Discover the benefits of Platelet-Rich Plasma (PRP) therapy for back pain relief with Meri Sehat. Explore a cutting-edge approach to healing.

Platelet-Rich Plasma (PRP) Therapy For Back Pain

New biochemical treatments like platelet-rich plasma are being explored to accelerate the body’s repair processes, particularly to treat lumbar radiculopathy and canal stenosis.

Introduction

Back pain is one of the most common and costly musculoskeletal conditions. Unfortunately, traditional therapies such as bed rest and medications don&rsquo;t always work. 
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PRP has come a long way, from being used in dental implant procedures to treating muscle injuries, joint injuries, and even cosmetic procedures. 

PRP stands for platelet-rich plasma, i.e., plasma with more platelets than are typically present in the blood. The normal platelet counts range from 150,000 /&mu;L to 350,000 /&mu;L However, the concentration of platelets in PRP can be 5-10 times richer than usual<a href="#accordion">[6]</a>.&nbsp; 

So, what makes it so wonderful for the patients?

Platelets are crucial in wound healing. They are rich in growth factors and cytokines. Not only do they form clots to stop bleeding at the site of injury, but support cell growth as well. This is why the therapy is increasingly used to promote muscle healing, treat <a href="https://merisehat.pk/article/natural-relief-for-arthritis-exploring-effective-remedies">arthritis</a> symptoms, and address various other health issues.

A medical professional takes a sample of the patient&rsquo;s blood to prepare a PRP injection. The amount of the sample depends on where the PRP is to be injected. It is sealed in a container and placed in a centrifuge. The spinning separates the blood sample into its components, one of which is PRP. The plasma is then extracted and prepared further for administration.

While doctors usually prefer PRP as a standalone treatment, injecting it into areas of tissue damage or inflammation, some mix it with other treatments like bone graft therapies to accelerate repair. 
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Major growth factors, like vascular endothelial growth factor, platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-), insulin-like growth factor 1, and epithelial growth factor, are found in large quantities in platelets. They facilitate healing when released from degranulated platelets. In addition to chemokines, cytokines, and metabolites, growth factors are crucial for angiogenesis, chemotaxis and migration, cell proliferation, and differentiatio.<a href="#accordion">[1]</a>

The issue arises when these wound-healing mechanisms don&#39;t always take place where required or at the speed required for the best restoration. Imaging techniques, like ultrasound, help doctors locate the specific areas for injection, like the tendon, which in turn helps to alleviate discomfort and return normal function to the spine.

Research in 2019 emphasized that PRP can restore function and structure in the spine following disc degeneration<a href="#accordion">[7]</a>. 
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Understanding of PRP therapy for back pain

Depending on the device used, the base platelet count of the patient, and the technique employed, a 30-cc venous blood draw generally produces 3-5 cc of PRP. 

A double centrifugation process of PRP entails<a href="#accordion">[5]</a>: 
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<ol>
	<li style="text-align:justify">Collection of approximately 34 ml of whole blood in anticoagulated vacutainer tubes.</li>
	<li style="text-align:justify">First spin or soft spin at a steady pace.</li>
	<li style="text-align:justify">Transfer the upper layer with a buffy coat to empty sterile tubes.</li>
	<li style="text-align:justify">Second spin or hard spin at a faster pace.</li>
	<li style="text-align:justify">Platelet pellets with few red blood cells accumulate at the bottom of the tubes.</li>
	<li style="text-align:justify">Platelet pellets are homogenized by thoroughly mixing them into the lower 1/3 volume of the plasma while discarding the upper 2/3 portion. 
	&nbsp;</li>
</ol>

Note: It&rsquo;s imperative to stop the platelets from activating too early or before use; hence, an anticoagulant such as citrate dextrose A is used. 
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These include:

<ul>
	<li style="text-align:justify">Premature release of growth factors via degranulation</li>
	<li style="text-align:justify">Growth factors released for a brief period after activation</li>
	<li style="text-align:justify">Growth factors are susceptible to proteolytic enzymes</li>
	<li style="text-align:justify">Varying concentrations and quality due to individual differences 
	&nbsp;</li>
</ul>

Moreover, despite extensive study, the optimal time for PRP implantation, the ideal platelet concentration in the PRP sample, and whether to use an inactivated or activated type of PRP is still not established.

Also, even though the substance being injected is from your own body, the fact that PRP involves injecting into the skin, there are some side effects involved. For example, infection, pain at the administration site, bleeding, nerve injuries, and tissue damage. The risk of allergic reactions is there, too, albeit lower compared to other injectable medications such as corticosteroids. 
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Conclusion

In a nutshell, this form of regenerative medicine is still controversial. New research has documented positive outcomes for the intramuscular injection of PRP to treat back discomfort. However, additional trials with bigger sample numbers and control groups are necessary to demonstrate its effectiveness and establish its regular use in surgery. 

It won&rsquo;t make you feel better instantaneously and will take time to work. But more research is needed to determine the stage of back pain at which PRP is most beneficial and how PRP infusions compare to more traditional treatments like NSAIDS and exercise. 
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Key Takeaways

<ul>
	<li style="text-align:justify">PRP has become hugely popular in recent years as a treatment for various conditions, ranging from hair loss to sports injuries.</li>
	<li style="text-align:justify">The therapy involves drawing the individual patient&rsquo;s blood, concentrating its healing properties (aka plasma), and reinjecting it back into the patient to speed up healing, reduce inflammation, or alleviate pain in the affected area.</li>
	<li style="text-align:justify">Some doctors still consider it as an experiential treatment. More research is warranted to corroborate its effectiveness.</li>
</ul>

[1] Gui K, Ren W, Yu Y, Li X, Dong J, Yin W. Inhibitory effects of platelet-rich plasma on intervertebral disc degeneration: a preclinical study in a rabbit model. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2015;21:1368.

[2] Marx RE. Platelet-rich plasma: evidence to support its use. Journal of oral and maxillofacial surgery. 2004 Apr 1;62(4):489-96.

[3] Navani A, Li G, Chrystal J. Platelet rich plasma in musculoskeletal pathology: a necessary rescue or a lost cause?. Pain Physician. 2017;20(3):E345.

[4] Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT-J. 2016;2.

[5] Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: a review and author's perspective. Journal of cutaneous and aesthetic surgery. 2014 Oct;7(4):189.

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