Adding Regenerative medicine to your practice.

[MitchLevi]

Co-pays and high deductible health plans basically leave patients functionally "cash pay" anyway.

When you add up the total cost of routine care you're not in any appreciable way cheaper than PRP.

---

Members don't see this ad.

 

[drusso]

Medicine (Baltimore)
. 2021 Dec 23;100(51):e27878. doi: 10.1097/MD.0000000000027878.
A case report of ultrasound-guided knee nerve pulse radiofrequency combined with platelet-rich plasma in the treatment of knee osteoarthritis

Hui Jin 1, Hao Zuo 1, Rui Xu 2, Youbo Ji 1, Zhonghan Wang 3
Affiliations expand
PMID: 34941033 PMCID: PMC8702092 DOI: 10.1097/MD.0000000000027878
Free PMC article

Abstract
Rationable: Knee osteoarthritis (KOA) is a disease characterized by noninflammatory degenerative changes of articular cartilage. The main clinical manifestations are joint pain and stiffness. Pulsed radiofrequency (PRF) is thought to treat pain by destroying nerve tissue and changing the physical characteristics of nerve tissue membrane.

Patient concerns: The patients presents with joint pain and tenderness. Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard.

Interventions: Four patients with knee osteoarthritis underwent pulsed radiofrequency thermocoagulation in the knee joint cavity under ultrasound guidance and injected 2 mL of 10 mg/mL platelet-rich plasma into the joint cavity once a week for a total of 4 times. Record the patient's Visual Analogue Scale (VAS) score and the degree of knee movement limitation before treatment, 1, 3, and 6 months after treatment.

Diagnoses: Four patients with knee osteoarthritis.

Outcomes: After treatment, the patient's VAS score improved, and the knee joint mobility function recovered well. Ultrasound-guided knee nerve pulse radiofrequency combined with intra-articular injection of platelet-rich plasma can effectively improve the knee joint function and reduce the pain of the patient. The clinical effect is significant, and it is worthy of clinical application.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

 

[Ducttape]

first 3 words says it all.

Case report. it be like:

i do like how they made the diagnosis: Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard.

 

[oreosandsake]

Medicine (Baltimore)
. 2021 Dec 23;100(51):e27878. doi: 10.1097/MD.0000000000027878.
A case report of ultrasound-guided knee nerve pulse radiofrequency combined with platelet-rich plasma in the treatment of knee osteoarthritis

Hui Jin 1, Hao Zuo 1, Rui Xu 2, Youbo Ji 1, Zhonghan Wang 3
Affiliations expand
PMID: 34941033 PMCID: PMC8702092 DOI: 10.1097/MD.0000000000027878
Free PMC article

Abstract
Rationable: Knee osteoarthritis (KOA) is a disease characterized by noninflammatory degenerative changes of articular cartilage. The main clinical manifestations are joint pain and stiffness. Pulsed radiofrequency (PRF) is thought to treat pain by destroying nerve tissue and changing the physical characteristics of nerve tissue membrane.

Patient concerns: The patients presents with joint pain and tenderness. Touching around the knee joint will induce pain and joint stiffness when the hand is pressed hard.

Interventions: Four patients with knee osteoarthritis underwent pulsed radiofrequency thermocoagulation in the knee joint cavity under ultrasound guidance and injected 2 mL of 10 mg/mL platelet-rich plasma into the joint cavity once a week for a total of 4 times. Record the patient's Visual Analogue Scale (VAS) score and the degree of knee movement limitation before treatment, 1, 3, and 6 months after treatment.

Diagnoses: Four patients with knee osteoarthritis.

Outcomes: After treatment, the patient's VAS score improved, and the knee joint mobility function recovered well. Ultrasound-guided knee nerve pulse radiofrequency combined with intra-articular injection of platelet-rich plasma can effectively improve the knee joint function and reduce the pain of the patient. The clinical effect is significant, and it is worthy of clinical application.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Sorry but this is crap masquerading as research

 

[drusso]

Sorry but this is crap masquerading as research

It's worse than crap.

 

[drusso]

J Shoulder Elbow Surg.

2022 Jan 11;S1058-2746(22)00017-9. doi: 10.1016/j.jse.2021.12.010. Online ahead of print.

Platelet-Rich Plasma Versus Corticosteroid Injections for the Treatment of Recalcitrant Lateral Epicondylitis: A Cost-Effectiveness Markov Decision Analysis

Kevin M Klifto 1, Stephen H Colbert 1, Marc J Richard 2, Oke A Anakwenze 2, David S Ruch 2, Christopher S Klifto 3
Affiliations expand
PMID: 35031496 DOI: 10.1016/j.jse.2021.12.010

Abstract
Background: Both platelet-rich plasma (PRP) and corticosteroid injections may be used to treat lateral epicondylitis. We evaluated the cost-effectiveness of PRP injections versus corticosteroid injections for the treatment of recalcitrant lateral epicondylitis.

Methods: Markov modeling was used to analyze the base-case 45-year-old patient with recalcitrant lateral epicondylitis, unresponsive to conservative measures, treated with a single injection of PRP or triamcinolone 40mg/mL. Transition probabilities were derived from randomized controlled trials, quality-of-life (QOL) values from the Tufts University Cost-Effectiveness Analysis Registry reported using Disabilities of the Arm, Shoulder and Hand (DASH) scores, and costs from institution financial records. Analyses were performed from healthcare and societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICER), reported as United States Dollars/quality-adjusted-life-years (USD/QALY) and net monetary benefits (NMB) to represent the values of an intervention in monetary terms. Willingness-to-pay thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed over 10,000 iterations.

Results: Both PRP and triamcinolone 40mg/mL injections were considered cost-effective interventions from a healthcare and societal perspective below the WTP threshold of $50,000. From a healthcare perspective, PRP injections were dominant compared to triamcinolone 40mg/mL injections, with an ICER of -$5,846.97/QALY. PRP injections provided a NMB of $217,863.98, while triamcinolone 40mg/mL provided a NMB of $197,534.18. From a societal perspective, PRP injections were dominant compared to triamcinolone 40mg/mL injections, with an ICER of -$9,392.33/QALY. PRP injections provided a NMB of $214,820.16, while triamcinolone 40mg/mL provided a NMB of $193,199.75.

Conclusions: Both PRP and triamcinolone 40mg/mL injections provided cost-effective treatments from healthcare and societal perspectives. Overall, PRP injections were the dominant treatment with the greatest NMB for recalcitrant lateral epicondylitis over the time horizon of five years.

Keywords: Adrenal Cortex Hormones; Cost-Benefit Analysis; Health Care Costs; Quality of Life; Quality-Adjusted Life Years; arm; platelet-rich plasma; tennis elbow.

Clinicoecon Outcomes Res. 2022 Jan 3;14:1-10. doi: 10.2147/CEOR.S327191. eCollection 2022.

Cost-Effectiveness Analysis for the Treatment of Diabetic Foot Ulcer in France: Platelet-Rich Plasma vs Standard of Care

Salvatore Russo # 1, Stefano Landi # 2, Stephane Courric 3
Affiliations expand
PMID: 35018103 PMCID: PMC8742138 DOI: 10.2147/CEOR.S327191
Free PMC article

Abstract
Introduction: Diabetic chronic foot ulcers (DFU) lead to pain, reduced quality of life and represent a severe economic burden for patients and health systems. The clinical results of PRP effectiveness in the treatment of DFU are promising; on the other hand, the costs associated with treating DFUs with PRP are higher than those using standard therapy. Therefore, this study aims to determine the cost-effectiveness of platelet-rich plasma (PRP) therapy compared to standard therapy from the French healthcare system perspective.

Methods: A cost-effectiveness analysis (CEA) was performed using a decision Markov model with a cohort of patients with chronic DFU (duration of >3 weeks) with high orthopaedic risk and with ulcers graded 3A according to University of Texas classification. The effectiveness outcomes are reported in terms of quality adjusted life year (QALY). The costs are reported in euro (€) currency evaluated in 2019. A micro-costing approach alongside a clinical study was used to assess resource use. Deterministic sensibility analyses are reported to evaluate the robustness of the results. The analyses were carried out in the French setting.

Results: The incremental cost-effectiveness ratio (ICER) of PRP treatment is -€613/ QALY, which, being lower than zero, indicates the dominance of the PRP therapy. Deterministic and probabilistic sensitivity analysis underlines the main parameter affecting CE results. Lowest number of standard of care weekly medications (from 5 to 3) leads to a €622/QALY while increasing PRP weekly medication (from 1 to 4) has an ICER of €732/QALY.

Discussion: PRP is a cost-effective or even a cost-saving alternative in the French setting. PRP has higher cost for the complete medication, but, in the absence of wound complications, has the potential to involve lower consumption of resources in the form of routine medication over a 1-year time horizon.

Keywords: cost-effectiveness analysis; cost-utility analysis; diabetic foot ulcer; platelet-rich plasma.

 

[drusso]

Knee Surg Sports Traumatol Arthrosc. 2021 Nov 12. doi: 10.1007/s00167-021-06793-4. Online ahead of print.

Bone marrow aspirate concentrate injections provide similar results versus viscosupplementation up to 24 months of follow-up in patients with symptomatic knee osteoarthritis. A randomized controlled trial

Angelo Boffa 1, Alessandro Di Martino 1, Luca Andriolo 1, Roberto De Filippis 2, Alberto Poggi 3, Elizaveta Kon 4 5 6, Stefano Zaffagnini 1, Giuseppe Filardo 7
Affiliations expand
PMID: 34767030 DOI: 10.1007/s00167-021-06793-4

Abstract
Purpose: The purpose of this double-blind randomized controlled trial (RCT) was to compare clinical improvement and radiographic findings up to 2 years of follow-up of a single intra-articular injection of bone marrow aspirate concentrate (BMAC) versus hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA). The hypothesis was that BMAC injection could lead to better clinical and radiographic results compared to viscosupplementation.

Methods: Patients with bilateral knee OA were randomized to one intra-articular injection of tibial-derived BMAC in one knee and one HA injection in the contralateral knee. Sixty patients were enrolled, and 56 were studied up to the final follow-up (35 men, 21 women, mean age 57.8 ± 8.9 years), for a total of 112 knees. Patients were evaluated before the injection and at 1, 3, 6, 12, and 24 months with the IKDC subjective score, VAS for pain, and the KOOS score. Minimal clinically important difference (MCID), patient treatment judgement, and adverse events were documented, as well as bilateral X-Rays (Rosenberg view) before and after treatment.

Results: No severe adverse events nor differences were reported in terms of mild adverse events (7.1% vs 5.4%, p = ns) and treatment failures (10.7% vs 12.5%, p = ns) in BMAC and HA groups, respectively. The IKDC subjective score improved from baseline to all follow-ups for BMAC (p < 0.0005), while it improved up to 12 months (p < 0.0005) and then decreased at 24 months (p = 0.030) for HA. Compared to HA, BMAC showed a higher improvement for VAS pain at 12 (2.2 ± 2.6 vs 1.7 ± 2.5, p = 0.041) and 24 months (2.2 ± 2.6 vs 1.4 ± 2.8, p = 0.002). The analysis based on OA severity confirmed this difference only in Kellgren-Lawrence 1-2 knees, while comparable results were observed in moderate/severe OA. Radiographic evaluation did not show knee OA deterioration for both treatment groups, without intergroup differences.

Conclusion: BMAC did not demonstrate a clinically significant superiority at short-term compared to viscosupplementation, reporting overall comparable results in terms of clinical scores, failures, adverse events, radiographic evaluation, MCID achievement, and patient treatment judgment. However, while HA results decreased over time, BMAC presented more durable results in mild OA knees.

Level of evidence: Level I.

Keywords: BMAC; Bone marrow; Hyaluronic acid; Injection; Knee; MSCs; Osteoarthritis.

 

[Ducttape]

i cant see the whole article. from what i can read, it seems like a reasonable study. double blinded RCT.

both treatments work, long term BMAC seems to provide longer results.

only concerns for the study - how did they choose which knee to get HA and which to get BMAC? for example, a confounder would be if the HA went in to the dominant knee the majority of times.

did they compare this to conservative treatment or to, say, 10 pound weight loss?


finally, ,results are beneficial for mild OA, which kind of makes sense. it doesnt work for the people i see, unfortunately.

edit btw the QALY articles in your prior post are, well, kind of useless trash imo. i remember reviewing articles that showed that fusion had best QALY numbers.....

 

[drusso]

Pain Med. 2022 Jan 19;pnac011. doi: 10.1093/pm/pnac011. Online ahead of print.

The long-term analgesic effectiveness of platelet-rich plasma injection for carpal tunnel syndrome: a cross-sectional cohort study

Chia-Ying Lai 1, Tsung-Ying Li 1 2, King Hei Stanley Lam 3 4 5 6, Yu-Ching Chou 7, Dueng-Yuan Hueng 8 9 10 11, Liang-Cheng Chen 1, Yung-Tsan Wu 1 2 12
Affiliations expand
PMID: 35043941 DOI: 10.1093/pm/pnac011

Abstract
Objective: Interest in perineural platelet-rich-plasma (PRP) injections for the treatment of carpal tunnel syndrome (CTS) has increased in recent years. However, evidence supporting the long-term effectiveness of PRP is lacking. Therefore, the aim of our cross-sectional cohort study was to investigate the long-term results of PRP injections for CTS.

Methods: Eighty-one patients diagnosed with CTS of any grade who received a single PRP injection at least 2 years prior were enrolled. Through structured telephone interviews, all patients were asked of their post-injection outcomes compared to their pre-injection condition. Symptom relief ≥50%, compared to the pre-injection condition, was considered an effective outcome. Binary logistic regression was applied to analyze each baseline variable as a regressor for determining the prognostic outcome factors.

Results: In total, 70% of patients reported positive outcomes ≥2 years post-injection. Shorter duration of symptoms before treatment (odds ratio: 0.991; 95% confidence interval [CI] 0.983-0.999; p = 0.023) and lower electrodiagnostic severity of CTS were the main prognostic factors for an effective outcome (mild grade vs. severe grade, odds ratio: 17.652; 95% CI 1.43-221.1; p = 0.025). Although there was a trend toward positive outcomes at longer follow-up durations (2-3 years vs. 3-4 years vs. 4-5 years), the difference was not statistically significant.

Conclusion: A single perineural PRP injection has a long-term analgesic effect on CTS, especially in mild-to-moderate cases.

Keywords: carpal tunnel syndrome; long-term effect; platelet-rich plasma.

 

[Ducttape]

okay. PRP helps with mild cases.

the patients were called some time after their injection. didnt even come back to the office. "hey buddy, how you doing after your shot a year or two ago?"

how does that compare to not doing anything? how does that compare to just exercises, or just splinting, or surgery?



i suspect that a randomized blinded study with a placebo group and a conservative treatment group would show similar results ie benefit, but it needs to be done to be a significant finding.

 

[drusso]

okay. PRP helps with mild cases.

the patients were called some time after their injection. didnt even come back to the office. "hey buddy, how you doing after your shot a year or two ago?"

how does that compare to not doing anything? how does that compare to just exercises, or just splinting, or surgery?



i suspect that a randomized blinded study with a placebo group and a conservative treatment group would show similar results ie benefit, but it needs to be done to be a significant finding.

37/39 RCTs of PRP for OA show it works...Do we have that data for DRG? Why do you still think PRP is experimental? It's proven.

An Update on RCTs for Knee Osteoarthrtitis - 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

 

[lobelsteve]

View attachment 348883

37/39 RCTs of PRP for OA show it works...Do we have that data for DRG? Why do you still think PRP is experimental? It's proven.

An Update on RCTs for Knee Osteoarthrtitis - 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

That's not data. That's advertising.

 

[drusso]

That's not data. That's advertising.

Which part of the data do you dispute?

 

[Ducttape]

if the individual studies that are linked there are the studies you have posted - a lot of them have insufficient data or conflicting results with each other. of course, they are cherry picked.

i randomly clicked on 2 studies:

The efficiency of platelet-rich plasma treatment in patients with knee osteoarthritis - PubMed

PRP treatment had positive effects on the pain, physical function, and quality of life of patients with knee OA, but it did not increase cartilage thickness.

pubmed.ncbi.nlm.nih.gov

MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial) - PubMed

In this study, in addition to the effect of PRP on VAS and WOMAC, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). For further evaluation, a longer study with a larger sample size is recommended.

pubmed.ncbi.nlm.nih.gov

lets call the first study #1 and the second #2.
#1 - random. not blinded. 2 study groups, PRP group got 3 shots, nonPRP got saline 1 shot. studied out to 6 months. PRP group did get pain reduction and better WOMAC, but no change in cartilage thickness.
#2 - random and blinded. one group got PRP, the other got no injection. both knees got exercise/conservative treatment, so at least the comparison was against standard of care. in this study, PRP group got pain benefit, but also got no structural changes: "In PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement."

so just randomly choosing 2 studies that were of course cherry picked for benefits in VAS and WOMAC (why else would you put them in this graph if you did not cherry pick the results), you have 1 study that was marginal at best in terms of study design, the other good in terms of study design, yet the two studies conflicted with whether there was improvement in the joint itself.

 

[lobelsteve]

Which part of the data do you dispute?

Same crappy data you have posted over last few years. Poorly done studies, no matter how many you post- does not equate to better data. Just more junk to sift through making it GRADE lower and appear less useful as a treatment.

 

[DODOCSS]

Same crappy data you have posted over last few years. Poorly done studies, no matter how many you post- does not equate to better data. Just more junk to sift through making it GRADE lower and appear less useful as a treatment.

discussion is the point my scientifitic friend

 

[drusso]

if the individual studies that are linked there are the studies you have posted - a lot of them have insufficient data or conflicting results with each other. of course, they are cherry picked.

i randomly clicked on 2 studies:

The efficiency of platelet-rich plasma treatment in patients with knee osteoarthritis - PubMed

PRP treatment had positive effects on the pain, physical function, and quality of life of patients with knee OA, but it did not increase cartilage thickness.

pubmed.ncbi.nlm.nih.gov

MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial) - PubMed

In this study, in addition to the effect of PRP on VAS and WOMAC, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). For further evaluation, a longer study with a larger sample size is recommended.

pubmed.ncbi.nlm.nih.gov

lets call the first study #1 and the second #2.
#1 - random. not blinded. 2 study groups, PRP group got 3 shots, nonPRP got saline 1 shot. studied out to 6 months. PRP group did get pain reduction and better WOMAC, but no change in cartilage thickness.
#2 - random and blinded. one group got PRP, the other got no injection. both knees got exercise/conservative treatment, so at least the comparison was against standard of care. in this study, PRP group got pain benefit, but also got no structural changes: "In PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement."

so just randomly choosing 2 studies that were of course cherry picked for benefits in VAS and WOMAC (why else would you put them in this graph if you did not cherry pick the results), you have 1 study that was marginal at best in terms of study design, the other good in terms of study design, yet the two studies conflicted with whether there was improvement in the joint itself.

And, all despite all those limitations, the data still point in a consistent direction.

Medicina (Kaunas). 2022 Jan 3;58(1):69. doi: 10.3390/medicina58010069.

Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review

Lucrezia Tognolo 1, Maria Chiara Maccarone 1, Stefania De Trane 2, Anna Scanu 1 3, Stefano Masiero 1, Pietro Fiore 2 4
Affiliations expand
PMID: 35056377 DOI: 10.3390/medicina58010069
Abstract
Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the review. The PICO framework was used (P-patient: athletes, I-Intervention: conservative treatment with therapeutic exercise or injection therapies, C-Comparison: not needed, O-Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology.

Keywords: early osteoarthritis; physical activity; professional athletes; sport; therapeutic exercise.

 

[Ducttape]

To summarize:

Exercise
Exercise
Exercise



And if that doesn't work, one can consider adding HA or PRP.

NOT:

PRP everything and see what sticks and by the way try some of these stretches while writing that check

 

[lobelsteve]

discussion is the point my scientifitic friend

That's what we are doing here. Regenex ads touting their products and pointing to a bunch of crap studies is not inspiring evidence.

 

[drusso]

That's what we are doing here. Regenex ads touting their products and pointing to a bunch of crap studies is not inspiring evidence.

The Regen evidence is orders of magnitude better than the IPM evidence. You're the Roger Chou of Regen!

 

[drusso]

Same crappy data you have posted over last few years. Poorly done studies, no matter how many you post- does not equate to better data. Just more junk to sift through making it GRADE lower and appear less useful as a treatment.

It's such a benign intervention with such a favorable benefit:risk ratio. It's not we're talking about a mass vaccination program for a mostly self-limited disease. How much data do you need to support shooting platelets into people?

 

[lobelsteve]

It's such a benign intervention with such a favorable benefit:risk ratio. It's not we're talking about a mass vaccination program for a mostly self-limited disease. How much data do you need to support shooting platelets into people?

When we can separate PRP from stem cells and shots for profits, there is hope.
When we have a standard PRP, there is hope.
Now we have 100 different kits, techniques, protocols. There can be only one (or two).

 

[Ducttape]

It's such a benign intervention with such a favorable benefit:risk ratio. It's not we're talking about a mass vaccination program for a mostly self-limited disease. How much data do you need to support shooting platelets into people?

false equivalency.

please dont try to equate a disease that has caused 870,000 deaths with an ouchie in the knee.

i agree with lobel. a standardized method of obtaining the PRP, a standardized dose, and prospective double blinded non-industry sponsored study with clinically significant benefit that can be accepted by all.

let science decide. no more "well it didnt work because you didnt use MY kit."

 

[drusso]

false equivalency.

please dont try to equate a disease that has caused 870,000 deaths with an ouchie in the knee.

i agree with lobel. a standardized method of obtaining the PRP, a standardized dose, and prospective double blinded non-industry sponsored study with clinically significant benefit that can be accepted by all.

View attachment 348949
let science decide. no more "well it didnt work because you didnt use MY kit."

You understand that an autologous therapy, by it's nature, is unique, right? The "factory" that makes juju for a person who eats whole foods and an anti-inflammatory diet is different than a "factory" that makes juju for a person who eats chili dogs and drinks Mnt Dew all day...

 

[Ducttape]

yes. this leads to "issues".

if unique, by nature, then that means that there will be no consensus on whether such treatment can be reliably trusted to benefit.

makes it highly unlikely that most insurances will cover.


and dont go insulting the Dew...

 

[MitchLevi]

please dont try to equate a disease that has caused 870,000 deaths with an ouchie in the knee.

Dying COVID + does not mean dying from COVID.

Certain Dx are reliably treated with PRP and safer than corticosteroids. $650 for greater outcomes than CSI.

 

[Ducttape]

Dying COVID + does not mean dying from COVID.

Certain Dx are reliably treated with PRP and safer than corticosteroids. $650 for greater outcomes than CSI.

If someone wants to pay out of pocket it is of course their prerogative. However, we should be performing scientifically verified treatments or we become no different from chiropractors or laser spine specialists.

Also, I don't think taxpayers should be paying for treatments where there is inconclusive data and subsequent consensus about benefit, and where the treatment is utterly dependent on an individual's protoplasm, as drusso noted.



FYI the Covid deaths have been undercounted in the US.

 

[MitchLevi]

If someone wants to pay out of pocket it is of course their prerogative. However, we should be performing scientifically verified treatments or we become no different from chiropractors or laser spine specialists.

Also, I don't think taxpayers should be paying for treatments where there is inconclusive data and subsequent consensus about benefit, and where the treatment is utterly dependent on an individual's protoplasm, as drusso noted.



FYI the Covid deaths have been undercounted in the US.

Not everyone should be offered PRP, but your avg 58 yo with knee or hip OA, supra or infraspinatus tendinopathy, chronic SIJ pain or tennis elbow should be offered PRP IMO - AFTER you do a CSI that provides significant but transient benefit.

The CSI is covered by insurance and I use that as a Dx/Tx tool. If it works and the pain comes back go to PRP.

Patient selection for PRP is no different than properly selecting who to implant or not implant with SCS, offer an ESI, Rx opiates, etc.

Just bc some Tx doesn't work for every patient with any selected Dx doesn't mean it isn't a great Tx.

If I had to bet I'd say you've never used PRP, especially not for those Dx listed above.

I'm a PRP pt as well. Right shoulder. Did great. I think you should give it a chance.

 

[Ducttape]

its not about me getting any injection.

personally, i wont get any injection, or surgery. well, other than an an ACL repair.

its about whether the science is appropriate such that we should be recommending these injections to those who can afford to pay.


i dont perform PRP, nor will i do so in the near future. partly due to patient population, partly due to admin, partly due to the lack of quality data for some of those listed conditions.

that doesnt mean that i dont suggest to patients see a particular provider or two who may talk to them about PRP for lateral epicondylitis.

 

[Agast]

its not about me getting any injection.

personally, i wont get any injection, or surgery. well, other than an an ACL repair.

its about whether the science is appropriate such that we should be recommending these injections to those who can afford to pay.


i dont perform PRP, nor will i do so in the near future. partly due to patient population, partly due to admin, partly due to the lack of quality data for some of those listed conditions.

that doesnt mean that i dont suggest to patients see a particular provider or two who may talk to them about PRP for lateral epicondylitis.

Would you recommend it if it were $50?

 

[Ducttape]

if the science shows that such a procedure is clinically beneficial with an appropriate risk/benefit profile, yes, i am.


that doesnt mean i wont critique some crappy study posted here.

 

[drusso]

its not about me getting any injection.

personally, i wont get any injection, or surgery. well, other than an an ACL repair.

its about whether the science is appropriate such that we should be recommending these injections to those who can afford to pay.


i dont perform PRP, nor will i do so in the near future. partly due to patient population, partly due to admin, partly due to the lack of quality data for some of those listed conditions.

that doesnt mean that i dont suggest to patients see a particular provider or two who may talk to them about PRP for lateral epicondylitis.

Don't let Admin dictate your practice of medicine or your ability to innovate your craft.

 

[drusso]

its not about me getting any injection.

personally, i wont get any injection, or surgery. well, other than an an ACL repair.

its about whether the science is appropriate such that we should be recommending these injections to those who can afford to pay.


i dont perform PRP, nor will i do so in the near future. partly due to patient population, partly due to admin, partly due to the lack of quality data for some of those listed conditions.

that doesnt mean that i dont suggest to patients see a particular provider or two who may talk to them about PRP for lateral epicondylitis.

Would you recommend it for skin grafts? Because burn medicine and wound care has been using it for like 30 years...experimenting on patients, that is...

Wound Care.
2022 Jan 2;31(1):86-90.
doi: 10.12968/jowc.2022.31.1.86.

Application of autologous platelet-rich plasma to graft donor sites to reduce pain and promote healing​

Samarth Gupta 1, Rakesh Kumar Jain 1
Affiliations expand

• PMID: 35077214
• DOI: 10.12968/jowc.2022.31.1.86

Abstract​

Objective: Platelet-rich plasma (PRP) is widely used for wound healing in medical care because of the numerous growth factors it contains. Traditionally, donor sites are left to heal with a primary dressing so wounds are not left open. However, a delay in healing accompanied by pain at a donor site is often seen. This study primarily throws light on the use of autologous PRP over split-thickness skin graft (STSG) donor sites to promote healing and reduce pain.
Method: The patients enrolled in this study in 2018-2019 were divided into two groups: the intervention group received autologous PRP applied topically at the donor site; in the control group, the wound was dressed traditionally. Pain scales were measured in the immediate postoperative period at six hours, 10 hours and 16 hours. The dressing was opened on the postoperative day 14 and observed for healing by an independent observer.
Results: A total of 100 patients were included in the study. Patients in the PRP group showed statistically significant faster healing at postoperative day 14 compared with the control group (p<0.05), who required dressings for 3-4 weeks postoperatively. Pain scale scores in the postoperative period were significantly less in the PRP group at six hours postoperatively compared with the control group (p<0.05). There was a reduced incidence of hypertrophic scar formation in the small number of patients in the PRP group who had developed hypertrophic scar previously.
Conclusion: Application of PRP is a safe, cost-effective and easy method to achieve faster healing in graft donor site areas that are troublesome to both patients and doctors. It also reduces postoperative pain at donor sites. The authors recommend PRP is used more often in the management of donor sites for STSGs.
Keywords: PRP; STSG; autologous platelet-rich plasma; donor site; hypertrophic scar formation; platelet-rich plasma; split-thickness skin graft; wound; wound care; wound dressing; wound healing.

 

[Agast]

Anyone going to the ARMI course in March?

ARMI | Advanced Regenerative Medicine Institute

advancedregenmedinstitute.com

 

[Ducttape]

doing studies to see if something works is inherently different than telling someone that what you are selling is standard of care and has shown to be beneficial and safe.


when i tell someone "id suggest you go see Dr. X to talk to him about PRP for your elbow", i am convincing someone to get a medical treatment. i have vetted the treatment and assessed the risks and benefits.

personally, i have not reviewed skin grafting or wound care to give an opinion to a patient. that study does look promising.

 

[lobelsteve]

Would you recommend it for skin grafts? Because burn medicine and wound care has been using it for like 30 years...experimenting on patients, that is...

Wound Care.
2022 Jan 2;31(1):86-90.
doi: 10.12968/jowc.2022.31.1.86.

Application of autologous platelet-rich plasma to graft donor sites to reduce pain and promote healing​

Samarth Gupta 1, Rakesh Kumar Jain 1
Affiliations expand

• PMID: 35077214
• DOI: 10.12968/jowc.2022.31.1.86

Abstract​

Objective: Platelet-rich plasma (PRP) is widely used for wound healing in medical care because of the numerous growth factors it contains. Traditionally, donor sites are left to heal with a primary dressing so wounds are not left open. However, a delay in healing accompanied by pain at a donor site is often seen. This study primarily throws light on the use of autologous PRP over split-thickness skin graft (STSG) donor sites to promote healing and reduce pain.
Method: The patients enrolled in this study in 2018-2019 were divided into two groups: the intervention group received autologous PRP applied topically at the donor site; in the control group, the wound was dressed traditionally. Pain scales were measured in the immediate postoperative period at six hours, 10 hours and 16 hours. The dressing was opened on the postoperative day 14 and observed for healing by an independent observer.
Results: A total of 100 patients were included in the study. Patients in the PRP group showed statistically significant faster healing at postoperative day 14 compared with the control group (p<0.05), who required dressings for 3-4 weeks postoperatively. Pain scale scores in the postoperative period were significantly less in the PRP group at six hours postoperatively compared with the control group (p<0.05). There was a reduced incidence of hypertrophic scar formation in the small number of patients in the PRP group who had developed hypertrophic scar previously.
Conclusion: Application of PRP is a safe, cost-effective and easy method to achieve faster healing in graft donor site areas that are troublesome to both patients and doctors. It also reduces postoperative pain at donor sites. The authors recommend PRP is used more often in the management of donor sites for STSGs.
Keywords: PRP; STSG; autologous platelet-rich plasma; donor site; hypertrophic scar formation; platelet-rich plasma; split-thickness skin graft; wound; wound care; wound dressing; wound healing.

I bet those wound care centers have marketing teams and free dinners selling their care/caid patients on $800 add on prp.

 

[drusso]

I bet those wound care centers have marketing teams and free dinners selling their care/caid patients on $800 add on prp.

The way I understand it is that, especially for burn centers, is that they're getting paid such a huge Vig on SOS/facility side that they're giving it away. It all gets bundled into some crazy reimbursement package--and because not every state has burn units, there's a lot of OON billing going on. The average cost for a moderate burn runs about $206,853, while a severe burn with no complications can cost seven figures, at $1,617,345. If there are complications, a burn can cost more than $10 million to treat.

It's not equitable that burn patients get endless runs through the PRP buffet for human experimentation therapy for free, but the middle-aged weekend warrior with sore knees has to pay to be experimented on with unproven therapies.

 

[lobelsteve]

The way I understand it is that, especially for burn centers, is that they're getting paid such a huge Vig on SOS/facility side that they're giving it away. It all gets bundled into some crazy reimbursement package--and because not every state has burn units, there's a lot of OON billing going on. The average cost for a moderate burn runs about $206,853, while a severe burn with no complications can cost seven figures, at $1,617,345. If there are complications, a burn can cost more than $10 million to treat.

It's not equitable that burn patients get endless runs through the PRP buffet for human experimentation therapy for free, but the middle-aged weekend warrior with sore knees has to pay to be experimented on with unproven therapies.

Maybe tell your patients to try blow torch therapy to their knees and you can then send them for prp.

 

[drusso]

Sci Rep. 2021 Dec 8;11(1):23603. doi: 10.1038/s41598-021-03081-6.

Two or four injections of platelet-rich plasma for osteoarthritic knee did not change synovial biomarkers but similarly improved clinical outcomes

Srihatach Ngarmukos 1 2, Chotetawan Tanavalee 1 3, Chavarin Amarase 1 2, Suphattra Phakham 4, Warayapa Mingsiritham 1 2, Rangsima Reantragoon 1 5, Nitigorn Leearamwat 5, Thidarat Kongkaew 5, Kittipan Tharakhet 6, Sittisak Honsawek 1 4, Sinsuda Dechsupa 4, Aree Tanavalee 7 8
Affiliations expand
PMID: 34880370 DOI: 10.1038/s41598-021-03081-6
Abstract
We compared two and four intra-articular injections of platelet-rich plasma (PRP) in terms of changes of synovial cytokines and clinical outcomes. One hundred twenty-five patients having knee osteoarthritis (OA) underwent PRP injections at a 6-week interval. Before each PRP injection, synovial fluid aspiration was collected for investigation. Patients were divided into two or four intra-articular PRP injections (group A and B, respectively). Changes in synovial biomarkers were compared with the baseline levels of both groups, and clinical outcomes were evaluated until one year. Ninety-four patients who had completed synovial fluid collection were included for final evaluation, 51 in group A and 43 in group B. There were no differences in mean age, gender, body mass index (BMI), and radiographic OA grading. The average platelet count and white blood cell count in PRP were 430,000/µL and 200/ µL, respectively. There were no changes of synovial inflammatory cytokines (IL-1β, IL-6, IA-17A, and TNF-alpha), anti-inflammatory cytokines (IL-4, IL-10, IL-13, and IL-1RA), and growth factors (TGF-B1, VEGF, PDGF-AA, and PDGF-BB) between baseline levels and six weeks in group A, and 18 weeks in group B. Both groups had significantly improved clinical outcomes from six weeks including visual analog scale (VAS), patient-reported outcome measures [PROMs; Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Short Form-12 (SF-12)], with a significant delayed improvement of performance-based measures [PBMs; time up and go (TUG), 5-time sit to stand test (5 × SST), and 3-min walk test (3-min WT)]. In conclusion, two- or four-PRP intra-articular injection at a 6-week interval for knee OA demonstrated no changes of synovial cytokines and growth factors but similarly improved clinical outcomes from 6 weeks until 1 year.


Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial

Alparslan Yurtbay 1, Ferhat Say 2, Hikmet Çinka 2, Ahmet Ersoy 2
Affiliations expand
PMID: 34705072 DOI: 10.1007/s00402-021-04230-2
Abstract
Introduction: The primary purposes of this study were to prove the efficacy of PRP injection therapy on knee pain and functions by comparing patients with mild to moderate OA with a placebo control group, and also to understand the effectiveness of multiple doses compared to a single dose. It was hypothesized that PRP would lead to more favorable results than the placebo at 1, 3, 6, 12 and 24 months after treatment.

Materials and methods: 237 patients diagnosed with OA were randomly separated into 4 groups, who were administered the following: single dose of PRP (n: 62), single dose of sodium saline (NS) (n: 59), three doses of PRP (n: 63), and three doses of NS (n: 53). Clinical evaluations were made pre-treatment and at 1, 3, 6, 12 and 24 months post-treatment, using the Knee Injury and Osteoarthritis Result Score (KOOS), Kujala Patellofemoral Score, knee joint range of motion (ROM), measurements of knee circumference (KC), and mechanical axis angle (MAA) and a Visual Analog Scale (VAS) for the evaluation of pain.

Results: The better score values in the groups were recorded at 3 and 6 months. Patients treated with PRP maintained better scores at 3, 6 and 12 months compared to the NS groups (p < 0.05). Multiple doses of PRP were seen to be more effective than single-dose PRP at 6 and 12 months (p < 0.05). At the end of 24 months, there was no significant score difference across all the groups. The most positive change in scores was found in stage 2 OA, and the most positive change in ROM was in stage 3 OA patients. In the PRP groups, KC decreased more at 1 and 6 months (p < 0.05). Compared to other age groups, patients aged 51-65 years scored better at 6 months (p < 0.05). A negative correlation was determined with MAA scores (r = - 0.508, p < 0.001).

Conclusion: In comparison to the placebo (NS), leukocyte-rich PRP treatment was determined to be effective in the treatment of OA. Multiple doses of PRP increase the treatment efficacy and duration. Of all the patients treated with PRP, the best results were obtained by patients aged 51-65 years, with lower MAA, and by K/L stage 2 OA patients.

J Orthop. 2022 Jan 19;29:31-37. doi: 10.1016/j.jor.2022.01.003. eCollection Jan-Feb 2022.

Consecutive injections of leukocyte-rich platelet-rich plasma are effective in not only mild but also severe knee degeneration

Masahiko Kemmochi 1
Affiliations expand
PMID: 35115742 PMCID: PMC8790296 (available on 2023-01-01) DOI: 10.1016/j.jor.2022.01.003

Abstract
Introduction: How can non-cultured platelet-rich plasma (PRP) therapy be the ultimate intervention in the treatment of total knee arthroplasty (TKA) -adaptive levels of knee osteoarthritis, as opposed to stem cell therapy that requires culture?

Methods: An intra-articular injection of leukocyte-rich PRP (LR-PRP) was administered to 260 patients every 4 weeks for over four times (mean 5.8 times); they were followed up for a maximum of 24 months. The clinical evaluation used the Knee Injury and Osteoarthritis Outcome Score, visual analogue scale, and magnetic resonance imaging osteoarthritis knee score-body mass lesions to determine the therapeutic effect using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International responder criteria for osteoarthritis.

Results: Among those administered with LR-PRP, the responder rate was 72.0%, 78.1%, 78.1%, and 77.1% at 3, 6, 12, and 24 months, respectively.

Conclusions: Our manually prepared LR-PRP was effective following multiple consecutive injections, despite severe degeneration.

Keywords: Bone marrow lesion; Bone marrow lesion, BML; Consecutive injection; Leukocyte-rich platelet-rich plasma; Leukocyte-rich platelet-rich plasma, LR-PRP; Magnetic resonance imaging knee osteoarthritis knee score; Magnetic resonance imaging, MRI; Outcome Measures in rheumatology-osteoarthritis research society international; Outcome Measures in rheumatology-osteoarthritis research society international, OMERACT-OARSI; Severe degeneration; total knee arthroplasty, TKA.

© 2022 The Author. Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.

 

[drusso]

J Orthop. 2022 Jan 19;29:31-37. doi: 10.1016/j.jor.2022.01.003. eCollection Jan-Feb 2022.

Consecutive injections of leukocyte-rich platelet-rich plasma are effective in not only mild but also severe knee degeneration

Masahiko Kemmochi 1
Affiliations expand
PMID: 35115742 PMCID: PMC8790296 (available on 2023-01-01) DOI: 10.1016/j.jor.2022.01.003

Abstract
Introduction: How can non-cultured platelet-rich plasma (PRP) therapy be the ultimate intervention in the treatment of total knee arthroplasty (TKA) -adaptive levels of knee osteoarthritis, as opposed to stem cell therapy that requires culture?

Methods: An intra-articular injection of leukocyte-rich PRP (LR-PRP) was administered to 260 patients every 4 weeks for over four times (mean 5.8 times); they were followed up for a maximum of 24 months. The clinical evaluation used the Knee Injury and Osteoarthritis Outcome Score, visual analogue scale, and magnetic resonance imaging osteoarthritis knee score-body mass lesions to determine the therapeutic effect using the Outcome Measures in Rheumatology-Osteoarthritis Research Society International responder criteria for osteoarthritis.

Results: Among those administered with LR-PRP, the responder rate was 72.0%, 78.1%, 78.1%, and 77.1% at 3, 6, 12, and 24 months, respectively.

Conclusions: Our manually prepared LR-PRP was effective following multiple consecutive injections, despite severe degeneration.

Keywords: Bone marrow lesion; Bone marrow lesion, BML; Consecutive injection; Leukocyte-rich platelet-rich plasma; Leukocyte-rich platelet-rich plasma, LR-PRP; Magnetic resonance imaging knee osteoarthritis knee score; Magnetic resonance imaging, MRI; Outcome Measures in rheumatology-osteoarthritis research society international; Outcome Measures in rheumatology-osteoarthritis research society international, OMERACT-OARSI; Severe degeneration; total knee arthroplasty, TKA.

© 2022 The Author. Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.

...and don't forget to order PT too...

J Healthc Eng. 2022 Jan 10;2022:7878064. doi: 10.1155/2022/7878064. eCollection 2022.

Application Effect of Different Concentrations of Platelet-Rich Plasma Combined with Quadriceps Training on Cartilage Repair of Knee Osteoarthritis
Zutong Wu 1, Jianwen Yin 1, Yajia Yue 2, Yiqun Zhang 1
Affiliations expand

PMID: 35111289 PMCID: PMC8801772 DOI: 10.1155/2022/7878064
Free PMC article
Abstract
We investigated the application effect of different concentrations of platelet-rich plasma (PRP) combined with quadriceps training on cartilage repair of knee osteoarthritis. Data of 37 patients with knee osteoarthritis (KOA) treated in our hospital (November 2019-February 2021) were retrospectively analyzed and the patients were divided into low concentration group (LCG) (n = 12), medium concentration group (MCG) (n = 12), and high concentration group (HCG) (n = 13) according to the order of admission. All patients received quadriceps training. Three groups above received knee injection of PRP, and the platelet concentrations were 1000-1400 × 109/L, 1400-1800 × 109/L, and 1800-2100 × 109/L, respectively. Articular cartilage thickness of the medial and lateral femur, knee joint function scores, inflammatory factor levels, and matrix metalloproteinases (MMPs) levels were compared. After treatment, compared with the MCG and HCG, articular cartilage thickness of the medial and lateral femur of the diseased side in the LCG was obviously lower (P < 0.05). At 2 months after treatment (T 3), compared with the HCG, articular cartilage thickness of the medial and lateral femur of the diseased side in the MCG was obviously higher (P < 0.05), without remarkable difference in articular cartilage thickness of the medial and lateral femur of the healthy side among three groups (P > 0.05). After treatment, compared with the LCG, knee joint function scores of the MCG and HCG were obviously better (P < 0.001). Compared with the HCG, the knee function score at T 3 in the MCG was obviously better (P < 0.001). After treatment, compared with the LCG, inflammatory factor levels and levels of MMPs in the MCG and HCG were obviously lower (P < 0.05). Compared with the HCG, inflammatory factor levels and levels of MMPs at T 3 in the MCG were obviously lower (P < 0.05). PRP combined with quadriceps training can accelerate cartilage repair of patients with KOA and reduce inflammatory factor levels and levels of MMPs, but the treatment effect of PRP depends on platelet concentration, with the best range of 1400-1800 × 109/L. Too high or too low platelet concentrations will affect recovery of knee function.

Copyright © 2022 Zutong Wu et al.

 

[clubdeac]

I feel like we’ve been basically doing the same thing in interventional pain for decades with the exception of some new innovative neuromodulatory and neurodestructive procedures. I wish we had good regenerative options for annular tears and painful degenerative discs. I also have patients ask me all the time about nutritional supplements and other options to “heal the disc”. It’s depressing that after all these years we got nothing. I know chiros recommend bone broth, chondroitin/glucosamine, collagen peptides etc. it makes sense as these are the building blocks of the various proteoglycans that constitute the annulus and nucleus. I’m however not aware of any studies looking at diet and nutritional intake in regards to spine health. I just think we gotta find better options than steroids, ablation and fusion

 

[bedrock]

I feel like we’ve been basically doing the same thing in interventional pain for decades with the exception of some new innovative neuromodulatory and neurodestructive procedures. I wish we had good regenerative options for annular tears and painful degenerative discs. I also have patients ask me all the time about nutritional supplements and other options to “heal the disc”. It’s depressing that after all these years we got nothing. I know chiros recommend bone broth, chondroitin/glucosamine, collagen peptides etc. it makes sense as these are the building blocks of the various proteoglycans that constitute the annulus and nucleus. I’m not aware of any studies looking at diet and nutritional intake in regards to spine health. I think we gotta find better options than steroids, ablation and fusion

Agree.

I have been doing caudal PRP for patients with annular tears the past three years. 75% of the patients achieve 70% relief. I only do this after they had good but brief relief after standard ESI and the facets have been ruled out with negative MBB. I stress to the patients beforehand that only 3/4 respond to the PRP. The 75% that do respond are really happy as generally nothing else has ever truly helped them.

I've done far fewer of these for patients with disc modic changes (not annular tears), and my results are definitely not as impressive, 40% achieve 50% relief.

I think that caudal PRP holds great promise for lumbar annular tears because the disc is mostly healthy and just needs some help to close up, similar to partially damaged tendon, which do great with PRP.
However, PRP for severely degenerated discs is similar to PRP for severely degenerated joints. PRP is just not enough to undo the severe damage and least delivered epidural not intradiscal.

For true discogenic pain, particularly with Modic changes, if they fail everything else including a good core program, all non opioid meds, etc, I offer PRP with major caveats about how often it works, and then I refer them out for Intracept, as it doesn't make sense for me financially, but it might help the patient.

 

[RoloTomassi]

Why caudal vs IL or TF? Do you think you get better ventral spread, or safety?

Also, what volume are you using? Dependent on what disc you're trying to reach?

 

[Dr. Ice]

Interlaminar epidural lysate PRP works well for annular tears in my experience. Also have had success with intradiscal PRP in a few patients.

 

[bedrock]

Why caudal vs IL or TF? Do you think you get better ventral spread, or safety?

Also, what volume are you using? Dependent on what disc you're trying to reach?

ILESI cannot be relied to consistently reach the disc. TFESI doesn't cover the central third of the disc, which is where most annular tears are located.

If someone has a lateral annular tear then yes I do TFESI with PRP instead of caudal. Volume depends on the level.

 

[Dr. Ice]

ILESI cannot be relied to consistently reach the disc. TFESI doesn't cover the central third of the disc, which is where most annular tears are located.

If someone has a lateral annular tear then yes I do TFESI with PRP instead of caudal. Volume depends on the level.

Never thought about caudal approach for these. Thanks for the tip

 

[RoloTomassi]

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

Just saw this.

 

[MitchLevi]

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

Just saw this.

Well, that's terrible.

Bedrock, I thought posterolateral was the vast majority of AF, and IMO you're far more likely to actually hit your target with a TF or IL at the level or one below rather than going so far distally with a caudal.

I only do caudals for L5-S1 pathology or a lumbosacral fusion and I wouldn't go on record saying a caudal reliably covers the L4-5 disk.

Your PRP must be very dilute right?

 

[RoloTomassi]

ILESI cannot be relied to consistently reach the disc. TFESI doesn't cover the central third of the disc, which is where most annular tears are located.

If someone has a lateral annular tear then yes I do TFESI with PRP instead of caudal. Volume depends on the level.

I don't inject enough contrast on caudals to see if it's going ventral or dorsal. Do you have pics? Or any literature of ventral spread rates? I have heard this from Dr. Lutz as well.

 

[lobelsteve]

Agree.

I have been doing caudal PRP for patients with annular tears the past three years. 75% of the patients achieve 70% relief. I only do this after they had good but brief relief after standard ESI and the facets have been ruled out with negative MBB. I stress to the patients beforehand that only 3/4 respond to the PRP. The 75% that do respond are really happy as generally nothing else has ever truly helped them.

I've done far fewer of these for patients with disc modic changes (not annular tears), and my results are definitely not as impressive, 40-50% achieve 50% relief.

I think that caudal PRP holds great promise for lumbar annular tears because the disc is mostly healthy and just needs some help to close up, similar to partially damaged tendon, which do great with PRP.
However, PRP for severely degenerated discs, is similar to PRP for severely degenerated joints. PRP is just not enough to undo the severe damage.

For true discogenic pain, particularly with Modic changes, if they fail everything else including a good core program, all non opioid meds, etc, I offer PRP with major caveats about how often it works, and then I refer them out for Intracept, as it doesn't make sense for me financially, but it might help the patient.

You must have that magic touch.
Care to show the data you have collected.
Not even intrigued, because your results are incongruous with reality.

From article just posted:

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.