great. dont use your patients as guinea pigs and drain their bank account while the scientific process plays out
Adding Regenerative medicine to your practice.
- Thread starter bronchospasm
- Start date
great. dont use your patients as guinea pigs and drain their bank account while the scientific process plays out
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Not everything covered by insurance works; Not everything that works is covered by insurance. Science...
Arthroscopy
.2021 Jan;37(1):309-325.
doi: 10.1016/j.arthro.2020.07.011. Epub 2020 Jul 15.
Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Meta-analysis of 26 Randomized Controlled Trials
Jixiang Tan 1, Hong Chen 2, Lin Zhao 1, Wei Huang 3Affiliations expand
- PMID: 32679294
- DOI: 10.1016/j.arthro.2020.07.011
Abstract
Purpose: To compare the effectiveness and safety of platelet-rich plasma (PRP) and hyaluronic acid (HA) in patients with adult knee osteoarthritis (KOA) and to explore the most effective and safe protocol by using a meta-analysis method.Methods: This study was based on Cochrane methodology for conducting a meta-analysis. Only randomized controlled trials with an experimental group that used PRP and a control group that received HA were eligible for this study. The participants were adults who had KOA. The outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS), the EuroQol VAS, the International Knee Documentation Committee, the Tegner score, the Lequesne Scale, the Knee injury Osteoarthritis Outcome Score, satisfaction rate, and adverse events. Subgroup analyses was performed for patients with different doses, types, and times of PRP interventions and grades of OA. The Review Manager Database was used to analyze the included studies.
Results: Twenty-six randomized controlled trials involving 2430 patients were included. The WOMAC total scores, WOMAC physical function scores, and VAS scores of the PRP group were better than the those of the HA group at 3, 6, and 12 months. The PRP group had better WOMAC pain, WOMAC stiffness, EuroQol VAS, and International Knee Documentation Committee scores than the HA group at 6 and 12 months. There was no significant difference in adverse events between the 2 groups (relative risk 1.21, 95% confidence interval 0.95-1.54; P = .13).
Conclusions: For the nonsurgical treatment of KOA, compared with HA, intra-articular injection of PRP could significantly reduce patients' early pain and improve function. There was no significant difference in adverse events between the 2 groups. PRP was more effective than HA in the treatment of KOA, and the safety of these 2 treatment options was comparable.
Level of evidence: Level I, meta-analysis of Level I RCTs.
Centrifuged blood left in breakroom freezer overnight
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ive had my girls inject my cervical and lumbar facets....ive done my own knees. Worked every time.
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I’ve had 6 total I think so N=7
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When you say “girls” it makes me think you had your MA inject your spine...please tell me I’m wrong
Your NP/PA does spine injections?
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No dude, I’m just horrified and disappointed that you’re training your midlevels to replace you.
This is why we can’t have nice things.
This. Most important, this.
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Hospitals trained them to replace doctors a long time ago, but doctors continue to work for hospitals. It's like a co-dependent, abusive relationship.
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I haven't done any regenerative medicine at all. I've been sitting back and watching it, waiting to what, if anything becomes proven, established and standard.
The other day, someone was telling me about "Fluid Flow" injections, amniotic fluid, etc. That they are "FDA approved" and "Medicare approved" for "Tendonitis, Arthritis, Bursitis, and chronic soft tissue injury." Hmm....
I did a search for this on specific product on this thread and couldn't find anything. But based on what little outside info I could find, I'm not impressed, to say the least. When I start hearing about medicare "Q-codes," monetary "rebates" and creative billing, I....
Well, what do you think. It all seems.............????????
The other day, someone was telling me about "Fluid Flow" injections, amniotic fluid, etc. That they are "FDA approved" and "Medicare approved" for "Tendonitis, Arthritis, Bursitis, and chronic soft tissue injury." Hmm....
I did a search for this on specific product on this thread and couldn't find anything. But based on what little outside info I could find, I'm not impressed, to say the least. When I start hearing about medicare "Q-codes," monetary "rebates" and creative billing, I....
Well, what do you think. It all seems.............????????
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were you horrified my MA was doing it?.... so which is it? Both? Ok fair enough. I made it all up. Neither one is true. Ive done both my knees and that's all i can reach myself.
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NP/PA's have been injecting for years. You know this.
Like i said above, i dont have an NP/PA.
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It’s a race to the bottom. Everyone is in on it. Even naturopaths and chiropractors. Hell, patients can’t tell either.
“I practice anesthesia and interventional pain management, fellowship trained. Training was very heavily interventional but in a university true multidisciplinary treatment program.
CRNAs independently practicing interventional pain has been going on for a while now.
A lot of non fellowship trained anesthesiologists and physiatrists practicing only interventional pain. Some family doctors and emergency room physicians attend weekend courses and conferences for fluoro and ultrasound guided blocks then call themselves pain specialists. Some of these courses are physician only. Some are not. I remember as a resident attending a very large name national annual pain conference and attending a few of the cadaver lab courses. Side by side with PAs/NPs who after speaking with them, want interventional only practices in rural areas.
Even chiropractors and naturopaths are out practicing interventional pain with ultrasound and fluoroscopy, especially the regenerative medicine cash only stuff. Even know of someone who had left residency without finishing and just opened a pain clinic, state specific.
Not hard to buy or lease a c arm and ultrasound machine.
No they are not only doing minor blocks. Some are out doing radiofrequency ablations and spinal cord stimulators.
I have worked in private practice with non fellowship trained physicians with a background in emergency medicine, family medicine, anesthesia, physiatry, and psychiatry. From my experience, the most knowledgeable and multidisciplinary focused are the psychiatrists.
The joke that pain management is really just interventional psychiatry is mostly true.
Overgeneralizing but many of the nonacademic anesthesia and physiatry guys just wanna go out after training and run a block shop. Again overgeneralizing, many of the family med and emergency medicine guys have little to no foundational understanding of the very basics of chronic pain or management. Many frequently tout disproven theories and treatments or experimental treatments on a cash only basis. Nothing is stopping a family doc from buying bone marrow aspiration kits, a centrifuge, and opening up shop. Nothing is stopping a new grad from opening up a ketamine clinic that claims to cure anything under the sun. Some pain docs used to overtest every urine sample with their own lab and found this is far more lucrative than interventional procedures. These "pee mills" really gave insurances a tough time. Now the DEA is cracking down hard on such behaviors. Heck, even dermatologists are pushing PRP and microRFA for many conditions. All real examples. Not trying to start a flame war, just my experience.
I'm not writing this to discourage you if you want to pursue this path but know that it's a wide open mostly unregulated market and many people from all sorts of educational backgrounds want a piece of the pain management pie.
The current pain market is saturated. Unless you want to go to the underserved boonies, it will be hard to open something for yourself.
Reimbursement has been dropping. Likely from over utilization. Even one of the biggest names in spinal cord stimulation is says it's way overused and may not be a covered benefit in the future if changes aren't made.
Some insurance companies will only allow you to bill for pain procedures if you are fellowship trained.”
Chronic Pain Management and Midlevel Encroachment
Resident here- So I'm having a discussion a few months ago with a chronic pain doc about my future plans as a generalist, and she opined that current residents need to 'strongly consider' doing a fellowship for "job security" with all the common arguments we've heard before. She mentioned her...
forums.studentdoctor.net
It’s a race to the bottom. Everyone is in on it. Even naturopaths and chiropractors. Hell, patients can’t tell either.
“I practice anesthesia and interventional pain management, fellowship trained. Training was very heavily interventional but in a university true multidisciplinary treatment program.
CRNAs independently practicing interventional pain has been going on for a while now.
A lot of non fellowship trained anesthesiologists and physiatrists practicing only interventional pain. Some family doctors and emergency room physicians attend weekend courses and conferences for fluoro and ultrasound guided blocks then call themselves pain specialists. Some of these courses are physician only. Some are not. I remember as a resident attending a very large name national annual pain conference and attending a few of the cadaver lab courses. Side by side with PAs/NPs who after speaking with them, want interventional only practices in rural areas.
Even chiropractors and naturopaths are out practicing interventional pain with ultrasound and fluoroscopy, especially the regenerative medicine cash only stuff. Even know of someone who had left residency without finishing and just opened a pain clinic, state specific.
Not hard to buy or lease a c arm and ultrasound machine.
No they are not only doing minor blocks. Some are out doing radiofrequency ablations and spinal cord stimulators.
I have worked in private practice with non fellowship trained physicians with a background in emergency medicine, family medicine, anesthesia, physiatry, and psychiatry. From my experience, the most knowledgeable and multidisciplinary focused are the psychiatrists.
The joke that pain management is really just interventional psychiatry is mostly true.
Overgeneralizing but many of the nonacademic anesthesia and physiatry guys just wanna go out after training and run a block shop. Again overgeneralizing, many of the family med and emergency medicine guys have little to no foundational understanding of the very basics of chronic pain or management. Many frequently tout disproven theories and treatments or experimental treatments on a cash only basis. Nothing is stopping a family doc from buying bone marrow aspiration kits, a centrifuge, and opening up shop. Nothing is stopping a new grad from opening up a ketamine clinic that claims to cure anything under the sun. Some pain docs used to overtest every urine sample with their own lab and found this is far more lucrative than interventional procedures. These "pee mills" really gave insurances a tough time. Now the DEA is cracking down hard on such behaviors. Heck, even dermatologists are pushing PRP and microRFA for many conditions. All real examples. Not trying to start a flame war, just my experience.
I'm not writing this to discourage you if you want to pursue this path but know that it's a wide open mostly unregulated market and many people from all sorts of educational backgrounds want a piece of the pain management pie.
The current pain market is saturated. Unless you want to go to the underserved boonies, it will be hard to open something for yourself.
Reimbursement has been dropping. Likely from over utilization. Even one of the biggest names in spinal cord stimulation is says it's way overused and may not be a covered benefit in the future if changes aren't made.
Some insurance companies will only allow you to bill for pain procedures if you are fellowship trained.”
Chronic Pain Management and Midlevel Encroachment
Resident here- So I'm having a discussion a few months ago with a chronic pain doc about my future plans as a generalist, and she opined that current residents need to 'strongly consider' doing a fellowship for "job security" with all the common arguments we've heard before. She mentioned her...
This is true. I trained in pain but decided not to do pain ultimately. Pain is a challenging field, both given the opioid management and the potential risk with procedures. It also has a very high operating cost. Patients tend to be demanding, get angry if you try to actually practice good medicine and cut down opioid consumption, or tell you that "procedures didn't work" if they don't get lifetime relief with one injection. Very draining. Always like your base specialty. I had an attending who even was considering going back to practice Anesthesia given that they were so drained with the practice of pain.
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It’s a race to the bottom. Everyone is in on it. Even naturopaths and chiropractors. Hell, patients can’t tell either.
“I practice anesthesia and interventional pain management, fellowship trained. Training was very heavily interventional but in a university true multidisciplinary treatment program.
CRNAs independently practicing interventional pain has been going on for a while now.
A lot of non fellowship trained anesthesiologists and physiatrists practicing only interventional pain. Some family doctors and emergency room physicians attend weekend courses and conferences for fluoro and ultrasound guided blocks then call themselves pain specialists. Some of these courses are physician only. Some are not. I remember as a resident attending a very large name national annual pain conference and attending a few of the cadaver lab courses. Side by side with PAs/NPs who after speaking with them, want interventional only practices in rural areas.
Even chiropractors and naturopaths are out practicing interventional pain with ultrasound and fluoroscopy, especially the regenerative medicine cash only stuff. Even know of someone who had left residency without finishing and just opened a pain clinic, state specific.
Not hard to buy or lease a c arm and ultrasound machine.
No they are not only doing minor blocks. Some are out doing radiofrequency ablations and spinal cord stimulators.
I have worked in private practice with non fellowship trained physicians with a background in emergency medicine, family medicine, anesthesia, physiatry, and psychiatry. From my experience, the most knowledgeable and multidisciplinary focused are the psychiatrists.
The joke that pain management is really just interventional psychiatry is mostly true.
Overgeneralizing but many of the nonacademic anesthesia and physiatry guys just wanna go out after training and run a block shop. Again overgeneralizing, many of the family med and emergency medicine guys have little to no foundational understanding of the very basics of chronic pain or management. Many frequently tout disproven theories and treatments or experimental treatments on a cash only basis. Nothing is stopping a family doc from buying bone marrow aspiration kits, a centrifuge, and opening up shop. Nothing is stopping a new grad from opening up a ketamine clinic that claims to cure anything under the sun. Some pain docs used to overtest every urine sample with their own lab and found this is far more lucrative than interventional procedures. These "pee mills" really gave insurances a tough time. Now the DEA is cracking down hard on such behaviors. Heck, even dermatologists are pushing PRP and microRFA for many conditions. All real examples. Not trying to start a flame war, just my experience.
I'm not writing this to discourage you if you want to pursue this path but know that it's a wide open mostly unregulated market and many people from all sorts of educational backgrounds want a piece of the pain management pie.
The current pain market is saturated. Unless you want to go to the underserved boonies, it will be hard to open something for yourself.
Reimbursement has been dropping. Likely from over utilization. Even one of the biggest names in spinal cord stimulation is says it's way overused and may not be a covered benefit in the future if changes aren't made.
Some insurance companies will only allow you to bill for pain procedures if you are fellowship trained.”
Chronic Pain Management and Midlevel Encroachment
Resident here- So I'm having a discussion a few months ago with a chronic pain doc about my future plans as a generalist, and she opined that current residents need to 'strongly consider' doing a fellowship for "job security" with all the common arguments we've heard before. She mentioned her...
Can you please cite sources?
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That’s like telling everyone you made out with your cousin in 5th grade and next day saying it was just a joke...
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Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review
Show all authorsMichael R. Baria, MD, MBA*, W. Kelton Vasileff, MD, James Borchers, MD, MPH, ...
First Published April 8, 2021 Research Article
https://doi.org/10.1177/0363546521998010
Abstract
Background:
Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect.Purpose:
To systematically review the clinical literature examining the combined use of PRP + HA.Design:
Systematic review.Methods:
A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs).Results:
A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone.Conclusion:
Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.
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How much does that cost?Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review
Show all authors
Michael R. Baria, MD, MBA*, W. Kelton Vasileff, MD, James Borchers, MD, MPH, ...
First Published April 8, 2021 Research Article
https://doi.org/10.1177/0363546521998010
Abstract
Background:
Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect.
Purpose:
To systematically review the clinical literature examining the combined use of PRP + HA.
Design:
Systematic review.
Methods:
A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs).
Results:
A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone.
Conclusion:
Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.
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Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review
Show all authors
Michael R. Baria, MD, MBA*, W. Kelton Vasileff, MD, James Borchers, MD, MPH, ...
First Published April 8, 2021 Research Article
https://doi.org/10.1177/0363546521998010
Abstract
Background:
Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect.
Purpose:
To systematically review the clinical literature examining the combined use of PRP + HA.
Design:
Systematic review.
Methods:
A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs).
Results:
A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone.
Conclusion:
Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.
We do a series of 3 synvisc. Is it supposed to be a series of 3 PRP as well? Did they inject them one after another/does order matter? If this works pretty well I would not mind doing the synvisc at cost and having the patient pay for the PRP only.
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That's what I do.
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Fraud.
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Even your MA can do it....lmao
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Since I’m offering a discount I’ll make the patient do it themselves
Lol sorry I shouldn't laugh but this was hilarious lol.
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New biosealant therapy might help stabilize injury caused by cartilage breakdown
Pennsylvania [US], April 11 (ANI): The findings of a recent animal-based study suggests that a new biosealant therapy may help to stabilize injuries that cause the cartilage to break down, paving the way for a future fix, or even better, begin working right away with new cells to enhance healing.
www.aninews.in
"In a large animal model, the researchers introduced the biogel to damaged cartilage
showing that it intertwined with the cartilage s matrix structure to stabilize the cartilage
They also demonstrated that it was retained for at least one week in the joint
environment. When living cartilage was tested in the lab, the researchers found that
applying the hyaluronic acid biogel restored regular activity to chondrocytes, the cells
within cartilage tissue. this meant that the microenvironment around the cells was now
being reinforced."
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um.... 2 out of 6 articles showed benefit? and those were 2 articles out of 431 screened?Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review
Show all authors
Michael R. Baria, MD, MBA*, W. Kelton Vasileff, MD, James Borchers, MD, MPH, ...
First Published April 8, 2021 Research Article
https://doi.org/10.1177/0363546521998010
Abstract
Background:
Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect.
Purpose:
To systematically review the clinical literature examining the combined use of PRP + HA.
Design:
Systematic review.
Methods:
A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs).
Results:
A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone.
Conclusion:
Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.
1 of the studies was based in Serbia with 57 patients. THU0424 THE NEW TREATMENT APPROACH IN KNEE OSTEOARTHRITIS: EFFICACY OF CELLULAR MATRIX COMBINATION OF PLATELET RICH PLASMA WITH HYALURONIC ACID VERSUS TWO DIFFERENT TYPES OF HYALURONIC ACID (HA) (PROSPECTIVE, RANDOMIZED, DOUBLE BLIND CONTROL STUDY) | Annals of the Rheumatic Diseases (bmj.com)
the other study was based in Malasia with 64 patients. only out 6 months. Intra-articular Hyaluronic Acid (HA) and Platelet Rich Plasma (PRP) injection versus Hyaluronic acid (HA) injection alone in Patients with Grade III and IV Knee Osteoarthritis (OA): A Retrospective Study on Functional Outcome (koreamed.org)
that is not a lot of data, yet that was all the data to suggest that combination worked, and none of it based in the United States. none with a control arm.
tells me - there arent a lot of studies out there. we need more data. to make a judgement based on 2 articles out of the wealth of literature out there is specious.
Last edited:
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I'm pretty tired of all the BS articles that get pasted in these forums. Seems to always involve orthobiologics too...
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Medicine (Baltimore)
. 2020 Mar;99(11):e19388.
doi: 10.1097/MD.0000000000019388.
Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: A meta-analysis
Zehan Chen 1, Chang Wang 1, Di You 2, Shishun Zhao 1, Zhe Zhu 3, Meng Xu 4Affiliations expand
- PMID: 32176063
- PMCID: PMC7220139
- DOI: 10.1097/MD.0000000000019388
Abstract
Background: This meta-analysis focuses on the controversial efficacy and safety of platelet-rich plasma (PRP) as compared with hyaluronic acid (HA) in the clinical treatment of knee osteoarthritis. We have attempted to provide an evidence-based medicine protocol for the conservative treatment of knee osteoarthritis. In addition, we included the latest relevant literature in this meta-analysis, and a staging study was conducted to compare the therapeutic effects of PRP and HA for knee osteoarthritis over different time periods.Methods: An online computer search with "platelet-rich plasma" and "knee osteoarthritis" as search terms was conducted in the PubMed, EMBASE, and Cochrane Library databases. We conducted a quality assessment of the retrieved literature and extracted the following indicators: visual analog scale (VAS) score, subjective International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and adverse events. RevMan5.3 software was used to determine the effect sizes, and indicators were compared across studies at three different time points from the administration of treatment.
Results: A total of 14 randomized controlled trials (RCTs) involving 1350 patients were included. Long-term VAS, IKDC, WOMAC-Pain, WOMAC-Stiffness, WOMAC-Physical Function, and WOMAC-Total scores at each time point were higher in the PRP group than in the HA group. There were no significant differences in the remaining indicators between the two groups.
Conclusion: Compared with HA, PRP offers obvious advantages in the conservative treatment of knee osteoarthritis. Treatment with PRP can reduce long-term pain and improve knee joint function with no additional risks. Therefore, PRP can be widely used for the conservative treatment of knee osteoarthritis.
Sounds like it didn't " work every time"
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a meta-analysis.
what did you say about meta-analysis a while ago, drusso? GIGA? GIGI? or GIGO?
anyways, they did collect more data, but still from limited number of studies because that is what is out there. 890 studies, and they boil down most of data to roughly 14 studies. much better than the other analysis.
data is mixed and interesting.
to summarize - VAS no benefit <3 months but significant benefit >3 months and 6 months.
IKDC - no benefit until at 6 months there was statistically significant benefit.
WOMAC and subtypes - no benefit until suddenly at 6 months, it was statistically significant.
KOOS - no statistically significant benefit at any point in time.
-------------------
personally, id like to see studies comparing PRP vs. 15 pounds of weight loss (if appropriate), and bag hyaluronidase
even better, some study somehow comparing different therapies - ie PRP vs. genicular RFA vs. weight loss vs. knee replacement.
what did you say about meta-analysis a while ago, drusso? GIGA? GIGI? or GIGO?
anyways, they did collect more data, but still from limited number of studies because that is what is out there. 890 studies, and they boil down most of data to roughly 14 studies. much better than the other analysis.
data is mixed and interesting.
to summarize - VAS no benefit <3 months but significant benefit >3 months and 6 months.
IKDC - no benefit until at 6 months there was statistically significant benefit.
WOMAC and subtypes - no benefit until suddenly at 6 months, it was statistically significant.
KOOS - no statistically significant benefit at any point in time.
-------------------
personally, id like to see studies comparing PRP vs. 15 pounds of weight loss (if appropriate), and bag hyaluronidase
even better, some study somehow comparing different therapies - ie PRP vs. genicular RFA vs. weight loss vs. knee replacement.
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When meta-analysis is used to justify "no treatment effect" it's largely GIGO. Can't prove the null hypothesis either prospectively or in aggregate. You can't improve the quality of dog crap science by aggregating it. You need better, well-controlled studies.
However, when meta-analysis finds a treatment effect (signal in the noise), it needs to be confirmed under prospective, well-controlled, randomized conditions.
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your last line is appropriate. however, it gets lost in the noise of "this study (the meta-analysis) found a good effect, so it justifies using the treatment".
additionally, this thought process can be used to decry all of the meta-analysis that portray regenerative medicine poorly, because currently the database consists almost exclusively of studies that attempt prove benefit.
really should not have it both ways.
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He is fighting SOS, leftist state regs, a pandemic, and a massive house getting built. He needs this....
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I am trying to do my PRP injections in house without a kit (thank you Doctodd) but having a problem finding citrate for the anticoagulant. Mckesson doesn't carry and my rep said its compounded. Anyone have a distributor they can suggest? Anyone use a different anticoagulant in their PRP?
Thanks in advance.
Thanks in advance.
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so maybe we shouldn't be posting the meta-analyses on this forum, just the prospective blinded trials...
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Only the positive meta-analyses...
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Try fresh squeezed. Just 1-2 drops.
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I don't have a supplier, but you can also use ACD or Heparin.
Alternatively, if you're fast, you can often do it without anticoagulation.
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Science | AAAS
www.sciencemag.org
I have written systematic reviews.
in theory it makes sense that they are the "highest level" of evidence. unfortunately so many confounding factors including different study protocols, and biases etc that can skew things.
there is one northern european author who has performed some PRCT on PRP and found no benefit between prp and control (PT, or CS i forget) they then went on to write a systematic review and they chose to go by primary end points for the study.
one study that they used as a "negative" study for prp was the Mishra study on tennis elbow. the primary end point was 12 weeks. no difference with CS. at 24 weeks the study had a distinct advantage for the PRP arm. they also included MULTIPLE studies with 8 week follow up periods.
most studies show that PRP when compared to CS, PRP is superior but takes time. CS + LA start to wear off while prp has durable benefits in functional outcome scales (DASH, ODI, etc) and pain. many many studies show crossover of the two study arms at the 12-16 week mark. if you stop your study at 8 weeks, you will never get to that point.
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what @oreosandsake wrote is some of the smartest stuff I've ever read on this forum...
Also,
Big Data: The Danger in Knowing Less and Less about More and More | The Lund Report
If policymakers want clearer direction about how to prioritize limited resources, then they can stop paying for meta-analysis.
www.thelundreport.org
The practice of meta-analysis resembles a sort of statistical alchemy. By combining the dregs and dross of individually insignificant studies, the meta-analytician may endeavor to produce the gold of a pooled positive result.
Other times, the meta-analytician may coax the opposite effect. By selectively choosing which studies to include in an analysis, weighting studies unequally, or leaving out studies that practicing experts would say are pivotal, real effects can be erased.
Importantly, meta-analysis being non-experimental in nature means that sources of bias are not controlled by the method: A good meta-analysis of badly designed studies will still result in bad statistics— known as the garbage in/garbage out effect.
So, at its best meta-analysis is an exercise in editorial discretion; conducting a meta-analysis involves many, many interpretative judgments. But, at its worst, meta-analysis can fuel an agenda-driven bias. I worry that the Big Crunch heralds a new age of paternalism in medicine.
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I appreciate the kind compliment.what @oreosandsake wrote is some of the smartest stuff I've ever read on this forum...
Also,
Big Data: The Danger in Knowing Less and Less about More and More | The Lund Report
If policymakers want clearer direction about how to prioritize limited resources, then they can stop paying for meta-analysis.
The practice of meta-analysis resembles a sort of statistical alchemy. By combining the dregs and dross of individually insignificant studies, the meta-analytician may endeavor to produce the gold of a pooled positive result.
Other times, the meta-analytician may coax the opposite effect. By selectively choosing which studies to include in an analysis, weighting studies unequally, or leaving out studies that practicing experts would say are pivotal, real effects can be erased.
Importantly, meta-analysis being non-experimental in nature means that sources of bias are not controlled by the method: A good meta-analysis of badly designed studies will still result in bad statistics— known as the garbage in/garbage out effect.
So, at its best meta-analysis is an exercise in editorial discretion; conducting a meta-analysis involves many, many interpretative judgments. But, at its worst, meta-analysis can fuel an agenda-driven bias. I worry that the Big Crunch heralds a new age of paternalism in medicine.
what you wrote above is much more articulate.
I have no doubt that it can be done well, just not very easy. if you have many scrutinizing eyes without industry or self motivated causes for bias that use very strict inclusion/exclusion criteria you can pool data and try to come up with a unified theme, IF one exists in the data. the problem is by the time that happens, the methods section reads something like this
"we identified 2420 manuscripts, on subject X. 9 of them were PRCT, 40 of them were Retrospective, 30 case reports and case series less than N of 10. once we used stringent criteria, only 2 studies were found to fit criteria, be of low risk for bias etc, for a total pooled N of 80 in the treatment arm"
then it's boring and you can't really write a systematic review and meta-analysis of 2 studies. so then you end up writing a narrative review which just describes what's been written without having strict criteria and you don't try to pool the data. pooling the data is the GIGO
recently, a major society has asked us to write a review of REVIEW papers (huh?) we are trying to create "best practice" guidelines based on summarizing systematic reviews. which tbh does not really make a lot of sense to me and will completely gloss over any fallacies between all the studies AS WELL as the reality of reviews covering the same papers.
as a thought experiment. you will see review papers covering the same topics come out every 1-2 years. in the meantime, hardly any new data has come out on the topic. see how the new authors re-hash the old data and come to similar or different conclusions. many societies do this. SIS, NASS, or ASIPP will publish something on bread and butter procedures every few years even if few people are still studying/publishing things that are generally well accepted and covered for my CMS. it is a monumental effort and I think undertaken mostly to help preserve the specialty from payor attack
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So again, this begs the question why there are so many meta-analyses being posted on this forum that suggest regenerative medicine is beneficial- when such analyses are fraught with potential and real bias.
Keep posting prospective double blinded studies on regenerative medicine, not what some here have already derided as GIGO.
Keep posting prospective double blinded studies on regenerative medicine, not what some here have already derided as GIGO.
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Because people are looking for a signal in the noise. Regen is a hot topic and gamechanger for all pain physicians.
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Here you go: Keep PRP away from your wife...
Gynecol Endocrinol
2021 Feb;37(2):141-145.
doi: 10.1080/09513590.2020.1756247. Epub 2020 May 2.
Effect of platelet-rich plasma on pregnancy outcomes in infertile women with recurrent implantation failure: a randomized controlled trial
Marzieh Zamaniyan 1 2, Sepideh Peyvandi 2, Hassan Heidaryan Gorji 3, Siavash Moradi 4, Jaefar Jamal 2, Fatemeh Yahya Poor Aghmashhadi 5, Mohammad Hossein Mohammadi 6Affiliations expand
- PMID: 32363968
- DOI: 10.1080/09513590.2020.1756247
Abstract
Methods: This study was directed to assess the efficacy of autologous platelet-rich plasma (PRP) on pregnancy rate in recurrent implantation failure. Between 2016 and 2019, a total of 98 women who unsuccessful to be pregnant after three or more high-quality embryo transfers undergoing frozen-thawed embryo transfer with or without an intrauterine infusion of platelet-rich plasma. Thus, 0.5 ml of platelet-rich plasma at 4-6 times higher concentration than peripheral blood infused intrauterine 48 h before embryo transfer. A control group underwent standard protocol.Results: There were no significant differences between the two groups in terms of age, body mass index and duration and cause of infertility and total transferred embryos and kind of treatment protocol, but secondary infertility and endometrial thickness 96 h before embryo transfer, was more in the intervention group. The clinical pregnancy (48.3% versus 23.26; p = .001) and ongoing pregnancy (46.7% versus 11.7%; p = .001) and implantation rate (58.3% versus 25%; p = .001) was more significant in the intervention group rather than controls. In conclusion, intrauterine infusion of platelet-rich plasma 48 h before freeze-thawed embryo transfer may have more effectiveness in in vitro fertilization (IVF) outcomes in recurrent implantation failure.
Keywords: Platelet-rich plasma; blastocyst transfer; fertilization in vitro; pregnancy rate; sperm injections.
