Low back pain
Low back pain (LBP) involves a spectrum of different types of pain (e.g., nociceptive, neuropathic, neoplastic, and nonspecific) that frequently overlap. LBP can be caused by lumbar spine elements (e.g., soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures). Therapy for LBP usually begins with self-care and medication in combination with non-pharmacological methods, such as physical therapy and psychological treatment, in appropriate patients.
Systematic reviews and single-arm meta-analyses showed that PRP may effectively manage discogenic LBP, radicular pain, facet joint pain, and sacroiliac joint pain. However, the levels of evidence vary. Intradiscal PRP injections can be a safe, inexpensive, and feasible treatment to counter the intervertebral disc degeneration associated with LBP. It is important to administer PRP early during treatment to stimulate the growth of the remaining cells in the disc. PRP injections in the lumbar multifidus muscle can be a safe and inexpensive approach to treating LBP. A few prospective trials have described that PRP injection may improve the pain or functional decline caused by facet joint arthropathy for a longer duration.
In 2017, a prospective comparative study including 46 patients showed statistically significant pain reduction in both groups (PRP, group A, and corticosteroid/local anesthesia, group B). However, for subjective satisfaction based on the modified MacNab criteria, the success rate for group B remained at 20% after 6 months, while it increased over time in group A. Therefore, autologous PRP was suggested as a superior treatment option for long-duration efficacy in lumbar facet joint syndrome.
Twenty patients completed another prospective clinical trial. The improvements in pain scores (numerical rating scale and Oswestry Disability Index scores) were positively correlated with platelet concentrations in the PRP group.
In conclusion, using PRP in various injections, such as intradiscal, interface, and intramuscular injections, has yielded significantly reduced pain and improved patient satisfaction, with the significant advantage of no major complications. However, further studies with larger sample sizes and control groups are needed to confirm its efficacy.
Myofascial pain syndrome
Myofascial pain is an important cause of disability in the whole population. Emerging symptoms arise from each painful myofascial trigger point, which is a hypersensitive spot within a taut band of skeletal muscle that produces pain on compression, stretch, overload, or contraction of the tissue. The result is usually pain that is perceived to be distant from the spot of origin. In a randomized controlled trial, there was no statistically significant difference in pain levels between the “lidocaine” and “PRP” groups before and 2 weeks after treatment; however, a statistically significant difference was found between the two groups 4 weeks after treatment (p<0.001). Specifically, 4 weeks after the injection, the average pain of the patients in the lidocaine and PRP groups was 3.4 and 0.9 on the visual analog scale (VAS), respectively.
There are a few studies associated with myofascial pain that were conducted only on the masticatory muscles, which are involved in the most common TM disorders. PRP injections effectively improved trigger-point symptoms in the masseter muscle at 1 and 3 months.
Lateral epicondylitis
As tendons have poor vascularity, the tissue has limited healing and the lesions are not reversible, resulting in tendinopathies due to trauma or excessive overload. This causes tendon soreness, reduced strength, pain upon exertion, and progressive reduction in function.
Lateral epicondylitis, also known as tennis elbow, is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle in adults, with a prevalence of 1% to 3% in the general population. The presenting symptoms include lateral elbow pain, pain caused by wrist extension, and weakened grip strength. The diagnosis is always made clinically through medical history and physical examinations. The treatment of lateral epicondylitis includes rest, nonsteroidal anti-inflammatory medication, bracing, physical therapy, extracorporeal shock wave therapy (ESWT), and botulinum toxin injection.
Compared with lateral epicondyle surgery, PRP injections provide similar improvements in pain and function in patients suffering from lateral epicondylitis. PRP components promote cell recruitment, proliferation, and angiogenesis. It has also been suggested that PRP induces a transient inflammatory response, resulting in a regenerative response and immunomodulatory effects on tenocytes.
A randomized study involving 83 patients was conducted in 2007. The study was composed of two groups: group A, local steroid injection (n=50), and group B, autologous PRP (n=33). A significant difference between the two groups (p=0.0001) was found in pain and function at the end of 6 months. Group B showed a 91% mean improvement (8.33–0.69) in the VAS score compared to a 42.2% mean improvement (7.98–4.61) in group A. Regarding function assessment, MAYO Elbow Scores also indicated a favorable outcome in the PRP-treated patients (group B) with a 54.4% mean improvement (61.51–95.0) compared to a 1.25% mean improvement (63.92–63.12) in the steroid-treated patients (group A), a statistically significant difference (p=0.0001).
Many systematic reviews and meta-analyses have found that PRP can be considered a safe and effective treatment option for lateral epicondylitis with clinical improvements in pain and function, although there is a lack of quantification of specific PRP content and considerable heterogeneity among randomized controlled trials exists.
Plantar fasciitis
Plantar fasciitis is a common cause of heel pain and is associated with significant morbidity. It is a debilitating degenerative condition of the plantar fascia resulting from repetitive microtrauma and excessive strain on the plantar surface of the foot. PRP may modulate plantar fascia degeneration because of its regenerative properties. PRP also releases vascular endothelial growth factor, which increases angiogenesis and may facilitate the healing of degenerative conditions by promoting neovascularization and repair.
PRP has been suggested as a safe therapeutic option in the treatment of plantar fasciitis, as it reduces pain and improves function in patients with this condition, and its effect persists long term.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens, and New Hyde Park – Long Island. Call the Queens office at (718) 215-1888 or (516) 419-4480 for the Long Island office to arrange an appointment with our Interventional Pain Management Specialists, Dr. Jeffrey Chacko or Dr. Sonny Ahluwalia.
