PRP in pain therapy: beyond the joints - new indications and protocols

PRP in pain therapy: beyond the joints - new indications and protocols

PRP in pain therapy: Revolutionary approaches beyond the Joints - A comprehensive guide for Physicians

Introduction: The changing face of pain therapy - a new Era of regeneration through Platelet Rich Plasma (PRP)

Imagine a patient who has been suffering from excruciating pain for years, making everyday life a living hell. Conventional therapies have failed and hope is fading. But then a new chapter in medicine appears on the scene: regenerative pain therapy with platelet rich plasma (PRP). Chronic pain is a global challenge that significantly impairs the quality of life of millions of people. Traditional pain therapies often focus on symptom relief. However, modern medicine strives for causal solutions, true healing and regeneration. In this context, regenerative medicine, in particular platelet-rich plasma (PRP) therapy, has established itself as a promising approach.

PRP, often referred to as "liquid gold", is already an established procedure in orthopaedics and aesthetics. Its ability to stimulate the body's own healing processes has made it an integral part of many treatment strategies, particularly for joint and tendon problems. However, the true revolution of PRP therapy is only now unfolding as medical professionals and researchers expand their view beyond the known indications. We are on the cusp of a new era in which PRP has the potential to address complex and often refractory pain conditions that were previously inadequately treated.

This in-depth article will take you on a fascinating journey through the latest findings and innovative applications of PRP in pain management. We will look in detail at how this endogenous healing concentrate not only regenerates joints, but also relieves neuropathic pain, resolves fascial discomfort and addresses chronic back pain beyond the intervertebral disc. Prepare to expand your understanding of PRP and discover the immense potential of this biological therapy for your practice.

The aim is to provide you, as a medical professional, with in-depth knowledge and practical insights to use PRP safely and effectively in your pain management practice.

PRP: The body's own healing concentrate - a scientific refresherEra of regeneration with Platelet Rich Plasma (PRP)

Before we dive into the depths of the new pain indications, let's briefly recap what makes PRP so unique. Platelet Rich Plasma is an autologous blood product obtained by centrifugation from the patient's own blood. The result is a plasma that contains a high concentration of platelets - typically 3 to 7 times the physiological concentration in whole blood. However, it is not the platelets themselves that cause healing, but the growth factors and cytokines stored in them.

When activated, the platelets release a veritable cascade of bioactive molecules, including:

  • Platelet-Derived Growth Factor (PDGF): Promotes cell growth, angiogenesis and collagen synthesis.
  • Transforming Growth Factor-beta (TGF-β): Regulates cell growth, differentiation and the formation of the extracellular matrix.
  • Vascular Endothelial Growth Factor (VEGF): Stimulates the formation of new blood vessels (angiogenesis), crucial for tissue healing.
  • Epidermal Growth Factor (EGF): Promotes the growth of epithelial cells and wound healing.
  • Fibroblast Growth Factor (FGF): Stimulates the proliferation of fibroblasts and collagen production.

These growth factors act synergistically to initiate and accelerate a variety of healing processes: they promote cell proliferation and migration, stimulate collagen synthesis, initiate angiogenesis (formation of new blood vessels) and modulate inflammatory processes. In the context of pain therapy, this means that PRP not only masks pain, but also addresses the underlying pathology on a biological level by promoting the regeneration of damaged tissue and reducing inflammatory reactions. This makes PRP a promising biological option in modern pain therapy that goes beyond purely symptomatic treatment.

PRP: The body's own healing concentrate - a scientific refresherEra of regeneration with Platelet Rich Plasma (PRP)

Neuropathic pain: When nerves become pain generators - The PRP response

Neuropathic pain is one of the most agonizing and difficult forms of pain to treat. It is caused by damage or dysfunction of the nervous system itself and often manifests itself as burning, stinging, numbness or electrifying sensations. Traditional treatments are often only effective to a limited extent and are associated with considerable side effects. This is where PRP offers a promising biological approach that goes beyond mere symptom control.

Research in recent years has shown that PRP has the potential to promote the regeneration of damaged nerves and modulate inflammatory processes that perpetuate neuropathic pain. The growth factors contained in PRP, in particular NGF (Nerve Growth Factor) and BDNF (Brain-Derived Neurotrophic Factor), play a crucial role in nerve regeneration, myelination and the reduction of nerve inflammation. Studies suggest that PRP can significantly reduce pain intensity in various neuropathic conditions [1, 2, 3].

Areas of application and protocols for neuropathic pain:

  • Diabetic neuropathy: one of the most common forms of neuropathic pain. PRP injections can improve nerve health and relieve symptoms by promoting microcirculation and supporting the regeneration of small nerve fibers [2].
  • Peripheral nerve compression syndromes (e.g. carpal tunnel syndrome, tarsal tunnel syndrome): PRP can be injected directly to the compressed nerve to reduce inflammation, promote nerve regeneration and improve nerve lubrication. Ultrasound-guided hydrodissection with PRP is a precise and effective method here [4].
  • Postherpetic neuralgia: Persistent neuropathic pain can occur after shingles. PRP could help alleviate this due to its anti-inflammatory and regenerative properties, although more research is needed.
  • Trigeminal neuralgia: Although complex, there are promising initial approaches to using PRP to reduce chronic nerve pain in trigeminal neuralgia [5].

Injection protocols: The injection of PRP for neuropathic pain requires the highest precision. Ultrasound- or fluoroscopy-guided injections are essential to place the PRP precisely on the damaged nerve or in the surrounding tissue. The number of injections and the concentration of PRP can vary depending on the indication and should be adjusted individually.

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Fascia complaints: Untangling the invisible pain network - PRP's potential

Fasciathe ubiquitous network of connective tissue that envelops muscles, organs and bones, are increasingly becoming the focus of pain therapy. Myofascial pain syndromes, fascial adhesions and inflammation can cause diffuse, persistent pain that is often difficult to localize and treat. Here, PRP offers an innovative approach to improve the regeneration and gliding ability of fascial tissue.

The growth factors contained in PRP stimulate fibroblasts, which are responsible for the production of collagen and elastin - the main components of fascia. This can help to restore normal fascia structure and function. In addition, the anti-inflammatory properties of PRP counteract the chronic inflammation that often accompanies fascial discomfort [6].

Areas of application and protocols for fascial complaints:

  • Myofascial trigger points (MTrPs): PRP injections directly into trigger points can be more effective than dry needling in the treatment of myofascial pain syndromes [7]. The growth factors promote healing of the overloaded tissue and reduce pain sensitivity.
  • Plantar fasciitis: A common cause of heel pain. PRP injections have been shown to be effective in relieving pain and improving functional recovery, often with better results than cortisone injections [8].
  • Chronic fascial inflammation (e.g. in fibromyalgia-like conditions): Although research here is still in its infancy, PRP could play a role in relieving diffuse fascial discomfort through its anti-inflammatory and tissue regenerating properties.

Injection protocols: For fascial discomfort, precise injection into the affected fascial tissue is critical. Ultrasound guidance can help to target injections into thickened or adhered fascial areas. Treatment may require several sessions to achieve optimal results.

Fascia complaints: Untangling the invisible pain network - PRP's potential

Chronic back pain: Beyond the intervertebral disc - PRP's broader horizon

Chronic back pain is a complex problem with a variety of causes that often go beyond mere disc degeneration. Facet joint arthrosis, sacroiliac joint dysfunction, ligament lesions and muscular imbalances contribute significantly to the pain. While PRP has already shown promising results with discogenic back pain, the areas of application are increasingly expanding to other pain-causing structures of the spine.

PRP can promote the regeneration of cartilage tissue in facet joints, reduce inflammatory processes in the joints and support the healing of overloaded ligaments and tendons in the area of the spine. The growth factors in PRP help to strengthen local structures and can therefore improve the stability of the spine and relieve pain [9, 10].

Areas of application and protocols for chronic back pain (non-discogenic):

  • Facet joint osteoarthritis: PRP injections into the facet joints can relieve pain and improve joint function by stimulating cartilage regeneration and reducing inflammation. This represents a biological alternative to steroid injections [11].
  • Sacroiliac joint dysfunction (SIG dysfunction): Pain in the sacroiliac joint area is often difficult to treat. PRP injections into the joint and surrounding ligaments can improve stability and reduce pain [12].
  • Ligamentous instability of the spine: Overstressed or damaged ligaments can lead to chronic back pain. PRP can promote healing and strengthening of these ligaments, resulting in improved stability and pain relief.
  • Muscular pain syndromes in the back: Similar to fascial complaints, PRP injections into chronically tense or painful back muscles can contribute to regeneration and break pain cycles.

Injection protocols: Here too, image-guided injections (fluoroscopy or ultrasound) are crucial in order to precisely apply the PRP to the structures causing the pain. The exact localization of the source of pain is the key to success. Several injections at intervals of several weeks are often necessary to achieve a lasting effect.

Chronic back pain: Beyond the intervertebral disc - PRP's broader horizon

Practical considerations for the use of PRP in pain therapy: A guide for practitioners

The expansion of the range of indications for PRP in pain therapy requires practitioners to have a deep understanding of the subject matter and careful planning. The success of the therapy depends not only on the correct indication, but also on the quality of the PRP preparation, the precision of the injection and comprehensive patient management.

1. PRP quality and collection: the key to successful therapy

The effectiveness of PRP is directly linked to the quality of the preparation obtained. Several factors play a role here:

  • Platelet concentration: A high-quality PRP preparation should have a platelet concentration that is - to - times the baseline concentration in whole blood. Studies show that too low a concentration can reduce the therapeutic effect. The choice of the right PRP tube and centrifuge is crucial here. For optimal PRP collection, we recommend the Vi PRP-PRO PRP tubes from prpmed.de. These CE-certified class IIa medical devices guarantee efficient and safe collection of up to 4.5 ml of highly concentrated PRP per tube thanks to their innovative separating gel and a vacuum capacity of 9 ml. Combined with a powerful centrifuge such as the DUO PRF/PRP centrifuge from prpmed.de, a class IIa medical device that achieves maximum speeds of 4500 rpm and an RCF of up to 2490 x g, you can ensure precise and reproducible blood processing. Look for certified systems that guarantee a reproducible and high platelet yield.
  • Leukocyte content: The role of leukocytes in PRP is the subject of intense debate. While some studies suggest a positive effect of certain leukocyte populations on healing, others (especially granulocytes) can have a pro-inflammatory effect and lead to undesirable side effects. The decision to use a leukocyte-rich (LR-PRP) or leukocyte-poor (LP-PRP) preparation should be made on an indication-specific basis.
  • Activation: Platelets can be activated to release growth factors ex vivo (e.g. with calcium chloride or thrombin) or in vivo (by contact with collagen in the tissue). The choice of activation method can influence the release kinetics and bioavailability of the growth factors.

Tip for the practice: Invest in high-quality PRP systems and train your staff regularly in correct collection and preparation. A standardized procedure ensures the quality and reproducibility of your treatments.

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2. Precision of the injection: imaging as an indispensable navigator

Precise placement of PRP is particularly important for complex pain conditions that affect deeper structures such as nerves, fascia or spinal joints. Blind injection carries the risk of missing the target tissue and thus reducing effectiveness or even causing complications.

  • Ultrasound guidance: Ultrasound has established itself as an excellent tool for real-time visualization of soft tissue structures, nerves and joints. It enables precise needle positioning, avoidance of vessels and nerves and direct control of PRP distribution in the target area. This is particularly valuable when hydrodissecting nerves or injecting into myofascial trigger points.
  • Fluoroscopy (X-ray image converter): For injections in the spine, particularly in facet joints or the sacroiliac joint, fluoroscopy provides excellent control of needle position in bony structures. The use of contrast media can also confirm the correct distribution of the PRP.

Tip for the practice: Invest in high-quality PRP systems such as the Vi PRP-PRO PRP tubes and the DUO PRF/PRP centrifuge from prpmed.de and train your staff regularly in correct collection and preparation. A standardized procedure ensures the quality and reproducibility of your treatments.

3. Patient management and expectations: transparency creates trust

Open and realistic communication with the patient is essential for the success of PRP therapy. PRP is not a "magic bullet" and results can vary. It is important to provide patients with comprehensive information:

  • Mechanism of action: explain clearly how PRP works and the role of the body's own healing powers.
  • Expected results: Set realistic expectations regarding the extent and timing of pain relief. Emphasize that PRP promotes regeneration, which takes time.
  • Course of treatment: Provide information on the number of expected injections, possible side effects (e.g. temporary increase in pain, swelling) and the need for aftercare and any accompanying therapies (e.g. physiotherapy).
  • Contraindications: Explain absolute and relative contraindications to ensure patient safety.

Tip for the practice: Create detailed information material for your patients and take sufficient time for the explanatory discussion. Well-informed patients are satisfied patients.

Conclusion: PRP - a game changer in pain therapy

The journey through the expanded fields of application of PRP in pain therapy shows impressively: PRP is far more than just a treatment for joint pain. It is a game changer, a biological tool that has the potential to fundamentally change the way we understand and treat chronic pain.

From regenerating damaged nerves in neuropathic pain to dissolving fascial adhesions and strengthening spinal structures in chronic back pain, PRP opens up new horizons for patients who have often suffered from their ailments for years.

However, the integration of PRP into modern pain therapy requires expertise, precision and a deep understanding of the underlying biology. For medical professionals willing to delve into this fascinating subject, PRP offers the opportunity to provide their patients with not only symptomatic relief, but true regeneration and a lasting improvement in quality of life.

It is an investment in the future of medicine, a future in which the body uses its own healing powers to conquer pain and restore health.

Research is constantly progressing and it is expected that more innovative applications and optimized protocols for PRP in pain management will be discovered in the coming years. Stay curious, stay informed and be part of this exciting development that has the potential to positively change the lives of countless pain patients.

References and studies

1. Wang, S., et al. (2024). Platelet-rich plasma (PRP) in nerve repair.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10997806/

2. Integrative Rehab Medicine. Understanding Neuropathy and PRP.

https://integrativerehabmedicine.com/platelet-rich-plasma-prp-a-breakthrough-treatment-for-diabetic-neuropathy/

3. Kuffler, D. P. (2013). Platelet-rich plasma and the elimination of neuropathic pain.

https://pubmed.ncbi.nlm.nih.gov/23832571/

4. Dr. Sebastian. (2022). Neuropathy Treatment - Nerve Hydrodissection w PRP.

https://www.youtube.com/watch?v=cs4GnedX0t4

5. Centeno-Schultz Clinic. PRP For Trigeminal Neuralgia.

https://centenoschultz.com/treatment/prp-for-trigeminal-neuralgia/

5. Li, N. (2024). Effects of platelet-rich plasma injection on electrical activity.

https://www.nature.com/articles/s41598-024-72554-1

6. Agarwal, V. (2022). Comparative Efficacy of Platelet-Rich Plasma and Dry Needling.

https://pubmed.ncbi.nlm.nih.gov/36445907/

7. Houston Sports Doctor. Platelet-rich plasma versus dry needling.

https://www.houstonsportsdoctor.com/blog/platelet-rich-plasma-versus-dry-needling-of-myofascial-meridian-trigger-points-in-treatment-of-plantar-fasciitis-10372.html

8. Akeda, K. (2019). Platelet-rich plasma in the management of chronic low back pain.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6394242/

9. Interventional Pain Doctors. PRP for Chronic Back Pain.

https://www.interventionalpaindoctors.com/post/prp-for-chronic-back-pain

10. Treat Pain Now. PRP: An All-Natural Treatment for Chronic Low Back Pain.

https://www.treatpainnow.com/blog/prp-an-all-natural-treatment-for-chronic-low-back-pain

10. The Morrison Clinic. Platelet Rich Plasma Therapy for Spine.

https://themorrisonclinic.com/platelet-rich-plasma-therapy-for-spine

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