Ozone therapy

Medical ozone is an oxygen-ozone mixture injected into tissue — most often paravertebrally or into a joint — on the proposition that it has anti-inflammatory and oxygenating effects. It is offered widely for disc herniation and osteoarthritis.

The evidence is limited. Studies for lumbar disc herniation are mostly small, frequently uncontrolled, and produce inconsistent results. It is not recommended in major international guidelines for back pain or osteoarthritis 12. In the United States, federal regulations describe ozone as a toxic gas with no known useful medical application 3.

That the evidence is weak, that better-supported options exist and should be tried first, and that a treatment being available and widely marketed is not evidence that it works.

We say this plainly because ozone therapy is heavily promoted in health tourism and patients frequently arrive having been told it is a standard treatment for disc herniation. It is not.

For disc herniation with radicular pain: structured rehabilitation, activity modification and appropriate pain management, with surgical opinion where there is progressive neurological deficit. For knee osteoarthritis: progressive exercise and weight management, which have the strongest evidence of anything available.

If you have completed those and want to discuss ozone as an additional option, we will have that conversation honestly, including what the realistic chance of benefit is.

Ozone must never be administered by direct inhalation — it is toxic to the lungs 3. Injection carries the risks of any injection: infection, bleeding and nerve injury, with additional reported risks including embolism in intravascular administration. Deaths have been reported from gas embolism when ozone entered the bloodstream — during autohaemotherapy, in which ozonated blood is returned into a vein, and probably through a vein punctured during a disc injection 78. A fatal bloodstream infection has also been described after ozone treatment for a lumbar disc herniation 9.

It is contraindicated in G6PD deficiency, pregnancy, uncontrolled hyperthyroidism and bleeding disorders.

It is offered in Türkiye widely and asked about often, and a page that simply omitted it would leave people to find the claims elsewhere without the counterweight.

So the page exists to state what the evidence supports, what it does not, and what we would recommend first — which is not the usual reason a clinic writes about a treatment it provides.

Administer it by inhalation, which is toxic to the lungs and can cause pulmonary oedema 3. Present it as a treatment for cancer, autoimmune disease, infection or as a general immune therapy — claims that appear in this field and are not supported.

Offer it before a genuine course of exercise-based treatment, or as an alternative to a surgical opinion where one is needed.

Because sciatica from a disc herniation often settles on its own, and the herniation itself often shrinks. In a 2023 meta-analysis of repeat scans in people treated without surgery, 70.4% of extruded herniations and 93.0% of sequestered ones regressed, and regression went together with improving symptoms 4. Anyone treated during that time may improve, whatever the treatment was.

Only trials with a comparison group can separate the effect of ozone from that natural recovery. A review of 15 randomised trials in low back pain and disc herniation found that none reached a good-quality standard and most were flawed by relevant bias 5. A good personal experience is real, but it cannot show that the injection caused it.