A doctor’s experience in PRP is important – a scientific update
Not all Platelet Rich Plasma doctors practice the same way, some are more experienced than others, some follow a standard protocol, some do steroid injections and then add PRP to their treatments.
Standard PRP care is difficult to measure and a lot of it falls on the experience of the physician offering the treatment. Because of the lack of standardization from doctor to doctor, even researchers find it difficult to objectively look at PRP to show scientifically it works.
“For over 20 years PRP has been used safely in a variety of conditions with promising implications. Unfortunately, most studies to date are anecdotal or involve small sample sizes-little is documented in the literature regarding the expected timeframe of tendon healing post-PRP injection. Also, there are no studies to date that review the need of post-PRP injection rehabilitation, nor are there any protocols.”(1)
Prolotherapy and Platelet Rich Plasma therapy can be practiced differently from office to office. Where one office may be successful performing these treatments in one fashion, another office may have less than hoped for results. This is borne out in the medical research. When researchers from England tried to outline how successful Platlet Rich Plasma therapy could be for back pain, they could not because “The current literature is complicated by a lack of standardization of study protocols, platelet-separation techniques, and outcome measures. As a result, there is uncertainty about the evidence to support the increasing clinical use of platelet-rich plasma and autologous blood concentrates as a treatment modality for orthopaedic bone and soft-tissue injuries.”
In other words, the results were mixed up by studying offices that may or may not have been “expert” in offering the technique.” (2)
There are many variations to PRP and the way it is performed by one doctor, may not be the same way it is performed by another doctor and without this standardization, the research cannot be clear.
“There are only a few studies of PRP treatment for cartilage on osteoarthritic knees. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies. The clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established.” (3)
Even when PRP is introduced in a surgical setting as an aid to speed wound healing: “In the field of platelet concentrates for surgical use, most products are termed Platelet-Rich Plasma (PRP). Unfortunately, this term is very general and incomplete, leading to many confusions in the scientific database.” (4)
And in sports medicine: “Basic science and preclinical data support the use of PRP for a variety of sports related injuries and disorders. The published, peer reviewed, human data on PRP is limited. Although the scientific evaluation of clinical efficacy is in the early stages, elite and recreational athletes already use PRP in the treatment of sports related injuries. Many questions remain to be answered regarding the use of PRP including optimal formulation…(5)
When choosing Platelet Rich Plasma Therapy, many factors help determine the realistic outlook for success, including the experience of the doctor perfroming the treatment and experiemnce in injectable therapies. As we write in our emails to patients asking for more information – Platelet Rich Plasma therapy can be practiced differently from office to office. Where one office may be successful performing these treatments in one fashion, another office may have less than hoped for results.
Not every doctor is proficient in PRP Therapy
Platelet Rich Plasma Therapy has become very popular in part because of patient demand and the use of this therapy in some high-profile athletes. Physicians who do not do traditional Prolotherapy and offer PRP are in some cases, untrained doctors who are injecting the platelets in a way that is often painful, debilitating for weeks, and can leave hematomas (collections of clotted blood) in the area injected. We believe that PRP is best delivered by a physician already experienced and well versed in Prolotherapy.
1. Sheth U, Simunovic N, Klein G, Fu F, Einhorn TA, Schemitsch E, Ayeni OR, Bhandari M. Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis. J Bone Joint Surg Am. 2012 Jan 11.
2. Sampson S, Gerhart M, Mandelbaum B, et al. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 December; 1(3-4): 165–174. 5
3. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health. 2012 Mar;4(2):162-72.
4. Ehrenfest DM, Bielecki T, Mishra A, Borzini P, Inchingolo F, Sammartino G, Rasmusson L, Evert PA. In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes. Curr Pharm Biotechnol. 2012 Jun;13(7):1131-7.
5. Mishra A, Harmon K, Woodall J, Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2012 Jun;13(7):1185-95.