PRP for management of pain

Dr Nandita Mehta
Chronic and degenerative musculoskeletal conditions impose a great challenge to treat and can have major negative impact on an otherwise active lifestyle. Old injuries can also mean lot of pain which is not relieved by pain killers and hot/cold fomentation.
Many of the patients might require a surgical intervention and follow-up rehabilitation program. Still, the outcome is not certain.
There are very few treatments, which offer repair and healing the injuries and hence offering relief of pain.
One effective option is the injection of platelet rich plasma (PRP), which is a simple yet cost effective technique devoid of any side effects for the management of various painful degenerative conditions.
In the medical science, this therapy is known as regenerative medicine which is a major part of rapidly emerging biomedical research. PRP is increasingly being used by many clinicians for tissue healing, regrowth and pain relief.
PRP is concentration of platelets in a small volume of plasma, where the platelet concentration is higher (typically up to five times higher) than the normal platelet concentration in a healthy person’s blood. Levels of platelets in whole blood is 1.5-3 lakhs/cu mm whereas the PRP contains 10 lakhs/cu mm.
How does PRP help
Our blood plasma has growth and various other factors which promote tissue healing, bone and cartilage regeneration and pain relief. Actually the platelets, in plasma, are the tiny components of blood and play a crucial frontline role in healing by forming blood clots and release the growth factors for tissue repair and rejuvenation during any injury. So, PRP acts by nurturing the damaged tissue cells that can heal on their own or can augment the healing process.
PRP contains alpha granules, in which about 70% of their growth factors will be secreted in the first 10 min, and almost all the stored amount will be released in the first hour.
As PRP is prepared from the patient’s own blood, there is no risk of immunological reactions and disease spread.
This therapy is a minimally invasive intervention which does not involve administration of drugs like steroids etc.
Emerging evidence suggests that PRP has the potential to have a regenerative effect on certain body tissues. It is helpful in the management of many painful conditions of the back, joints, tendon and fascia, depending on the tissue damage and the stage at which patient presents. PRP is increasingly being used by physicians catering to sports injury.
Different painful conditions where PRP can help in regeneration and pain relief include:
* Osteoarthritis of joints like knees, ankle, hips, shoulder, elbow etc.
* Facet joint arthropathy of back and neck.
* Planter fasciitis, Tendo- Achilles’ degeneration, Tennis & Golfer’s elbow.
* Partial tear of various muscles, tendons & ligaments, which can happen as a part of sports injury and even aging.
How is PRP prepared?
Only 10 – 20 ml of patient’s own blood is drawn, in special sterile tubes containing ACD anticoagulant and Gel. Then it is centrifuged at a specific speed and temperatures for 20 minutes.
The centrifuged blood gets separated into various constituents above the gel and the red blood cells get separated and settle down at the bottom of tube below the gel. The amber colored liquid above the gel is called plasma and gets separated into three layers. The layer just above the gel is the Buffy coat that is rich in WBC and on top of it around 2-3 ml is platelet rich plasma (PRP) and the topmost layer is Platelet poor plasma which is around 3-5ml.The different layers of plasma are withdrawn in two separate syringes making sure to take the buffy coat along with PRP without disturbing the RBC.
This freshly prepared plasma is injected into the desired tissue under fluoroscopy/Ultra Sound guidance taking all precautions of asepsis. The entire procedure of preparation and injection takes less than an hour and there is no need of indoor admission or hospitalization. Ideally, PRP should be freshly prepared and injected without delay, taking all precautions of minimum handling in preparation and injecting.
Following the injection, the patient can be sent home immediately and advised not to take pain killers which are anti-inflammatory.
Injection of PRP in various joints and tissues can help in tissue healing and regeneration and hence many major surgeries can be avoided or delayed. Prolonged use of various analgesics/pain killers lead to many side effects on different organs of the body which can be avoided by the use of PRP. Sometimes the elderly patients who have a lot of other associated medical conditions and are at increased risk of getting complications due to surgery can be helped to achieve pain relief with the use of this modality of treatment. This technique which is easily affordable, can be used in all age groups irrespective of the medical condition. Since it is the patient’s own blood which is being injected back after proper separation so there is no chance of any allergic reaction or any untoward incident.
All this has huge financial implications as the number of days of absenteeism from work are markedly decreased and if surgery can be avoided, a lot of money can be saved.
PRP is very promising futuristic therapy and its use has increased extensively over the last decade due to advanced technology.
(The author is Prof & Head Deptt of Anesthesiology & Intensive Care ASCOMS & Hospital, Jammu)