Treatment methods offered by AlleviO₃
Depending on the clinical condition, oxygen-ozone therapy may be administered systemically, through loco-regional infiltration, or by topical application to skin lesions.
Major Autohemoinfusion (GAE) — systemic route
This consists of drawing a small amount of the patient’s blood (typically 50–100 mL), which is brought into contact, within a closed and sterile circuit, with a controlled-concentration oxygen-ozone mixture and then reinfused intravenously into the same patient. This is the systemic method, indicated particularly for circulatory disorders, chronic inflammatory conditions, immune support and, in oncology, as a complementary therapy — never as a replacement — during ongoing chemotherapy or radiotherapy.
Loco-regional infiltrations
The mixture is injected directly into the affected area: paravertebrally, intra-articularly, peritendinously or, in selected cases and under radiological guidance, intradiscally or intraforaminally. This is the method most commonly used for spinal pain (neck pain, thoracic back pain, low back pain, lumbosciatica), disc herniation and osteoarthritis of the major joints.
Topical application — ozone therapy for skin ulcers
For chronic skin lesions with slow healing, the mixture is applied locally using a sterile device (“ozonobag”) that isolates the affected area, or through ozonated oil and water used for wound dressing. It is indicated for vascular ulcers of the lower limbs, diabetic foot ulcers, pressure sores and surgical wounds with difficult healing.
Main clinical indications
| Area |
Main applications |
| Spinal disorders and chronic pain |
Disc herniation and disc protrusions, lumbosciatica, neck pain, thoracic back pain, post-spinal-surgery pain |
| Joint and tendon disorders |
Knee osteoarthritis, hip osteoarthritis, degenerative shoulder arthropathies, tendinopathies (shoulder, epicondylitis), entrapment syndromes |
| Circulation and difficult-to-heal wounds |
Peripheral arterial disease, diabetic angiopathy, vascular ulcers, diabetic foot ulcers, pressure sores |
| Chronic inflammation and immunity |
Rheumatoid arthritis, states of general debilitation, immune support in geriatric care |
| Neuropathic pain |
Postherpetic neuralgia, trigeminal and Arnold’s neuralgia, atypical facial pain |
| Oncology |
Complementary supportive therapy (never a replacement) during chemotherapy/radiotherapy |
The level of scientific evidence is not uniform across the various indications: for lumbar disc herniation/lumbosciatica and knee osteoarthritis, the Tuscany Region Guidelines (2020) assign a stronger level of evidence (evidence A); for other orthopaedic applications, the level of evidence is considered B; for the remaining indications, the evidence base consists mainly of scientific society protocols (SIOOT, ISCO3) and clinical literature, with greater heterogeneity among the available studies.
Disc herniation and lumbosciatica: the indication with the strongest evidence
Among the applications of oxygen-ozone therapy, infiltrative treatment of lumbar disc disease and lumbosciatica is supported by the strongest evidence base and by a dedicated regional guidance pathway: in 2020, the Tuscany Region, through its Technical Scientific Committee, approved a specific guidance document for this indication, defining patient selection criteria (clinical-radiological confirmation by magnetic resonance imaging, absence of severe structural spinal deformities, absence of calcified hernias) and the therapeutic pathway. Treatment is generally reserved for cases of radicular pain with clinical-radiological correlation, following careful specialist evaluation; it is a conservative option to be considered within a broader treatment pathway together with Pain Medicine and, where indicated, Manual Therapies.
Preliminary assessment and safety
Before beginning a course of oxygen-ozone therapy, particularly Major Autohemoinfusion, the physician takes a targeted medical history and prescribes the blood tests necessary to rule out the main contraindications.
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Complete blood count with platelets, to rule out thrombocytopenia and coagulation disorders
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G6PD (glucose-6-phosphate dehydrogenase) testing: screening for G6PD deficiency (favism) is a mandatory step, as it represents the only universally recognised absolute contraindication to systemic treatment due to the risk of acute haemolysis
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Thyroid function (TSH), to rule out uncontrolled hyperthyroidism
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Coagulation parameters, particularly in patients receiving anticoagulant therapy
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Pregnancy test in women of childbearing age
Treatment is contraindicated during pregnancy, in G6PD deficiency, severe cardiovascular instability, recent myocardial infarction, active bleeding or active seizure states; it requires case-by-case assessment in the presence of hyperthyroidism, uncontrolled diabetes, a history of epilepsy, ACE inhibitor therapy or ongoing anticoagulant/antiplatelet therapy. Before each course, specific written informed consent is obtained for the route of administration used.
Systemic oxygen-ozone therapy falls within substances/methods not permitted under anti-doping regulations: competitive athletes must inform their physician.
How the treatment pathway works
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Initial assessment
Medical history, physical examination and definition, together with the patient, of the indication and most appropriate route of administration.
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Preliminary examinations
Prescription and completion of the necessary blood tests, particularly for Major Autohemoinfusion, and collection of informed consent.
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Course of sessions
Sessions are scheduled at intervals determined by the physician according to the clinical condition and route of administration (generally closer together at the beginning of the course and subsequently more spaced out); each session lasts approximately 20–40 minutes.
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Reassessment and follow-up
At the end of the treatment course, and during the following weeks, the clinical response is reassessed (pain intensity, functional ability and, for skin lesions, progression of healing) in order to decide together with the patient whether the treatment pathway should be continued or repeated.
A treatment integrated into the care pathway
At AlleviO₃, oxygen-ozone therapy is offered as part of a multidisciplinary care pathway, coordinated with the centre’s other areas:
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Pain Medicine, for the overall assessment of chronic pain and integration with other infiltrative techniques
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Manual Therapies (physiotherapy, osteopathy, kinesiology), for functional recovery
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Outpatient General Surgery, for the management of difficult wounds and skin lesions when surgical assessment is also required
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Nutritional Medicine, to support the management of chronic inflammation and diabetic foot conditions
When to consult a specialist
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Chronic back pain, lumbosciatica or cervicobrachialgia caused by disc herniation or disc protrusion
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Osteoarthritis of the knee, hip or shoulder that is not adequately controlled by other treatments
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Persistent tendinopathies or painful entrapment syndromes
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Chronic wounds or skin ulcers with slow healing, including diabetic foot ulcers
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Need for complementary supportive therapy during an oncology treatment pathway already established by the treating oncologist
Oxygen-ozone therapy is not an emergency treatment and never replaces oncology, cardiology or surgical treatments indicated by the relevant specialist: it must always be included, with their agreement, within the patient’s overall treatment plan.
An integrated therapeutic option, personalised to the individual patient
At AlleviO₃, oxygen-ozone therapy is offered only after careful clinical assessment, in accordance with scientifically recognised indications and contraindications, as part of a multidisciplinary care pathway.
Scientific references
Verification carried out during this session: the existence and most recent edition of the Madrid Declaration on Ozone Therapy were confirmed (3rd ed., approved on 22/03/2020, with the 4th edition being prepared for 2025); the text and regulatory reference of Tuscany Region Decision No. 12/2020 on ozone therapy for lumbar disc disease were confirmed; the current activity of SIOOT was confirmed (6th International Congress, Rome, 16–18 May 2025, 40th anniversary of the society). Technical session parameters (concentrations, volumes, number of sessions) are not included in this public information text, as they fall within the centre’s internal clinical protocol and must be personalised on a case-by-case basis with the specialist. No dedicated review of the most recent literature concerning topical ozone therapy for skin ulcers was conducted: the content relating to this specific application derives from SIOOT/ISCO3 protocols.
