Virginia Thornley, M.D., Neurologist
January 26, 2020

Introduction
Pain is one of the most common conditions that brings a patient to see a physician. Pain is a sign of dysfunction, something is not quite right. There is a plethora of research devoted to understanding the mechanisms.

Some of the more novel approaches are platelet-rich plasma and stem cell therapy. Currently, it is not FDA approved in the United States. It is a novel approach used more extensively outside of the United States.

Mechanism of action
PRP has several growth factors that helps with pain one of which is platelet derived growth factor (PDGF). PDGF arises in the setting of injury when platelets are degranulated. It activates cells which develop high phosphate bonds which leads to specific activities. These activities include mitogenesis, angiogensis and stimulation of macrophage activity. Other growth factors include TGF-beta or transforming growth factor-beta. The target cells are pre-osteoblasts, fibroblasts and marrow stem cells. VEGF or vascular endothelial growth factor is found which stimulates angiogenesis or the formation of new blood vessels. EGF or epidermal growth factor stimulates growth of cells, proliferation and differentiation (1).

Indications
It was found to be helpful in helping injured ligaments and tendons in sports injury.
In one study of 22 patients with intradiscal pain, PRP intradiscal injections were performed which showed encouraging results (2). There are many other indications for PRP in terms of pain control for other conditions.

Summary
PRP shows promising results for various types of pain which was initially used in sports medicine injury but is now expanding to other areas. Large randomized-controlled clinical trials are still needed. However, it is still a viable option. More studies are needed.


References
Jain., N.K., Gulati, M, Platelet-rich plasma: a healing virtuoso, Blood Res. 2016 Mar; 51(1):3-5.
Levi, D., Horn, S., Tyszko, S., Levin, J., Hecht-Leavitt, C., Walko, E., Intradiscal platelet-rich plasma injection for chronic discogenic low back pain: preliminary results from a prospective trial, Pain Med. 2016, Jun; 17(6):1010-1022.