Regenerative Medicine – Platelet Rich Plasma Provides Joint Pain Relief

As a neurologist who sees many patients with neck, back and various joint pains, I practice an area of medicine known as neuro-orthopedics. As such, I treat patients for their pain without surgical intervention. Many patients with neck, back and joint pain (knee pain, shoulder pain, elbow pain, etc.) can be successfully treated without invasive surgery and the many risk that go along with this. With surgery there is also a prolonged recovery time and need for extensive rehabilitation. The area of medicine that applies to successfully treating patients without surgery or use of narcotic medications is known as regenerative medicine. In this field, platelet rich plasma is injected into the affected joint, tendon, ligament or soft tissue area that has pain and is failing to heal completely. Tendons attach muscle to bone and ligaments attach bones to bones. Platelet rich plasma (PRP) is the concentrated healing components of the blood. Only one percent of the blood contains the bioactive proteins and platelets that are involved in healing. Through a specialized process, we can take the patient’s own blood and concentrate the platelets and bioactive proteins up to 500%. This small amount of concentrated PRP is then injected into the joint or other body area, that needs regeneration, after local anesthetic is administered. The PRP graft is then activated with thrombin and the healing process begins. Using the patient’s own blood eliminates the risk of transmitting disease and prevents graft rejection. PRP also has the benefit of being antimicrobial, killing off bacteria thereby limiting the risk of infection. David Crane, MD published an excellent overview of platelet rich plasma.

Platelet rich plasma works by first being injected into the affected area and activated. The activated platelets attach themselves to the damaged tissue, whether that be tendons, ligaments, muscle or bone. The platelets release alpha granules and dense particles. The small packets contain powerful bioactive proteins that begin the healing process. The alpha granules contain clotting factors, growth factors, cytokines and adhesion molecules. These substances allow the PRP graft to attach to the damaged tissue and start recruiting other healing cells to migrate into the area. The dense particles contain proteins that allow the platelets to clump together, forming the structural matrix of the PRP graft.

Bioactive proteins recruit fibrinocytes that move into the area, attaching to the matrix. Fibrinocytes begin laying done new collagen. Collagen is the basic building block for soft tissue, tendons, ligaments and cartilage structures in the joint area. Initially after platelet rich plasma is injected there is an inflammatory response where the new cells, including fibrinocytes, white blood cells and stem cells move into the graft. This phase usually lasts about a week and may be associated with slight swelling and mild pain.  As new collagen is being laid down, the proliferation phase begins. During this phase, the collagen is laid down in sufficient quantities to regenerate the damaged tissue. A stem cell is an immature cell that can transform into whatever tissue is needed for repair. This phase can take about 4 weeks. After this the remodeling phase occurs, where the new collagen contracts and becomes much stronger, building stronger tendons and ligaments. The entire process takes about 6 weeks but remodeling can go on for as long as six months.

Regenerative medicine offers patient with hip, knee, shoulder, elbow, neck and back pains the opportunity to have the damaged tissues repaired non-surgically. Injection of PRP results in regenerating the damaged tissue and thus restoring normal function. It also offers patients hope for pain relief, who have failed surgery and do not want to take (or continue to take) narcotics. PRP is also excellent for some patients who have joint problems that would prefer to avoid surgery or are not good surgical candidates. This may be especially true for patients with severe knee arthritis. PRP is safe and effective. It has been FDA approved for 20 years. Platelet rich plasma has the advantage that it can be done as an outpatient procedure and there is virtually no “recovery time.”

Platelet rich plasma has been used many times in professional athletics. Hines Ward, the Pittsburgh Steeler’s wide receiver, sprained his medial collateral knee ligament. It was thought that he would not be able to play in the Super Bowl due to his knee pain. He was given a PRP treatment and went on to play in the Super Bowl. He actually caught the 38 yard pass that won the game! During his knee surgery, Tiger Woods had the additional benefit of having a PRP graft put on the surgical site of his knee surgery. Both the NFL and MLB consider platelet rich plasma a viable medical treatment in the management of their elite athletes. For athletes with intractable tennis elbow, PRP is an excellent treatment modality to avoid surgery. Similar benefits can be found in the treatment of professional baseball pitchers who suffer from pitcher’s shoulder.
Platelet rich plasma therapy can be used in other chronic painful conditions such as plantar fasciitis – a condition characterized by persistent foot pain that is difficult to treat. A PRP graft can be administered to the heel area and frequently provides patients with healing of the plantar fasciitis.  Sacroiliitis, an inflammation of the tailbone where it attaches to the hip bones is a very common cause of persistent lower back pain. It can mimic sciatica (leg pain) and yet has nothing to do with the low back spinal nerves. In patients who fail to respond to standard therapies such as anti-inflammatory agents, physical therapy or a cortisone injection, PRP is a excellent treatment alternative to heal and regenerate the sacroiliac joint ligaments. Patients with persistent hip pain frequently have a condition known as trochanteric bursitis. This is a hip bursitis that is sometimes difficult to treat. PRP repairs the tendon damage, thereby relieving the pain.

In summary, platelet rich plasma and regenerative medicine offer patients an exciting and innovative treatment that has a proven track record of healing patients and regenerating damaged tissues. With an experienced treating physician, success rates of up to 85% can be seen. Depending on the severity of the injury anywhere from 1-3 treatments with PRP may be needed, at 4 week intervals. PRP is an ideal treatment modality as it can be given to patients who would prefer to avoid surgery or it can be given after surgery, in patients who have persistent pain, despite adequate rehabilitation. If you have chronic joint, neck or back pain, you may want to consider getting PRP therapy. PRP therapy clearly can improve a patient’s quality of life. Call today for a consultation and evaluation to see if platelet rich plasma therapy may be right for you. For more information, see Sarasota Neurolgy PRP blog site at PRP Stops Pain.