Someone in town doing PRP for SIJ. What's your opinion about it?

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wscott

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Hi,

There is a guy in town doing PRP for the SIJ. Anyone else doing this? Are you aware of any position papers about this procedure delineating protocols and outcomes?

Thanks
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I do it. I like it.

Go to the PRP thread in this forum.
 
wscott said:
Hi,

There is a guy in town doing PRP for the SIJ. Anyone else doing this? Are you aware of any position papers about this procedure delineating protocols and outcomes?

Thanks
Click to expand...
Been doing it for a while now. 60 cc LP PRP, 3 cc into the joint and 1-2 around ligaments. Works well. In people who have gotten great but short term relief from cs into joint.

Btw, has anyone heard of private insurances covering PRP for knee OA and not lubricants? I have a friend of a friend who told me their ortho wants to do PRP because it’s covered but lubs aren’t.
 
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Dr. Ice said:
Been doing it for a while now. 60 cc LP PRP, 3 cc into the joint and 1-2 around ligaments. Works well. In people who have gotten great but short term relief from cs into joint.

Btw, has anyone heard of private insurances covering PRP for knee OA and not lubricants? I have a friend of a friend who told me their ortho wants to do PRP because it’s covered but lubs aren’t.
Click to expand...
Are you aware of any position papers about this procedure delineating protocols and outcomes?

Which randomized and placebo controlled studies can you recommend to support PRP in SIJ?
 
wscott said:
Are you aware of any position papers about this procedure delineating protocols and outcomes?

Which randomized and placebo controlled studies can you recommend to support PRP in SIJ?
Click to expand...
It works. I do it 5-6 times a year.

There isn’t level one evidence for PRP of the SIJ, but level one evidence only exists for spine RFA, (and for nothing else in pain medicine)

but what else are you going to offer these patients who had good but brief relief after steroid injections?
SIJ RFA isn’t covered and SIJ fusions cause more pain and dysfunction in the majority of patients.

PRP is the clear choice.
 
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academic.oup.com

The Effectiveness of Platelet-Rich Plasma Injection for the Treatment of Suspected Sacroiliac Joint Complex Pain; a Systematic Review

AbstractObjective. To determine the effectiveness of platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) for the treatment of suspected
academic.oup.com academic.oup.com

"The literature supporting the effectiveness of PRP for SIJC pain is very low-quality according to the GRADE system. Well-designed RCTs and large cohort studies with consistent selection protocols and reporting characteristics are needed to determine the effectiveness of PRP and BMAC for the treatment of SIJC pain."
 
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It’s up to you. If you limit your treatments to level one evidence only, you’ll doom many your patients to a lifetime of unnecessary pain.

I see a number of second opinions with various pain issues who were treated at our local medical school.
The academic physicians are so uptight about only doing procedures with perfect evidence that they abandon many patients to chronic pain that I later successfully treat when I see these same patients as a second opinion.
 
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bedrock said:
It’s up to you. If you limit your treatments to level one evidence only, you’ll doom many your patients to a lifetime of unnecessary pain.

I see a number of second opinions with various pain issues who were treated at our local medical school.
The academic physicians are so uptight about only doing procedures with perfect evidence that they abandon many patients to chronic pain that I later successfully treat when I see these same patients as a second opinion.
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I understand and appreciate your point. It woud be nice to have level one evidence, but it's not there - at all.

Even if it is not "perfect evidence", what evidence do you hang your hat on and relay to the patients in your education and consent to perform the procedure?
 
I offer it. Response rate 50/50. Better than a fusion. SIJ RFA is my least favorite procedure I routinely perform by a longshot.

In terms of educating the patient I usually shrug my shoulders and say, "Sometimes it works and sometimes it doesn't. What do you want to do?"
 
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informed con$ent while di$cu$$ing the benefit$ of procedure.

dru$$o has po$ted $ome $tudie$ on $I PRP.


honestly, id look in the Regenerative Medicine thread.

as far as what else to do, like every injection we do, none of thse injections are rarely curative. teaching people how to manage pain, and how to remain fully functional with minimal disability from the pain are important goals.


i believe i also heard that some private insurances are covering PRP. in a very quick search, i only find Tricare which will cover for knee and lateral epicondylitis.

Provisional Coverage Program | TRICARE

The Provisional Coverage Program covers some emerging services and supplies.
www.tricare.mil www.tricare.mil
 
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wscott said:
I understand and appreciate your point. It woud be nice to have level one evidence, but it's not there - at all.

Even if it is not "perfect evidence", what evidence do you hang your hat on and relay to the patients in your education and consent to perform the procedure?
Click to expand...
pubmed.ncbi.nlm.nih.gov

Responsible, Safe, and Effective Use of Biologics in the Management of Low Back Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines - PubMed

Regenerative medicine, platelet-rich plasma, medicinal signaling cells, mesenchymal stem cells, stromal vascular fraction, bone marrow concentrate, chronic low back pain, discogenic pain, facet joint pain, Food and Drug Administration, minimal manipulation, evidence synthesis.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
The only harm that could occur from the procedure is financial. I could also delay potentially other treatments that may be more effective.
 
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lobelsteve said:
The only harm that could occur from the procedure is financial. I could also delay potentially other treatments that may be more effective.
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I am interested in what other treatments (after good PT for SI joint, belt, and steroid injection) would be more effective, and that would be delayed by PRP for the SI joint?
 
kstarm said:
I am interested in what other treatments (after good PT for SI joint, belt, and steroid injection) would be more effective, and that would be delayed by PRP for the SI joint?
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Lateral branch block and SIJ RF.

pubmed.ncbi.nlm.nih.gov

A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain - PubMed

SIJ pain is felt to be an underdiagnosed and undertreated element of LBP. There is an emerging disconnect between the growing incidence of diagnosed SI pathology and underwhelming treatment efficacy of medical treatment. This has led to an increase in SI joint fixation. We have created a clearer...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

From your KOL's at ASPN. If you cannot fuse them, burn them.
 
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SIJ ablations are a beloved procedure to most payers.
 
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lobelsteve said:
So is prp
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We all know PRP is cash only, but you're implying SIJ ablation is a great option for pts when we all know it isn't...

You're paying cash for both.
 
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MitchLevi said:
Both. I've had successes and failures with both.
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Which of the following do you see more:

Success with PRP after SIJ RF failure?
Or
Success with SIF RF after PRP failure?

Have you studied it in your own practice?
 
Baron Samedi said:
I offer it. Response rate 50/50. Better than a fusion. SIJ RFA is my least favorite procedure I routinely perform by a longshot.

In terms of educating the patient I usually shrug my shoulders and say, "Sometimes it works and sometimes it doesn't. What do you want to do?"
Click to expand...
It’s not a favorite of mine either. Why don’t you like it?
 
wscott said:
Which of the following do you see more:

Success with PRP after SIJ RF failure?
Or
Success with SIF RF after PRP failure?

Have you studied it in your own practice?
Click to expand...
I do at most 5 SIJ RFA per yr. Insurance regularly denies these.

I have not kept data on this bc I surely do not have the time or energy to do it.
 
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Painologist said:
What do you guys charge patients for SIJ-PRP?
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Depends.

We're anything from $400 to $1000 depending on any number of things. An SIJ PRP injxn is $800.

The cheapest I've done it is like $200.

Anyone who received a 2nd injxn gets $200 off the price.

Seems most ppl in the region charge $1500-$2000, and I've seen work comp pay $5k to another pain group.

We use Accellerated Biologics Pure PRP.

Processing PRP and drawing blood takes time. One of my MAs does that.

PRP works much better in other places than it does in the SIJ in my hands. The shoulder is my most common body part. Lots of rotator cuff tears.
 
MitchLevi said:
Depends.

We're anything from $400 to $1000 depending on any number of things. An SIJ PRP injxn is $800.

The cheapest I've done it is like $200.

Anyone who received a 2nd injxn gets $200 off the price.

Seems most ppl in the region charge $1500-$2000, and I've seen work comp pay $5k to another pain group.

We use Accellerated Biologics Pure PRP.

Processing PRP and drawing blood takes time. One of my MAs does that.

PRP works much better in other places than it does in the SIJ in my hands. The shoulder is my most common body part. Lots of rotator cuff tears.
Click to expand...
Agree partial tears do reasonably well. Glut med/min works well from my experience. Tennis elbow works really well, haven’t had the same success with golfers. Also use accelerated. My MA does blood draw and processing as well
 
Dr. Ice said:
Agree partial tears do reasonably well. Glut med/min works well from my experience. Tennis elbow works really well, haven’t had the same success with golfers. Also use accelerated. My MA does blood draw and processing as well
Click to expand...

Agree on tennis elbow and glutes. PRP seems to perform poorly in the hip joint in my experience. Hit or miss in the knee. Quad tendon works well.

I see a lot of supra and infraspinatus tendinopathy with impingement, bursitis, AC arthropathy.

Accellerated Biologics 7cc of LP-PRP split between the supra and infraspinatus, AC joint and the subacromial bursa. That's a common PRP injxn I do and it is reliably effective.
 
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Have had really good success with hip labral tears as welll
 
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Emcyte is manufacturer of Accellerated's centrifuge. I use the same.
 
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Are any of you guys using Apex biologics setup? I'm currently using the Regenlab setup, but I'm not crazy about it and thinking of upgrading. Max you can do with one kit is 30 mL blood, and it can be awkward to use. I want a 60 mL in one go setup.
 
Need a head to head comparison of the top 5 kits.
Make PRP with all of them and then check for "drussokines"- or whatever markers the regen folks are most important.
 
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