PRP Injections For Chronic Pain

PRP stepsWhat is PRP?

Platelet-Rich Plasma injections are used to stimulate and accelerate the natural repair process of the body. The injections are prepared from the patient’s own blood, minimizing risks and side-effects. The blood is collected from the patient and spun in a centrifuge to separate the blood into different components. The component of blood with the highest concentration of platelets is extracted. This is then injected back into the target site, where it stimulates the body’s natural healing process.

What are Platelets?

Platelets are mostly known for their ability to clot blood. They are the first to be recruited to an area of injury. More importantly, platelets release numerous growth factors that recruit cells involved in repair and healing, such as stem cells, to the site of injury. Studies have shown that increased concentration of growth factors can speed up the healing process. Because of this ability, there is a rising popularity of PRP among athletes.

Where can it treat?

Current studies show that PRP is most effective in treating chronic tendon injuries affecting the ankle, knee and elbow. It has been proven to help heal conditions such as tennis elbow. It is also helpful for healing muscles, ligaments, and intervertebral discs.

How to prepare

You will be able to go home the day you receive the procedure. A typical procedure can take 45-90mins. You may need to stop taking certain types of medications before the procedure, such as NSAIDs, corticosteroids, and anticoagulants.

What to expect and considerations

The patient may experience some local bruising and tenderness at the injection site for a few days following the procedure. Note that PRP injections are not recommended for patients who suffer from bleeding disorders, active infections, or cancer. Patients who are taking anti-coagulation medications and pregnant women should also avoid this treatment.

Everyone experiences pain differently and we offer two levels of PRP injections to best suit your needs.

Standard Level PRP

Standard Level PRP may require a minimum of three treatments (likely three separate appointments) for best results. This type of injection offers a base level of PRP concentration. Standard Level PRP injections do not have as high a level of concentration of PRP as High-End PRP injections.

High-End PRP

High-End PRP injections have a higher concentration of PRP and most patients require fewer injections to reach the same results as with Standard Level PRP. Usually, a patient needs only one injection of High-End PRP versus three injections of Standard Level PRP to experience a similar amount of pain relief.

Platelet Rich Plasma (PRP) Injection — Information and Instructions for Patients       

Background on PRP

PRP is derived from your own blood by taking a sample of venous blood, placing it in a special tube, and spinning the blood in a centrifuge for about 15 min. This separates whole blood into its components including red blood cells, platelets, and plasma (the non—cellular fluid in blood). The middle layer constitutes PRP, which contains highly concentrated platelets, the cells that normally promote blood clotting. These cells also contain a number of specialized chemicals called growth factors. These include platelet derived growth factor, transforming growth factor beta, and vascular endothelial growth factor. These factors interact with the local cells and send signals that initiate a variety of events such as cell division and migration. The basic idea behind PRP injection is to deliver high concentrations of growth factors to an area of injury, with the hope of stimulating a healing response and reducing inflammation in the tissue. To some extent, injection of whole blood will stimulate the same response, but to a lesser degree.  PRP has been used since about 1987 to help promote healing in dental, orthopedic, and plastic surgery procedures. Over about the past 5 years, PRP has been recognized for its potential in treating both chronic and acute musculoskeletal injuries involving tendons, ligaments, and muscles. This procedure is gaining wide media attention as it has been used  in professional athletes in attempts to return them to competition as soon as possible Potential Benefits and Risks While PRP has been injected for many musculoskeletal disorders (see Further Reading below), carefully controlled studies are not available for the majority of musculoskeletal injuries. Injection of PRP into degenerated or partially torn tendons in tennis elbow has been shown to be effective in the majority of patients; however these results may not translate directly to other tendons or conditions. As such, how effective PRP will be in treating your particular condition is not known. Most PRP injections are being done in areas of tendondegeneration or tendinopathy which are causing pain for the patient. Examples include the Achilles tendon, elbow tendons, rotator cuff, and hamstring tendons. PRP may also be beneficial in treatment of muscle strain injuries, but again, there is very little controlled data to support this as yet. Overall, your physician and radiology consultant feel that PRP is a reasonable alternative for you when compared with the options — cortisone injection, surgery, or no treatment except oral medications and physical therapy; the potential benefits appear to outweigh the risks.   Because PRP is derived from your own blood (“autologous” transplantation), there is NO chance of having an allergy or immune reaction. Indeed in the literature, side effects or complications of PRP injection are extremely rare. The main risks include local infection  1% chance) and pain at the site of injection. Injection of none—buffered PRP (which is acidic) tends to be very painful, thus we add a small amount of sodium bicarbonate to the solution to neutralize the pH, which seems to alleviate much of the pain associated with injection. In addition, we will anesthetize the area before PRP injection with long-acting local anesthetic.  Your referring physician may give you a prescription for pain medication to be taken if you are in significant pain afterwards.

Pre-procedure Planning, and What to Expect During the Procedure You should stop taking any non-steroidal anti-inflammatory medications 7 days before the procedure, and should not take these medications again for 7 days after the procedure.  Common examples of these medications include ibuprofen, naproxyn, and indomethacin or as well as aspirin. None—steroidal medications work by blocking the action of some of the growth factors present in PRP, thus may render the injection ineffective. You may use acetaminophen (Tylenol) before or after the procedure. For lower extremity injections, we strongly recommend having someone else with you to drive you home. In some cases, your referring physician may want you to be on crutches for 1—2 days after the injection and this should be arranged ahead of time. Crutches are mainly useful if pain is severe in when standing or walking after lower extremity injections.

If you had an MRI bring these images to the procedure either on disk or on film.  The following steps will occur when you arrive in Wilderman Medical Clinic – Nursing staff will draw approximately 50 cc of blood from an arm vein and place it in the centrifuge to concentrate the PRP – Ultrasound of the affected area will be done to help localize areas of injury, and to determine if the procedure can be safely performed.  – Under sterile technique, local anesthetic will be used to numb the skin and the area of injection, followed by PRP injection. This may include needling of the adjacent bony attachment of a tendon, which can contribute to procedural and post- procedural pain.  – Following needle removal, you will rest for 15 minutes in the exam room – Discharge home, the entire procedure typically taking about 1 hour.

What to Do and What NOT to Do after the Procedure You may ice the area for 20 minutes every 2-3 hours for the first 24-48 hours after the procedure. About 1 in 10 patients experience a “flare” reaction beginning the day after the procedure, manifested by intense pain. If this occurs, begin taking the prescribed pain medication and notify the staff by the phone number 905.886.1212. While some redness and swelling are common after the procedure, if any progressive swelling, redness, drainage or fever occurs, notify the performing radiologist and/or the referring physician to be assessed for possible infection (again, an extremely rare complication but which may warrant antibiotic treatment). If symptoms are severe, you may be directed to the nearest Emergency Room for evaluation.

 Activity Level and Follow-up For the day of the procedure and the day after, limit the activity related to the injection site to activities of daily living. Depending on the injection site and your referring physician, you may be on crutches for 1-2 days until pain is not increased with weight bearing. Return to higher level activities such as running, cycling, golf, weight training, etc, will be directed by your referring physician and physical therapist, if one is involved. It is expected that it will take up to 6-8 weeks to adequately assess your response to the therapy. Please make an appointment with your referring physician at that time point to assess your progress and help us collect systematic data that will be useful for research and will benefit future patients.

Our office offers PRP injections for sport and overuse injuries, joint, bursa and tendon pain, osteoarthritis, trochanteric bursitis, knee Bursitis, ischial tuberosity bursitis, achilles tendonitis, bicipital tendonitis, De Quervain’s tenosynovitis, rotator cuff syndrome, trigger finger, knee ligament tendonitis, and tears, calcaneal spurs and plantar fasciitis, meniscal tears, Baker’s cysts, and lateral and medial epicondylitis.


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