Gestione efficace del dolore lombare cronico negli anziani: uno studio prospettico a un anno con terapia ossigeno–ozono sotto guida TC associata ad acido alfa-lipoico

Contesto e obiettivo – La lombalgia cronica rappresenta una delle principali cause di disabilità nella popolazione anziana. L’aumento delle patologie degenerative della colonna vertebrale richiede terapie efficaci e poco invasive. Questo studio osservazionale ha valutato l’efficacia della combinazione tra infiltrazioni di ossigeno–ozono (O2–O3) sotto guida TC e una supplementazione orale di acido alfa-lipoico (ALA), palmitoiletanolamide (PEA) e mirra.

Metodi – Sono stati inclusi 276 pazienti, età compresa tra 65 e 92 anni, con lombalgia cronica unilaterale o bilaterale. Tutti hanno ricevuto infiltrazioni paravertebrali di miscela O2–O3 e un ciclo orale di 30 giorni con ALA (800 mg/die), PEA (600 mg/die) e mirra (200 mg/die). Gli esiti sono stati valutati a 1 mese e a 1 anno mediante Visual Analog Scale (VAS) e scala di McNab modificata.

Risultati – Dopo un mese, il 32,9% dei pazienti ha riportato un miglioramento eccellente, con riduzione media della VAS da 8,17 a 2,81. A un anno, il 68,1% presentava esiti positivi, e il 17,8% riferiva la completa scomparsa del dolore. La VAS media a un anno era 3,57.

Conclusioni – La combinazione di ossigeno–ozono con ALA, PEA e mirra rappresenta un trattamento promettente, capace di ridurre il dolore e migliorare la qualità della vita negli anziani con lombalgia cronica. Ulteriori studi sono necessari per confermare i benefici a lungo termine.

References

• 1 Wong AY, Karppinen J, Samartzis D. Low back pain in older adults: Risk factors, management options and future directions. Scoliosis Spinal Disord. 2017; 12: 14. [CrossRef] [PubMed]

• 2 Weiner DK, Sakamoto S, Perera S, et al. Chronic low back pain in older adults: Prevalence, reliability, and validity of physical examination findings. J. Am. Geriatr. Soc. 2006; 54: 11-20. [CrossRef]

• 3 DoEaSA UN. World Population Ageing 2009; United Nations Publicatio. New York, NY, USA, 2010.

• 4 Greengross S, Murphy E, Quam L. et al. Aging: A subject that must be at the top of world agendas. BMJ. 1997; 315: 1029. [CrossRef]

• 5 Elliott RJ, Gardner DL. Changes with age in the glycosaminoglycans of human articular cartilage. Ann. Rheum. Dis. 1979; 38, 371-377. [CrossRef] [PubMed]

• 6 Modic MT, Steinberg PM, Ross JS; et al. Degenerative disk disease: Assessment of change in vertebral body marrow with MRI. Radiology. 1988; 166, 193-199. [CrossRef]

• 7 Siddall PJ, Cousins MJ. Spine update. Spinal pain mechanism. Spine. 1997; 22: 98-104. [CrossRef] [PubMed]

• 8 O’Donnell J. Prostaglandin E2 content in herniated lumbar disc disease. Spine .1997; 21: 1653-1656. [CrossRef]

• 9 Kawakami M, Tamaki T. The role of phospholipase A2 and nitric oxide in pain related behavior produced by an allograft of intervertebral disc material to the sciatic nerve of the rat. Spine. 1997; 22: 1074-1079. [CrossRef]

• 10 Saal JS, Franson RC, Dobrow R, et al. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine. 1990; 15: 674-678. [CrossRef]

• 11 Docking RE, Fleming J, Brayne C, et al. Epidemiology of back pain in older adults: Prevalence and risk factors for back pain onset. Rheumatology. 2011; 50: 1645-1653. [CrossRef]

• 12 Ferrell BA. Pain evaluation and management in the nursing home. Ann. Intern. Med. 1995; 123: 681-687. [CrossRef] [PubMed]

• 13 D’Astolfo CJ, Humphreys BK. A record review of reported musculoskeletal pain in an Ontario long term care facility. BMC Geriatr. 2005; 6: 5. [CrossRef]

• 14 Stewart Williams J, Ng N, Peltzer K, et al. Risk factors and disability associated with low back pain in older adults in low- and middle-income countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE). PLoS ONE. 2015; 10: e0127880. [CrossRef] [PubMed]

• 15 Jacobs JM, Hammerman-Rozenberg R, Cohen A, et al. Chronic back pain among the elderly: Prevalence, associations, and predictors. Spine. 2006; 31: E203–E207. [CrossRef]

• 16 Won AB, Lapane KL, Vallow S, et al. Persistent nonmalignant pain and analgesic prescribing patterns in elderly nursing home residents. J. Am. Geriatr. Soc. 2004; 52: 867-874. [CrossRef]

• 17 Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. Pain. Med. 2009; 10: 1062- 1083. [CrossRef]

• 18 O’Neil CK, Hanlon JT, Marcum ZA. Adverse effects of analgesics commonly used by older adults with osteoarthritis: Focus on non-opioid and opioid analgesics. Am. J. Geriatr. Pharmacother. 2012; 10: 331-342. [CrossRef] [PubMed]

• 19 Iliakis E. Ozone treatment in low back pain. Orthopaedics. 1995; 19: 29-33.

• 20 Iliakis E, Valadakis V, Vynios D, et al. Rationalization of the activity of medical ozone on intervertebral disc: A histological and biochemical study. Riv. Neuroradiol. 2001; 14: 23-30. [CrossRef]

• 21 Andreula CF, Simonetti L, De Santis F, et al. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. Am. J. Neuroradiol. 2003; 24: 996-1000.

22 Muto M, Andreula C, Leonardi M. Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J. Neuroradiol. 2004; 31: 183-189. [CrossRef] [PubMed]

23 Bonetti M, Fontana A, Cotticelli B, et al. Intraforaminal O2-O3 versus periradicular steroidal infiltrations in lower back pain: Randomized controlled study. Am. J. Neuroradiol. 2005; 26: 996-1000.

• 24 Bonetti M, Fontana A, Albertini F. CT-guided oxygen-ozone treatment for first degree spondylolisthesis and spondylolysis. Acta Neurochir. Suppl. 2005; 92: 87-92. [PubMed]

• 25 Oder B, Loewe M, Reisegger M, et al. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease--effect of age, gender, disc pathology and multi-segmental changes. Neuroradiology. 2008; 50: 777-785. [CrossRef]

26 Xu L, Li ZL, He XF, et al. Evaluation of the Clinical Curative Effect of an O2-O3 mixture to Treat Lumbar Disc Herniation with Different Treatment Sessions. Interv. Neuroradiol. 2009; 15: 159-163. [CrossRef] [PubMed]

• 27 Bonetti M, Ottaviani GM, Fontana A, et al. Diagnosis and subsequent treatment with oxygen-ozone therapy of Baastrup’s disease. Eur. J. Musculoskelet. Dis. 2020; 9: e00002.

• 28 Bonetti M, Zambello A, Princiotta C, et al. Non-discogenic low back pain treated with oxygen-ozone: Outcome in selected applications. J. Biol. Regul. Homeost. Agents. 2020; 34 (Suppl. S1): 21-30.

• 29 Bonetti M, Fontana A, Martinelli F, et al. Oxygen-Ozone Therapy for Degenerative Spine Disease in the Elderly: A Prospective Study; Springer: Vienna, Austria. 2011: 137-142.

• 30 Steppan J, Meaders T, Muto M, et al. A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs. J. Vasc. Interv. Radiol. 2010; 21: 534-548. [CrossRef]

• 31 Magalhaes FN, Dotta L, Sasse A, et al. Ozone therapy as a treatment for low back pain secondary to herniated disc: A systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2012; 15: E115-E129.

• 32 Zhang Y, Ma Y, Jiang J, et al. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J. Back. Musculoskelet. Rehabil. 2013; 26: 317- 322. [CrossRef]

• 33 Bonetti M, Zambello A, Leonardi M, et al. Herniated disks unchanged over time: Size reduced after oxygen-ozone therapy. Interv. Neuroradiol. 2016; 22: 466-472. [CrossRef]

• 34 Rimeika G, Saba L, Arthimulam G, et al. Metanalysis on the effectiveness of low back pain treatment with oxygen-ozone mixture: Comparison between image-guided and non- image- guided injection techniques. Eur. J. Radiol. Open. 2021; 8: 100389. [CrossRef]

• 35 Krahulik D, Vaverka M, Hrabalek L, et al. Periradicular corticosteroid infiltration for radicular pain. Comparison of Diprophos and Depomedrone and ozone effects. Biomed. Pap. Med. Fac. Univ. Palacky. Olomouc Czech Repub. 2023; 167: 80- 84. [CrossRef] [PubMed]

• 36 Bocci V. Ozone as a bioregulator. Pharmacology and toxicology of ozonetherapy today. J. Biol. Regul. Homeos Agents. 1998; 10: 31-53.

• 37 Chen H, Yu B, Lu C, et al. The effect of intra-articular injection of different concentrations of ozone on the level of TNF-α, TNF-R1, and TNF-R2 in rats with rheumatoid arthritis. Rheumatol. Int. 2013; 33: 1223-1227. [CrossRef]

• 38 Goupille P, Jayson MI, Valat JP, et al. The role of inflammation in disk herniation-associated radiculopathy. Semin. Arthritis Rheum. 1998; 28: 60-71. [CrossRef]

• 39 Hawkins CL, Davies MJ. Direct detection and idintefication of oxydative radicals generated during the hydroxyl radical induced degradation of hyaluronic acid and related materials. Rad. Biol. Med. 1996; 133: 321-325.

• 40 Kawakami M, Tamaki T, Matsumoto T, et al. Role of leukocytes in radicular pain secondary to herniated nucleus pulposus. Clin. Orthop. 2000; 376: 268-277. [CrossRef]

• 41 Kang JD, Georgescu HI, McIntyre-Larkin L, et al. Herniated Lumbar IntervertebraI Discs Spontaneously Produce Matrix Metalloproteinases, Nitric Oxide, InterIeukin-6, and ProstagIandin E2. Spine. 1996; 21: 271-277. [CrossRef]

• 42 Leonardi M, Simonetti L, Barbara C. The effects of the ozone on the nucleous pulposus: Pathological data on one surgical specimen. Riv. Neuroradiol. 2001; 14: 57-61. [CrossRef]

• 43 Simonetti L, Agati R. Why does disc-root conflict generate pain? Riv. Neuroradiol. 1998; 11: 403-404. [CrossRef]

• 44 Simonetti L, Raffi L, Cenni P, et al. Pharmacological Mechanisms Underlying Oxygen-Ozone Therapy for Herniated Disc. Neuradiol. J. 2003; 16: 201-204. [CrossRef]

• 45 Bilska A, Wlodek L. Lipoic acid: The drug of the future? Pharm. Rep. 2005; 57: 570-577.

• 46 Costantino M, Guaraldi C, Costantino D, et al. Peripheral neuropathy in obstetrics: Efficacy and safety of alpha lipoic acid supplementation. Eur. Rev. Med. Pharmacol. Sci. 2014; 18: 2766–2771. [PubMed]

• 47 HanT,BaiJ,LiuW,etal.Asystematicreviewandmetanalysisof α-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur. J. Endocrinol. 2012; 167: 465-471. [CrossRef] [PubMed]

• 48 Matsugo S, Yan L, Han D, et al. Elucidation of antioxidant activity of alpha-lipoic acid towards hydroxyl radical. Bio-Chem Biophys Res. Commun. 1995; 208: 161-167. [CrossRef]

• 49 Mijnhout GS, Kollen BJ, Alkhalaf A, et al. Alpha lipoic acid for symptomatic peripheral neuropathy in pa-tients with diabetes: A meta-analysis of randomized controlled trials. Int. J. Endocrinol. 2012; 201: 456279.

• 50 Nagamatsu M, Nickander KK, Schmelzer JD, et al. Lipoic acid improves nerve blood flow, reduces oxidative stress, and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care. 1995; 18: 1160-1167. [CrossRef]

• 51 Park S, Karunakaran U, Jeoung NH, et al. Physiological effect and therapeutic application of alpha lipoic acid. Curr. Med. Chem. 2014; 21: 3636-3645. [CrossRef]

• 52 Salehi B, Berkay Yılmaz Y, Antika G, et al. Cho WC Sharifi- Rad Insights on the Use of alpha-Lipoic Acid for Therapeutic Purposes. J. Biomol. 2019; 9: 356.

• 53 Paladini A, Fusco M, Cenacchi T, et al. Palmitoylethanolamide, a special food for medical purposes, in the treatment of chronic pain: A pooled data meta-analysis. Pain Physician. 2016; 19: 11- 24. [PubMed] 54Petrosino S, Di Marzo V. The pharmacology of palmitoylethanolamide and first data on the therapeutic efficacy of some of its new formulations. J. Pharmacol. 2017; 174: 1349- 1365.

•55 Fernandez-Cuadros ME, Albaladejo-Florin MJ, Martin-Martin LM, et al. Ef-fectiveness of Physical Therapy Plus TIOBEC® (α-Lipoic Acid Vitamin B, C, and E) on Complex Regional Pain Syndrome (CRPS): A Small Case Series/Pilot Study. Middle East J. Rehabil. Health Stud. 2020; 7: e100636. [CrossRef]

• 56 El Ashry ES, Rashed N, Salama OM, Saleh, A. Components, therapeutic value, and uses of myrrh. Pharmazie 2003; 58: 163- 168.

• 57 Nomicos EY. Myrrh: Medical marvel or myth of the Magi? Holist. Nurs. Pract. 2007; 21: 308-323. [CrossRef]

• 58 Dolara P, Luceri C, Ghelardini C, et al. Analgesic effects of myrrh. Nature. 1996; 379: 29. [CrossRef] [PubMed]

• 59 Bonetti M, Lauritano D, Ottaviani GM, et al. Oxygen- Ozone Therapy Associated with Alpha Lipoic Acid Plus Palmitoylethanolamide and Myrrh versus Ozone Therapy in the Combined Treatment of Sciatic Pain Due to Herniated Discs: Observational Study on 318 Patients. Int. J. Environ. Res. Public Health. 2022; 19: 5716. [CrossRef]

• 60 Bonetti M, Lauritano D, Ottaviani GM, et al. New approach to chronic Back pain treatment: A case control study. Biomedicines. 2022; 11: 73. [CrossRef]

• 61 Latini E, Bonasia G, Petroselli L, et al. Alpha-Lipoic Acid, Palmitoylethanolamide, Myrrh, and Oxygen-Ozone Therapy Improve Pharmacological Therapy in Acute Painful Lumbosacral Radiculopathy due to Herniated Disc. Pain Physician. 2023; 26: E363–E373. [CrossRef] [PubMed]

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