What is Ozone Therapy? Q & A

In Principles and Applications of Ozone Therapy (2011), Dr. Frank Shallenberger tells of his introduction to ozone therapy via the work of his predecessor, Dr. Charles Farr. In the 1980s, Dr. Farr began treating patients with Auto Immune Disease Syndrome (AIDS)—caused by the accumulation of molecules called oxidants—by injecting hydrogen peroxide, a powerful oxidant, directly into their veins. Dr. Farr’s success at alleviating symptoms such as fatigue, insomnia, brain fog, joint and muscle pain, and muscle weakness suggested that “the reason people get sick and diseased as they get older might have something to do with how they utilize and process oxygen” (Shallenberger, 2011).

The following Q & A is intended provide an introduction to ozone, and the various ozone therapies our clinic provides:

Q: What is ozone?

A: Consisting of three oxygen (O2) atoms that share a common electron, ozone (O3) is a naturally occurring molecule—called an oxidant—in the earth’s atmosphere.

Q: What is ozone therapy?

A: Working in a manner similar to vaccines that promote the production of viral antibodies, ozone therapy stimulates the formation of oxidants in the blood, essentially training the body to utilize them efficiently.

Q: How is ozone administered?

A: There are three administration techniques for ozone therapy. The first, called an Ozone Sauna, involves the patient entering a hyperbaric chamber into which heated ozone is pumped. The heat causes the patient to perspire, while the ozone promotes the formation of oxidants in the blood that the body must then dispose of. When someone says they are “sweating it out,” this is the technique to which they are referring.

The second option, called minor-Auto-Hemo-therapy (mAH), involves the blood being drawn out of the body, mixed with ozone, and then injected directly into the treatment site, while the third option administers blood-ozone intravenously, and is referred to as Major-Auto-Hemo-therapy (MAH).

Q: What conditions can ozone therapy treat?

A: Here at Restorative Health Clinic, we offer ozone therapy for patients with Lyme disease, chronic fatigue syndrome (CFS), and the chronic infections typically related to such illnesses. Essentially, any condition that impairs the body’s natural immunity can be treated with ozone, as it stimulates auto-immune defense mechanisms, necessary for tissue and cellular repair.

Q: How do I know if ozone therapy is right for me?

A: Consult your physician regarding the potential benefits and appropriate administration method for your particular condition. Dr. Vosloo and Dr. Hatlestad look forward to providing their guidance to anyone looking to improve their health and vitality.

If you would like to schedule an appointment, please give us a call at 503.747.2021.

Prolotherapy Can Improve Knee Osteoarthritis

A colleague and someone that I learned directly from, Jeff Patterson DO, co-authored a recent blinded trial of dextrose prolotherapy vs. placebo injection or exercise therapy. The results suggested that prolotherapy is an effective solution for knee osteoarthritis with reductions in pain and stiffness and an increase in range of motion and function. This is not new, but more confirmatory results of the effectiveness of prolotherapy for numerous types of joint pain and musculoskeletal complaints.

 

June 04, 2013

Dextrose Prolotherapy Can Improve Knee Osteoarthritis

(HealthDay News) – For adults with knee osteoarthritis, dextrose prolotherapy is associated with greater improvements in pain, function, and stiffness compared with saline injections or at-home exercise, according to a study published in the May/June issue of the Annals of Family Medicine.

David Rabago, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a three-arm blinded, randomized controlled trial involving 90 adults with ≥3 months of painful knee osteoarthritis. Participants were randomized to receive blinded injection (dextrose prolotherapy or saline) or at-home exercise. Injections were provided at weeks one, five, and nine, with additional treatments at weeks 13 and 17, as needed. An exercise manual and in-person instruction were provided to exercise participants.

The researchers found that all groups reported an improvement in composite Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores from baseline to 52 weeks. The improvement in WOMAC scores at 52 weeks was significantly more for the dextrose prolotherapy group compared with the saline or exercise groups, after adjustment for age, sex, and body mass index. In the prolotherapy group, the individual knee pain scores also improved more. High satisfaction was noted with prolotherapy and there were no adverse events reported.

“Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises,” the authors write.

The Abstract From the Recent Study:

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

  1. David Rabago, MD1⇑, Jeffrey J. Patterson, DO1, Marlon Mundt, PhD1,Richard Kijowski, MD2, Jessica Grettie, BS1, Neil A. Segal, MD, MS3 andAleksandra Zgierska, MD, PhD1

Author Affiliations:
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Departments of Orthopaedics & Rehabilitation, Epidemiology, and Radiology, The University of Iowa, Iowa City, Iowa

Corresponding Author:
David Rabago, MD, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, david.rabago@fammed.wisc.edu

Abstract

PURPOSE
Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.

METHODS
Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.

RESULTS
No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.

CONCLUSIONS
Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.

For full text of this research study: http://www.annfammed.org/content/11/3/229.full

Dr Glen Jarosz is a skilled practitioner of prolotherapy as well as numerous other regenerative injection therapies. Please contact him for a free consultation to see if you may benefit from prolotherapy.

Fibromyalgia Pain Treated With Prolotherapy

It is interesting to note that the classical tender points of fibromyalgia are over tendon and ligament insertions. These insertion points have the lowest pain threshold of any somatic structure, meaning, even a small stimulus can be interpreted as a large amount of pain. Weak or lax ligaments are potential nociceptors (nerve stimulus receptors) in fibromyalgia, and that this is potentially correctable with prolotherapy.

Treatment of Consecutive Severe Fibromyalgia Patients with Prolotherapy,

  1. Dean Reeves, MD

Abstract: The potential of tendon and ligament triggers as primary nociceptors in fibromyalgia led to treatment of primary fibromyalgia patients with tendon and ligament strengthening injections. The injection of ligaments and tendons with proliferant (Prolotherapy) offers the advantage of creating increased strength of the connective tissue in the region of injection as well as affecting the pain cycle. Reduction in pain levels and increased functional abilities were seen in excess of 75% of patients with severe fibromyalgia in this study.

Journal of Orthopaedic Medicine Vol 16 1994 No 3

 

For full research article go to:

http://www.drreeves.com/sites/default/files/fibromyalgia%20study.pdf

Knee Osteoarthritis and Improvement with Prolotherapy

More and more research is being published about the benefits of prolotherapy for numerous musculoskeletal complaints, this particular one on knee osetoarthritis. Prolotherapy is a form of regenerative injection technique that is very effective at treating injuries to tendons and ligaments. It has also been  shown to be beneficial for arthritis and discopathy. If you have pain or instability at or around a joint that impairs your daily activities, contact Dr Jarosz for more information.

Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study. 

Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C, Allard J, Bélanger M. Pain Med. 2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print]

Source 

Dr. Georges-L.-Dumont Regional Hospital, Vitalité Health Network, Moncton, New Brunswick Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick Dieppe Family Medicine Unit, Dieppe, New Brunswick Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec Department of Mathematics and Statistics, Université de Moncton, Moncton, New Brunswick Research Centre, Vitalité Health Network, Moncton, New Brunswick, Canada.

Abstract 

Objective. We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Design. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Patients. Thirty-six patients with chronic knee osteoarthritis. Interventions. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. Outcome Measures. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Results. Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1 ± 13.9, P = 0.11). There was a significant decrease in this groups’ WOMAC scores during the last 16 weeks when the participants received RIT (-9.3 ± 11.4, P = 0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. Conclusions. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks. 

Gentle nerve stimulation effective for migraines

Gentle nerve stimulation effective for migraines

Non-toxic, non-drowsy, non-chemical, non-addictive headache medicine that WORKS…………….. no side effects!

This kind of medicine is more along the lines of what is needed to make a lasting difference in chronic pain.

As you can see in the quoted MedPage study below, the highlighted words indicate the merit of micro-current as an electro medical modality:

  1. Non invasive – good, decreases side effects.
  2. Non chemical – good, less chance of messing something else up and needing more treatment for that in sensitive or multiple chemical sensitivity patients
  3. Affects trigeminal nerve – great, this is a very important pain generator in migraine headache

Results of electrical stimulation of branches of the trigeminal nerve:

  • Fewer monthly migraine attacks (19% versus 4% decline)
  • Fewer days per month with any headache (33% versus 4% reduction)
  • Lower monthly intake of acute anti-migraine drugs (-37% versus +1%)

Other options:

Neuraltherapy injections to the stellate and spehnopalatine ganglia are also very effective in clearing up migraine and sinus headaches.

Cleaning up your diet by avoiding the usual culprit foods like wheat, gluten, egg etc and

supporting your liver and gallbladder also are very helpful in cutting down the pain or sometimes better.

Trigger points in the base of the skull, muscles of the neck and shoulders are also very strongly involved in migraine headache causation.

Werner Vosloo ND, MHom

Nerve Stimulation Cuts Down on Migraines

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: February 11, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

 

A noninvasive device that electrically stimulates the trigeminal nerve prevented migraines for patients whose episodes were not well controlled by medication alone, a trial showed.

The number of days with a migraine dropped significantly by about two per month in the supraorbital transcutaneous stimulation group, without a change in the sham control group, Jean Schoenen, MD, PhD, of Belgium’s Liège University, and colleagues found.

While the difference between the two didn’t reach statistical significance, the coprimary endpoint showed three times more responders with at least a 50% drop in migraine days with neurostimulation (38% versus 12%, P=0.023), the group reported in the Feb. 19 issue of Neurology.

“The therapeutic gain (26%) is within the range of those reported for other preventive drug and nondrug anti-migraine treatments,” they wrote.

An accompanying editorial called for further study due to some issues with the trial, particularly whether blinding was good enough.

The 16 mA electrical pulses delivered by the device at 60 Hz intervals would be easy to feel if patients touched the electrodes whereas the 1 mA-, 1 Hz-sham stimuli “would be barely noticeable,” noted Eishi Asano, MD, PhD, of Wayne State University in Detroit, and Peter J. Goadsby, MD, PhD, of the University of California San Francisco.

“Taken together, this study has provided Class III evidence that neurostimulation with this device is effective and safe as a preventive therapy for migraine,” they concluded.

The PREMICE trial (Prevention of Migraine using the STS Cefaly) randomized 67 adults with at least two migraine attacks per month, regardless of aura, at five Belgian tertiary headache clinics to wear the sham or real device for 20 minutes daily for 3 months.

The Cefaly device consists of an eye glasses-style band with a self-adhesive electrode above the bridge of the nose covering the supratrochlear and supraorbital branches of the trigeminal nerve.

In an attempt to minimize unblinding, patients weren’t asked what the stimulation with their device felt like, weren’t enrolled if they were acquainted with another participant, and were kept from contact with each other during office visits so they wouldn’t have a chance to compare.

The sham group had a 20% drop in migraine days in the first month of treatment, similar to the active treatment group, but that effect disappeared thereafter.

By month 3, the mean number of migraine days in the neurostimulation group had fallen 30% to an average of 4.88 versus 6.94 per month during the run-in phase (P=0.023).

The average showed no change in the control group (6.54 versus 6.22 days per month, P=0.608).

“That the reduction in migraine days after effective supraorbital transcutaneous stimulation treatment just failed to reach the level of significance compared to sham stimulation may be due to the fact that the study was powered for responder rates, not for reduction in migraine days,” the researchers suggested.

Results didn’t differ by migraine aura status.

Among the secondary endpoints, significant advantages of neurostimulation versus sham were:

  • Fewer monthly migraine attacks (19% versus 4% decline)
  • Fewer days per month with any headache (33% versus 4% reduction)
  • Lower monthly intake of acute anti-migraine drugs (-37% versus +1%)

 

By comparison, the migraine prevention drug topiramate (Topamax) reduced monthly migraine days by 44% and monthly migraine attacks by 48%, with a 50% responder rate of 45% across its clinical trials.

Responder rates for other anticonvulsants, propranolol (Inderal), and behavioral therapy are in the same range as for the neurostimulation device.

“Since supraorbital transcutaneous stimulation therapy seems to be effective and well tolerated, it can be combined with drug treatments without risking cumulative adverse effects,” Schoenen’s group pointed out.

No adverse events or side effects occurred in either group.

The researchers acknowledged partial unblinding as a potential limitation of the study, as well as the younger age and shorter duration of migraine in the treatment group.

Cheap Medicine Effective for Fibromyalgia Too: New Study

Our take:

“This is a recent post by Dr. Jacob Teitelbaum for Dr. Oz’s blog. This is most interesting, and our clinical observations completely support Dr. T’s, as well as the study results–the older medicines, used judiciously and in combination, usually trump the newer more expensive meds in better symptom relief and fewer side effects.”

 

5¢/day medication beats $8/day medication in recent Fibromyalgia studies

Two new studies give a fascinating insight into medications for Fibromyalgia pain and sleep– that you won’t likely  hear about elsewhere. It will also help you understand first hand why our health care system costs are unnecessarily spiraling out of control.

A large study of 747 patients taking Lyrica (Pregabalin)1 showed that the 300 and 600 mg dose did not have a significant pain benefit overall, but they were able to show mild benefit from the 450 mg/day dose—in part, largely because of the large number of patients in the study allowed modest benefits to be statistically significant.

On the other hand, another placebo controlled study2 by Dr Harvey Moldofsky, my favorite FMS Sleep researcher, showed that very low dose Flexeril (generic cyclobenzaprine) was very effective for Fibromyalgia sleep and pain. Though in most cases, I find generics and brand name medications to work equally well (with some rare exceptions), this is a case where the generic will even work BETTER than the expensive brand name, whose release to too slow to give the benefits here, where you want a quick bedtime rise in blood level, but still have the medication out of your system by morning to avoid side effects.

In the Flexeril study, pain dropped 25% and energy improved 14% by 8 weeks. Sleep also improved significantly.  Patients were given a very low doses (beginning with 1 mg at bedtime and increasing to a maximum 4 mg at bedtime). Severe side effects were more common in the placebo group than the treatment group. The medication was well tolerated overall, but mild side effects (mild enough that no patient needed to stop the medication for side effects)  included headache, sedation, dry mouth, dizziness and constipation. If side effects are an issue, the dose can even be lowered further. The lower doses work better than the standard 10 mg 3 x day dose used  for muscle pain, which is more likely to cause side effects than this very low dose. So more is not better!

So let’s do the math

Lyrica at 150 mg 3 x day costs $8.64/day (Costco price—which is usually lower than elsewhere), is high in side effects and has modest benefit (though it can be very helpful in some patients, so I am glad to have it in our “tool kit”)

vs.

Flexeril (Cyclobenzaprine) 5 mg generic 10 CENTS a pill (So the treatment cost is 2 to 8 Cents a day—less than 1% of the cost of Lyrica). It has less side effects and appears to be more effective in both the studies and my experience than the Lyrica.

So which one will most physicians likely hear about? The Lyrica of course!  Why???? Being over 100 times the cost makes it far more profitable, so the company can spend $70 million a year advertising it to you and your physician. At 2 cents a day, no one will pay to advertise the Flexeril, so most physicians will never hear about this research (though I keep the Fibromyalgia and Fatigue Center physicians up to daye). In fact, keep an eye out and see how many times you see ads for each (a lot for Lyrica and none for flexeril will be my bet), so you can see for yourself that this is so.

This same scenario plays itself out for literally hundreds of medical treatments (In fact, I suspect for most of them). So it should be no surprise that health care costs are skyrocketing.

So which health care plan will solve this? Will it be the president’s plan (dubbed “ObamaCare”) or our current system? If you guessed neither, you guessed correctly. This is why I consider the current health care debate to be doomed to failure, as both sides recommendations will cause prices to skyrocket without improving care.

There is a 3rd alternative which would work though. Reread the above and see if you can figure it out. If you guessed have expert panels decide, recent studies showed that most of these expert panels are stacked with doctors paid by the drug companies—so that doesn’t work.4

Can you figure it out? Stay tuned!

SOURCES:

1- An International, Randomized, Double-blind, Placebo-controlled, Phase III Trial of Pregabalin Monotherapy in Treatment of Patients with Fibromyalgia

LYNNE PAUER, ANDREAS WINKELMANN, PIERRE ARSENAULT, ANDERS JESPERSEN, LAURENCE WHELAN, GARY ATKINSON, TERESA LEON, BERNHARDT ZEIHER on Behalf of the A0081100 Investigators
J Rheumatol. 2011; 38:2643-2652.

2-Effects of Bedtime Very Low Dose Cyclobenzaprine on Symptoms and Sleep Physiology in Patients with Fibromyalgia Syndrome: A Double-blind Randomized Placebo-controlled Study
HARVEY MOLDOFSKY, HERBERT W. HARRIS, W. TAD ARCHAMBAULT, TERENCE KWONG, and SETH LEDERMAN
J Rheumatol. 2011; 38:2653-2663.

http://www.jrheum.org/content/38/12/2653.full

3- Costco Price Checker (a VERY helpful tool!) http://www.costco.com/Pharmacy/DrugInformation.aspx?p=1

4-“Prevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and the United States: cross sectional study.” Neuman J, Korenstein D, Ross J, and Keyhani S. BMJ 2011; DOI: 10.1136/bmj.d5621.

“Practice guidelines developed by specialty societies: The need for a critical appraisal.” Grilli R, Magrini N, Penna A, et al. Lancet2000; 355:103-106.

“Conflicts of Interest Abound in Diabetes Guidelines Committees.” Gale EAM. BMJ 2011; DOI: 10.1136/bmj.d5728.