Adding Regenerative medicine to your practice.

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drusso said:
PRP is injected INTO tendons. If you said steroid is just as good and tried to do that to me I'd smack you in your face.
Click to expand...
are purposely trying to be this obtuse?

re-read what i wrote
 
Randomized Controlled Trial

Int Orthop

. 2021 Feb;45(2):391-399.
doi: 10.1007/s00264-020-04687-7. Epub 2020 Jul 2.

Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study​

Philippe Hernigou 1, Charlie Bouthors 2, Claire Bastard 3, Charles Henri Flouzat Lachaniette 3, Helene Rouard 4, Arnaud Dubory 3
Affiliations expand

Abstract​

Purpose: There is an increasing number of reports on the treatment of knee osteoarthritis (OA) using mesenchymal stem cells (MSCs). However, it is not known what would better drive osteoarthritis stabilization to postpone total knee arthroplasty (TKA): targeting the synovial fluid by injection or targeting on the subchondral bone with MSCs implantation.
Methods: A prospective randomized controlled clinical trial was carried out between 2000 and 2005 in 120 knees of 60 patients with painful bilateral knee osteoarthritis with a similar osteoarthritis grade. During the same anaesthesia, a bone marrow concentrate of 40 mL containing an average 5727 MSCs/mL (range 2740 to 7540) was divided in two equal parts: after randomization, one part (20 mL) was delivered to the subchondral bone of femur and tibia of one knee (subchondral group) and the other part was injected in the joint for the contralateral knee (intra-articular group). MSCs were counted as CFU-F (colony fibroblastic unit forming). Clinical outcomes of the patient (Knee Society score) were obtained along with radiological imaging outcomes (including MRIs) at two year follow-up. Subsequent revision surgeries were identified until the most recent follow-up (average of 15 years, range 13 to 18 years).
Results: At two year follow-up, clinical and imaging (MRI) improvement was higher on the side that received cells in the subchondral bone. At the most recent follow-up (15 years), among the 60 knees treated with subchondral cell therapy, the yearly arthroplasty incidence was 1.3% per knee-year; for the 60 knees with intra-articular cell therapy, the yearly arthroplasty incidence was higher (p = 0.01) with an incidence of 4.6% per knee-year. For the side with subchondral cell therapy, 12 (20%) of 60 knees underwent TKA, while 42 (70%) of 60 knees underwent TKA on the side with intra-articular cell therapy. Among the 18 patients who had no subsequent surgery on both sides, all preferred the knee with subchondral cell therapy.
Conclusions: Implantation of MSCs in the subchondral bone of an osteoarthritic knee is more effective to postpone TKA than injection of the same intra-articular dose in the contralateral knee with the same grade of osteoarthritis.
Keywords: Bone marrow; Cartilage degeneration; Knee osteoarthritis; Mesenchymal stem cells; Subchondral bone; Synovial fluid; Synovium.
 
20 cc subchondral sounds like a lot of volume?

l have a lot of patients requesting regen Med injections prophylactically. I say no but this is an interesting study and def something patients have a lot of interest in. Curious as to others perspective.
 
Subchondral seems to be getting very popular. There was a case of intraosseous PRP in the spine that helped heal a painful Schmorl's node. I'd rather do Intracept but it is very interesting for joints.

To anyone doing it, what's the risk of vascular uptake? Seems very high given IO fluid resuscitation in femur, cement uptake in kypho. Does being more superficial in the subchondral bone mitigate the risk that much?

josr-online.biomedcentral.com

Vertebral intraosseous plasma rich in growth factor (PRGF-Endoret) infiltrations as a novel strategy for the treatment of degenerative lesions of endplate in lumbar pathology: description of technique and case presentation - Journal of Orthopaedic Su

Background Motivation and necessity to adopt minimally invasive therapies in the field of spinal regenerative medicine is increasing. Autologous platelet-rich plasma (PRP) therapy has recently been used as an effective technological and biological approach to tissue repair and has shown to...
josr-online.biomedcentral.com josr-online.biomedcentral.com
 
so...

subchondral injections are better than intraarticular.

doesnt give enough information as to whether PRP injections are better than conservative therapy.

also, i am unclear if the study was blinded, which might affect results.
 
Ducttape said:
so...

subchondral injections are better than intraarticular.

doesnt give enough information as to whether PRP injections are better than conservative therapy.

also, i am unclear if the study was blinded, which might affect results.
Click to expand...

Not all PRP is the same. #lookforthebuffycoat #amberPRP #Regen4Life #gamechanger #community

Orthop J Sports Med

2021 Jun 30;9(6):23259671211011948.
doi: 10.1177/23259671211011948. eCollection 2021 Jun.

Adverse Reactions and Clinical Outcomes for Leukocyte-Poor Versus Leukocyte-Rich Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review and Meta-analysis​

Jun-Ho Kim 1, Yong-Beom Park 2, Chul-Won Ha 3, Young Ju Roh 4, Jung-Gwan Park 5
Affiliations expand

Abstract​

Background: Platelet-rich plasma (PRP) has gained attention as a therapeutic option for knee osteoarthritis; however, its efficacy varies widely. Leukocytes in PRP raise the concern of aggravating proinflammatory activity. To date, PRP has rarely been investigated with regard to leukocyte concentration.
Purpose: To provide clinical evidence of the intra-articular injection of PRPs containing different leukocyte concentrations.
Study design: Systematic review; Level of evidence, 4.
Methods: We systematically searched the MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases. PRP was classified into leukocyte-poor (LP-PRP) and leukocyte-rich (LR-PRP). Clinical outcomes including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, and adverse reactions were evaluated. The Methodological Index for Non-Randomized Studies criteria were used for quality assessment.
Results: Included were 32 studies with an evidence level between 1 and 4. Both LP-PRP and LR-PRP showed improvements above the minimal clinically important difference (MCID) in VAS pain score. No significant intergroup difference was seen at 3, 6, or 12 months of follow-up. Regarding function, both LP-PRP and LR-PRP showed improvements above the MCID in the WOMAC and IKDC scores, with no significant difference between the groups. Adverse reactions for pain were significantly higher in LR-PRP than in LP-PRP (odds ratio, 1.64; 95% confidence interval, 1.29-2.10; P = .01). After intra-articular PRP injection, LR-PRP showed a significantly higher rate of swelling than LP-PRP (odds ratio, 1.56; 95% confidence interval, 1.22-1.99; P = .02). The mean Methodological Index for Non-Randomized Studies score of the included studies was 18.6 (range, 10-24).
Conclusion: Intra-articular PRP injection resulted in improvements above the MCID in terms of pain and function in patients with knee osteoarthritis up to 12 months. The risk of local adverse reactions appeared to be increased after LR-PRP compared with LP-PRP injection. The findings of this review can support the potential use of intra-articular PRP injection for the treatment of knee osteoarthritis. In clinical application, clinicians need to consider selecting a specific type of PRP for knee osteoarthritis.
Keywords: clinical outcome; knee; leukocyte; osteoarthritis; platelet-rich plasma.
 
drusso said:
Not all PRP is the same. #lookforthebuffycoat #amberPRP #Regen4Life #gamechanger #community

Orthop J Sports Med

2021 Jun 30;9(6):23259671211011948.
doi: 10.1177/23259671211011948. eCollection 2021 Jun.

Adverse Reactions and Clinical Outcomes for Leukocyte-Poor Versus Leukocyte-Rich Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review and Meta-analysis​

Jun-Ho Kim 1, Yong-Beom Park 2, Chul-Won Ha 3, Young Ju Roh 4, Jung-Gwan Park 5
Affiliations expand

Abstract​

Background: Platelet-rich plasma (PRP) has gained attention as a therapeutic option for knee osteoarthritis; however, its efficacy varies widely. Leukocytes in PRP raise the concern of aggravating proinflammatory activity. To date, PRP has rarely been investigated with regard to leukocyte concentration.
Purpose: To provide clinical evidence of the intra-articular injection of PRPs containing different leukocyte concentrations.
Study design: Systematic review; Level of evidence, 4.
Methods: We systematically searched the MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases. PRP was classified into leukocyte-poor (LP-PRP) and leukocyte-rich (LR-PRP). Clinical outcomes including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, and adverse reactions were evaluated. The Methodological Index for Non-Randomized Studies criteria were used for quality assessment.
Results: Included were 32 studies with an evidence level between 1 and 4. Both LP-PRP and LR-PRP showed improvements above the minimal clinically important difference (MCID) in VAS pain score. No significant intergroup difference was seen at 3, 6, or 12 months of follow-up. Regarding function, both LP-PRP and LR-PRP showed improvements above the MCID in the WOMAC and IKDC scores, with no significant difference between the groups. Adverse reactions for pain were significantly higher in LR-PRP than in LP-PRP (odds ratio, 1.64; 95% confidence interval, 1.29-2.10; P = .01). After intra-articular PRP injection, LR-PRP showed a significantly higher rate of swelling than LP-PRP (odds ratio, 1.56; 95% confidence interval, 1.22-1.99; P = .02). The mean Methodological Index for Non-Randomized Studies score of the included studies was 18.6 (range, 10-24).
Conclusion: Intra-articular PRP injection resulted in improvements above the MCID in terms of pain and function in patients with knee osteoarthritis up to 12 months. The risk of local adverse reactions appeared to be increased after LR-PRP compared with LP-PRP injection. The findings of this review can support the potential use of intra-articular PRP injection for the treatment of knee osteoarthritis. In clinical application, clinicians need to consider selecting a specific type of PRP for knee osteoarthritis.
Keywords: clinical outcome; knee; leukocyte; osteoarthritis; platelet-rich plasma.
Click to expand...

i got about 80% done with this exact SR about 3-4 years ago largely in part to poorly qualified helpers who got their pain fellowships and abandoned the work...
 
My local Medicare:


Proposed Local Coverage Determination for Platelet Rich Plasma (DL39068)
Analysis of Evidence
(Rationale for Determination)

The use of autologous biologics to replace or restore damaged tissue is a relatively new area of medicine that has yet to substantiate its oucomes.54 The American Academy of Orthopedic Surgeons (AAOS) announced at its November 2019 meeting that over the next 5 years, it would prioritize research and development for biologics to create evidence-based position statements. Their goals are to establish registries for postmarket monitoring, standardize reporting requirements and clarify by disease state a consensus approach for biological markers and clinical trial design.59

PRP is a general term describing a therapy with no gold standard of preparation or administration technique. This heterogeneity and the small number of controlled trials make it difficult to assess the efficacy of PRP for any disorder. There is a lack of standardization of the preparations of PRP amongst the trials, with varying concentration of platelet, frozen vs. fresh preparations, and the filtration of white cells. While the body of evidence of utility for PRP is large, the overall quality of evidence is low. The studies are relatively small, observational studies, often confounded by lack of treatment control, precluding cause-and-effect conclusions. RCTs that compare outcomes in patients whose treatment is standardized are needed to determine definitive patient selection criteria and clinical utility. The lack of level I evidence, no clinical practice guideline endorsement, as well as no commercial coverage, argue strongly against current PRP coverage as reasonable and necessary for treatment of Medicare patients.

While promising, we believe that there is insufficient high-quality evidence to justify the use of PRP for the treatment of any condition except for within the confines of a well-designed clinical trial. Thus, Novitas Solutions considers PRP injection and PRP combined with stem cells not medically reasonable and necessary because its effectiveness has not been established. PRP therapy is an evolving area of research. Once PRP preparations are standardized, trials can more precisely highlight which factors are associated with better outcomes, yielding more effective PRP preparations and patient selection criteria. Novitas Solutions will continue to monitor scientific developments and may adjust this coverage policy in accordance.
 
nvrsumr said:
My local Medicare:


Proposed Local Coverage Determination for Platelet Rich Plasma (DL39068)
Analysis of Evidence
(Rationale for Determination)

The use of autologous biologics to replace or restore damaged tissue is a relatively new area of medicine that has yet to substantiate its oucomes.54 The American Academy of Orthopedic Surgeons (AAOS) announced at its November 2019 meeting that over the next 5 years, it would prioritize research and development for biologics to create evidence-based position statements. Their goals are to establish registries for postmarket monitoring, standardize reporting requirements and clarify by disease state a consensus approach for biological markers and clinical trial design.59

PRP is a general term describing a therapy with no gold standard of preparation or administration technique. This heterogeneity and the small number of controlled trials make it difficult to assess the efficacy of PRP for any disorder. There is a lack of standardization of the preparations of PRP amongst the trials, with varying concentration of platelet, frozen vs. fresh preparations, and the filtration of white cells. While the body of evidence of utility for PRP is large, the overall quality of evidence is low. The studies are relatively small, observational studies, often confounded by lack of treatment control, precluding cause-and-effect conclusions. RCTs that compare outcomes in patients whose treatment is standardized are needed to determine definitive patient selection criteria and clinical utility. The lack of level I evidence, no clinical practice guideline endorsement, as well as no commercial coverage, argue strongly against current PRP coverage as reasonable and necessary for treatment of Medicare patients.

While promising, we believe that there is insufficient high-quality evidence to justify the use of PRP for the treatment of any condition except for within the confines of a well-designed clinical trial. Thus, Novitas Solutions considers PRP injection and PRP combined with stem cells not medically reasonable and necessary because its effectiveness has not been established. PRP therapy is an evolving area of research. Once PRP preparations are standardized, trials can more precisely highlight which factors are associated with better outcomes, yielding more effective PRP preparations and patient selection criteria. Novitas Solutions will continue to monitor scientific developments and may adjust this coverage policy in accordance.
Click to expand...

It must remain cash-pay therapy for now. But, I think things will be very different in 15 years.
 
I have had not only personal success after an MTB wipe-out but strong clinical success with this too.

#Gamechanger

Med Sci Sports Exerc

. 2021 Jul 23.
doi: 10.1249/MSS.0000000000002758. Online ahead of print.

Efficacy of Hematoma Aspiration and Platelet-rich Plasma Muscle Injections for the Treatment of Hamstring Strains in Athletes​

Lukas M Trunz 1, Jeffrey E Landy, Christopher C Dodson, Steven B Cohen, Adam C Zoga, Johannes B Roedl
Affiliations expand

Abstract​

Introduction: The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet.

Purpose: To assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes.

Methods: MRIs of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015 athletes were treated conservatively and from 2016 to 2018 with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs. aspiration/PRP) using ANOVA and Fisher's Exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain).

Results: Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 days in the conservative group and 23.5 days in the aspiration/PRP group (p < 0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (p = 0.025).

Conclusion: Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared to athletes receiving conservative treatment.

Copyright © 2021 American College of Sports Medicine.
 
drusso said:
I have had not only personal success after an MTB wipe-out but strong clinical success with this too.

#Gamechanger

Med Sci Sports Exerc

. 2021 Jul 23.
doi: 10.1249/MSS.0000000000002758. Online ahead of print.

Efficacy of Hematoma Aspiration and Platelet-rich Plasma Muscle Injections for the Treatment of Hamstring Strains in Athletes​

Lukas M Trunz 1, Jeffrey E Landy, Christopher C Dodson, Steven B Cohen, Adam C Zoga, Johannes B Roedl
Affiliations expand

Abstract​

Introduction: The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet.

Purpose: To assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes.

Methods: MRIs of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015 athletes were treated conservatively and from 2016 to 2018 with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs. aspiration/PRP) using ANOVA and Fisher's Exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain).

Results: Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 days in the conservative group and 23.5 days in the aspiration/PRP group (p < 0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (p = 0.025).

Conclusion: Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared to athletes receiving conservative treatment.

Copyright © 2021 American College of Sports Medicine.
Click to expand...
Will try this today.
 
so... what effect of benefit is from aspiration of the hematoma and what effect of benefit is from the PRP?

also a retrospective study that was not done concurrently - ie conservative treatment for 3 years, then aspiration/PRP for 3 years.

need an up to date blinded prospective study of aspiration vs aspiration/PRP with conservative control group. that will eliminate a lot of bias.
 
Ducttape said:
so... what effect of benefit is from aspiration of the hematoma and what effect of benefit is from the PRP?

also a retrospective study that was not done concurrently - ie conservative treatment for 3 years, then aspiration/PRP for 3 years.

need an up to date blinded prospective study of aspiration vs aspiration/PRP with conservative control group. that will eliminate a lot of bias.
Click to expand...
Why? Why do you need this? What’s the harm of just doing an aspiration and squirting in PRP?
 
For those doing regen, any opinion on the RMSK certification that so many seem to possess?
 
Im old school.

every procedure has risks and benefits.

do no harm. unless you can show that the benefits outweigh the risks.

you have not shown that the benefits of the aspiration and PRP is better than just hematoma aspiration.



I would like evidence showing that withdrawing a blood clot then inserting blood elements back in is better than just withdrawing the clot alone and shows no harm.
 
#Gamechanger.


Pain Physician

. 2021 Aug;24(5):E649-E660.

Plasma Rich in Growth Factors (PRGF) in the Treatment of Cervical and Lumbar Back Pain: A Retrospective Observational Clinical Study​

Fernando Kirchner 1, Isidro Milani 1, Alex Martinez 1, Nicolas Kirchner-Bossi 2, Roberto Prado 3, Sabino Padilla 4, Eduardo Anitua 4
Affiliations expand
  • PMID: 34323453

Abstract​

Background: Plasma rich in growth factors (PRGF) is a leukocyte-free platelet-rich plasma (PRP) that is an effective biological approach to tissue repair and has been demonstrated to significantly improve multiple conditions, including low back pain and degenerative disc pathology.

Objectives: The objective of this retrospective study was to analyze the effectiveness of treating both cervical and lumbar spine pain with minimally invasive infiltrations of PRGF-Endoret.

Study design: Retrospective study design.

Setting: Outpatient private practice facility.

Methods: The effectiveness of PRGF has been assessed by patient-reported outcomes (PRO) through validated questionnaires, namely Numeric Rating Scale (NRS) for back pain, Spine Tango Core Outcome Measure Index (COMI) Questionnaire for lumbar and cervical pain, and OSWESTRY Disability Index questionnaire for lumbar pain cases. Score differences between pre- and post-treatment have also been assessed stratified for multiple sub-groups of patients based on the sector of the column treated, gender, and age.

Results: This study includes 65 patients (18 with cervical pain and 47 with lumbar back pain). The average time of back pain evolution was 10 years. Patients received at least 2 PRGF infiltration series about one month apart. Each patient received intervertebral disc and epidural infiltrations, root infiltrations, in case of radicular injury, and intraarticular infiltrations, in case of osteoarthritis of the facet joints. Results show statistically significant (P < 0.05) improvements on all analyzed scores. Regarding the stratified analyses, 249 (99%) sub-groups showed an improvement in all tests (252 cases overall). From the 249 improving cases, 154 (62%) showed a statistically significant difference between the pre- and the post- treatment periods.

Limitations: This research is a retrospective study with a relatively small sample cohort. Only PRO have been assessed.

Conclusions: According to the results obtained in this study, and taking into account their limitations, PRGF infiltrations are an effective and minimally invasive biological strategy in the treatment of both cervical and lumbar pain, evaluated according to PRO.

Keywords: degenerative disc disease; growth factors; intervertebral disc degeneration; plasma rich in growth factors; platelet-rich plasma; regenerative medicine; tissue engineering; Back pain.
 
no, not a gamechanger as soon as you look at the title.

OBSERVATIONAL RETROSPECTIVE.

intradiscal PRP injection.

they lump data all in together into one. 18 cervical, of which only 7 males. 47 lumbar. a few got intraosseous injections (2 cervical 5 lumbar) ,others did not. all got 2, most got 3, some got 4, a few got 5 injections. 80% had nerve root injections, but not all. 44$ of cervical and 74% of lumbar got facet infiltration. 83% got epidural infiltration.

essentially, each patient got a disc injection with something different, dealers choice. get the disc and/or epidural and/or bone and/or facet and/or root....

follow up was from 1 month to 24 months. average was 5 whopping months. huge range in follow up.

importantly - all got sedation. all got 2.5 mg midaz and apparently 3.2 mg/kg (which seems excessively high!) fentanyl. unknown number got bolus dose or doses of propofol, "depending on the duration of the procedure".

obviously, no control group or comparison group. not blinded. people were directly asked after if it helped.


here are the indications:

The inclusion criteria are as follows: patients of both genders, aged between 18 and 76 years, with symptoms of low back pain or cervicalgia, of at least 3 months of evolution, that have not responded to drug treatment, diagnosed by Magnetic Resonance Imaging (RMI), with a minimum of one month of follow-up, and who have completed all baseline and follow-up questionnaires. Patients with the following scenarios are included: 1) degeneration of the lumbar IVD, classified in the Pfirrmann’s system between 3 and 4 (24); 2) degeneration of the cervical IVD according to the classification of Miyazaki (25) or Suzuki (26); 3) positive signs visible on MRI, including rupture of the annulus fibrosus, annular fissure, with or without a herniated disc; 4) presence of sciatica or brachialgia produced by radicular compression, due to the direct compressive effect of the herniated disc; 5) patients with indirect trauma with mechanical disc overload; 6) patients who have finally relapsed after previous treatments with analgesic medications, muscle relaxants, and anti-inflammatories; 7) lumbar fracture, extruded herniated discs, and hernias with signs of calcification; 8) endplate lesions as Modic changes (MC) type 1-3, or other subchondral lesions (hernias of Shmörl); and 9) patients who have undergone previous spinal surgery or rhizolysis.
Click to expand...


if you really are touting this study, then you are saying that one procedure fits all approach for any potential disc problem, be it traumatic, degenerative/arthritic, with or without disc herniation.....




as a side note, I would conservatively estimate that 90% of my patients would have clinically meaningful benefit from any procedure - say, for example, an intravascular injection of a thrombosed hemorrhoid - if I gave them 2.5 mg midaz with 250 mcg of fentanyl (again, pdf says 3.2 mg/kg, not mcg/kg) and multiple doses of propofol thereafter...
 
Ducttape said:
no, not a gamechanger as soon as you look at the title.

OBSERVATIONAL RETROSPECTIVE.

intradiscal PRP injection.

they lump data all in together into one. 18 cervical, of which only 7 males. 47 lumbar. a few got intraosseous injections (2 cervical 5 lumbar) ,others did not. all got 2, most got 3, some got 4, a few got 5 injections. 80% had nerve root injections, but not all. 44$ of cervical and 74% of lumbar got facet infiltration. 83% got epidural infiltration.

essentially, each patient got a disc injection with something different, dealers choice. get the disc and/or epidural and/or bone and/or facet and/or root....

follow up was from 1 month to 24 months. average was 5 whopping months. huge range in follow up.

importantly - all got sedation. all got 2.5 mg midaz and apparently 3.2 mg/kg (which seems excessively high!) fentanyl. unknown number got bolus dose or doses of propofol, "depending on the duration of the procedure".

obviously, no control group or comparison group. not blinded. people were directly asked after if it helped.


here are the indications:




if you really are touting this study, then you are saying that one procedure fits all approach for any potential disc problem, be it traumatic, degenerative/arthritic, with or without disc herniation.....




as a side note, I would conservatively estimate that 90% of my patients would have clinically meaningful benefit from any procedure - say, for example, an intravascular injection of a thrombosed hemorrhoid - if I gave them 2.5 mg midaz with 250 mcg of fentanyl (again, pdf says 3.2 mg/kg, not mcg/kg) and multiple doses of propofol thereafter...
Click to expand...

The study has strong ecological validity and reflects the treatment patients get "in the real world."
 
cowboydoc said:
#changegamer #gettinGIGOwithit

"Can you expand on how this study's design and results have changed your patients' outcomes for the better?"
Click to expand...

No. I mostly post it to annoy @Ducttape and @lobelsteve. But, I'm excited about non-steroid options for treating disc pathology...
 
drusso said:
No. I mostly post it to annoy @Ducttape and @lobelsteve. But, I'm excited about non-steroid options for treating disc pathology...
Click to expand...
50 years of research has me convinced that we do not have adequate treatment for disc pathology other than dynamic lumbar stabilization and CBT. Better research is needed on new methods of treating. And it starts with proof of concept then on to DBRCT. It does not start with experimenting on your patients for profit.
 
lobelsteve said:
50 years of research has me convinced that we do not have adequate treatment for disc pathology other than dynamic lumbar stabilization and CBT. Better research is needed on new methods of treating. And it starts with proof of concept then on to DBRCT. It does not start with experimenting on your patients for profit.
Click to expand...

Define the difference between experimenting and innovating. Regen technology is over 50 years old. Ever visit a burn unit or do a blood patch? There is nothing new under the sun. Just re-arranging cords on the sheet of music. Not everything covered by insurance works and not everything that works is covered by insurance.

A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification | Skin Appendage Disorders | Karger Publishers

Abstract. Platelet-rich plasma (PRP) is currently used in different medical fields. The interest in the application of PRP in dermatology has recently
www.karger.com www.karger.com

"Hematologists created the term PRP in the 1970s in order to describe the plasma with a platelet count above that of peripheral blood, which was initially used as a transfusion product to treat patients with thrombocytopenia [2]. Ten years later, PRP started to be used in maxillofacial surgery as PRF. Fibrin had the potential for adherence and homeostatic properties, and PRP with its anti-inflammatory characteristics stimulated cell proliferation."

Doctors should stop doing something only when there is convincing evidence to stop. Otherwise, carry the bias on helping patients not being nihilistic.

J Pain Res
. 2021 Feb 19;14:505-512. doi: 10.2147/JPR.S292335. eCollection 2021.
The Effect of Intradiscal Platelet-Rich Plasma Injection for Management of Discogenic Lower Back Pain: A Meta-Analysis
Min Cheol Chang 1, Donghwi Park 2
Affiliations expand
PMID: 33642874 PMCID: PMC7903948 DOI: 10.2147/JPR.S292335
Free PMC article

Abstract

Objective: Although several types of research of animal and human subjects have yielded promising results regarding intradiscal injection of platelet-rich plasma (PRP) for the management of intervertebral disc (IVD) pathologies, small sample sizes and unstandardized graft preparation procedures hampered these research efforts. Therefore, we conducted a meta-analysis to evaluate the effectiveness of intradiscal PRP injection for the treatment of discogenic lower back pain.

Methods: The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published from January 01, 1980 to December 14, 2020. The keywords used for the search were (platelet-rich plasma) AND (intradiscal OR back pain OR lumbar spine OR discogenic). Filters were used to select studies with human participants; all study designs were included.

Results: After the systematic review, three articles, including one randomized control trial and two prospective observational studies, were included in the final analysis. Analysis of changes in visual analogue scale (VAS) scores showed that VAS scores were significantly reduced two and six months after intradiscal PRP injection (two months: standardized mean difference [SMD] = -0.837, 95% CI = -1.158 to -0.516, P < 0.001; six months: SMD = -1.430, 95% CI = -2.209 to -0.652, P < 0.001), but not after one month (SMD = -0.661, 95% CI = -1.346 to 0.023, P = 0.058). Regarding changes in Owestry Disability Index (ODI), ODI scores were significantly reduced after six months (SMD = -0.964, 95% CI = -1.885 to -0.043, P = 0.040).

Conclusion: Intradiscal PRP injections are effective in relieving pain and improving disabilities caused by discogenic lower back pain. However, the pain-reducing effect significantly manifests two or six months after the injections, but not after one month.

Keywords: degenerative disc disease; discogenic lower back pain; intervertebral disc; platelet-rich plasma; review.
 
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drusso said:
Define the difference between experimenting and innovating. Regen technology is over 50 years old. Ever visit a burn unit or do a blood patch? There is nothing new under the sun. Just re-arranging cords on the sheet of music. Not everything covered by insurance works and not everything that works is covered by insurance.

A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification | Skin Appendage Disorders | Karger Publishers

Abstract. Platelet-rich plasma (PRP) is currently used in different medical fields. The interest in the application of PRP in dermatology has recently
www.karger.com www.karger.com

"Hematologists created the term PRP in the 1970s in order to describe the plasma with a platelet count above that of peripheral blood, which was initially used as a transfusion product to treat patients with thrombocytopenia [2]. Ten years later, PRP started to be used in maxillofacial surgery as PRF. Fibrin had the potential for adherence and homeostatic properties, and PRP with its anti-inflammatory characteristics stimulated cell proliferation."

Doctors should stop doing something only when there is convincing evidence to stop. Otherwise, carry the bias on helping patients not being nihilistic.

J Pain Res
. 2021 Feb 19;14:505-512. doi: 10.2147/JPR.S292335. eCollection 2021.
The Effect of Intradiscal Platelet-Rich Plasma Injection for Management of Discogenic Lower Back Pain: A Meta-Analysis
Min Cheol Chang 1, Donghwi Park 2
Affiliations expand
PMID: 33642874 PMCID: PMC7903948 DOI: 10.2147/JPR.S292335
Free PMC article

Abstract

Objective: Although several types of research of animal and human subjects have yielded promising results regarding intradiscal injection of platelet-rich plasma (PRP) for the management of intervertebral disc (IVD) pathologies, small sample sizes and unstandardized graft preparation procedures hampered these research efforts. Therefore, we conducted a meta-analysis to evaluate the effectiveness of intradiscal PRP injection for the treatment of discogenic lower back pain.

Methods: The PubMed, SCOPUS, Embase, and Cochrane Library databases were systematically searched for relevant studies published from January 01, 1980 to December 14, 2020. The keywords used for the search were (platelet-rich plasma) AND (intradiscal OR back pain OR lumbar spine OR discogenic). Filters were used to select studies with human participants; all study designs were included.

Results: After the systematic review, three articles, including one randomized control trial and two prospective observational studies, were included in the final analysis. Analysis of changes in visual analogue scale (VAS) scores showed that VAS scores were significantly reduced two and six months after intradiscal PRP injection (two months: standardized mean difference [SMD] = -0.837, 95% CI = -1.158 to -0.516, P < 0.001; six months: SMD = -1.430, 95% CI = -2.209 to -0.652, P < 0.001), but not after one month (SMD = -0.661, 95% CI = -1.346 to 0.023, P = 0.058). Regarding changes in Owestry Disability Index (ODI), ODI scores were significantly reduced after six months (SMD = -0.964, 95% CI = -1.885 to -0.043, P = 0.040).

Conclusion: Intradiscal PRP injections are effective in relieving pain and improving disabilities caused by discogenic lower back pain. However, the pain-reducing effect significantly manifests two or six months after the injections, but not after one month.

Keywords: degenerative disc disease; discogenic lower back pain; intervertebral disc; platelet-rich plasma; review.
Click to expand...

It takes 2 months for the check to clear!
Poorly done research cherry picked to attempt to show a difference is not fact nor clinically relevant.
Keep trying.
Innovation on patients for cash: Not the practice of medicine = false hope for profit.
Research: Write a hypothesis, write a protocol, stick to the protocol, have validated endpoints, timeframes 3/6/12/18 mo, have n of 100 in each arm of a DBRCT. Getting an IRB is easy, doing it right is easy, but costly.
 
lobelsteve said:
It takes 2 months for the check to clear!
Poorly done research cherry picked to attempt to show a difference is not fact nor clinically relevant.
Keep trying.
Innovation on patients for cash: Not the practice of medicine = false hope for profit.
Research: Write a hypothesis, write a protocol, stick to the protocol, have validated endpoints, timeframes 3/6/12/18 mo, have n of 100 in each arm of a DBRCT. Getting an IRB is easy, doing it right is easy, but costly.
Click to expand...

Regen is proven safe and effective. The fact that insurance doesn't broadly cover it is just a travesty. I can't change the rules of what gets paid for by whom. I can only offer patients the best options based upon my experience, interpretation of the evidence, and clinical experience.

That's what I get paid to do.
 
drusso said:
Regen is proven safe and effective. The fact that insurance doesn't broadly cover it is just a travesty. I can't change the rules of what gets paid for by whom. I can only offer patients the best options based upon my experience, interpretation of the evidence, and clinical experience.

That's what I get paid to do.
Click to expand...
proven safe, proven effective? Meh, not yet. Promising data for tennis elbow and OA knee. Unimpressive data for all other indications. But risk/benefits make it not unreasonable if you are not profiteering off your false hopes. Looks worse than the SOS.
 
lobelsteve said:
proven safe, proven effective? Meh, not yet. Promising data for tennis elbow and OA knee. Unimpressive data for all other indications. But risk/benefits make it not unreasonable if you are not profiteering off your false hopes. Looks worse than the SOS.
Click to expand...

Safety data is there--derm, plastics, urology, ortho, burn, urology, wound care, etc...

Efficacy data is there for tendinopathy, OA, ACL, meniscus/cartilage, skin, collagen, even myelin...

Innovation based upon overlapping tissue types above emerging before your very eyes...
 
lobelsteve said:
proven safe, proven effective? Meh, not yet. Promising data for tennis elbow and OA knee. Unimpressive data for all other indications. But risk/benefits make it not unreasonable if you are not profiteering off your false hopes. Looks worse than the SOS.
Click to expand...
how does the PRP know when it is in an elbow tendon or a knee or a horse or your jaw? Why would it work on some places and not others? Please show the "high quality research" from Pfizer and JnJ regarding PRP that you are used to seeing? Oh that's right.....Pfizer and JnJ cant make any money off your PRP. Wonder why that is?
 
Doctodd said:
how does the PRP know when it is in an elbow tendon or a knee or a horse or your jaw? Why would it work on some places and not others? Please show the "high quality research" from Pfizer and JnJ regarding PRP that you are used to seeing? Oh that's right.....Pfizer and JnJ cant make any money off your PRP. Wonder why that is?
Click to expand...

The molecules don't know what they're supposed to do. They just do it.
 
Here you go
 

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but... 2014.

and I published in my mind seminal work about how data does matter in 2015.

and long term follow up study in 2021.
 
US guided aspiration for hematoma works great. I can see the logic behind the use of PRP but I wouldn't think it was necessary unless for a high level athlete where the potential value in a few days earlier (maybe, who knows?) return would perhaps justify the cost/risk of the procedure. Haven't considered doing it personally. Usually the conversations is aspiration vs do nothing procedure wise and then breaking down the rehab piece.
 
Orthop J Sports Med.
2021 Sep 1;9(9):23259671211024937. doi: 10.1177/23259671211024937. eCollection 2021 Sep.

Comparison of a Platelet-Rich Plasma Injection and a Conventional Steroid Injection for Pain Relief and Functional Improvement of Partial Supraspinatus Tears

Marvin Thepsoparn 1, Phark Thanphraisan 1, Thanathep Tanpowpong 2, Thun Itthipanichpong 1

Affiliations expand
PMID: 34485587 PMCID: PMC8414632 DOI: 10.1177/23259671211024937
Free PMC article

Abstract
Background: Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy.

Purpose: To compare pain relief, functional improvement, and complications after an intratendinous PRP injection versus a subacromial corticosteroid injection for partial supraspinatus tears.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 32 patients with partial supraspinatus tears were randomly assigned to receive a leukocyte-poor PRP (LP-PRP) injection or a corticosteroid injection. One patient withdrew from the PRP group, leaving 15 patients in the PRP group and 16 patients in the corticosteroid group. The ultrasound-guided procedures were performed by a single experienced pain physician. Pain relief and functional improvement were evaluated using the visual analog scale (VAS) and the Oxford Shoulder Score (OSS), respectively. Treatment efficacy and complications were documented, and the 2 groups were compared at 1- and 6-month follow-up.

Results: There were no differences in VAS and OSS scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group had on both the VAS and OSS at 6-month follow-up (VAS: 14.5 ± 15.4 vs 37.5 ± 24.9, respectively; OSS: 16.2 ± 3.9 vs 25.0 ± 10.2, respectively; P < .01 for both). Both groups showed significant improvement in VAS and OSS scores from before treatment to 1-month follow-up (mean difference, 35.67 and 11.47 points, respectively, for the PRP group; mean difference, 29.69 and 11.13 points, respectively, for the corticosteroid group; P < .01 for all). The VAS and OSS scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and OSS scores between 1- and 6-month follow-up (mean difference, 15.87 and 7.40 points, respectively; P < .01 for both). There were no complications in either group.

Conclusion: An injection using either a corticosteroid or LP-PRP resulted in a similar reduction in pain and improvement in function at 1 month in patients with a partial supraspinatus tear. However, PRP showed superior benefits over the corticosteroid at 6-month follow-up.

Keywords: pain intervention; platelet-rich plasma; rotator cuff tear; supraspinatus tear.
 
drusso said:
Orthop J Sports Med.
2021 Sep 1;9(9):23259671211024937. doi: 10.1177/23259671211024937. eCollection 2021 Sep.

Comparison of a Platelet-Rich Plasma Injection and a Conventional Steroid Injection for Pain Relief and Functional Improvement of Partial Supraspinatus Tears

Marvin Thepsoparn 1, Phark Thanphraisan 1, Thanathep Tanpowpong 2, Thun Itthipanichpong 1

Affiliations expand
PMID: 34485587 PMCID: PMC8414632 DOI: 10.1177/23259671211024937
Free PMC article

Abstract
Background: Partial supraspinatus tendon tears have frequently been treated using a subacromial corticosteroid injection or surgery. The clinical use of a platelet-rich plasma (PRP) injection is an alternative treatment method for the condition, despite the paucity of evidence of its efficacy.

Purpose: To compare pain relief, functional improvement, and complications after an intratendinous PRP injection versus a subacromial corticosteroid injection for partial supraspinatus tears.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 32 patients with partial supraspinatus tears were randomly assigned to receive a leukocyte-poor PRP (LP-PRP) injection or a corticosteroid injection. One patient withdrew from the PRP group, leaving 15 patients in the PRP group and 16 patients in the corticosteroid group. The ultrasound-guided procedures were performed by a single experienced pain physician. Pain relief and functional improvement were evaluated using the visual analog scale (VAS) and the Oxford Shoulder Score (OSS), respectively. Treatment efficacy and complications were documented, and the 2 groups were compared at 1- and 6-month follow-up.

Results: There were no differences in VAS and OSS scores between the PRP and corticosteroid groups at 1-month follow-up. However, the PRP group had better scores than the corticosteroid group had on both the VAS and OSS at 6-month follow-up (VAS: 14.5 ± 15.4 vs 37.5 ± 24.9, respectively; OSS: 16.2 ± 3.9 vs 25.0 ± 10.2, respectively; P < .01 for both). Both groups showed significant improvement in VAS and OSS scores from before treatment to 1-month follow-up (mean difference, 35.67 and 11.47 points, respectively, for the PRP group; mean difference, 29.69 and 11.13 points, respectively, for the corticosteroid group; P < .01 for all). The VAS and OSS scores did not change significantly at 6-month follow-up in the corticosteroid group; however, the PRP group showed continued improvement in both VAS and OSS scores between 1- and 6-month follow-up (mean difference, 15.87 and 7.40 points, respectively; P < .01 for both). There were no complications in either group.

Conclusion: An injection using either a corticosteroid or LP-PRP resulted in a similar reduction in pain and improvement in function at 1 month in patients with a partial supraspinatus tear. However, PRP showed superior benefits over the corticosteroid at 6-month follow-up.

Keywords: pain intervention; platelet-rich plasma; rotator cuff tear; supraspinatus tear.
Click to expand...

Why do these guys keep doing crappy research.
n=15 in one group and 16 in the other.
No difference at a month.
PRP>CS at 6 mo.
How did they control for other treatments, exercises, aggravating factors from months 1-6?
 
1. how did they justify injecting 2 different structures and comparing the results? - this is not really a study of PRP vs steroids, this is specifically a study of PRP to tendon vs. steroid to bursa...
2. not blinded by the proceduralist.
3. "The PRP group was significantly younger than was the corticosteroid group (P = .006), but the other characteristics were similar between the groups." Average age of PRP group 51, of the Steroid group 62...
 
lobelsteve said:
Why do these guys keep doing crappy research.
n=15 in one group and 16 in the other.
No difference at a month.
PRP>CS at 6 mo.
How did they control for other treatments, exercises, aggravating factors from months 1-6?
Click to expand...

It always takes PRP longer to work. Tissue healing takes time. Studies consistently show non-inferior effects to CS at 1 month and superior effects at 6 months.

@Ducttape do you inject CS into tendons?
 
No.


steroids only for nerve blocks, epidurals. not a big joint injector either - will do genicular or suprascapular over intraarticular.
 
Braz J Anesthesiol

. 2021 Oct 5;S0104-0014(21)00359-6.
doi: 10.1016/j.bjane.2021.09.009. Online ahead of print.

Prophylactic use of platelet-rich plasma for post-spinal low back pain following gynecological surgery: a randomized clinical trial​

Ghada Mohammad Abo Elfadl 1, Abdelraheem Mahmoud Elawamy 2, Abualauon Mohamed Abedalmohsen 3, Azza Abo Elfadl El Sayed 4, Mustafa Bahloul Mohammed 5, Eman Ahmed Ismail 2
Affiliations expand
Free article

Abstract​

Background: Post-spinal back pain is suggested to occur as a result of a localized inflammatory response that is often associated with some degree of muscle spasm. We aimed to evaluate the effect of platelet-rich plasma (PRP) in reducing the incidence of post-spinal back pain.
Methods: One hundred patients were randomly enrolled and scheduled for elective gynecological surgery under spinal anesthesia. After the subarachnoid block, group A (placebo) received 2 mL of sodium chloride 0.9% injected into the track of spinal needle during its withdrawal (2 mm after outward withdrawal in muscles and subcutaneous tissues). While patients in group B (PRP); received 2 ml of PRP injected into the track of the spinal needle during its withdrawal. The primary outcome was the number of patients who developed post-spinal low back pain within the first week following the subarachnoid block. Secondary outcomes included the time of the first analgesic request and total meperidine consumption during the first 24 h postoperatively.
Results: Fifteen patients in the PRP group developed low back pain during the first week following subarachnoid block compared to 26 patients in the placebo group (p = 0.037). There was a significant decrease in the mean meperidine consumption during first 24 h postoperatively in PRP group (174 ± 14 mg) compared to placebo group (210 ± 22 mg) (p < 0.0001). Also, the first analgesic request was significantly delayed in PRP group (243 ± 21 min.) compared to placebo group (185 ± 31 min.) (p < 0.0001).
Conclusion: This study demonstrated the positive effects of platelet-rich plasma on the prevention of post-spinal backache.
Keywords: Gynecological surgery; Platelet-rich plasma (PRP); Post-spinal backache; Spinal anesthesia.
 
drusso said:
Braz J Anesthesiol

. 2021 Oct 5;S0104-0014(21)00359-6.
doi: 10.1016/j.bjane.2021.09.009. Online ahead of print.

Prophylactic use of platelet-rich plasma for post-spinal low back pain following gynecological surgery: a randomized clinical trial​

Ghada Mohammad Abo Elfadl 1, Abdelraheem Mahmoud Elawamy 2, Abualauon Mohamed Abedalmohsen 3, Azza Abo Elfadl El Sayed 4, Mustafa Bahloul Mohammed 5, Eman Ahmed Ismail 2
Affiliations expand
Free article

Abstract​

Background: Post-spinal back pain is suggested to occur as a result of a localized inflammatory response that is often associated with some degree of muscle spasm. We aimed to evaluate the effect of platelet-rich plasma (PRP) in reducing the incidence of post-spinal back pain.
Methods: One hundred patients were randomly enrolled and scheduled for elective gynecological surgery under spinal anesthesia. After the subarachnoid block, group A (placebo) received 2 mL of sodium chloride 0.9% injected into the track of spinal needle during its withdrawal (2 mm after outward withdrawal in muscles and subcutaneous tissues). While patients in group B (PRP); received 2 ml of PRP injected into the track of the spinal needle during its withdrawal. The primary outcome was the number of patients who developed post-spinal low back pain within the first week following the subarachnoid block. Secondary outcomes included the time of the first analgesic request and total meperidine consumption during the first 24 h postoperatively.
Results: Fifteen patients in the PRP group developed low back pain during the first week following subarachnoid block compared to 26 patients in the placebo group (p = 0.037). There was a significant decrease in the mean meperidine consumption during first 24 h postoperatively in PRP group (174 ± 14 mg) compared to placebo group (210 ± 22 mg) (p < 0.0001). Also, the first analgesic request was significantly delayed in PRP group (243 ± 21 min.) compared to placebo group (185 ± 31 min.) (p < 0.0001).
Conclusion: This study demonstrated the positive effects of platelet-rich plasma on the prevention of post-spinal backache.
Keywords: Gynecological surgery; Platelet-rich plasma (PRP); Post-spinal backache; Spinal anesthesia.
Click to expand...
Demerol? Really?
 
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