Adding Regenerative medicine to your practice.

[lobelsteve]

You would only know the standards if you're competent. Only the competent know the standards. It's Dunning-Kruger in action.

Regenerative Medicine Standards Portal

An interactive database of regenerative medicine standards, including existing and in-development standards and standards areas of need.

portal.standardscoordinatingbody.org

Regulatory and Ethical Aspects of Orthobiologic Therapies

Orthobiologic therapies show significant promise to improve outcomes for patients with musculoskeletal pathology. There are considerable research efforts to develop strategies that seek to modulate the biological environment to promote tissue regeneration ...

www.ncbi.nlm.nih.gov

Website Physician Reporting Form - Interventional Orthobiologics Foundation

interventionalorthobiologics.org

The OJSM is the best thing you have posted in this thread, too bad it is ignored by 99% of those delivering the good$.

Inmates running the asylum.

---

Members don't see this ad.

 

[nvrsumr]

@drusso any real studies showing superiority of clinical outcomes using PRP adhering to KOL $tandards vs ghetto juice

Yeah no

 

[drusso]

@drusso any real studies showing superiority of clinical outcomes using PRP adhering to KOL $tandards vs ghetto juice

Yeah no

Uh, yeah... Like "dose matters." Older patients need higher concentrations than younger patients. And use leukocytes-rich PRP sparingly.

The optimal platelet concentration in platelet-rich plasma for proliferation of human cells in vitro—diversity, biases, and possible basic experimental principles for further research in the field: A review

In the last decades, several in vitro studies have tested the effect of plate-rich plasma (PRP) on the proliferation of human cells in search of a wizard for the use of PRP in a clinical setting. However, the literature displays striking differences regarding ...

www.ncbi.nlm.nih.gov

The JAMA weak sauce ghetto juice PRP studies cemented these facts. Standards matter. And, @lobelsteve and others should not be allowed to practice below ANY standard of care...

Platelet-Rich Plasma Injections vs Placebo for Patients With Ankle Osteoarthritis

To the Editor After review of the recent clinical trial1 examining platelet-rich plasma (PRP) injections for ankle osteoarthritis, we think there are several methodological concerns that make its concluding statement of “not supporting the use of PRP injections for ankle osteoarthritis,” without...

jamanetwork.com

"Therefore, we were surprised that the authors did not characterize the PRP products used in this study1 and did not follow the minimum standards recommended for reporting. The unknown content of the PRP products leads to uncertainty about whether patients received a supraphysiologic dose of platelets with their PRP treatment or a physiologic dose, unlikely to elicit clinical benefit. With the considerable variability in preparation methods and outcomes of studies investigating PRP, adequate description of the biologic characteristics of a PRP intervention ensures quality control and allows for comparison across studies.3 Failure to do so is a major flaw in research because reproducibility is compromised."

 

[nvrsumr]

Just cause one pays the franchise fee doesn't mean their McPRP is any better than homemade PRP.

Cell counts and hoods don't matter except for marketing.

 

[drusso]

Just cause one pays the franchise fee doesn't mean their McPRP is any better than homemade PRP.

Cell counts and hoods don't matter except for marketing.

Don't be anti-scientific and mislead junior practitioners like @lobelsteve into an inflated sense of confidence about his ignorance. He will hurt people. No one can just bombastically say, "Hey, my ghetto juice, weak sauce PRP is just has good as your higher concentration, dose characterized ortho-biologic."

In God we trust; everyone else please bring a pre-/post- CBC before making wild ass claims. Just like anything else in medicine, you need to choose the right tissue product, at the right time, for the right patient.

1) Cell counts matter because dose matters.

2) Sterility and preparation matter because if you're injecting IO, intradiscal, or epidural you can have complications from contamination.

Int Orthop. 2022 Oct;46(10):2219-2228.
doi: 10.1007/s00264-022-05524-9. Epub 2022 Aug 6.

Percutaneous autologous bone marrow concentrate for knee osteoarthritis: patient-reported outcomes and progenitor cell content​

Christopher J Centeno 1 2, Dustin R Berger 2, Brandon T Money 1, Ehren Dodson 2, Christopher W Urbanek 1, Neven J Steinmetz 3
Affiliations expand

• PMID: 35932306
• PMCID: PMC9492580
• DOI: 10.1007/s00264-022-05524-9

Free PMC article

Abstract​

Purpose: Knee osteoarthritis (OA) is a common, progressively debilitating joint disease, and the intra-articular injection of autologous bone marrow concentrate (BMC) may offer a minimally invasive method of harnessing the body's own connective tissue progenitor cells to counteract accompanying degenerative effects of the disease. However, the extent to which the progenitor cell content of BMC influences treatment outcomes is unclear. We sought to determine whether patient-reported outcome measures associated with BMC treatment for knee OA are related to the concentration of progenitor cells provided.
Methods: In the present study, 65 patients (72 knees) underwent treatment for knee OA with autologous BMC and self-reported their outcomes for up to one year using follow-up questionnaires tracking function, pain, and percent improvement. A small fraction of each patient's BMC sample was reserved for quantification with a haematological analyzer and cryopreserved for subsequent analysis of potential connective tissue progenitor cells using a colony-forming unit fibroblast (CFU-F) assay.
Results: Patients reported significant increases in function and overall percent improvement in addition to decreases in pain relative to baseline levels following treatment with autologous BMC that persisted through 12 months. Patients reporting improved outcomes (46 of 72 knees) received BMC injections having higher CFU-F concentrations than non-responding patients (21.1×103 ± 12.4×103 vs 14.3×103 ± 7.0 x103 CFU-F per mL). A progenitor cell concentration of 18×103 CFU-F per mL of BMC was found to best differentiate responders from non-responders.
Conclusion: This study provides supportive evidence for using autologous BMC in the minimally invasive treatment of knee OA and suggests that increased progenitor cell content leads to improved treatment outcomes.
Trial registration: ClinicalTrials.gov Identifier: NCT03011398, 1/7/17.
Keywords: Bone marrow concentrate (BMC); Colony-forming unit fibroblast (CFU-F); Connective tissue progenitor cells; Knee osteoarthritis (OA).
© 2022. The Author(s).



Cartilage. 2023 Jun 22;19476035231166127.
doi: 10.1177/19476035231166127. Online ahead of print.

Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma​

Miguel A Khoury 1, Karim Chamari 1, Montassar Tabben 1, Khalid Alkhelaifi 1, Emmanuel Papacostas 1, Theodorakys Marín Fermín 1, Markus Laupheimer 1, Pieter D Hooghe 1
Affiliations expand

• PMID: 37350015
• DOI: 10.1177/19476035231166127

Abstract​

Objective: To directly compare clinical and MRI outcomes of multiple intra-articular injections of adipose-derived stromal cells (ASCs) or platelet-rich plasma (PRP) in patients with knee osteoarthritis (OA).
Design: We retrospectively compared 24-month outcomes in (1) 27 patients receiving 3-monthly intra-articular injections with a total of 43.8 million ASCs and (2) 23 patients receiving 3-monthly injections of 3-ml preparation of PRP. All patients had Kellgren-Lawrence grade 1, 2, or 3 knee OA with failed conservative medical therapy. The Numeric Pain Rating Scale (NPRS) scores; Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, and 24 months after the first injection; and the MRI Osteoarthritis Knee Score (MOAKS) at 12 and 24 months were considered as outcomes.
Results: No major complications occurred in any patient. Both groups significantly improved in pain NPRS score and KOOS at 6 months. At 12- and 24-month evaluations, the ASC group significantly decreased scores to a greater degree (P < 0.001) than the PRP group. MOAKS scores indicated a decrease in disease progression in the ASC group.
Conclusion: Both ASCs and PRP were safe and resulted in clinical improvement in patients with knee OA at 6 months; however, at 12 and 24 months, ASCs outperformed leukocyte-poor PRP in clinical and radiological outcomes.

Keywords: adipose-derived stromal cells; cartilage injury; intra-articular injection; osteoarthritic knee pain; stem cells.


Acta Biomed. 2022 Oct 26;93(5):e2022222.
doi: 10.23750/abm.v93i5.12845.

Clinical and functional evaluation of bone marrow aspirate concentrate vs autologous conditioned serum in the treatment of knee osteoarthritis​

Matteo Vitali 1, Marco Ometti 2, Pierluigi Pironti 3, Damiano Salvato 4, Alice Sandrucci 5, Orlando Leone 6, Vincenzo Salini 7
Affiliations expand

• PMID: 36300237
• PMCID: PMC9686147
• DOI: 10.23750/abm.v93i5.12845

Free PMC article

Abstract​

Background and aim: The aim of this study was to compare the efficacy of a single Bone Marrow Aspirate Concentrate (BMAC) with a cycle of 4 Autologous Conditioned Serum (ACS) injections in the treatment of early-stage knee osteoarthritis (OA).
Methods: Two groups of 12 patients with degenerative knee OA were treated with a single BMAC injection and with a cycle of 4 ACS injections respectively. Follow-up was set at baseline (t0), one-month (t1) and six-months (t2) evaluating VAS for pain, WOMAC index and range of motion (ROM).
Results: We reported a significant improvement in WOMAC after BMAC injection both at t1 (p= 0,001) as well as t2 (p< 0,001), plus a reduction of VAS values in BMAC group at six months follow-up (p = 0,024). In contrast, no significant differences in ROM between the two groups were observed.
Conclusions: Both the approaches are safe and effective in the treatment of knee OA, with a major efficacy of BMAC.

 

[nvrsumr]

@drusso. I appreciate the time you have put into this thread and the numerous studies you have posted.

Open to changing my mind that PRP platelet numbers correlate in a “dose” dependent manner with improved clinical outcomes when there is actual evidence.

 

[drusso]

@drusso. I appreciate the time you have put into this thread and the numerous studies you have posted.

Open to changing my mind that PRP platelet numbers correlate in a “dose” dependent manner with improved clinical outcomes when there is actual evidence.

I'm just having a bit of fun with everyone. Even @lobelsteve weak sauce, ghetto juice PRP is better than 80 mg triamcinolone in a knee joint...

Growth Factors. 2023 Jun 23;1-13.
doi: 10.1080/08977194.2023.2227273. Online ahead of print.

Comparative evaluation of autologous platelet-rich plasma and platelet lysate in patients with knee osteoarthritis​

Sareh Hosseini 1, Mohammad Sadegh Soltani-Zangbar 2 3, Majid Zamani 4, Yoda Yaghoubi 3, Reza Rikhtegar Ghiasi 5, Roza Motavalli 3, Ali Ghassabi 3, Rahim Iranzad 3, Amir Mehdizadeh 6, Seyed Kazem Shakouri 1, Alireza Pishgahi 1, Mehdi Yousefi 3 5
Affiliations expand

• PMID: 37351894
• DOI: 10.1080/08977194.2023.2227273

Abstract​

Autologous platelet-rich plasma (PRP) and platelet lysate (PL) are nowadays promising candidates in the treatment of articular cartilage lesions. We aimed to compare PRP and PL injection effectiveness in patients with knee osteoarthritis (KOA). A total of fifty women with KOA were included in the study. Patients were treated with intra-articular injections of PRP and PL. Clinical outcomes were evaluated using the comparison of VAS, WOMAC, and ROM scores. The concentration levels of growth factors and cytokines were measured by ELISA. All patients showed significant improvements in pain and function following treatment of KOA with PL and PRP compared to baseline. Moreover, PL's concentration of growth factors was significantly higher than PRP. A significant increase was also observed in all of the aforementioned mediators in both PRP and PL products compared to control. These results can introduce PL as a promising and alternative option for KOA therapy in the future.
Keywords: KOA therapy; Knee osteoarthritis; platelet lysate; platelet-rich plasma.

Knee. 2023 Mar 29;42:161-169.
doi: 10.1016/j.knee.2023.03.002. Online ahead of print.

Effects of platelet-rich plasma on subchondral bone marrow edema and biomarkers in synovial fluid of knee osteoarthritis​

Wanchang Lin 1, Li Xie 1, Liang Zhou 1, Jiapeng Zheng 1, Wenliang Zhai 2, Dasheng Lin 3
Affiliations expand

• PMID: 37001332
• DOI: 10.1016/j.knee.2023.03.002

Abstract​

Background: The aim of the study was to investigate the effect of platelet-rich plasma (PRP) on subchondral bone marrow edema (BME) and the level of biomarkers in synovial fluid of the knee osteoarthritis.
Methods: Eighty-one patients with symptomatic knee osteoarthritis were randomly divided into two groups according to the number of inpatients. Forty-five cases were treated with intra-articular injection of PRP (PRP group), 36 cases were treated with sodium hyaluronate (SH group), and the clinical effects were evaluated using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. The changes of subchondral BME were assessed by magnetic resonance imaging (MRI) before and after treatment. The levels of TNFα, IL-6, MCP-1, MMP-1, MMP-3, and MMP-9 in synovial fluid were also detected.
Results: All the patients completed the corresponding treatment and were followed up for 12 months without serious complications. After the treatment, the VAS and WOMAC scores of the two groups were significantly decreased, and the difference was statistically significant at different time points (P < 0.05). The VAS and WOMAC scores of the PRP group were better than those of the SH group (P < 0.05). MRI showed that the subchondral bone edema of the two groups were reduced in varying degrees, and the reduction was more noticeable in the PRP group (P < 0.05). The levels of TNFα, IL-6, MCP-1, MMP-1, MMP-3, and MMP-9 in two groups were decreased, and the difference was statistically significant at different time points (P < 0.05). However, the levels of TNFα, IL-6, MCP-1, MMP-1, MMP-3, and MMP-9 in the PRP group were significantly lower than those in the SH group (P < 0.05).
Conclusions: Intra-articular injection of PRP can significantly reduce the subchondral BME and the level of biomarkers in synovial fluid of the symptomatic knee osteoarthritis.
Keywords: Intra-articular injection; Knee osteoarthritis; Platelet-rich plasma; Sodium hyaluronate.

 

[lobelsteve]

Adding Regenerative medicine to your practice.

I do PRP on request. Joints, bursa. Spin blood in office here. No kits. I wouldn't do it on request. I would only do it when medically indicated.

forums.studentdoctor.net

J Cutan Aesthet Surg. 2014 Oct-Dec; 7(4): 189–197.
doi: 10.4103/0974-2077.150734

Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective​

Rachita Dhurat and MS Sukesh

PRP method​

1. Obtain WB by venipuncture in acid citrate dextrose (ACD) tubes
2. Do not chill the blood at any time before or during platelet separation.
3. Centrifuge the blood using a ‘soft’ spin.
4. Transfer the supernatant plasma containing platelets into another sterile tube (without anticoagulant).
5. Centrifuge tube at a higher speed (a hard spin) to obtain a platelet concentrate.
6. The lower 1/3rd is PRP and upper 2/3rd is platelet-poor plasma (PPP). At the bottom of the tube, platelet pellets are formed.
7. Remove PPP and suspend the platelet pellets in a minimum quantity of plasma (2-4 mL) by gently shaking the tube.

Buffy coat method​

1. WB should be stored at 20°C to 24°C before centrifugation.
2. Centrifuge WB at a ‘high’ speed.
3. Three layers are formed because of its density: The bottom layer consisting of RBCs, the middle layer consisting of platelets and WBCs and the top PPP layer.
4. Remove supernatant plasma from the top of the container.
5. Transfer the buffy-coat layer to another sterile tube.
6. Centrifuge at low speed to separate WBCs or use leucocyte filtration filter.

There is no consensus on whether or not platelets must be previously activated before their application and with which agonist. Some authors activate platelets with thrombin or calcium, whereas others apply platelets without being previously activated, arguing that better results are obtained.[15]

Convinced me to have the lab change to PRP method above. In office, free processing.
No franchise fee.

 

[drusso]

Adding Regenerative medicine to your practice.

I do PRP on request. Joints, bursa. Spin blood in office here. No kits. I wouldn't do it on request. I would only do it when medically indicated.

forums.studentdoctor.net

J Cutan Aesthet Surg. 2014 Oct-Dec; 7(4): 189–197.
doi: 10.4103/0974-2077.150734

Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective​

Rachita Dhurat and MS Sukesh

PRP method​

1. Obtain WB by venipuncture in acid citrate dextrose (ACD) tubes
2. Do not chill the blood at any time before or during platelet separation.
3. Centrifuge the blood using a ‘soft’ spin.
4. Transfer the supernatant plasma containing platelets into another sterile tube (without anticoagulant).
5. Centrifuge tube at a higher speed (a hard spin) to obtain a platelet concentrate.
6. The lower 1/3rd is PRP and upper 2/3rd is platelet-poor plasma (PPP). At the bottom of the tube, platelet pellets are formed.
7. Remove PPP and suspend the platelet pellets in a minimum quantity of plasma (2-4 mL) by gently shaking the tube.

Buffy coat method​

1. WB should be stored at 20°C to 24°C before centrifugation.
2. Centrifuge WB at a ‘high’ speed.
3. Three layers are formed because of its density: The bottom layer consisting of RBCs, the middle layer consisting of platelets and WBCs and the top PPP layer.
4. Remove supernatant plasma from the top of the container.
5. Transfer the buffy-coat layer to another sterile tube.
6. Centrifuge at low speed to separate WBCs or use leucocyte filtration filter.

There is no consensus on whether or not platelets must be previously activated before their application and with which agonist. Some authors activate platelets with thrombin or calcium, whereas others apply platelets without being previously activated, arguing that better results are obtained.[15]

Convinced me to have the lab change to PRP method above. In office, free processing.
No franchise fee.

Have the lab take the final autologous, ortho-biologic product and run a platelet count on it in a hemo-analyzer. Compare it to a pre-processed platelet count. Now, you know the real characteristics of your weak sauce, ghetto juice PRP.

Also, make sure you track your patient outcomes in a registry.

Regenerative Orthobiologics Registry (ROR) | OBERD

Optimize your patient outcomes and your practice with OBERD.

www.oberd.com

OBERD powers Regenerative Orthobiologics Registry to advance orthopaedics

Optimize your patient outcomes and your practice with OBERD.

www.oberd.com

 

[lobelsteve]

Have the lab take the final autologous, ortho-biologic product and run a platelet count on it in a hemo-analyzer. Compare it to a pre-processed platelet count. Now, you know the real characteristics of your weak sauce, ghetto juice PRP.

Also, make sure you track your patient outcomes in a registry.

Regenerative Orthobiologics Registry (ROR) | OBERD

Optimize your patient outcomes and your practice with OBERD.

www.oberd.com

OBERD powers Regenerative Orthobiologics Registry to advance orthopaedics

Optimize your patient outcomes and your practice with OBERD.

www.oberd.com

I can run the lab. But I’m not paying to join a registry.

 

[drusso]

I can run the lab. But I’m not paying to join a registry.

You'll be accused of "experimenting" on people if you don't keep track of your results in a Registry. How will you know if your little ghetto-juice, weak sauce PRP is "working?" It could all be psychokinesis and healing intentions.

You're a walking Josef Mengele...

 

[lobelsteve]

You'll be accused of "experimenting" on people if you don't keep track of your results in a Registry. How will you know if your little ghetto-juice, weak sauce PRP is "working?" It could all be psychokinesis and healing intentions.

You're a walking Josef Mengele...

I will keep my own records.

 

[Ducttape]

If I charge $850 for a PRP treatment for partial tear, and downgrade it to $650 in which I lose money, you’re telling me that people can’t afford it, but they would be ok if their ****ty insurance knows that they would pay $20 for a bandaid at a hospital. The people that “can’t afford” could also pay $650 for a number of things that they probably “can’t afford.” What’s Obamas book called..”the audacity of hope” isn’t that title as passive aggressive as I am..

they generally are not paying $20 directly.

You'll be accused of "experimenting" on people if you don't keep track of your results in a Registry. How will you know if your little ghetto-juice, weak sauce PRP is "working?" It could all be psychokinesis and healing intentions.

You're a walking Josef Mengele...

yet this is most likely the case of the vast majority of "practitioners" who are offering PRP.

===
question, why did you include studies that compared PRP to stem cells in a forum that seemed to be focusing on "weak sauce PRP" vs. "new and improved" "extra strength" PRP?

---

 

[nvrsumr]

Because there is zero evidence platelet counts matter but it sounds good when up-selling a customer(patient) to supersize their McPRP order.

 

[drusso]

Because there is zero evidence platelet counts matter but it sounds good when up-selling a customer(patient) to supersize their McPRP order.

Rats don't lie...

Biochem Biophys Res Commun.
2023 Jun 10;672:185-192.
doi: 10.1016/j.bbrc.2023.05.123. Online ahead of print.

Platelet-rich plasma promotes skeletal muscle regeneration and neuromuscular functional reconstitution in a concentration-dependent manner in a rat laceration model​

Huayi Gao 1, Zhidong Zhao 2, Ji Li 3, Zheng Guo 4, Fei Zhang 5, Ketao Wang 6, Xiaowei Bai 7, Qi Wang 8, Yu Guan 9, Yaoting Wang 10, Pengli Zhang 11, Ningyu Lv 12, Heng Zhu 13, Zhongli Li 14
Affiliations expand

• PMID: 37354612
• DOI: 10.1016/j.bbrc.2023.05.123

Abstract​

Abnormal function of injured muscle with innervation loss is a challenge in sports medicine. The difficulty of rehabilitation is regenerating and reconstructing the skeletal muscle tissue and the neuromuscular junction (NMJ). Platelet-rich plasma (PRP) releases various growth factors that may provide an appropriate niche for tissue regeneration. However, the specific mechanism of the PRP's efficacy on muscle healing remains unknown. In this study, we injected PRP with different concentration gradients (800, 1200, 1600 × 109 pl/L) or saline into a rat gastrocnemius laceration model. The results of histopathology and neuromyography show that PRP improved myofibers regeneration, facilitated electrophysiological recovery, and reduced fibrosis in a concentration-dependent manner. Furthermore, we found that PRP promotes the activity of satellite cells by upregulating the expression of the myogenic regulatory factor (MyoD, myogenin). Meanwhile, PRP promotes the regeneration and maturation of acetylcholine receptor (AChR) clusters of the Neuromuscular junction (NMJ) on the regenerative myofibers. Finally, we found that the expression of the Agrin, LRP4, and MuSK was upregulated in the PRP-treated groups, which may contribute to AChR cluster regeneration and functional recovery. The conclusions proposed a hypothesis for PRP treatment's efficacy and mechanism in muscle injuries, indicating promising application prospects.

Keywords: Biomaterial; Platelet-rich plasma; Skeletal muscle injury; Sports medicine.

 

[lobelsteve]

Rats don't lie...

Biochem Biophys Res Commun.
2023 Jun 10;672:185-192.
doi: 10.1016/j.bbrc.2023.05.123. Online ahead of print.

Platelet-rich plasma promotes skeletal muscle regeneration and neuromuscular functional reconstitution in a concentration-dependent manner in a rat laceration model​

Huayi Gao 1, Zhidong Zhao 2, Ji Li 3, Zheng Guo 4, Fei Zhang 5, Ketao Wang 6, Xiaowei Bai 7, Qi Wang 8, Yu Guan 9, Yaoting Wang 10, Pengli Zhang 11, Ningyu Lv 12, Heng Zhu 13, Zhongli Li 14
Affiliations expand

• PMID: 37354612
• DOI: 10.1016/j.bbrc.2023.05.123

Abstract​

Abnormal function of injured muscle with innervation loss is a challenge in sports medicine. The difficulty of rehabilitation is regenerating and reconstructing the skeletal muscle tissue and the neuromuscular junction (NMJ). Platelet-rich plasma (PRP) releases various growth factors that may provide an appropriate niche for tissue regeneration. However, the specific mechanism of the PRP's efficacy on muscle healing remains unknown. In this study, we injected PRP with different concentration gradients (800, 1200, 1600 × 109 pl/L) or saline into a rat gastrocnemius laceration model. The results of histopathology and neuromyography show that PRP improved myofibers regeneration, facilitated electrophysiological recovery, and reduced fibrosis in a concentration-dependent manner. Furthermore, we found that PRP promotes the activity of satellite cells by upregulating the expression of the myogenic regulatory factor (MyoD, myogenin). Meanwhile, PRP promotes the regeneration and maturation of acetylcholine receptor (AChR) clusters of the Neuromuscular junction (NMJ) on the regenerative myofibers. Finally, we found that the expression of the Agrin, LRP4, and MuSK was upregulated in the PRP-treated groups, which may contribute to AChR cluster regeneration and functional recovery. The conclusions proposed a hypothesis for PRP treatment's efficacy and mechanism in muscle injuries, indicating promising application prospects.

Keywords: Biomaterial; Platelet-rich plasma; Skeletal muscle injury; Sports medicine.

PRP causes cancer.
Heliyon. 2020 Mar; 6(3): e03660.
Published online 2020 Mar 28. doi: 10.1016/j.heliyon.2020.e03660

Thus, preliminary data deriving from clinical settings have shown that fat grafting-PRP combination in breast reconstruction after tumor removal has led to ambiguous results [19]. PRP has been reported to induce angiogenesis and stem cell differentiation. In fact, endothelial cells close to the application site are stimulated by PRP and favor the formation of new blood vessels [21]. Thus, PRP may induce tumor growth. the main growth factors released by PRP are represented in Figure 3. If one takes into consideration that PRP has different growth factors, its administration in sites previously affected by malignant tumors may trigger the neoplastic proliferation from residual cells [19] - the platelet-derived growth factor signaling pathway increases luminal breast cancer cell proliferation [19].

 

[Ducttape]

Rats don't lie...

Biochem Biophys Res Commun.
2023 Jun 10;672:185-192.
doi: 10.1016/j.bbrc.2023.05.123. Online ahead of print.

​

rats =/= humans.

now mice are also not humans, but here is an article about how studies in one animal model does not correlate to human clinical trials:

Why Drugs Tested in Mice Fail in Human Clinical Trials - Science in the News

Mice are considered a standard method for drug development in humans, but are these species an ideal model of the human brain?

sitn.hms.harvard.edu

 

[Doctodd]

PRP causes cancer.
Heliyon. 2020 Mar; 6(3): e03660.
Published online 2020 Mar 28. doi: 10.1016/j.heliyon.2020.e03660

Thus, preliminary data deriving from clinical settings have shown that fat grafting-PRP combination in breast reconstruction after tumor removal has led to ambiguous results [19]. PRP has been reported to induce angiogenesis and stem cell differentiation. In fact, endothelial cells close to the application site are stimulated by PRP and favor the formation of new blood vessels [21]. Thus, PRP may induce tumor growth. the main growth factors released by PRP are represented in Figure 3. If one takes into consideration that PRP has different growth factors, its administration in sites previously affected by malignant tumors may trigger the neoplastic proliferation from residual cells [19] - the platelet-derived growth factor signaling pathway increases luminal breast cancer cell proliferation [19].

I probably wouldn’t advise injecting prp near any tumors such as in a breast.

 

[drusso]

PRP causes cancer.
Heliyon. 2020 Mar; 6(3): e03660.
Published online 2020 Mar 28. doi: 10.1016/j.heliyon.2020.e03660

Thus, preliminary data deriving from clinical settings have shown that fat grafting-PRP combination in breast reconstruction after tumor removal has led to ambiguous results [19]. PRP has been reported to induce angiogenesis and stem cell differentiation. In fact, endothelial cells close to the application site are stimulated by PRP and favor the formation of new blood vessels [21]. Thus, PRP may induce tumor growth. the main growth factors released by PRP are represented in Figure 3. If one takes into consideration that PRP has different growth factors, its administration in sites previously affected by malignant tumors may trigger the neoplastic proliferation from residual cells [19] - the platelet-derived growth factor signaling pathway increases luminal breast cancer cell proliferation [19].

Thus, it can be concluded that MOA of PRP doesn't work by psychokinesis nor the healing intentions of the practitioner...unless you think that your doctor WANTS you have cancer...

 

[lobelsteve]

Thus, it can be concluded that MOA of PRP doesn't work by psychokinesis nor the healing intentions of the practitioner...unless you think that your doctor WANTS you have cancer...

Why do you want people to have cancer? You are selling PRP for everything and spreading cancer.

 

[Doctodd]

Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up.​

Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up. | Read by QxMD

read.qxmd.com

 

[drusso]

Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up.​

Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up. | Read by QxMD

read.qxmd.com

If I got randomized to the CS arm, I'd be pissed. At this point, it's a Declaration of Helsinki violation and Nuremberg crime not to stop this cruel human experiment and inject all elbows with PRP.

 

[lobelsteve]

If I got randomized to the CS arm, I'd be pissed. At this point, it's a Declaration of Helsinki violation and Nuremberg crime not to stop this cruel human experiment and inject all elbows with PRP.

Surprised any patients were left after 6 mo in either group. Never saw tennis elbow beyond 3 mo not be completely gone or go to surgery.

 

[Ducttape]

If I got randomized to the CS arm, I'd be pissed. At this point, it's a Declaration of Helsinki violation and Nuremberg crime not to stop this cruel human experiment and inject all elbows with PRP.

terrific advice.

can you post your petition to CMS to authorize PRP for Medicare and Medicaid patients so i can send the same one in too?

 

[drusso]

terrific advice.

can you post your petition to CMS to authorize PRP for Medicare and Medicaid patients so i can send the same one in too?

That's making a political statement.

 

[Doctodd]

terrific advice.

can you post your petition to CMS to authorize PRP for Medicare and Medicaid patients so i can send the same one in too?

waiting for you to dispute/dissect the study

 

[Ducttape]

again, terrific advice to recommend PRP for lateral epicondylitis, but if you want to get PRP for everyone, then you need to make a statement to CMS - as part of your stance

At this point, it's a Declaration of Helsinki violation and Nuremberg crime not to stop this cruel human experiment and inject all elbows with PRP.

in other words, based on this, it appears you would be obligated by your Hippocratic Oath to tell CMS to deny steroid injections and cover PRP...

waiting for you to dispute/dissect the study

and why would i dispute that?

clearly you have not read any of my posts regarding use of PRP for conditions such as lateral epicondylitis or tendonitis or rotator cuff.

ill say it again. i do believe PRP is the treatment modality of choice, with the caveat that most cannot afford it.

as far as the study:
1. study protocol seems okay.

2. relatively small sample size.

3. there was more short term benefit from steroid injection at 3 months than PRP. which would make sense because we all believe that CS only last 3 months. what would be the comparison if CS and PRP injections were done over the long haul? this is the same argument that we have made regarding supporting epidural steroid injections - no long term benefit because the steroids only last 3 months.... we should not be hypocritical...

4. they say difference in DASH was statistically significant and same with PRTEE.

but when you look at the graph that they provided.... compare the differences with baseline.

there is a significant difference between the starting point of of DASH score of 43-45 to the end DASH scores of 4 and 7, yet the researchers chose to focus only on the difference between 4 and 7 at the 2 year mark....

same graph with the PRTEE scores.

clearly both groups got significant benefit from 1 injection, 2 years previously. both groups had DASH and PRTEE scores in the mid 40s go to <10. at the endpoint, on the whole scale of things, the PRP was better than the CS, but....

 

[Doctodd]

agree with most except the comparison to ESI. Treating a tendon vs a radic is very different.

 

[drusso]

More bad news for the steroid KOL's. If my RVU's depended upon steroid injections, I'd be pissed.

Cureus. 2023 May 30;15(5):e39728.

doi: 10.7759/cureus.39728. eCollection 2023 May.

Comparing the Efficacy of Intra-articular Platelet-Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial​

Tarun Kumar Somisetty 1, Hariprasad Seenappa 1, Subhashish Das 2, Arun H Shanthappa 1
Affiliations expand

• PMID: 37398735
• PMCID: PMC10310540
• DOI: 10.7759/cureus.39728

Abstract​

Introduction: Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary. Platelet-rich plasma (PRP) has emerged as an alternative therapy for adhesive capsulitis, but the literature on its effectiveness is limited. This study aimed to compare the efficacy of IA PRP and CS injections in managing FS.

Methods: In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP, and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder. Outcome measures included pain; shoulder range of motion (ROM); the condensed version of the disabling conditions of the arm, shoulder, and hand (QuickDASH) score; and the shoulder pain and disability index (SPADI) score. Participants were monitored via follow-up for 24 weeks, with pain and function assessed at each evaluation using the visual analog scale (VAS) score, the SPADI score, and the QuickDASH score.

Results: The IA PRP injections demonstrated better long-term outcomes than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance. After 24 weeks, the mean VAS score in the PRP and methylprednisolone acetate groups was 1.00 (1.0 to 1.0) and 2.00 (2.0 to 2.0), respectively (P≤0.001). The mean QuickDASH score was 41.83 ± 6.33 in the PRP group and 48.76 ± 5.08 in the methylprednisolone acetate group (P≤0.001). The mean SPADI score was 53.32 ± 7.49 in the PRP group and 59.24 ± 5.80 in the methylprednisolone acetate group (P≤0.001), indicating a significant improvement in the PRP group's pain and disability scores after 24 weeks. The rate of complications was similar between the two groups.

Conclusions: Our findings suggest that IA PRP injections provide better long-term results than IA CS injections for managing FS. Platelet-rich plasma can be used as a treatment modality for better outcomes, particularly when the patient is contraindicated or refuses CS treatment. Further research is needed to evaluate the efficacy of these treatment modalities at different stages of FS and explore the potential benefits of ultrasound-guided injections.

Keywords: frozen shoulder; intraarticular corticosteroid injection; intraarticular platelet-rich plasma injection; periarthritis shoulder; quickdash; spadi.

Copyright © 2023, Somisetty et al.

 

[lobelsteve]

More bad news for the steroid KOL's. If my RVU's depended upon steroid injections, I'd be pissed.

Cureus. 2023 May 30;15(5):e39728.

doi: 10.7759/cureus.39728. eCollection 2023 May.

Comparing the Efficacy of Intra-articular Platelet-Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial​

Tarun Kumar Somisetty 1, Hariprasad Seenappa 1, Subhashish Das 2, Arun H Shanthappa 1
Affiliations expand

• PMID: 37398735
• PMCID: PMC10310540
• DOI: 10.7759/cureus.39728

Abstract​

Introduction: Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary. Platelet-rich plasma (PRP) has emerged as an alternative therapy for adhesive capsulitis, but the literature on its effectiveness is limited. This study aimed to compare the efficacy of IA PRP and CS injections in managing FS.

Methods: In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP, and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder. Outcome measures included pain; shoulder range of motion (ROM); the condensed version of the disabling conditions of the arm, shoulder, and hand (QuickDASH) score; and the shoulder pain and disability index (SPADI) score. Participants were monitored via follow-up for 24 weeks, with pain and function assessed at each evaluation using the visual analog scale (VAS) score, the SPADI score, and the QuickDASH score.

Results: The IA PRP injections demonstrated better long-term outcomes than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance. After 24 weeks, the mean VAS score in the PRP and methylprednisolone acetate groups was 1.00 (1.0 to 1.0) and 2.00 (2.0 to 2.0), respectively (P≤0.001). The mean QuickDASH score was 41.83 ± 6.33 in the PRP group and 48.76 ± 5.08 in the methylprednisolone acetate group (P≤0.001). The mean SPADI score was 53.32 ± 7.49 in the PRP group and 59.24 ± 5.80 in the methylprednisolone acetate group (P≤0.001), indicating a significant improvement in the PRP group's pain and disability scores after 24 weeks. The rate of complications was similar between the two groups.

Conclusions: Our findings suggest that IA PRP injections provide better long-term results than IA CS injections for managing FS. Platelet-rich plasma can be used as a treatment modality for better outcomes, particularly when the patient is contraindicated or refuses CS treatment. Further research is needed to evaluate the efficacy of these treatment modalities at different stages of FS and explore the potential benefits of ultrasound-guided injections.

Keywords: frozen shoulder; intraarticular corticosteroid injection; intraarticular platelet-rich plasma injection; periarthritis shoulder; quickdash; spadi.

Copyright © 2023, Somisetty et al.

View attachment 373842

View attachment 373843

Looks pretty similar for 3 months. Weird to do a 2 year follow up for a condition that is not followed for 2 years.
Love the description in methods for how they did the IA steroid injection.

 

[MitchLevi]

"Intra-articular area" is a nice term. TBF, I have read studies that describe adhesive capsulitis as a 24 month Dx.

 

[SSdoc33]

"Intra-articular area" is a nice term. TBF, I have read studies that describe adhesive capsulitis as a 24 month Dx.

Ive also read ones that say saline works just as well.


Is it me or is drusso getting stranger as time goes on?

 

[MitchLevi]

Capsular distension I can understand that as potentially being helpful, but how exactly does PRP help?

On one hand I'm told PRP tightens "ligaments and tendons and stuff." It "tightens stuff up and stabilizes the SIJ."

In cases of listhesis with or without spondylolysis, and especially in cases of multifidus atrophy the PRP "tightens that stuff up." I was even told it stabilizes that slip...I was told it stabilizes the slip!

Now, I'm told it helps the ol adhesive cap...Does it loosen it up or something?

It's like one of those stem cells that automatically knows where to go and what to do.

Edit - If I had frozen shoulder I'd personally try PRP bc why TH not. I've had it twice for different things bc why TH not.

 

[Ducttape]

um....

just looking at your pictures...

did both groups get better 2 years out?

is it my imagination but did the Quick/DASH score for CS group go from 67.91 to 48.76?

and is the difference between 67.91 and 48.76 greater than the difference between 48.76 and 41.83?


nah. cant be. steroid injections dont help at all.... right???

More bad news for the steroid KOL's. If my RVU's depended upon steroid injections, I'd be pissed.

id really like to see that letter you sent to CMS to get PRP for all. id sign and send it...

 

[drusso]

id really like to see that letter you sent to CMS to get PRP for all. id sign and send it...

That's a political statement. It's no mistake that CMS doesn't pay for regen.

 

[Ducttape]

That's a political statement. It's no mistake that CMS doesn't pay for regen.

Didn't you previously say "elections matter"?

And again, if you tout that CS is not standard of care from a medical standpoint, then should you not be petitioning CMS during biden s or trumps term of office?

Yes I'm being a pain in the arse, but pls put your money where your mouth leads you so I can do PRP for LET or rotator cuff injuries or knee pain........ 😊

 

[sloh]

Capsular distension I can understand that as potentially being helpful, but how exactly does PRP help?

On one hand I'm told PRP tightens "ligaments and tendons and stuff." It "tightens stuff up and stabilizes the SIJ."

In cases of listhesis with or without spondylolysis, and especially in cases of multifidus atrophy the PRP "tightens that stuff up." I was even told it stabilizes that slip...I was told it stabilizes the slip!

Now, I'm told it helps the ol adhesive cap...Does it loosen it up or something?

It's like one of those stem cells that automatically knows where to go and what to do.

Edit - If I had frozen shoulder I'd personally try PRP bc why TH not. I've had it twice for different things bc why TH not.

When the claim is it works for everything you can be pretty sure it works for nothing.

 

[drusso]

Because there is zero evidence platelet counts matter but it sounds good when up-selling a customer(patient) to supersize their McPRP order.

Dose doesn't matter...my ass.

Angiogenesis and Tissue Repair Depend on Platelet Dosing and Bioformulation Strategies Following Orthobiological Platelet-Rich Plasma Procedures: A Narrative Review

Angiogenesis is the formation of new blood vessel from existing vessels and is a critical first step in tissue repair following chronic disturbances in healing and degenerative tissues. Chronic pathoanatomic tissues are characterized by a high number of inflammatory cells; an overexpression of...

www.mdpi.com

 

[melancholy]

Capsular distension I can understand that as potentially being helpful, but how exactly does PRP help?

On one hand I'm told PRP tightens "ligaments and tendons and stuff." It "tightens stuff up and stabilizes the SIJ."

In cases of listhesis with or without spondylolysis, and especially in cases of multifidus atrophy the PRP "tightens that stuff up." I was even told it stabilizes that slip...I was told it stabilizes the slip!

Now, I'm told it helps the ol adhesive cap...Does it loosen it up or something?

It's like one of those stem cells that automatically knows where to go and what to do.

Edit - If I had frozen shoulder I'd personally try PRP bc why TH not. I've had it twice for different things bc why TH not.

Maybe PRP has some other mechanisms which are pain modulating rather than just trying to stimulate healing in regards to frozen shoulder?

I don't do PRP, only dextrose based prolotherapy and perineural injection therapies, but the concept of "tightening" things up is oversimplified. Sometimes the concept traditional prolotherapy is demonstrated w tensegrity models and the goal to improve integrity and function so that the whole system works better together. It can sound like a lot of hand waving, but some of it does make sense, esp when you think about some patients you see that probably had severe arthritis, but didn't start to actually complain of pain limiting function until they had some minor injury or tweak that impacts the whole system. Problem w dextrose prolotherapy is that you actually have to examine surrounding structures and strategize what to address. It doesn't always get best results if you spot treat. I have no idea if that becomes cost prohibitive to use PRP in that manner.

 

[Dr. Ice]

PRP has been found to ironically have a strong anti-inflammatory effect as well..umm yeah that’s why I said ironically

 

[drusso]

Is There Solid Research on Using PRP to Treat Spinal Pain? - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.

regenexx.com

"The upshot? It’s great to see the explosion of RCTs on PRP use in the spine these past few years. These results, in general, support what I have been observing since 2005. In other words, I have little doubt that PRP will eventually become a mainstay treatment for the spine."

 

[lobelsteve]

Is There Solid Research on Using PRP to Treat Spinal Pain? - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.

regenexx.com

View attachment 374475


"The upshot? It’s great to see the explosion of RCTs on PRP use in the spine these past few years. These results, in general, support what I have been observing since 2005. In other words, I have little doubt that PRP will eventually become a mainstay treatment for the spine."

Someone drank too much Kool-aid at ASPN.

 

[drusso]

Someone drank too much Kool-aid at ASPN.

 

[drusso]

Someone drank too much Kool-aid at ASPN.

I'll go to SIS in September and purge.

 

[melancholy]

Is There Solid Research on Using PRP to Treat Spinal Pain? - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.

regenexx.com

View attachment 374475


"The upshot? It’s great to see the explosion of RCTs on PRP use in the spine these past few years. These results, in general, support what I have been observing since 2005. In other words, I have little doubt that PRP will eventually become a mainstay treatment for the spine."

Hmm... coming to a Kaiser HMO near you... in the next 30 years?

 

[Ducttape]

so you are saying there are exactly 2 RCTs for lumbar discogenic pain regarding PRP in the last 10 years, and only 1 was beneficial?

fwiw,

Safety and Efficacy of Platelet Rich Plasma for Treatment of Lumbar Discogenic Pain: A Prospective, Multicenter, Randomized, Double-blind Study - PubMed

These findings are markedly different than the highly promising results of the 2016 PRP study. This study posits necessary caution for researchers who wish to administer PRP for therapeutic benefit and may ultimately point to necessary redirection of interventional research for discogenic pain...

pubmed.ncbi.nlm.nih.gov

why the initial 2016 study by Zielinski is in red.

Results: Within group assessment showed clinically significant improvement in 17% of PRP patients and clinically significant decline in 5% (1 patient) of the active group. Clinically significant improvement was seen in 13% of placebo group patients and no placebo patients had clinically significant decline secondary to the procedure.

Conclusions: These findings are markedly different than the highly promising results of the 2016 PRP study. This study posits necessary caution for researchers who wish to administer PRP for therapeutic benefit and may ultimately point to necessary redirection of interventional research for discogenic pain populations.

===

The role of intra-articular injection of autologous platelet-rich plasma versus corticosteroids in the treatment of synovitis in lumbar facet joint disease - PubMed

Both PRP and CS injections were effective in improving MRI-detected FJ synovitis while concurrently improving all examined parameters at follow-up after 3 months. However, PRP promoted better improvement in MRI-detected synovitis grade, suggesting that it may be a better treatment option for...

pubmed.ncbi.nlm.nih.gov

kotb study.

Conclusion: Both PRP and CS injections were effective in improving MRI-detected FJ synovitis while concurrently improving all examined parameters at follow-up after 3 months. However, PRP promoted better improvement in MRI-detected synovitis grade, suggesting that it may be a better treatment option for longer duration efficacy.

No significant difference (p>0.05) in FJs with synovitis was observed between both groups 3 months after the intervention. However, as mentioned before, joints injected with PRP showed a significantly greater decrease in synovitis grades on MRI at all lumbar FJ levels, suggesting improvement compared to those injected with CS, which showed a significant decrease in synovitis grade at only 2 levels.

in explanation - they thought the MRI findings for L12, L23, L34, L45 and L5S1 were all better on MRI scan with PRP, but with CS only L45 and L5S1 was better. that is their main basis for saying that PRP is better.
===

Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study - Indian Journal of Orthopaedics

Purpose To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. Methods 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid...

link.springer.com

Singh.

Conclusion​

Transforaminal injections of PRP and steroid improve short-term (up to 3 months) clinical outcome scores in discogenic lumbar radiculopathy, but clinically meaningful improvements sustaining for 6 months were provided by PRP only.

that conclusion sounds definitive yet...

On intergroup comparison, better results were seen in steroid group at 1 month (P < 0.001 for both VAS and MODI), and in PRP group at 6 months (P < 0.001 for both VAS and MODI) with non-significant difference at 3 months (P = 0.605 for MODI and P = 0.612 for VAS).

it is interesting the conclusion is worded in a way that is entirely favorable for PRP yet their own study suggests that CS injection provides clinically meaningful improvement at 1 and 3 months.

and what do we say about the length of benefit from CS transforaminals?




we need to do much better to be able to convince insurance companies to cover PRP.

 

[drusso]

so you are saying there are exactly 2 RCTs for lumbar discogenic pain regarding PRP in the last 10 years, and only 1 was beneficial?

fwiw,

Safety and Efficacy of Platelet Rich Plasma for Treatment of Lumbar Discogenic Pain: A Prospective, Multicenter, Randomized, Double-blind Study - PubMed

These findings are markedly different than the highly promising results of the 2016 PRP study. This study posits necessary caution for researchers who wish to administer PRP for therapeutic benefit and may ultimately point to necessary redirection of interventional research for discogenic pain...

pubmed.ncbi.nlm.nih.gov

why the initial 2016 study by Zielinski is in red.


===

The role of intra-articular injection of autologous platelet-rich plasma versus corticosteroids in the treatment of synovitis in lumbar facet joint disease - PubMed

Both PRP and CS injections were effective in improving MRI-detected FJ synovitis while concurrently improving all examined parameters at follow-up after 3 months. However, PRP promoted better improvement in MRI-detected synovitis grade, suggesting that it may be a better treatment option for...

pubmed.ncbi.nlm.nih.gov

kotb study.


in explanation - they thought the MRI findings for L12, L23, L34, L45 and L5S1 were all better on MRI scan with PRP, but with CS only L45 and L5S1 was better. that is their main basis for saying that PRP is better.
===

Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study - Indian Journal of Orthopaedics

Purpose To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. Methods 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid...

link.springer.com

Singh.

that conclusion sounds definitive yet...


it is interesting the conclusion is worded in a way that is entirely favorable for PRP yet their own study suggests that CS injection provides clinically meaningful improvement at 1 and 3 months.

and what do we say about the length of benefit from CS transforaminals?




we need to do much better to be able to convince insurance companies to cover PRP.

No one wants insurance companies to cover it. Just like no insurance companies cover aesthetics.

 

[Ducttape]

why not? unlike aesthetics, doesnt PRP improve pain and functioning (in certain conditions)?



oh...

its all about the $$$.

which is why I remain skeptical about whether this is the best care to offer people.

 

[MitchLevi]

why not? unlike aesthetics, doesnt PRP improve pain and functioning (in certain conditions)?



oh...

its all about the $$$.

which is why I remain skeptical about whether this is the best care to offer people.

...about the money?

Why boil it all the way down to such a simple explanation?

How much money do you think the avg guy/gal offering PRP is making off it?

I don't make a killing on PRP. In fact, it doesn't pay that great considering the use of resources involved in the process. Drawing the blood, spinning it, processing it...You have to plan on PRP with the patient, which involves holding certain meds, discussing post injection protocols...

It's much faster to set up the patient for recurring steroid injections Q3-4M.

Most of us offering PRP do it because we believe it not only works, it's also safer than steroids.

I've made a difference in a lot of lives with PRP dude.

 

[Ducttape]

if you are making so much difference in a lot of lives, shouldnt we be advocating for CMS to allow PRP for all patients with Medicare, and encourage insurances to pay for PRP?

you may be able to offer services to more people and help more people that way.


otherwise, if those who are advocating for PRP only to be self pay are only interested in the money, right?