What is PRP?
PRP is platelet-rich-plasma therapy. The therapy is a process placing your own concentrated platelet-rich plasma directly to your injury site.
By drawing a 60ml. syringe of blood from your arm and concentrating this down to 6 ml., the platelet-rich portion of plasma can be used for injection into your injured area.
How does PRP work?
In recent years, scientific research and technology has provided a new perspective on platelets, usually known for the clotting process. Studies suggest that platelets contain an abundance of growth factors that can affect inflammation, bone formation along with wound, muscle tear and soft tissue healing. Research shows that platelets also release many bioactive proteins responsible for attracting white blood cells, stem cells and bone- building cells that not only promote removal of degenerated and dead tissue, but also enhance tissue regeneration and healing.
In studies on tennis elbow chronic pain conditions, when PRP was compared with steroid injections the steroid treated patient felt pain relief quicker but the effect was short lived, needed to be repeated, and did nothing to make the tendons stronger. The PRP patients, on the other hand, saw slower pain relief but their pain relief was longer lasting and the tendons showed continual signs of strengthening for the long term.
Although, it is not exactly clear how PRP works, the increased concentration of growth factors and proteins in PRP are thought to intensify and speed up the body’s efforts to heal.
Does Insurance cover stem cell therapy?
No, Insurance does not cover Stem Cell Therapy. If you think you are a candidate for Stem Cell therapy and have a condition that can be treated with this therapy, please contact our office at (913) 901-8880. Pricing may vary on the condition/area to be treated. Your initial visit to determine if you are a candidate can be billed to your health insurance. To complete an appointment request, click here.
Are there any research studies on PRP and is it effective?
Platelet Rich Plasma therapy was initially developed in the 1970s and first used in 1987 in an open heart surgery procedure. Doctors have used PRP since the mid-1990s to aid bone healing after spinal injury and soft tissue recovery following plastic surgery. In 2004, studies at Stanford University found that PRP therapy got 90% healing at 6 months in injuries as long out as 20 months. PRP and stem cell treatments have been used extensively outside the United States for over 20 years with reported good health results. For years, elite athletes have had to travel to Europe to get these treatments before they were available in the U.S.
Most of the research studies are from Veterinary medicine and have been very positive for PRP in terms of tendon-healing effects in animals. More clinical trials on humans are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness include: the area of the body being treated, the overall health of the patient and whether the injury is recent or chronic, the timing of initiation of the therapy and the quality and quantity of PRP used.
Click below to see videos or read more scientific information
YouTube: Duke University Community Education Series, Dr. Robert Jones, Platelet Rich Plasma Injections
Why are there limited research studies on PRP?
Studies are very expensive to conduct and usually done by pharmaceutical companies, who can afford the testing. Since we are using the patient’s own blood and there is no drug product involved, pharmaceutical companies have no reason to back any research or pump money into scientific studies.
If there isn’t hard evidence yet, why do you give PRP to your patients?
There is some evidence from cohort studies, and anecdotally we have had some good experiences where we think it’s worthwhile to offer it to some patients. The ones that we offer it to have failed other types of conservative therapy, such as physical therapy, manipulation, acupuncture and steroid injection.
Who is using PRP therapy?
PRP is being used by Pain Management doctors, Orthopedic doctors, Physical Medicine and Rehabilitation doctors, Plastic Surgeons, Oral Surgeons, Radiologists and Veterinarians. A search on youtube.com will show many different medical specialties using PRP and Stem cells with good reported outcomes.
PRP has gained publicity when used by high profile athletes such as golf’s Tiger Woods, football’s Troy Polamalu, baseball’s Takashi Saito and basketball’s Brandon Roy.
Dr. Bruning has also had PRP Therapy with good results.
What does the PRP treatment entail?
- 60ml of blood is taken from the patient’s arm and placed in a centrifuge to separate the plasma from the red blood cells.
- The plasma is again centrifuged to separate the platelet rich plasma.
- PRP is collected into a sterile syringe
- The skin is cleaned with antiseptic and the area is anesthetized with a local numbing agent.
- With the aid of ultrasound or fluoroscopy, The PRP filled syringe is then guided into the injured body site and the area filled with the PRP.
How long does the procedure take?
The procedure takes about 30-45 minutes from start to finish.
Will the PRP injection hurt?
There will be discomfort. A greater degree of discomfort will result if the underlying tissue is severely inflamed or painful and depending on the severity and duration of the injury. Local anesthetic helps numb the skin, surrounding tissue and joint.
What is the recovery time & what should I expect during recovery?
You may return to work immediately and resume regular activities or light exercises. Avoid strenuous physical activity for the next 7 days.
The anesthetic utilized to numb the skin generally wears off in 1-2 hours. Mild pain, swelling, and bleeding may occur at the injection site for several hours. You may have local bruising.
You will feel a notable increase in pain and swelling of your injury site up to 3 days following the injection. Some of the swelling is due to the volume of PRP being injected which must be absorbed by the body. Pain intensity will become less each day.
When will I feel results from PRP therapy?
You should notice gradual improvement in symptoms and return of function 2-8 weeks after PRP therapy.
Pain relief is not expected to be immediate as with other treatments. Remember that this is to stimulate healing in the body and create the long-term effect of a stronger joint and/or ligament structure.
How long will results last from PRP or Stem cell therapy?
Results can last from 6-9 months or longer.
What are alternative therapies?
- Do nothing
- Physical Therapy
- Manipulation (Chiropractic care)
- Steroid injection
What are the risks of PRP?
- Pain or itching at the injection site (usually resolves in 24 hours)
- Post treatment discomfort, swelling, redness, and bruising (usually resolves in 3 days
- Post treatment infection requiring further treatment (Rare, but can be serious)
- Injury to a nerve and/or muscle
- Tendon or ligament rupture
- Dizziness or fainting (during or after blood draw)
- Pneumothorax, if injection site is near the lungs
- Loss of limb or death
Are there contraindications to PRP?
Patients with the following conditions are not candidates for PRP:
- Acute or Chronic infections
- Abnormal platelet disorders
- Blood or bone cancer
- Anemia (Hemoglobin <10)
- Use of a blood thinner within 5 days prior to the procedure
- Use of anti-inflammatory medicine within 1 week prior to the procedure
- Use of a corticosteroid within 2 weeks prior to the procedure
Is PRP/Stem Cell Therapy FDA approved?
Since the cells used for PRP and Stem cell therapy come from the individual patient’s body and are not altered, there is no need for FDA approval. We are just concentrating your own body’s cells and putting them where they are needed to promote healing.
PainCARE’s position on PRP
Up until now, we have been limited in treating injuries that are bad enough to possibly need surgery. Everything else is just monitoring the body healing itself. There is no evidence that we can do anything to slow or reverse the normal wear and tear of the aging process, or at least lessen pain by promoting healing that doesn’t worsen as time goes on. We believe that utilizing PRP therapy may: provide a treatment option for injuries previously deemed untreatable, help heal chronic injuries, slow the progression of more serious injuries, decrease the overall time of healing and be an alternative to surgical intervention.
Is PRP the same as Stem Cell Therapy?
No. The differences are:
- PRP is obtained by drawing blood from the patient’s arm. Stem cells are obtained from the patient’s hipbone or from amniotic tissue collected at the time of delivery.
- PRP therapy may be administered in less than one hour while stem cell therapy may take up to 2-3 hours
- There is more immediate discomfort to obtain a patient’s stem cells than platelet-rich plasma. It may also take several days longer to recover from retrieval of the patient’s stem cells.
- PRP provides proteins to signal the patient’s stem cells to activate, while stem cell therapy directly places stem cells into the injured area.
- Stem cell therapy is more costly than PRP.
What is Stem Cell Therapy and how does it work?
Stem cells obtained from amniotic tissue at delivery are injected directly to your injury site.
Stem cells are immature cells that are influenced by their surroundings. When brought to an injury site, a stem cell may develop into the kind of cell needed to help in healing muscle, ligament and cartilage. They may also provide an anti-inflammatory effect, recruit other adult stem cells for healing and support tissue remodeling over scar formation.
Are stem cells better than PRP?
There are no clinical trials showing better results with Stem Cell therapy vs. PRP therapy.
The doctors at PainCARE believe that PRP is a reasonable first therapy for treatment.
If there is no response to PRP, you and your doctor can discuss whether Stem Cell therapy is the next appropriate step.
Is PRP therapy a substitute for surgery?
Possibly. While many chronic conditions may respond to PRP therapy, obviating the need for a surgical procedure, it is impossible to predict which will respond and which will fail to improve.
On average, how many platelets for injection will be yielded in the PRP process?
Our office uses a two-spin centrifuge process. We believe this yields a purer platelet yield, eliminating as many red blood cells as possible. There are between 7.5 – 9.5 trillion platelets in a 7ml. treatment sample.
How often do I need PRP and when should I start treatment?
There is no clear consensus in any published articles on when to start PRP Therapy or how often to repeat the therapy. Most physicians using PRP therapy find relief comes within the first or second injection. Our doctors recommend waiting at least 1 month after the first injection before you consider a second injection. You will need to discuss this with your physician 1 month after the first injection.
What is the expected cost of PRP therapy?
PRP therapy will cost between $800 and $1200 per injection depending on the injection site
Stem cell therapy will cost between $2100 and $2500 per injection depending on the injection site
What is a stem cell and how does it know what type of tissue to grow into?
Stem cells are immature cells that are influenced by their surroundings. When brought to an injury site, a stem cell may develop into the kind of cell needed to help in healing muscle, ligament and cartilage. Based on research in this area, we know that stem cells become programmed by the cell type already present to develop into the same cell type. This is accomplished by direct contact with adult cells and the growth factors concentrated in the area.
What types of stem cells can be used for therapy?
Stem cells for therapy can be obtained from amniotic tissue collected at the time of a delivery, fat cells collected after liposuction and bone marrow cells collected by aspiration from the hip bone.
There are no clinical trials showing stem cells derived from any area to be superior over another.
What kinds of stem cells are utilized by PainCARE?
We are proponents of using stem cells obtained from amniotic tissue obtained at the time of a delivery. These amniotic tissue stem cells are high in mesenchymal types, necessary to heal bone, cartilage and ligaments and more biologically active than adult stem cells. These cells have not been shown to cause cancer or tumors and there is no additional procedure to you to obtain these cells.
Fat derived stem cells are obtained by liposuction, which carries a 3-10% complication rate. (The amount of fat taken has no beneficial cosmetic effect.)
Bone marrow derived stem cells can be of poorer quality due to the age of the individual, can have an increased risk of infection from the aspiration site, and cause an increase in discomfort and healing time.
How do stem cells know when to stop growing?
Stem cells will stop proliferating when they physically contact each other. This is because they are repair cells and when an area in need of repair is fully covered, they get the signal to stop growing. These are the same body signals that tell these cells to stop growing naturally in healing a bone fracture or ligament tear present in your body.