When we suffer an injury, our body immediately springs into action to begin the healing process. After an initial inflammatory response, healing cells head towards the injury. In some cases, this healing process can be stimulated and further aided by platelet rich plasma therapy. This promising treatment offers hope and help for people who suffer from chronic pain due to both slow-healing injuries or acute injuries that do not respond to traditional treatments. Here’s what you should know about this therapy.
What is platelet rich plasma therapy?
Platelet rich plasma (PRP) is an enriched blood product composed primarily of platelets, a type of cell found in the blood. In PRP therapy, blood plasma is concentrated with higher than normal amounts of platelets. Platelets are crucial for blood clotting but also release protein growth factors involved in many other biological responses (including healing and tissue repair).
The theory behind platelet rich plasma therapy is that introducing large, concentrated amounts of platelets to the site of injury stimulates healing, especially in hard-to-heal connective tissues. An injection introduces platelets into the area.
Platelet rich plasma therapy is also referred to by other names, including:
- Platelet rich protein injections
- PRP injections
- Plasma rich protein therapy
- PRP treatments
Platelet rich plasma therapy was first used during an open heart procedure in 1987 and has since found application in a wide variety of medical specialties. These include:
- Sports medicine
- Cosmetic/maxillofacial surgery
- Cardiothoracic surgery
The growing medical application of platelet rich plasma therapy is due to an increased understanding of platelets and their physiological role in healing processes.
How does PRP therapy work?
Blood is primarily comprised of cellular components, including red blood cells, white blood cells, and platelets. These are all present in plasma, the fluid that brings them together to make blood. Plasma is primarily composed of water and acts to transport cells (such as red blood cells, white blood cells, and platelets), proteins, electrolytes, and other critical materials throughout the body.
Each part of the blood has a role in the proper and healthy function of the human body.
- Red blood cells move oxygen and carbon dioxide throughout the body to sustain energy production and life
- White blood cells are the body’s immune defense system that fights infection and removes waste from the body
Platelets are small, disc-like cells formed in the bone marrow. These are important for blood clotting, vascular growth, healing, and repair. Platelets carry blood clotting compounds and over 300 growth factors within them. When activated by vascular (vessel) wall damage or by other inducing factors in the blood, these compounds and growth factors aid in the healing process.
The ratio of normal red blood cells to platelets is high. Red blood cells make up over 90% of the cellular components of normal blood, but platelets account for only 6% of the total cell volume of blood. Platelet rich plasma therapy reverses this ratio and increases the percentage of platelets, more critical to healing processes than other blood components. For PRP therapy, platelets are concentrated to at least four times the amount found in normal blood. Platelet rich plasma injections then use the patient’s own blood to stimulate a healing response.
Goals of treatment
The goal of platelet rich plasma therapy is to prompt an inflammatory response at the site of injection. During this inflammatory response, unhealthy and injured tissue is absorbed by the body, paving the way for the formation of healthy tissue further stimulated by the growth factors in the platelets.
Why this occurs and how the body knows to utilize the growth factors is complex. Researchers are still trying to pinpoint the exact process by which platelets spur healing.
What is the platelet rich plasma therapy procedure like?
The first step to any medical procedure is a conversation with your doctor. They will explain the specific procedure to you, along with any risks, complications, and benefits you might experience. In general, you may experience results in just one PRP injection, but extensive tissue damage or injury may require additional injections.
Once your doctor answers your questions and explains the procedure, a small amount of your blood will be drawn. In a procedure called blood fractionation, this blood is placed in a sterile tube and spun in a centrifuge to separate the different components. Once spun, the bottom of the tube will contain the heaviest cells (the red blood cells), while the top will contain fluid plasma with platelets.
Separating these two layers is a small white, “buffy coat” layer, which contains the white blood cells and some platelets. The top plasma layer is then separated from the rest of the blood product and spun down more aggressively within a centrifuge to force the platelets to the bottom. These are then extracted to completely separate the platelets from other cells.
The procedure itself
When the platelet rich plasma is ready, you will get comfortable on the procedural table, either lying or sitting to keep the area easily accessible. The site of injection is cleaned and sterilized before your doctor injects a local anesthetic, such as lidocaine, to provide local anesthesia during the procedure. This injection may sting a bit, but the area should numb quickly. If you are concerned about the sting, your doctor can provide a topical anesthetic before injecting the lidocaine.
After the area is numb, your doctor guides the needle to the injection site. Your doctor may use ultrasound guidance to direct the needle to the correct location and to confirm that the PRP is in the proper place and fully injected. Ultrasound increases the accuracy of this therapy, potentially reducing post-procedural pain. If ultrasonography is used in conjunction with PRP injection, the patient and physician will review the imaging results during the procedure. To make sure that the platelets stay where they are needed most, your doctor may also inject additional medications.
The entire procedure, from the time your blood is drawn to when you get up from the table, is between one and two hours.
Note that not all patients will be candidates for platelet rich plasma injections, including those who have:
- Infection or broken skin at the injection site
- Blood clotting disorders
- Concurrent anti-coagulant therapy
- Multiple prior injections
- Unstable or inaccessible joints
Patients should discuss any of these conditions with their physician before undergoing a PRP procedure.
In general, platelet rich plasma injections are very safe when performed by an experienced pain management physician. They can be effective at treating chronic musculoskeletal pain when other more conservative treatments have failed. Because a patient’s own blood is used for the procedure, risks of transmissible infections or allergic reactions to the procedure are very low.
Although the potential side effects are low, all injection procedures carry with them some inherent risks.
- Infection at the site of injection
- Bleeding, especially with anticoagulant therapy or bleeding disorders
- Tendon rupture due to improper needle placement
Following platelet rich plasma therapy, watch for increased pain, swelling or redness at the injection site, or fever. These may may indicate a possible infection. Bleeding is rare, so talk to your doctor if bleeding at the injection site occurs or persists.
It is entirely normal to experience pain at the injection site for up to 48 hours after the procedure. In general, the higher the volume of injected PRP, the more post-injection pain you can expect. Ice and acetaminophen can help ease the pain. Avoid ibuprofen and aspirin, as they can have anti-platelet and anti-coagulant effects and thus make the PRP therapy less effective.
In rare cases, short-term pain medications can help with extreme post-injection pain, but this is an unusual excepttion.
Your doctor may request a follow-up visit a day or two after the injection to monitor for complications.
It is also possible that the PRP injection therapy may simply fail to provide adequate relief. While unlikely, if such a scenario occurs, you and your doctor can discuss alternative therapies to heal your injury and manage your pain.
What conditions can platelet rich plasma therapy help with?
Musculoskeletal injuries are one of the most common causes of chronic pain and disability in the world, and platelet rich plasma therapy is a good treatment option for them. These injuries include damage to the tendons, a connective tissue that is vulnerable to damage and slow to heal.
Composed of thick fibers, tendons are vulnerable to injury because they connect muscle to bone and are subject to large amounts of force. They heal very slowly because the fibrous tissue contains very little vascular supply to receive blood and healing compounds, such as platelets. Because of this, a concentrated amount of platelets can go a long way towards healing.
Some of the best-documented tendon-related musculoskeletal conditions that have been effectively treated with PRP therapy include the following.
1. Epicondylitis/epicondylar tendinosis
Lateral epicondylitis (“tennis elbow”) and medial epicondylitis (“golfer’s elbow”) refer to inflammation and pain at the bony insertions on either side of the elbow where tendons tether to muscles of the forearm.
Epicondylitis is often an overuse injury that can cause chronic pain that can be difficult to treat.
Tendons throughout the body that have suffered from overuse injuries leading to chronic pain and tendon thickening are good candidates for PRP therapy. Tendinopathy is common in professional athletes and those who work in construction trades.
Common sites of tendinopathy include tendons in the:
- Achilles (heel)
- Patellar (knee)
- Rotator cuff (shoulder)
3. Other pain conditions
Recent research has found that platelet rich plasma therapy is effective for other specific conditions, including:
- Bursitis (inflammation of fluid-filled sacs that lie between tendons and bone or skin)
- Plantar fasciitis (heel pain)
- Wound healing
Clinical studies continue to accumulate data on the potential benefits of PRP therapy, and researchers recommend a continued focus on large-scale studies that standardize the preparation of platelet rich plasma injections.
Does PRP therapy work?
PRP represents an alternative to more conventional treatments of chronic pain. These conventional treatments do not often address the challenges with healing in the connective tissues. Platelet rich plasma therapy actually introduces growth factors that can stimulate the body’s instinct to heal and remove damaged tissue. Initial improvement in pain generally occurs within a few weeks and often accelerates as tissue heals.
Platelet rich plasma therapy has shown great promise in preliminary but scientifically significant controlled trials, especially for epicondylitis and other tendon-related injuries. A 2018 study found that patients receiving PRP injections experienced pain relief that was statistically more significant than patients who received other treatments. Earlier reports note that the promise of PRP came well before the science, but that research is catching up. These same reports highlight the need for more research as well as standardizing platelet preparation for best results.
The benefits of platelet rich plasma therapy increase when combined with physical therapy that stimulates new tissue growth. At Arizona Pain, our pain physicians can help design an individualized treatment plan that includes diet, cutting-edge treatments, and exercises to help your body heal.
If you have more questions or want to see if platelet rich plasma therapy can work for you, get in touch with Arizona Pain today!