FAQs on Platelet Rich Plasma
One of the most exciting advancements in regenerative medicine over the last 10 years has been platelet rich plasma. The procedure has been used for many years in other areas of medicine, and recently began to see promising results in musculoskeletal conditions. Numerous athletes have undergone PRP treatments such as Tiger Woods, Fred Couples, Dwight Howard, Alex Rodriguez, Tracy McGrady, Chris Canty and Cliff Lee along with Hines Ward and Troy Polamolu.
What exactly is platelet rich plasma therapy?
PRP therapy, as it is also known for short, uses the patient’s own blood and separates out the plasma which is rich in platelets and growth factors. This part of the blood is then injected into the problem area for regenerative treatment. Platelet rich plasma treatment falls into the regenerative medicine category, whereas, most pain management treatments to date simply suppress symptoms but do not actually repair or regenerate tissue.
PRP is rich in platelets and growth factors, which can help directly in tissue regeneration along with “calling in” stem cells to help with tissue repair. The treatment represents a very promising and low risk option for those dealing with a soft tissue problem, and recently arthritis has shown benefit in small studies.
For what conditions is PRP therapy helpful?
For many years, PRP has been used in medical field outside of the musculoskeletal variety, including ophthalmology, cardiovascular, urology and wound care to name a few. Over the past decade however, PRP has begun to achieve good results with musculoskeletal conditions. These include:
- Tendonitis – extremities
- Golfers and tennis elbow, Medial and Lateral Epicondylitis
- Rotator cuff problems
- Ligament injuries
- Tendon tears
- Degenerative arthritis
- Degenerative Disc Disease – research ongoing
How is PRP therapy performed?
These injections are typically performed an office setting. If the injection is going into a joint that is tricky to get into (like the hip), it may be necessary to do it in a procedure center using fluoroscopic guidance. Initially, a simple blood draw is taken from the patient of 30 to 60 mL. The blood taken is then placed into a centrifuge machine. This spins the whole blood very quickly, and separates it into three layers.
It is the top layer that contains a significant amount of platelets and growth factors. This is the platelet rich plasma and is separated from the rest to be injected. The area to be injected is sterilized and the injection is performed along with some numbing medicine. The injection usually takes just a few minutes, and the whole procedure usually takes less than an hour.
How well do these procedures work?
Thousands of research studies have looked at platelet rich plasma, but it is still controversial. The World Anti-Doping Agency along with the NFL, NBA and MLB have all decided that PRP is a reasonable treatment to provide.
Large scale studies looking at the effect of PRP in musculoskeletal conditions do not exist. Platelet rich plasma introduces growth factors and platelets that can help soft tissues to heal. Most pain treatments in the past simply masked symptoms, but do not actually regenerate or repair tissue. Usually, with PRP treatment, pain improvements generally occur within a few weeks, which is more gradual than a steroid injection since the tissue is being spurred on to actually heal (Sampson et al 2008).
The PRP treatments are often combined with physical therapy, which can also help facilitate new tissue growth for regeneration and pain relief. The theory of what makes PRP injections work is that the growth factors and platelets act as an “attractant” for stem cells, which can come in and help to heal soft tissues and provide pain relief.
Small studies have shown exciting results for pain relief for both soft tissue inflammatory conditions such as tennis elbow and knee arthritis in middle aged individuals (Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):516-27) Larger studies are presently ongoing to hopefully supplement the good results seen in smaller anecdotal ones.
Is PRP covered by health insurance?
At this point, PRP injections are not covered by insurance. The office visit may be covered, but the material itself is still considered experimental. Most pain management clinics offer it as a fee for service treatment ranging from $500 to $1500.
The risks of platelet rich plasma therapy are very low. The treatment uses the patient’s own blood, so the risk there is very small. There is always the risk of an allergic reaction to the numbing medicine used, and also a small risk of infection with the procedure.
One thing that may be seen with PRP is an increase in pain for the first couple of days due to the inflammatory reaction that the treatment sparks up. The first phase of healing is inflammation, and the injection brings on inflammation but then will settle down after a few days with pain relief beginning.
What is the bottom-line?
PRP treatment represents a very exciting regenerative medicine option for those with numerous musculoskeletal conditions including arthritis, bursitis, ligament injury and tendinitis. The treatment is on the cutting edge of regenerative medicine, and is currently being offered at most modern pain management clinics.