• Dr. Jennifer Nicole Falk

Platelet-Rich Plasma vs Prolotherapy for Chronic Musculoskeletal Pain

Updated: Aug 13, 2018



​​Platelet-Rich Plasma (PRP) and Prolotherapy are both used for the treatment of chronic musculoskeletal conditions. In the lower extremity, this includes Achilles tendinosis, plantar fasciosis, and osteoarthritis. While PRP and prolotherapy differ in their composition, but both aim to stimulate, and use, the body’s own healing process to help speed up recovery. Continue below to learn more about how these two injection therapies differ, how they are administrated, and what the research studies are showing regarding their effectiveness.

BACKGROUND


Platelet-Rich Plasma (PRP)​​

Blood is made up of plasma, red & white blood cells, and platelets. Platelets function to help with clotting of blood, but they also contain growth factors that aid in the healing process. Platelet-rich plasma, or PRP, is plasma that contains a higher concentration of platelets than normal. The purpose of PRP injections is to increase the number of growth factors into and around an area of damage or injury, thus stimulating and speeding up the healing process. The ultimate goal is to decrease pain, improve function, and return to sports and activities quicker.


Prolotherapy​​

Prolotherapy (aka proliferation therapy) is a serial injection of a dextrose solution. The purpose of the injection is to stimulate an acute low-grade traumatic process, allowing the body to use its own inflammatory markers to aid in the body’s healing process naturally, thus regenerating and repairing damaged tissues, restoring joint stability, and improving pain.

THE PROCEDURE

Procedure Prep

Before either injection, certain anti-inflammatory medications and corticosteroids may be stopped as they can decrease the effectiveness of the injection. ​

The Procedure


PRP Injections (in-office or at an outpatient surgery center)​​

  • A local anesthetic block may be performed to numb the area around the injection site.​​

  • Blood is drawn from the patient's arm and then centrifuged.

  • The prepared PRP is then injected around the affected area.

  • Multiple injections may be necessary, which are typically given 4-6 weeks apart.


Prolotherapy (in-office)​​

  • A local anesthetic block may be performed to numb the area around the injection site.​​

  • The pre-mixed dextrose solution is injected into and around the affected area.

  • Injections are administered every 4 weeks until symptoms are resolved (estimate 4-6 injections) or until improvement is no longer noted.

Post-Procedure

Every doctor may have a different protocol, so it is important to follow the doctor's guidelines and remain compliant. Some post-procedure protocol for both injections may include limitations of weight-bearing status and/or immobilization in a walking boot, as well as restrictions with activity level and avoidance of certain anti-inflammatory medications during the healing process. Usually an exercise, or stretching, program is implemented during the rehabilitation period to help get patients back to their pre-injury level quicker.

WHAT DOES THE RESEARCH SHOW?

PRP

A study came out this year on the use of PRP in plantar fasciitis, which showed a significant improvement in the VAS (pain) score 3 months after a single PRP injection into 100 feet. Post-procedure protocol included limitation of activities for 2 days, followed by initiation of a stretching regimen and then return to activities, as tolerated, after 4 weeks (3).

Prolotherapy

A 2017 case series showed improvement of pain and functional scores in patients with intra-tendinous Achilles tears after a single injection of prolotherapy (1:1 mixture of 50% dextrose with 0.5% Marcaine), followed by walking boot immobilization for 4-6 weeks and then an exercise rehabilitation program (1).

A 2017 prospective, randomly controlled study compared prolotherapy injections (three sets of injections, given 3 weeks apart) to stretching in patients with chronic plantar fasciitis. Using three different outcomes scores (assessing pain and function), significant improvements were seen in both the prolotherapy group and the stretching group. Significant differences were also seen between the two groups at different time intervals during and after treatment, with the prolotherapy group having better outcomes scores, except for at 360 days, at which time they were similar (2).

PRP vs Prolotherapy

A randomized, double-blinded trial was done on patients with knee osteoarthritis (OA), comparing PRP to prolotherapy injections. Patients received two injections of their assigned solution, one month apart. The WOMAC Index was used to evaluate patients’ pain, stiffness, and functional status before the injections and at three different time periods afterwards, with the last assessment being at 6 months after the first injection. Compared to pre-injection values, both groups showed a significant improvement in the WOMAC score at the 6-month mark, with a greater improvements seen in the PRP group compared to the prolotherapy group (4).

SUMMARY

When it comes to treating chronic musculoskeletal conditions, there are now more injection therapy options available outside of traditional steroid injections. Injections like PRP and prolotherapy may also be safer, more advantageous, and have less side effects. Comparing the two against each other, studies have shown both PRP injections and prolotherapy to be beneficial in treating chronic musculoskeletal conditions; however, with prolotherapy being easier to prepare and more affordable, it may be the more appealing choice for patients to try first (2).

Should you be interested in either one of these injection therapies, please contact the doctor, or your own healthcare specialist, for more information and to learn if either of these are right for you.

DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns, related to your health.

References:

1. Chan, O., Havard, B., Morton, S., Pritchard, M., Maffulli, N., Crisp, T., ... & Morrissey, D. (2017). Outcomes of prolotherapy for intra-tendinous Achilles tears: A case series. Muscles, ligaments and tendons journal, 7(1), 78.

2. Ersen, Ö., Koca, K., Akpancar, S., Seven, M. M., Akyıldız, F., Yıldız, Y., & Özkan, H. (2018). A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turkish Journal of Physical Medicine & Rehabilitation (2587-0823), 64(1).

3. Gopinath, S., Gudi, N. S., & Das, S. (2018). A study of outcome of autolougous platelet rich plasma injection in patients with chronic plantar fasciitis. International Journal of Orthopaedics, 4(1), 940-943.

4. Rahimzadeh, P., Imani, F., Faiz, S. H. R., Entezary, S. R., Zamanabadi, M. N., & Alebouyeh, M. R. (2018). The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clinical interventions in aging, 13, 73.

#PRP #PRPinjections #prolotherapy #dextrosesolution #chronicpain #achillestendinitis #plantarfasciitis #osteoarthritis #anklepain #footpain

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