Without scalpel: Dr Vijay Sheel Kumar applies ozone therapy

It was a single swing of her golf club that triggered the severe, unyielding pain in her lower back and leg. In a fraction of a second, the 39-year-old woman had twisted her spine, acquiring a ruptured disc. Jelly-like material oozed out from within the disc and pushed against nerves, leading to intense, intractable pain in her back and leg. When the pain didn?t subside after several weeks of pain-killing medications and rest, she was a candidate for surgery to repair the ruptured disc. But she didn?t want to undergo spinal surgery.

Then neurosurgeon Vijay Sheel Kumar in New Delhi injected a mixture of oxygen and ozone (a different version of oxygen) into the woman?s back. Over a period of three weeks, she received six of these injections. By the end of the fourth week, her pain reduced significantly. And in three months, she was back on the golf course, says Dr Kumar, a senior consultant at the Indraprastha Apollo Hospital in New Delhi. The woman was among the first in India to receive ozone therapy for intractable back pain caused by disc problems.

Ozone therapy is a relatively new technique to treat back pain that arises from spinal problems caused by damage or injury to the discs, commonly known as prolapse or rupture of the discs. In these conditions, a tear or a rupture of a disc causes the jelly-like fluid within it to flow out and exert pressure on the nerves, leading to pain that may affect the back or run along the legs.

Most back pain and associated leg pain settles down with adequate rest, pain-killers and special exercises. However, in a small section of patients, the symptoms persist for weeks. ?Patients with back pain that hasn?t gone away despite over six weeks of therapy may be helped with ozone therapy,? says Kumar who directs a pain management centre in New Delhi. It is an alternative to surgery and offers typical advantages of scalpel-less treatment ? a shorter hospital stay, a less traumatic procedure, and lower cost of treatment.

Doctors in Italy who pioneered the use of ozone therapy to treat disc problems claim that over 30,000 ozone injections have been performed without serious complications. But doctors warn that not all patients are candidates for ozone injections.

Kumar says that ozone therapy is not suitable for patients whose injury to the disc has led to severe bowel or bladder dysfunctions or threatens to cause paralysis. Such patients require quick surgery. Ozone therapy is also not offered to patients with infections or fractures.

In ozone therapy, doctors use a sharp needle to inject a gaseous mixture of oxygen and ozone ? a tiny bit of ozone with a lot of oxygen ? into the damaged disc.

While oxygen molecules contain two atoms of oxygen, ozone has three atoms of oxygen. The third atom, sometimes called a singlet oxygen or a free radical, holds the key to treatment. Injected into the body, the extra atom attaches itself to the jelly-like substance called proteoglycam, causing a rupture of chemical bonds in proteoglycam that helps it retain water.

The loss of its water-retention ability causes the proteoglycam to shrink and its pressure on the nerves drops.

Researchers say it?s almost ironic that a free radical is used for healing. Free radicals are among the most feared molecules in biology. They can damage cells and genetic machinery. Much of medical research is involved in finding ways to prevent the harmful effects of free radicals.

But Kumar says the amount of ozone used in ozone therapy is far too small for concerns about safety. ?We call this a calculated oxidative insult,? says he. When it is introduced into the region of the injury, the ozone initiates a cascade of reactions that reduces the pain in multiple ways. The supply of oxygen to the region of damage also improves the blood supply and helps in the healing process.

Over the past year, Kumar has used ozone injections in 45 patients. It has been successful in 40 and failed in 5, he has reported in a paper accepted for publication in an Italian medical journal Ozonoterapia, devoted to this new technique. Kumar says it?s a treatment that uses ozone to achieve the same kind of results that were being obtained from an enzyme extracted from papaya seeds during the 1980s.

The procedure known as chemonucleolysis involved injecting an enzyme called chemopapain that also caused the proteoglycam to shrink. Kumar says the enzyme had side effects in a small fraction of patients and the procedure fell out of favour. Marco Leonardi, an Italian doctor who?s used ozone therapy, says ozone may be delivered through a narrower needle than chemopapain and the period of discomfort after treatment is shorter.

However, one pain specialist cautioned that while ozone therapy appears promising, there is not enough data to support its widespread use. ?For the moment, it?s seen as just one among many non-surgical options to treat back pain,? says Dr G.P. Dureja, head of the pain clinic at the All India Institute of Medical Sciences, New Delhi. ?We need large studies that compare the results between ozone therapy and traditional surgical techniques and just plain rest.?