Ozone Oil Massage Therapy for Pain Relief and Joint Health

Table of Contents

Ozone therapy can jumpstart healing and rebalance inflammatory responses. Anecdotally, some people find that topical ozone oil used in massage therapy can enhance the pain-relieving benefits of the massage.

In this article, we’ll review the limited evidence and explore how ozone oil massage therapy works.

At a Glance:

  1. Like ozone sauna, topical ozone oils deliver lipid peroxidation byproducts, which can get absorbed through the skin. 
  2. According to ozone sauna clinical studies, delivering LOPs through the skin can improve blood oxygen levels and trigger changes in oxidative status.
  3. Improved oxygen levels, blood circulation, and normalizing oxidative stress and inflammation may explain the benefits of ozone oil massage therapy. 
  4. Direct evidence on topical ozone oil’s benefits beyond the skin is limited to 1 clinical trial for osteoarthritis. Participants with severe osteoarthritis experienced significant pain relief, compared to placebo.
  5. Evidence from other types of ozone therapy may provide circumstantial evidence explaining the benefits of ozone oil massage therapy. However, we need more studies to fully understand how it works and learn about all the benefits.
  6. Ozone oil could be a great addition to massage therapy to boost recovery, reduce pain and inflammation, break adhesion, and more. Other beneficial ingredients like CBD and essential oils can also be added after oil ozonation. 

How does topical ozone oil massage help with joint issues and body pain?

While there are not many studies looking at the internal effects of ozone oil on the skin, it’s safe to assume that ozone oil massage delivers some similar effects as ozone skin exposure in an ozone sauna.

Ozone saunas expose your skin to ozone, creating lipid oxidation byproducts (LOPs). Smaller LOPs can be absorbed through the skin, although reactive oxygen species and larger molecules may not cross the skin barrier [1]. Similarly, massaging ozone oil into the skin allows LOPs in the oil to be absorbed into the bloodstream. Whereas, ozone gas cannot be absorbed through the skin.

In a small clinical trial involving seven male volunteers by Dr. Bocci’s group, a 20-min ozone sauna session temporarily increased the following [1]:

  • Oxygen in the venous blood
  • Oxidative stress, white blood cells, and inflammatory cytokine IL-8
  • Total antioxidant status

Some other observed effects in this study, such as increased body temperature and heart rate, were likely due to heat exposure and were not applicable to ozone oil massage.

During ozone oil production, ozone reacts with the unsaturated fatty acids in the oil, forming ozonides and peroxides. These ozonides are stable oxygen-rich compounds that can release oxygen slowly over time. These compounds can enhance oxygen availability when absorbed into the tissue [2, 3].  

In short, both ozone sauna and ozone oil massages work by delivering lipid peroxidation byproducts through the skin. This activates the immune system and the body’s antioxidant response. Now, let’s look at various ways it helps with pain, muscle, and joint health.

Improving tissue oxygenation and blood flow

Poor circulation contributes to soreness and worsened pain in exercise-related and injury-related pain. Most pain treatments, such as massages, electrostimulation, and even physiotherapy work by improving blood flow to the area. 

In ozone oil massage, the ozonides improve blood oxygen levels and blood flow beyond what massages can provide. Improved blood flow is crucial for several reasons [4]:

  • Removal of toxins and inflammatory mediators
  • Improved nutrient delivery
  • Increasing local temperature both from blood flow and reaction between the ozonides and molecules in the skin

Stimulating mitochondrial function

Some powerful recovery technologies such as red light therapy work by improving mitochondrial function. Beyond producing energy, the mitochondria are also responsible for sensing dangers and coordinating chronic inflammation in the body [5]. So, stimulating mitochondrial function may tell your cells that it’s safe to finally heal and stop signaling pain. 

Ozone oil massage can support mitochondrial function in the immediate areas by [6]:

  • Activation of Antioxidant Response: LOPs can induce mild oxidative stress. This stress stimulates cellular antioxidant pathways, such as Nrf2, catalase, superoxide dismutase, and glutathione peroxidase. Oxidative stress can cause mitochondrial dysfunction, so stimulating antioxidant response supports mitochondrial health. 
  • Enhanced Oxygen Utilization: By increasing the oxygen supply to tissues, ozone oil helps mitochondria produce energy more efficiently. This provides more energy for tissue repair and reducing fatigue.
  • Improved Cellular Signaling: Ozone can modulate various signaling pathways to promote tissue growth and regeneration [7].

Reducing inflammation 

Ozone therapy can powerfully support the body to normalize inflammatory responses partly due to its effects on prostaglandins [8]. These are fat-based inflammatory mediators that could be pro or anti-inflammatory. Similarly, small amounts of LOPs can help moderate inflammation [9].

Prostaglandins are produced at sites of tissue damage or infection, where they cause pain, inflammation, and fever.

Ozone modulates prostaglandins by [10–12]:

  • Modulation of COX activity to reduce inflammatory prostaglandins
  • Improving your cells’ ability to neutralize oxidative stress associated with inflammation
  • Changing molecules that would become prostaglandins so you have less inflammatory prostaglandins overall

These changes tend to have a net effect of lower pain and swelling. This reduction in inflammation allows tissue to heal. 

A clinical trial evaluated the effects of topical ozone oil for arthritic knee pain relief involving 80 patients. It found that C-reactive protein, a blood marker of inflammation, somewhat decreased along with pain levels and degree of osteoarthritis. However, while the degree of arthritis and pain significantly decreased, this CRP reduction (14.62 to 12.81 mg/dL) was not statistically significant [13]. 

Stimulating healing and regenerative processes

Topical ozone oil has other regenerative benefits, making it an invaluable tool, especially for joints and muscles. Ozone oil can work to:

  • Enhance fibroblast activity: Fibroblasts are cells that produce collagen and other extracellular matrix components essential for the structural integrity of tissues. By enhancing fibroblast activity, ozone oil promotes the synthesis of new connective tissue, aiding in the repair of damaged muscles and ligaments [14].
  • Promote blood vessel formation (angiogenesis): Improved blood supply to injured or degenerative tissues ensures a constant oxygen and nutrient supply, crucial for the healing and regeneration of damaged tissues [15].
  • Immunomodulatory effects: Ozone can modulate the immune system by balancing Th1 and Th2 cell responses [16]. This means it may also mitigate some autoimmune reactions [16].

How to use ozone oil for muscle and joint pain

Applying to the joint or muscles

Using ozone oil topically on joints or muscles can provide significant relief and aid in the healing of various conditions. Proper application for topical ozone oil includes [17]:

  1. Cleaning the Area: Before applying ozone oil, ensure that the skin over the joint or muscle is clean and dry to improve absorption of the oil and LOPs.
  2. Application:
    • Direct Application: Pour a small amount of ozone oil into your palm or on a cotton pad and gently rub it into the affected area until it is absorbed into the skin. 
    • With Massage: For deeper penetration, particularly for sore muscles or deep joint pain, massage the area with ozone oil. Use firm but gentle pressure to work the oil deeper into the tissue. This can help increase blood flow and oxygenation to the area, enhancing the therapeutic effects. A massage spray including a mix of ozone oil and cosmetic-grade alcohol may also enhance the absorption of the LOPs [18]. 
  3. Frequency of Application: Ozone oil can be applied 1-2 times daily. The specific frequency depends on the severity of the symptoms and the advice of a healthcare professional.
  4. Duration of Treatment: The duration of using ozone oil can vary based on the condition being treated. some text
    • Acute conditions, such as sprains or muscle strains, might require a few days to weeks of use. 
    • Chronic conditions necessitate long-term use as necessary.
  5. Post-Massage Care:
    • Cover the Area: After the massage, it may be beneficial to cover the treated area with a warm towel or cloth to enhance further absorption of the ozone oil. Delay showers for at least 2 hours.
    • Hydration: Encourage hydration post-massage to help flush out toxins that may have been released during the massage.

The recommended application regimen takes into consideration a variety of factors, including:

  • Frequency of Massage: For therapeutic benefits, a massage with ozone oil can be performed once or twice a week, depending on the severity of the condition.
  • Duration of Treatment: Each massage session can last from 30 to 90 minutes, based on the areas treated and the specific needs of the individual.
  • Long-Term Care: Ongoing sessions may be required for chronic conditions, with evaluations every few weeks to assess progress and adjust treatment as necessary.

Conditions that may benefit from topical ozone oil application include:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Tendonitis
  • Muscle strains and sprains
  • Back pain
  • Post-surgical recovery
  • Chronic pain management
  • Sports injuries

Some precautions and considerations include:

  • Skin Sensitivity: Before starting regular applications, apply a small amount of ozone massage oil to a skin patch to check for any allergic reactions or sensitivity.
  • Medical Advice: It is advisable to consult with a healthcare provider before beginning any new treatment regimen, especially for individuals with underlying health conditions or those already under medication for other treatments.
  • Storage: Ozone oil should be stored in a cool, dark place to maintain its effectiveness. Exposure to high temperatures or direct sunlight can degrade the oil.

By following these guidelines, users of topical ozone oil can safely and effectively manage and potentially alleviate the symptoms of various joint and muscle conditions, enhancing mobility and quality of life.

By integrating ozone oil into massage therapy, individuals can receive enhanced benefits, particularly in the realms of pain management, inflammation reduction, and overall wellness promotion. This approach combines the mechanical advantages of massage with the biochemical benefits of ozone, providing a powerful tool for health and recovery.

Oils and other ingredients that synergize with ozone oils 

Ozone oils can be effectively combined with other therapeutic oils like CBD oil and various essential oils to amplify their health benefits. 

Each oil brings its unique properties and mechanisms of action, which when combined with ozone oil, can create a more comprehensive treatment solution for various conditions.

Some considerations for combined usage include:

  • Compatibility: Ensure that the oils are compatible in terms of their chemical properties and intended use. Not all essential oils may be suitable for mixing directly with ozone oil, so proper formulation and testing are essential.
  • Concentration: The concentration of each oil should be adjusted to ensure efficacy without overpowering the therapeutic properties of the other. Over-concentration can lead to skin irritation or other unwanted side effects.

Adding CBD or essential oils may enhance the effectiveness of each component, and even enhance the treatment’s mental health benefits. 


The health benefits of combining topical ozone oil therapy with CBD oil include:

Enhanced anti-inflammatory effects: Ozone oil and CBD oil possess strong anti-inflammatory properties. 

CBD interacts with the body’s endocannabinoid system to modulate inflammation and cellular response [19]. When used with ozone oil, the combined effect can significantly reduce inflammation more effectively than either oil alone. This is beneficial for conditions such as:

  • Arthritis
  • Muscle soreness
  • Skin inflammation

Pain relief: CBD is well-known for its analgesic properties, helping to alleviate chronic pain by impacting endocannabinoid receptor activity and reducing inflammation [19]. Combined with the pain-relieving properties of ozone oil, users may experience more profound relief from chronic pain and acute discomfort.

Enhanced oxidative stress regulation: Ozone oil induces an adaptive increase in antioxidant capacity, while CBD has been found to exert a protective role against oxidative stress in neurons and other cells, thus providing joint protective effects [19].

Essential oils

Many essential oils such as lavender, eucalyptus, and peppermint have specific therapeutic properties, such as antimicrobial and anti-inflammatory [20, 21].

Many essential oils also stimulate relaxation responses in the nervous system, which can help with stress and sleep quality. This can enhance the healing environment for the ozone oil’s mechanisms, potentially accelerating recovery processes [21].

Alcohol and dimethyl sulfoxide (DMSO)

Alcohol (ethanol) is a common ingredient in skincare and massage therapy products, as it thins out the mix. Ethanol also has antibacterial properties and enhances the absorption of fat-soluble substances through the skin [18]. 

Dimethylsulfoxide (DMSO) is a byproduct of papermaking. Topical DMSO has several overlapping benefits with ozone therapy and ozone oil. For example, it can help with pain, wound healing, and injury healing [22]. It’s also a standard solvent that is often used to enhance drug absorption through the skin [23].

Muscle and joint benefits of ozone oil massages

Exercise and injury recovery

Ozone is gaining recognition as a valuable adjunct in exercise recovery. It may help athletes and fitness enthusiasts boost recovery and training responses. Unlike ozone IV therapy, ozone oil massage is not a banned treatment for professional athletes.

Ozone oil massage therapy may deliver some exercise recovery benefits through its healing, tissue oxygenation, and anti-inflammatory benefits.  

In a case study, medical ozone therapy was investigated as an adjunct treatment for hamstring injuries in athletes. After two weekly sessions of medical ozone infiltrations, significant improvements were observed. Pain intensity, initially recorded at seven on the visual analog scale, decreased to two. Mobility in the injured area showed considerable enhancement–the toe touch test results improved from an 8 cm distance from the toes at baseline to 0 cm, indicating full mobility restoration. Thermography revealed an increase in local perfusion with temperatures rising from 31.2°C to 32°C after two treatments, reflecting increased blood flow to the area.

The findings of this study underline the potential of medical ozone as a valuable adjuvant treatment in the recovery process of sports-related tendinopathies [24].

A cohort study of 40 patients experiencing shoulder pain for six months evaluated the efficacy of oxygen-O3 (ozone) therapy in treating partial tears of the supraspinatus tendon, a critical component of the rotator cuff. Ultrasound-guided infiltration of oxygen-O3 therapy was an effective treatment for patients with partial tears of the supraspinatus tendon, showing promising results in alleviating symptoms associated with the condition [25]. 

A review investigated the effectiveness of oxygen-O3 therapy in treating shoulder adhesive capsulitis, commonly known as frozen shoulder, a condition characterized by a significant reduction in the range of active motion and associated with unclear origins and onset of pain. 

The treatment utilized a mixture of 95–96% oxygen and 4–5% ozone (O3) administered through local injections. O3 treatment proved beneficial in several key aspects, including pain reduction via the alteration of levels of serotonin and bradykinin, chemicals involved in pain sensation. Inflammation was also modulated by neutralizing proinflammatory cytokines like interferon-alpha, tumor necrosis factor-alpha (TNF-α), and denaturing cellular proteins involved in inflammation pathways, such as kallikrein, kininogen, and cyclooxygenase (COX). A significant effect of ozone therapy is its direct action on muscle fibers, providing a muscle relaxant effect that is particularly beneficial for the stiff muscles associated with adhesive capsulitis [26].

A case study of a 58-year-old woman experiencing severely limited joint movement and pain evaluated the effectiveness of O3 therapy in treating the glenohumeral joint, which is part of the shoulder complex. Following O3 injection into the glenohumeral joint and microdoses injected into the long head of the bicep muscle and subacromial bursa, the patient reported significant improvements. There was a noted decrease in pain during the night, an increase in mobility in the shoulder, and a complete alleviation of pain [25].

The LOPs absorbed through the skin may deliver some, but not all, health benefits of ozone therapy. By deduction, some results of ozone IV therapy and injection may be replicated in therapeutic ozone oil massage.

Caveat: Ozone gas injection may not be the same as ozone oil massage on the skin. Admittedly, there is very little ozone research on ozone oil. Using ozone injection studies to explain the effects of topical ozone oil could be too far a deduction to make. However, this could help you understand how topical ozone oil works. We need more research to understand whether ozone oil has a similar effect as ozone injection. Our goal is to provide you, the reader, with up-to-date information so you can make informed decisions.


A placebo-controlled, triple-blind, randomized controlled trial investigated the use of ozone oil to alleviate symptoms of osteoarthritis patients older than 50 years. Eighty patients were randomly divided into two groups: treatment (ozonated oil) and placebo (non-ozonated oil). The oils were used twice a day for 60 days. A significant improvement in pain relief was observed in all groups except in the placebo group where patients had been diagnosed with severe osteoarthritis (p = 0.021) [13].

An animal study experimented with intra-articular injections of ozone at various concentrations to treat rheumatoid arthritis (RA) in rats. An ozone concentration of 40 µg/mL was most effective in treating RA by significantly reducing synovial TNF-α levels and suppressing pathological features of RA including synovial hyperplasia (the excessive growth of synovial cells) and joint swelling. Treatment also modulated TNF receptors to promote the apoptosis (programmed cell death) of synovial cells, preventing their overproliferation. This study’s findings suggest that ozone therapy could be a promising new treatment for managing rheumatoid arthritis. The ability of ozone to modulate key inflammatory mediators and pathways, particularly TNF-α and its receptors, highlights its potential as a therapeutic agent that might overcome some of the limitations associated with existing RA treatments [27]. 

Improve energy levels

Topical ozone oil may help boost energy levels by improving mitochondrial functions, and oxygen utilization, and supporting the body’s antioxidant properties.

A clinical trial investigated the effects of ozone therapy on three patients with chronic fatigue syndrome (CFS). These patients presented symptoms such as:

  • Fatigue
  • Muscle weakness
  • Sleep disturbances
  • Frequent headaches

The therapy regimen did not follow a fixed schedule but was adapted based on individual responses, totaling 28, 32, and 40 treatments over 3.5, 4, and 5 months, respectively. This was followed by a three-month rest period. Initial assessments included testing the total antioxidant capacity (TAS) of the patients' plasma, which was within normal ranges (1.3–1.8 mM). TAS levels post-ozonation showed a decrease of no more than 15%, while peroxidation levels (TBARS) increased significantly at higher ozone concentrations, confirming effective blood ozonation. 

After continuous therapy for 3.5 to 4 months, most symptoms were markedly decreased, and all patients reported feeling practically normal six months post-treatment. Patients reported no side effects and experienced significant improvements in energy and a general sense of euphoria, highlighting the therapy's potential effectiveness [28]. 

Break myofascial adhesions

Myofascial adhesions refer to the bands of painful, rigid tissue that can form within muscles and between muscle layers. These adhesions, often referred to as "knots," are areas where the fascia (the connective tissue surrounding muscles) has become restricted due to injury, overuse, inactivity, or inflammation. The fascia is meant to be flexible and slide smoothly, but adhesions cause it to become stiff and less compliant.

Breaking up myofascial adhesions is crucial for restoring normal muscle function and reducing pain. The benefits include:

  • Increased range of motion
  • Reduced pain and discomfort
  • Improved circulation
  • Enhanced muscle performance

Myofascial adhesions are common in conditions such as [29]:

  • Chronic muscle pain syndromes like myofascial pain syndrome
  • After injuries or surgery where scar tissue has formed
  • In athletes or individuals with repetitive strain injuries
  • Postural imbalances and chronic back or neck pain

There is no direct evidence that ozone therapy or ozone oil breaks adhesions. However, various clinical studies have shown that ozone therapy helps with myofascial pain and increasing ranges of motion in temporomandibular disorders and fibromyalgia. Therefore, addressing myofascial adhesions might be one of the ways ozone massage helps with pain [30].

Back pain

Topical ozone oil is increasingly recognized as a beneficial treatment for back pain, which is a common ailment affecting a large segment of the population at some point in their lives.

A systematic review investigated the role of ozone therapy in treating back pain across seven selected studies. These studies compared various treatments: ozone versus placebo, ozone therapy combined with global postural re-education versus global postural re-education alone, ozone with steroids versus steroids alone, and ozone therapy versus microdiscectomy.

The majority of these studies demonstrated that those receiving ozone therapy experienced similar or improved outcomes compared to the control groups. Only three studies reported on side effects –two indicated no complications, and one noted a low incidence of adverse effects, which were not significantly different between the experimental and control groups [31].

A clinical trial investigated the efficacy and safety of intramuscular paravertebral lumbar ozone injections as a minimally invasive treatment for lower back pain. 109 patients underwent intramuscular paravertebral lumbar injections of ozone due to lower back pain. Pain intensity and radiating pain were measured using a 10-cm horizontal Visual Analogue Scale (VAS), while perceived functional status and disability were assessed using the Oswestry Disability Index (ODI), both before treatment and one month after the last injection.

Survey results showed a reduction in the VAS score in 23 out of 29 treatment cycles (79%), indicating a significant decrease in pain. The average reduction in the VAS score was 2.3 points. Additionally, all but one patient reported a reduction in their ODI score, with an average decrease of 9%, demonstrating an improvement in functional status and a decrease in disability. No complications were associated with the treatment. The findings suggest that lumbar paravertebral ozone injections are a minimally invasive, safe, and cost-effective method for alleviating low back pain and disability [32]. 

A multicenter randomized, double-blind, simulated therapy-controlled trial evaluated the efficacy of intramuscular-paravertebral injections of an oxygen-ozone (O2O3) mixture for treating acute low back pain (LBP) due to lumbar disc herniation (LDH). Sixty patients with acute LBP from LDH were randomized into two groups: one receiving intramuscular O2O3 injections and the other a simulated therapy. At the 6-month follow-up, 61% of the patients in the O2O3 group were pain-free compared to 33% in the control group (P < 0.05). The O2O3 group also reported lower mean pain scores and significant improvements in LBP-related disability throughout the observation period. The oxygen-ozone therapy also resulted in reduced usage of nonsteroidal anti-inflammatory drugs at the initial follow-ups [33].


Aside from 1 clinical trial, the evidence is very limited for ozone oil massage therapy beyond the skin. However, anecdotally, we’ve observed great results with topical ozone oil for joint and muscle pain. There is also some circumstantial evidence suggesting that ozone oil on the skin, such as for massage therapy, could reduce inflammation and discomfort beyond the skin.


Bocci, V., Borrelli, E., Valacchi, G. and Luzzi, E. (1999) Quasi-total-body exposure to an oxygen-ozone mixture in a sauna cabin. Eur. J. Appl. Physiol. Occup. Physiol. 80, 549–554

Pryor, W. A., Das, B. and Church, D. F. (1991) The ozonation of unsaturated fatty acids: aldehydes and hydrogen peroxide as products and possible mediators of ozone toxicity. Chem. Res. Toxicol. 4, 341–348

Harrison, K. A. and Murphy, R. C. (1996) Direct mass spectrometric analysis of ozonides: application to unsaturated glycerophosphocholine lipids. Anal. Chem. 68, 3224–3230

Clavo, B., Pérez, J. L., López, L., Suárez, G., Lloret, M., Rodríguez, V., et al. (2003) Effect of ozone therapy on muscle oxygenation. J. Altern. Complement. Med. 9, 251–256

Galluzzi, L., Kepp, O. and Kroemer, G. (2012) Mitochondria: master regulators of danger signalling. Nat. Rev. Mol. Cell Biol. 13, 780–788

König, B. and Lahodny, J. (2022) Ozone high dose therapy (OHT) improves mitochondrial bioenergetics in peripheral blood mononuclear cells. Transl Med Commun 7, 17

Yan, Z., Jin, Y., An, Z., Liu, Y., Samet, J. M. and Wu, W. (2016) Inflammatory cell signaling following exposures to particulate matter and ozone. Biochim. Biophys. Acta 1860, 2826–2834

de Sire, A., Marotta, N., Ferrillo, M., Agostini, F., Sconza, C., Lippi, L., et al. (2022) Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review. Int. J. Mol. Sci. 23 https://doi.org/10.3390/ijms23052528

Ayala, A., Muñoz, M. F. and Argüelles, S. (2014) Lipid peroxidation: production, metabolism, and signaling mechanisms of malondialdehyde and 4-hydroxy-2-nonenal. Oxid. Med. Cell. Longev. 2014, 360438

10  Madden, M. C., Eling, T. E. and Friedman, M. (1987) Ozone inhibits endothelial cell cyclooxygenase activity through formation of hydrogen peroxide. Prostaglandins 34, 445–463

11  Clavo, B., Rodríguez-Esparragón, F., Rodríguez-Abreu, D., Martínez-Sánchez, G., Llontop, P., Aguiar-Bujanda, D., et al. (2019) Modulation of Oxidative Stress by Ozone Therapy in the Prevention and Treatment of Chemotherapy-Induced Toxicity: Review and Prospects. Antioxidants (Basel) 8 https://doi.org/10.3390/antiox8120588

12  Petracca, B., Nădăban, A., Eeman, M., Gooris, G. S. and Bouwstra, J. A. (2021) Effects of ozone on stratum corneum lipid integrity and assembly. Chem. Phys. Lipids 240, 105121

13  Anzolin, A. P., Collares, D. da S., Tadeu Dos Santos, R., Pasqualotti, A., Rossato-Grando, L. G. and Bertol, C. D. (2021) Effectiveness of topical ozonated oil in severe osteoarthritis: A randomised, triple-blinded, placebo-controlled study. Complement. Ther. Clin. Pract. 43, 101351

14  Xiao, W., Tang, H., Wu, M., Liao, Y., Li, K., Li, L., et al. (2017) Ozone oil promotes wound healing by increasing the migration of fibroblasts via PI3K/Akt/mTOR signaling pathway. Biosci. Rep. 37 https://doi.org/10.1042/BSR20170658

15  Pchepiorka, R., Moreira, M. S., Lascane, N. A. da S., Catalani, L. H., Allegrini, S., Jr, de Lima, N. B., et al. (2020) Effect of ozone therapy on wound healing in the buccal mucosa of rats. Arch. Oral Biol. 119, 104889

16  Tahmasebi, S., Qasim, M. T., Krivenkova, M. V., Zekiy, A. O., Thangavelu, L., Aravindhan, S., et al. (2021) The effects of oxygen-ozone therapy on regulatory T-cell responses in multiple sclerosis patients. Cell Biol. Int. 45, 1498–1509

17  (2022, September 20) Ozone Massage. Prozone Health - Seize your health, Prozone Health https://prozonehealth.com/ozone-massage/

18  Gupta, R., Badhe, Y., Rai, B. and Mitragotri, S. (2020) Molecular mechanism of the skin permeation enhancing effect of ethanol: a molecular dynamics study. RSC Adv. 10, 12234–12248

19  Meissner, H. and Cascella, M. (2023) Cannabidiol (CBD), StatPearls Publishing

20  Pezantes-Orellana, C., German Bermúdez, F., Matías De la Cruz, C., Montalvo, J. L. and Orellana-Manzano, A. (2024) Essential oils: a systematic review on revolutionizing health, nutrition, and omics for optimal well-being. Front. Med. 11, 1337785

21  Sattayakhom, A., Wichit, S. and Koomhin, P. (2023) The Effects of Essential Oils on the Nervous System: A Scoping Review. Molecules 28 https://doi.org/10.3390/molecules28093771

22  Swanson, B. N. (1985) Medical use of dimethyl sulfoxide (DMSO). Rev. Clin. Basic Pharm. 5, 1–33

23  Marren, K. (2011) Dimethyl sulfoxide: an effective penetration enhancer for topical administration of NSAIDs. Phys. Sportsmed. 39, 75–82

24  Hidalgo-Tallón, F. J., Pinto-Bonilla, R., Baeza-Noci, J., Menéndez-Cepero, S. and Cabizosu, A. (2023) Medical ozone on hamstring injury in a professional athlete assessed by thermography: a clinical case report. BJR Case Rep 9, 20220078

25  Seyam, O., Smith, N. L., Reid, I., Gandhi, J., Jiang, W. and Khan, S. A. (2018) Clinical utility of ozone therapy for musculoskeletal disorders. Med. Gas Res. 8, 103–110

26  Neviaser, A. S. and Neviaser, R. J. (2011) Adhesive capsulitis of the shoulder. J. Am. Acad. Orthop. Surg. 19, 536–542

27  Chen, H., Yu, B., Lu, C. and Lin, Q. (2013) The effect of intra-articular injection of different concentrations of ozone on the level of TNF-α, TNF-R1, and TNF-R2 in rats with rheumatoid arthritis. Rheumatol. Int. 33, 1223–1227

28  Bocci, V. The Clinical Application of Ozonetherapy. Ozone: Sci. Eng., Nature Publishing Group 97

29  Jafri, M. S. (2014) Mechanisms of Myofascial Pain. Int Sch Res Notices 2014 https://doi.org/10.1155/2014/523924

30  Torres-Rosas, R., Marcela Castro-Gutiérrez, M. E., Flores-Mejía, L. A., Torres-Rosas, E. U., Nieto-García, R. M. and Argueta-Figueroa, L. (2023) Ozone for the treatment of temporomandibular joint disorders: a systematic review and meta-analysis. Med. Gas Res. 13, 149–154

31  Costa, T., Linhares, D., Ribeiro da Silva, M. and Neves, N. (2018) Ozone therapy for low back pain. A systematic review. Acta Reumatol. Port. 43, 172–181

32  Biazzo, A., Corriero, A. S. and Confalonieri, N. (2018) Intramuscular oxygen-ozone therapy in the treatment of low back pain. Acta Biomed. 89, 41–46

33  Paoloni, M., Di Sante, L., Cacchio, A., Apuzzo, D., Marotta, S., Razzano, M., et al. (2009) Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection. Spine  34, 1337–1344

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