Ozone Therapy in the Treatment of Low Back Pain: A Systematic Review of Its Evolution, Clinical Application, and Efficacy.

Low back pain is a major cause of disability worldwide. Ozone therapy has emerged as a therapeutic alternative; however, its efficacy and safety remain controversial. A systematic review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, Embase, Ovid, EBSCOhost, and Google Scholar (2013-2023). Randomized clinical trials, observational studies, systematic reviews, and meta-analyses were included. Study selection was performed using Rayyan, and methodological quality was assessed with STROBE, CONSORT, and QUADAS.A total of 28 studies were included. Although some reported clinical improvement, methodological heterogeneity, the use of combined therapies, the absence of adequate control groups, and the presence of adverse events predominated. Current evidence is insufficient to support the recommendation of ozone therapy as an effective treatment for low back pain. Further studies with stronger methodological designs, clear diagnostic criteria, and standardized intervention protocols are needed.