Platelet rich plasma therapy, or PRP therapy, is a cutting-edge treatment option for chronic pain patients. This exciting therapy approach can jump-start your body’s natural healing processes, reduce inflammation, and help resolve nagging pain from previous injuries. It can also promote the regeneration of soft tissue and healing within the body without the risks and extended recovery time often associated with surgery. For many patients, it can help them get their life back. Today we look at your top questions about this treatment option. Read on to learn about this cutting-edge new pain management option.
1. What is PRP therapy?
PRP therapy has recently received national media attention after famous athletes – Tiger Woods and tennis star Rafael Nadal – have received injections to help alleviate sports-induced injuries. However, platelet rich plasma isn’t just used for professional athletes; anyone can potentially benefit from this treatment. PRP therapy is an exciting option that:
- Uses your own blood in the form of platelet rich plasma to help encourage your own body’s healing to regenerate healthy tissues
- Is safe, with no risks of disease transmission, since your own blood is used
- Has been used by athletes like Tiger Woods and Hine Ward to heal their sports injuries
- May help reduce pain related to sports injuries, plantar fasciitis, arthritis, and Achilles tendinitis
PRP therapy may be known by a few names, including:
- Platelet rich protein injections
- Plasma rich protein injections
- PRP injections
- Plasma rich protein therapy
It can help with conditions like:
- Lateral epicondylitis
- Patellar tendinopathy
- Achilles tendinopathy
- Medial collateral ligament tears
- Rotator cuff tendinopathy
- Rotator cuff tears
- Anterior cruciate ligament tears
- Muscle fibrosis
- Articular cartilage defects
- Meniscal injury
- Chronic synovitis
- Joint inflammation
- Muscle strains
The treatment is non-surgical, minimally invasive, and has a low side effect profile. Dr. Tory McJunkin at Arizona Pain gives a brief overview of how regenerative medicine works for pain patients. The rest of this post goes over the most commonly asked questions about this therapy.
2. What is platelet rich plasma?
The American Academy of Orthopaedic Surgeons explains that platelet rich plasma is:
“Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries. PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.”
The compound is prepared by:
- Withdrawing blood from the patient
- Using centrifugation to increase the concentration
- Injecting it into the area that was damaged or injured
The concentration of platelets in centrifuged blood may be as high as one million platelets per uL. Typical concentrations of platelets from whole blood are between 150,000 and 350,000 platelets/uL.
3. How does PRP work?
Although first used in the 1970s, PRP therapy was limited to operating room procedures because the equipment was large and expensive and the procedure required large quantities of the patient’s blood. Starting in the 1990s, multiple reports and studies demonstrated dramatic benefits of PRP therapy.
Today PRP therapy targets a number of different pain conditions. The procedure uses an injection of autologous growth factors, secretory proteins, and concentrated platelets to encourage healing processes. These compounds work in unison to repair damaged tissue and speed the healing of surgical procedures.
As the Virginia Spine Institute explains:
“Platelets are naturally extremely rich in the connective tissue growth and healing factors. The body’s first response to tissue injury is to deliver platelets to the area. Platelets initiate repair and attract stem cells to the injury. Injecting these growth factors into damaged ligaments, tendons, and joints stimulates the natural repair process. In order to maximize the healing process, the platelets must be concentrated and separated from the red blood cells. The goal of PRP is to maximize the number of platelets while minimizing the number of red blood cells in a solution that is injected into the injured or pained area(s). In summary, PRP creates, stimulates, and accelerates the body’s natural healing process.”
In addition to the use of platelet-rich plasma therapy in pain management, the procedure is also widely used in healing bone grafts and fractures, in plastic surgery, and wound care. Early successes in treating fractures spurred the use of platelet-rich plasma therapy for other orthopedic conditions. Pain reduction at two years post-treatment for chronic tendinitis, for example, was reported at 93%. The treatment received media attention after Pittsburgh Steelers’ wide receiver Hines Ward received it for medial collateral ligament sprain and went on to win the Super Bowl that year.
4. What are the benefits of PRP therapy?
Some of the benefits of PRP therapy include:
- Natural processes: This treatment simply takes the patient’s own blood and processes it in a centrifuge to separate out the components. Doctors are left with platelet rich plasma that is injected back into the patient. The process uses the body’s natural healing properties to improve the condition or injury.
- No risk of reaction: Because blood is drawn from the patient and then used to create the plasma that is re-injected, there is absolutely no risk of rejection or allergic reaction.
- Faster healing time: Platelet rich plasma therapy can be used by patients with chronic conditions to help improve the body’s natural healing process. It also speeds up the healing time for patients with acute injuries that typically take weeks to heal.
- Help for osteoarthritis and other chronic conditions: New studies have shown that this therapy may be helpful for patients dealing with the effects of osteoarthritis. Some specialists are even hopeful that it may become a viable alternative to hip replacement surgery.
According to current research, factors that may influence the effectiveness of PRP treatment include the overall health of the patient, the particular area of the body that is being treated, and whether the injury is acute or chronic
5. What conditions are treated with PRP therapy?
In addition to those listed earlier in this post, PRP therapy can be used to treat the following conditions:
- Arthritis and osteoarthritis
- Rotator cuff tears
- Plantar fasciitis
- ACL injuries
- Tennis elbow
- Ankle sprains and strains
- Achilles tendinitis
- Ligament sprains
- Other sports or overuse injuries
Some anecdotal evidence has also supported the use of PRP for hair loss, facial pain, back pain, and other forms of knee pain.
6. What can I expect with a platelet rich plasma injection procedure?
If you’re interested in PRP therapy, you’ll first undergo a consultation with a physician in regenerative medicine. Your doctor will help determine if PRP or another regenerative medicine therapy is an appropriate treatment approach for you and your pain. Because there are numerous different conditions that result in pain and could benefit from regenerative medicine therapies, an accurate diagnosis can help you decide on the most appropriate treatment.
They’ll ask questions about:
- Your condition
- Your symptoms
- Previously attempted treatments
If they decide that PRP therapy is right for you, they’ll discuss what you can expect from the procedure. Generally, prior to the preparation of platelet rich plasma, blood is drawn from you for the separation of platelets during the centrifugation process. After this is completed, the increased concentration of platelet rich plasma is combined with the remaining blood. It is then carefully injected with a needle into the injured area. The PRP injection often includes a mixture of pain-relieving anesthetic along with the platelet rich plasma.
The entire process including preparation and cleaning of the injection site and recovery usually takes approximately one to two hours. For a short period after the procedure, pain at the PRP injection site may increase; however, it typically diminishes within a couple of days. PanettaPT created a great overview video of a person receiving a platelet rich plasma injection. You’ll be able to see what you can expect during the procedure.
7. What are PRP injection side effects?
Since PRP therapy uses your own blood, the risk of PRP injection side effects are minimal. They may include:
- Soreness or bruising at the injection site
- Increased pain for a few days following the procedure, depending on the location
“PRP therapy has low risk and few side effects. Concerns such as hyperplasia have been raised regarding the use of growth factors, however there have been no documented cases of carcinogenesis, hyperplasia, or tumor growth associated with the use of autologous PRP. PRP growth factors never enter the cell or its nucleus and act through the stimulation of external cell membrane receptors of adult mesenchymal stem cells, fibroblasts, endothelial cells, osteoblasts, and epidermal cells. This binding stimulates expression of a normal gene repair sequence, causing normal healing – only much faster. Therefore PRP has no ability to induce tumor formation. Also, because it is an autologous sample, the risk of allergy or infectious disease is considered negligible. Evidence also exists in studies that PRP may have an antibacterial effect.”
8. What is the PRP injection recovery time?
Most procedures take less than an hour. You’ll be seen in an outpatient clinic and can undergo the procedure without general anesthesia. Regenerative medicine treatment protocols are done on an outpatient basis and require little to no recovery period. Oftentimes you’ll be able to return to work directly following the procedure.
The Orthopaedic Specifics of NC note that:
“You will feel a notable increase in pain in the days immediately following the injection. Pain intensity becomes less each day as functional mobility and general functional ability increase along with endurance and strength. You will notice gradual improvement 2-6 weeks after PRP therapy. Some patients report ongoing improvement 6-9 months after PRP therapy is administered.”
In the days following a PRP injection, practice self-care by resting, avoiding alcohol and tobacco products, and restricting the use non-steroidal anti-inflammatory drugs. Patients are encouraged to minimize activity for at least 24 hours following the procedure. However, most patients are able to participate in their daily activities immediately after the procedure. Patients should continue to participate in any ongoing physical therapy programs, and if they felt some relief from the platelet rich plasma therapy, additional treatments may be warranted.
9. What does a PRP injection cost?
PRP injection cost depends on the treatment being performed and the doctor you’re visiting. Costs can range from $500 to $2,000. Since the treatment is still considered experimental, unfortunately it is often not covered by insurance plans.
However, treatment protocols created by Northwestern Memorial Hospital is trying to change that. Lead author, Dr. Hsu notes that:
“Insurers have not covered PRP because of the lack of science. Patients currently pay out of pocket, sometimes thousands of dollars, to get PRP. With evidence-based recommendations, insurance companies hopefully will consider coverage for this therapy.”
10. What’s the research behind PRP therapy?
PRP research is ongoing, because this could be a therapy with a huge potential to change patient’s lives. However, more are surveys needed of the existing literature, as well as large-scale randomized controlled trials. Others note that more systematic study designs and parameters can show the efficacy of this therapy. Some highlights of existing research include:
- A Podiatry Today study that posits that PRP is a viable treatment option and alternative to surgery
- A clinical study posted on American Academy of Orthopaedic Surgeons that shows that PRP is more effective than cortisone shots
- A study from Orthopedics that showed significant improvement in patients who received PRP for plantar fasciitis
- A study in Foot & Ankle International that showed the benefits of using PRP for plantar fasciitis pain that hadn’t resolved from other treatments
- Another study from Techniques in Foot & Ankle Surgery that noted: “The augmented healing response facilitated by administration of PRP, its safety, and ease of use make this treatment attractive.”
For up-to-date news and research on PRP therapy, follow the Hospital for Special Surgery’s post on PRP.
11. Does PRP for plantar fasciitis work?
As the above-mentioned research notes, PRP for plantar fasciitis is one of the most scientifically-backed uses for PRP therapy. Plantar fasciitis is an extremely common foot pain condition, affecting one out of every ten adults. The thick connective tissue on the bottom of the foot, the plantar fascia, can become damaged or strained with overuse. This leads to inflammation and pain. PRP for plantar fasciitis encourages the natural healing processes of the body to reduce inflammation related to plantar fasciitis.
This video from the University Foot and Ankle Institute shows how one patient received help from PRP for her plantar fasciitis pain.
12. What is the PRP treatment for face pain?
PRP treatment for face pain depends on the type of face pain experienced. Our video on the subject discusses some of the more common chronic face pain conditions. If you’ve tried other treatment options already, talk to your pain doctor about PRP treatment for face pain.
13. PRP injections for knee pain?
PRP injections for knee pain are one of the most common uses for PRP therapy. These injections for knee pain may include treating pain related to:
- Sports injuries
- Tendon strains or sprains
14. What about PRP for tendonitis?
Achilles tendonitis, an overuse injury impacting the Achilles tendon at the back of the ankle, can be treated by PRP therapy. This is often done after other more conservative treatment options, like physical therapy and rest, have been found not to work. Dennis Cardone, DO, has an interesting interview in Scientific American where he notes the healing results for PRP for tendonitis.
15. Does PRP for tennis elbow work?
PRP for tennis elbow is another common use for this cutting-edge treatment. Tennis elbow, an overuse injury typically experienced by tennis players or those who have physical jobs, can be excruciating. PRP therapy provides another option by encouraging the body’s own natural healing processes. We have an entire post devoted to using PRP for tennis elbow symptoms.
This infographic from Dr. PRP USA also gives a quick rundown of how this treatment can help with tennis elbow.
16. How can PRP therapy help with ankle pain?
Like knee pain, most applications of PRP therapy for ankle pain are to help reduce arthritis pain or pain related to sports injuries.
Emory Healthcare gives a comprehensive overview of how PRP therapy can help with ankle pain. As they note, PRP therapy provides another option for their patients that doesn’t require surgery or other interventional treatments.
17. Does PRP for hair loss work?
While PRP for hair loss isn’t within the purview of pain doctors, many patients come to us with this question. At the Orange County Hair Restoration Center, you can find research about this possible use for PRP therapy.
18. What about PRP injection for shoulder injuries?
One of the first larger journalism pieces on PRP therapy came from The New Yorker in their article, “The Blood Injections That Might Transform Orthopedics.” In that piece, they looked at one patient who suffered from a rotator cuff injury. As they reported, the patient saw results immediately. PRP therapy almost completely reduced any pain. Dr. Ibrahim, who performed the procedure was quoted in the article:
“The outcome didn’t surprise Ibrahim, who estimates that he has treated around five thousand people with P.R.P. over the past five years. He says that the treatment can repair tendons, ligaments, cartilage, and nerves, and can even regrow tissue that has been frayed or damaged. This, he suspects, is what happened with Waddell’s rotator cuff. ‘For a lot of conditions, it’s almost a wonder drug,’ Ibrahim told me. ‘We’ve figured out a way to help the body regenerate itself.'”
PRP therapy is an exciting new option for many pain patients who haven’t found success with more conservative treatment options. While there is still much research to be done on this treatment, anecdotal evidence and an increasing amount of studies are beginning to support the use of this treatment for many pain conditions.
If you think you may benefit from learning more about platelet rich plasma injection therapy, talk to your pain doctor today. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.