Expert consensus of Chinese Association for the Study of Pain on the application of ozone therapy in pain medicine

A Randomized Controlled Trial Assessing the Effect of Preoperative Ibuprofen Administration on Postoperative Pain Reduction Following Miniscrew Insertion

OBJECTIVE

To evaluate the impact of preoperative oral ibuprofen premedication as a preemptive analgesia protocol on postoperative pain following the insertion of a single miniscrew insert.

METHODS

A randomized, single-blind, placebo-controlled parallel-group trial design was adopted. A total of 68 patients seeking miniscrew insert placement were recruited based on inclusion and exclusion criteria. Patients were randomly assigned in a 1:1 ratio to either the ibuprofen group or the control group, with 34 patients in each group. The ibuprofen group and the control group received 300 mg of ibuprofen sustained-release capsules and a placebo, respectively, 30 min before surgery. Postoperative analgesics were administered as needed. Pain scores at 2, 4, 6, 8, 12, and 24 h postoperatively were recorded using the Numerical Rating Scale (NRS), and the postoperative analgesic consumption was documented.

RESULTS

A total of 68 patients (34 in the control group and 34 in the preemptive analgesia group) completed the trial. No adverse events such as nausea or vomiting occurred in any of the patients. The preemptive analgesia group exhibited significantly lower pain scores at 2, 4, 6, and 8 h postoperatively [2 (0,3), 0 (0,2), 0 (0,0), 0 (0,0.25), respectively] compared to the control group [3 (2,5), 3 (2,4), 2 (0.75,4), 1 (0,3), respectively] (P = 0.0396, P = 0.0067, P = 0.0111, P = 0.0299). The proportions of patients requiring additional analgesics within 2-24 h postoperatively were 17.6% (6/34) in the preemptive analgesia group and 64.7% (22/34) in the control group, with a statistically significant difference between the two groups (P = 0.013).

CONCLUSION

Preemptive analgesia with ibuprofen can effectively reduce postoperative pain following miniscrew insert placement and represents a safe and effective perioperative pain management strategy.

TRIAL REGISTRATION

The UK's Clinical Study Registry; ISRCTN68332234 (Retrospectively registered); 20/12/2024.

Effect of Medical Ozone Therapy in Preventing Compromised Nasal Skin in Revision Rhinoplasty

BACKGROUND

Ozone is often used as an additive therapy for skin conditions like infectious diseases, wound healing, diabetic foot, and pressure ulcers. The viability of the nasal skin has crucial importance in revision rhinoplasty cases. The study investigates the potential benefits of medical ozone therapy in healing the nasal skin in multiple-operated cases.

METHODS

The study retrospectively examined 523 revision rhinoplasty patients operated by the first author from January 2017 to January 2024. Patients consenting to ozone therapy received 3 major autohemotherapy sessions post-surgery. Patients were divided into 2 groups: those with compromised nasal skin (infection, poor vascular supply) and those with normal healing. Age, gender, smoking, diabetes, previous surgeries, grafting materials, and techniques were considered.

RESULTS

Of the 523 patients, 12 (2.3%) experienced major skin complications like infection and necrosis, while 511 (97.7%) had no or minor issues, such as discoloration. In total, 301 patients accepted and received ozone therapy. Of the patients without major complications, 299 (58.3%) received ozone therapy, while 212 (41.7%) did not. Among the 12 with major complications, two (16.7%) received ozone therapy, and the remaining 10 (83.3%) did not. Ozone therapy recipients showed statistically fewer skin problems (p<0.05). Costal cartilage as tip and septal extension graft was linked to skin issues (p<0.05). No major adverse effects from ozone therapy were noted.

CONCLUSIONS

Our findings indicate that ozone therapy may be a safe and potentially effective option for patients undergoing revision rhinoplasty, especially those with compromised nasal skin. It appears to aid in skin healing and regeneration, possibly through enhancing oxygen delivery and modulation of the immune response. Ozone therapy is a promising adjunct treatment for managing skin complications in revision rhinoplasty patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction of MRONJ risk after exodontia by virtue of ozone infiltration: A randomized clinical trial

INTRODUCTION

Exodontia is commonly considered as a risk factor for the development of medication-related osteonecrosis of the jaw (MRONJ) in individuals exposed to bone modifying agents. This study was aimed at assessing the efficiency and safety of a gaseous oxygen-ozone mixture as an adjuvant to a standard exodontia to reduce the risk of MRONJ development.

METHODS

A randomized, open-label, phase II, single-center clinical trial involving 117 patients at risk of MRONJ was conducted. The study protocol tested injections of an oxygen-ozone mixture in the post-extraction site. Participants were randomly assigned to two groups: oxygen-ozone therapy, and standard tooth extraction protocol. Post-extraction wound healing was assessed using the Inflammatory Proliferative Remodeling (IPR) Wound Healing Scale.

RESULTS

The oxygen-ozone therapy group exhibited a significant improvement in wound healing post-extraction during the inflammatory and proliferative phases, as indicated by the IPR scale scores at 3-5 days (p = 0.006) and 14 days (p < 0.001) respectively.

CONCLUSION

Oxygen-ozone therapy shows promise in improving post-extraction healing in patients at risk of MRONJ. Future studies with larger sample sizes and multicenter collaborations are recommended to confirm the validity of these findings and explore the long-term efficacy of ozone therapy.

Ozone alleviates MSU-induced acute gout pain via upregulating AMPK/GAS6/MerTK/SOCS3 signaling pathway

BACKGROUND

Gout pain seriously affects the quality of patients' life. There is still no effective treatment. The inflammatory response is the main mechanism of gout. Here, we found that ozone can reduce the inflammatory reaction in the joints of gouty mice and relieve gout pain, and we further explore its protective mechanism.

METHODS

MSU was used to establish the gouty mice model. Nociception was assessed by Von Frey hairs. Cell signaling assays were performed by western blotting and immunohistochemistry. The mouse leukemia cells of monocyte macrophage line RAW264.7 were cultured to investigate the effects of ozone administration on macrophage.

RESULTS

Ozone reduced inflammation, relieved gout pain and improved the paw mean intensity and duty cycle of the gouty mice. Ozone increased the phosphorylation of AMP-activated protein kinase (AMPK), induced suppressor of cytokine signaling 3 (SOCS3) expression and inhibited metallopeptidase 9 (MMP9) expression. In vivo, ozone activated AMPK to induce Gas6 release, and upregulated MerTK/SOCS3 signaling pathway to reduce inflammation in mouse macrophage line RAW264.7. Inhibitors of AMPK and MerTK, respectively abolished the analgesic and anti-inflammatory effects of ozone in vivo and in vitro. Gas6 knockout cancelled the protectively effects of ozone on gout pain and the paw mean intensity and duty cycle of gouty mice. Additionally, the level of Gas6 and protein S in plasma of patients with hyperuricemia was significantly higher than that of healthy contrast group.

CONCLUSION

Ozone reduces inflammation and alleviates gout pain by activating AMPK to up-regulate Gas6/MerTK/SOCS3 signaling pathway.

Editorial for the special issue of the Chinese Association for the Study of Pain

The Ministry of Health of China officially issued a document, adding the first level diagnosis and treatment discipline “Algology” in the list of diagnosis and treatment subjects of medical institutions on July 16, 2007. As the most important pain academic organization in China, the Chinese Association for the Study of Pain has made outstanding contributions in promoting the development of pain discipline and in establishing pain standards and disease diagnosis and treatment guidelines. In this special issue, under the leadership of Yan-Qing Liu, Chairman of the 7^th Committee of the Chinese Association for the Study of Pain, nine consensus and one guideline were included.