PRP

Just How Effective Are PRP Injections For Pain Conditions?

/ Thomas Cohn, MD

prp injectionThe field of regenerative medicine has been booming over the last several years. It includes the use of injections of stem cells and the use of platelet rich plasma (PRP) to hopefully cure many muscle, joint, ligament and tendon issues in the body. However, it is a fairly unregulated medical field. Most procedures have little scientific data to support their efficacy and therefore are rarely paid for by insurance. There is a lot of case report-type success but very little truly scientific studies to prove the success of these procedures. Many physicians recommend these procedures, knowing the research results would probably change many people’s mind.  

Recently, research on PRP was presented at the American Academy of Orthopedic Surgeons by Dr. Herman Johal, MD.  He performed a comprehensive review of the literature, especially of studies that were well designed control trials. The findings were surprising for the supporters of these procedures, and somewhat predictable. The procedures may be helpful for conditions like tennis elbow, lateral epicondylitis and knee pain. However, for tennis elbow it was no better than dry needling of the elbow tendons and it was significantly more expensive. For knee osteoarthritis, it did work, but again it was no better than hyaluronic acid treatments that are well researched, and are scientifically proven effective and covered by insurance.

PRP and Its Effectiveness

The use of PRP in all other areas of the body including the spines discs, muscles and other joints, especially the shoulders, was not effective. Traditional treatments such as physical therapy and exercise, anti-inflammatory medications as well as steroid injections were more successful. These new techniques pushed by many legitimate physicians are just not helpful. This is a stark reminder that placebos, otherwise known as sugar pills or sham treatments, will work in about 30 percent of people no matter what.  

The message for many pain patients is that there often is a reason for a procedure not to be covered by insurance. If Medicare has approved a procedure and it has an approved specific billing code, then the procedure has scientific studies demonstrating its safety and effectiveness. Currently, the use of platelet rich plasma does not have the designation and it appears to be due to a lack of proven effectiveness. Unless one is independently wealthy, caution should be noted when a procedure is done strictly on a cash basis in our society, like PRP often is.

New Pain Treatment: Platelet Rich Plasma

/ Thomas Cohn, MD

Blood spinning PRPRecently, platelet rich plasma (PRP) has been making news as a treatment for hip bursitis after a presentation at the American Academy of Orthopedic Surgery annual meeting. PRP is blood that has been spun and has concentrated factors that stimulate tissue repair and growth. This concentrated solution can be injected back into the body in affected areas to improve healing in damaged tissue. New areas for use are being found regularly.

Initially, PRP was first used in trials for repair after a heart attack, but it has expanded into areas of tendon repair, nerve injury and bursitis. Most commonly it has been used in sports injuries, and for many of these patients it has been quite successful. Instead of just calming down inflammation like many medical treatments, PRP helps more intensely stimulate the body to repair the injury. The downside to this treatment is that it is still considered experimental and insurance rarely covers the cost which can be in the several thousand dollar range.

PRP for Tendonitis and Bursitis

The most common uses in pain management for platelet rich plasma is for shoulder, elbow, hip and knee pain especially related to tendinopathy, tenosynovitis and bursitis. Blood is taken from the patient and then spun in a centrifuge. The residual plasma is rich in a number of proteins and substances that promote healing in the body. The plasma then is injected with either ultrasound or X-ray guidance into the appropriate area, whether the shoulder, hip or by certain tendons to stimulate healing. A series of several injections may be necessary to fully promote healing.  Since it is an all natural product of the patient themselves, it is very safe, and may be very effective for the right conditions.

Tendonitis, bursitis, joint and ligament pain is always treated conservatively first. Rest, heat and ice, and physical therapy are the first lines of treatment. If the problems are not improving, medications like oral or topical anti-inflammatory drugs combined with exercises and therapy may also be effective. If those treatments do not help, corticosteroid injections may also be indicated and evaluation by a physical medicine pain specialist to guide treatment would be beneficial.

The medical literature at this time is showing that the use of platelet rich plasma may have many benefits in the treatment of some of these joint related conditions of pain and inflammation. PRP is not the first line of treatment; it is used when other courses have failed. Furthermore, insurance has not endorsed its use and the cost will most likely be the responsibility of the patient. As of now, the injections are mainly for athletes or people who can afford the treatment when other avenues have failed.