and the recovery time is significantly
shorter.
A metaanalysis of the effectiveness and
safety of ozonetreatments for herniatedlumbardiscs.
To determine statistically significant effects of oxygen/ozone treatment of herniateddiscs with respect to pain, function, and complication rate.
MATERIALS AND METHODS:
Random-effects metaanalyses were used to estimate outcomes for oxygen/ozone treatment of
herniateddiscs. A literature search provided relevant studies that were weighted by a study quality score. Separate metaanalyses were
performed for visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcome scales, as well as for complication rate. Institutional review board approval was not required
for this retrospective analysis.
RESULTS:
Twelve studies were included in the metaanalyses. The inclusion/exclusion criteria, patient demographics, clinical trial rankings,
treatment procedures, outcome measures, and complications are summarized. Metaanalyses were performed on the oxygen/ozone treatment results for almost 8,000 patients
from multiple centers. The mean improvement was 3.9 for VAS and 25.7 for ODI. The likelihood of showing improvement on the modified MacNab scale was 79.7%. The means for the VAS and ODI outcomes are
well above the minimum clinically important difference and the minimum (significant) detectable change. The likelihood of complications was 0.064%.
CONCLUSIONS:
Oxygen/ozone treatment of herniateddiscs is an effective and extremely safe procedure. The estimated improvement in pain and function is impressive in view of the broad inclusion criteria, which included patients
ranging in age from 13 to 94 years with all types of disc herniations. Pain and function outcomes are similar to the outcomes for lumbardiscs treated with surgical discectomy, but the complication rate is much lower (<0.1%) and the recovery time is significantly shorter.
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