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Pain Management

Platelet-Rich Plasma Therapy

platelet rich plasma therapy - National Pain & Spine

Platelet-Rich Plasma therapy, also know as PRP therapy, is a regenerative treatment, that harnesses your body’s ability to heal. Platelet-Rich Plasma (PRP) contains a high concentration of platelets, important healing elements normally found in your blood.

It is obtained by taking a sample of your blood and spinning it at very high speeds, with the help of a lab device. This separates the platelets from other parts of the blood that are not needed for this treatment. The healing mixture of plasma and platelets is then injected into your painful joint or other painful areas.

At Stem Cell ARTS, a clinic affiliated with NSPC, we use ultrasound and X-ray to make sure that PRP is placed exactly, at the site that is causing you pain. Pain relief may last for 6-12 months, or longer. Pain specialists use PRP therapy to treat joint, ligament, tendon or muscle pain. This therapy helps both patients with sports injuries and patients with arthritis joint pain.

PRP – what does it do?

PRP is the part of your blood that is rich in platelets. Injury activates platelets to release healing proteins that speed up tissue repair. PRP uses the healing potential of your own blood components, while also stimulating your immune system to aid in healing.

For example, you have probably noticed how a skin cut heals little by little every day, until it completely disappears. This is the result of platelets gathering at the site of injury in order to start the tissue repair.

Why platelets help with healing:

  • They are “first responders”, gathering at the site of injury to stop bleeding and start healing.
  • Platelets release a large number of molecules that control important activities like inflammation and fighting microbes.

What is the difference between PRP and Stem Cell therapy?

In addition to PRP you may have heard about Stem Cell therapy and wondered how the two compare. Both methods are used to treat joint pain due to arthritis and injuries of the ligaments and tendons.

PRP therapy uses only certain components of blood: the platelets. For PRP therapy, blood is drawn from a vein in your arm and spun down using a centrifuge. The resulting concentrated platelet mixture is then injected back into your arthritic joint (or injured ligament/tendon/muscle area).

PRP processing – Test tubes.pdf

By contrast, Stem Cell therapy uses entire cells from a number of locations in the body, such as the bone marrow in your pelvic bones. Other harvest areas rich in Stem Cells include fat from the abdomen, back or flank areas. Your doctor uses local numbing in the harvested area in order to get these cells. This technique is slightly more complicated than the simple blood draw needed for PRP.

Conditions treated with PRP

Initially, PRP was used to treat tennis elbow, a form of tendon inflammation that produces pain in the outer part of the elbow. Over the last decade, PRP therapy has extended to other areas of treatment. It is now used to treat joint arthritis and any ligament, tendon or muscle injury, as long as the injury does not involve a complete tear.

PRP therapy is used to treat the following:

Problems in the neck and back

  • Cervical/lumbar facet injury  –  injury of the small spine joints in the neck/back areas resulting in neck/back pain. There is a limited ability to twist, referred pain such as headaches, and pain in the buttocks, hips, and back of the thighs. May start after whiplash injury.
  • Herniated or bulging disc  –  a problem with one of the rubbery cushions between the backbones. May result in back pain and pressure on a nearby nerve (causing pain that shoots into your arm or leg).
  • SI joint syndrome  –  swelling and pain in a large joint that connects your lower spine to the pelvis. It can cause pain in your buttocks or lower back. Pain can extend down one or both legs. Pain increases with prolonged standing or stair climbing.

Problems in the shoulder

  • Rotator cuff tears  –  injury to a group of muscles and tendons that surround the shoulder joint. A common injury in people who repeatedly perform overhead motions (painters, carpenters, baseball players).
  • AC joint separation  –  shoulder separation due to disruption of the acromioclavicular joint (AC separation). Can result from a direct blow to the shoulder (seen in football, rugby, or hockey) or a fall on an outstretched hand (falling off a bicycle).

Problems in the arm/wrist/fingers

  • Medial and lateral epicondylitis (tennis elbow/golfer’s elbow)  –  pain and swelling caused by overuse of the muscles and tendons of the forearm, leading to inflammation and pain around the elbow joint. Tennis elbow involves pain on the outer part of the elbow. Golfer’s elbow involves pain on the inner part of the elbow.
  • Wrist tendinitis  –  irritation and inflammation of the tendons around the wrist joint.
  • Finger tendinitis, finger dysfunction  –  inflammation of the tendons in the forearm as they pass through the wrist,  into the hand. Caused by activities that strain the fingers and hand (like tennis) and repetitive strain at work (assembly line work).

Problems in the knee

  • Patellar-femoral syndrome  –  pain in the front of the knee and around the kneecap. Also called “runner’s knee” or “jumper’s knee” because it is common in people who practice sports.
  • Chondromalacia patella  –  swelling of the underside of the patella, a cartilage that absorbs absorber in your knee. Common in young individuals who are active in sports and older adults who overwork their knees.
  • Pes anserine bursitis  –  inflammation and pain in the inner knee area due to inflammation of the jelly-like sac (bursa) that is located between the shinbone (tibia) and surrounding knee tendons.
  • Partially torn or strained ligaments of the knee (ACL, PCL, LCL, MCL).
  • Meniscus tears  –  tears in the menisci, the two pieces of cartilage that act as shock absorbers between the tibia and femur bones in the knee. Tears result from over-flexing or twisting of the knee joint.

Problems in the foot

  • Tendon and ligament injuries in the foot area
  • Tarsal tunnel syndrome   –  pressure on the posterior tibial nerve that causes tingling, pain or numbness inside of the ankle and the foot. Results from flat feet, a ganglion cyst, or arthritic bone spur. Seen after an ankle sprain and diseases, such as diabetes or arthritis.
  • Plantar fasciitis  –  inflammation of a band of tissue (fascia) that extends from the heel to the toes. Often results in heel pain. Caused by a bone spur, a stress fracture, or arthritis.

For other conditions treated with PRP, click here.

When is PRP used?

PRP therapy is offered by your pain specialist or by an orthopedic doctor when conservative treatment (rest, anti-inflammatory medications) fails. It may be used alongside other injections such as Hyaluronic acid. Your pain specialist will advise which injection is right for you, depending on the type of injury.

Injection alternatives to PRP:

  • Hyaluronic acid (HA)  –  is a substance that is naturally present in the human body. It is found in the eye fluid and it is naturally produced in joints. Hyaluronic acid is also extracted from rooster combs or made by bacteria in a laboratory. It can be taken in pill form or injected by a doctor during eye surgeries, like cataract removal. If injected into arthritic joints, it can lubricate them and offer pain relief.
  • Steroid joint injection (Cortisone shot)  –  studies show that Cortisone offers better immediate pain relief for arthritis joint pain while PRP offers better long-term results. Cortisone shots may help with initial inflammation. However, they are not used repeatedly as they can slow down ligament healing.
  • Stem Cell treatment  –  contains platelets and other powerful cells, such as mesenchymal cells (cells that can self-renew). These cells communicate with other cells in the body to influence inflammation and healing.

PRP Procedure

  1. A sample of blood is taken from a vein in your arm.
  2. The blood is taken to another room (on-site lab) and spun in a centrifuge. This machine uses high speeds in order to separate the platelets from the unwanted red blood cells. At our Stem Cell ARTS clinic, we use our own lab processing technique, provided by the Regenexx program.
  3. Sample processing is done in a lab in the pain clinic. You do not need to leave the exam room, at any time.
  4. Your doctor then returns with a syringe filled with the platelet-rich plasma concentrate and injects it back into your painful area. An aseptic technique is used (your skin is disinfected at the site of injection).
  5. Ultrasound (an imaging technique that shows live images of your joints, muscles, ligaments, and tendons) or X-ray are used during the injection.
  6. PRP re-injection usually takes less than an hour to complete.
  7. After a PRP injection, you may feel sore and need relative rest for 2-4 weeks. PRP takes effect slowly, over 2-4 months.

Treatment outcomes

PRP therapy success varies from person to person, possibly depending on the quality of your platelets. This is a non-surgical, minimally invasive treatment. It is considered a safe procedure, carrying the usual small risks of infection, bleeding, associated with any injection.

A recent, 2016 review looked at how effective PRP injections are in treating knee osteoarthritis (wear-and-tear arthritis). The review included over 1000 patients from Level I studies, the most reputable type of study available. Results showed that patients had similar pain relief at 6 months after treatment, regardless of whether they received PRP or hyaluronic acid (HA). HA is an older, but still effective treatment for joint pain. Functional improvement (i.e. ability to walk) improved equally in patients who received PRP and HA injections.

However, at 12 months after the injection, patients who had received PRP injections did better than patients treated with HA. It was concluded that PRP has a longer pain relief effect, related to its ability to rejuvenate joints.

Click here for more information on our state-of-the-art regenerative therapy facility: StemCell ARTS. 

References

1. Dai WL, Zhou AG, Zhang H, et al. Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2017 Mar;33(3):659-670.

2. Pourcho, A. M., Smith, J., Wisniewski, et al. Intraarticular platelet-rich plasma injection in the treatment of knee osteoarthritis: Review and recommendations. American Journal of Physical Medicine and Rehabilitation, 2014 93(11), S108-S121.