Platelet-Rich Plasma (PRP) Therapy for Low Back Pain

Platelet-Rich Plasma (PRP) Therapy for Low Back Pain

By Staff

People who received intradiscal platelet-rich plasma (PRP) injections to treat low back pain found a significant improvement in both pain and function, according to a study led by Dr. Gregory Lutz, Medical Director of the Regenerative SportsCare Institute, and Physiatrist-in-Chief Emeritus, Hospital for Special Surgery.  Dr. Lutz followed 49 patients for two years, and presented his results at the Interventional Orthopedics Foundation’s Annual Conference.

He noted patient satisfaction of 60% for those using the therapy to treat early-stage degenerative spinal disc disease that resulted in lasting improvements in pain and function.  The study was double-blind, randomized, controlled trial design, rigorous selection process and long term data collection.  All patients enrolled in the study had failed conservative treatments and were considering spinal fusion surgery.

Age, poor posture, and injury weaken spinal discs, causing cracks or tears to develop in the disc wall over time. Because spinal discs are filled with small nerve endings, these tears can develop into sources of chronic back pain in many patients. The adult disc has a limited blood supply, and therefore poor inherent healing potential. Conventional treatments for degenerated discs, which include physical therapy, anti-inflammatory medications, and spinal fusion surgery, are often not effective in the long-term and can come with complications.

Intradiscal PRP is an outpatient procedure that uses the patient’s own blood platelet cells to address the underlying issue of disc health, rather than merely alleviate disease symptoms.

“Blood is taken from the patient, processed in a centrifuge to concentrate the platelets, loaded into a syringe and then gently advanced into the painful disc levels under precise x-ray guidance,” said Dr. Lutz. “Growth factors are activated to help repair the tissue and the PRP fills and seals the tears in the outer wall of the disc. The beauty of intradiscal PRP is that it harnesses the patient’s own innate ability to heal.”

According to a media release from the Regenerative SportsCare Institute, the subjects in the study included a 54-year-old woman with severe, chronic low back pain, among others. After two years of failed therapies and pain, the female patient, having received PRP injections at the time of discography, reported near complete pain relief. At 2 years post-procedure, she continued to report sustained improvement in both pain and function. The results attest to the potential of intradiscal PRP to sustain long-term improvements in patients suffering from degenerative disc disease of the lumbar spine.

“Biologic therapies like intradiscal PRP represent the beginning of a paradigm shift in orthopedics. Using a patient’s own cells, we are able to help patients not only avoid more aggressive spinal fusion surgery, but also eliminate the need for long-term medications.” Dr. Lutz and his research team will be initiating research trials in the near future for knee osteoarthritis and other degenerative conditions using the patient’s own stem cells.

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Authored by: Staff

There are 13 comments for this article
  1. Jean Price at 10:26 am

    Paul, I’m so sorry you and a couple of others here have evidently had poor outcomes with this therapy! Like else everything in medicine, there often can be effects which are NOT helpful, and even can cause further problems! Yet our same treatment failures may be the salvation for many others!! It’s all so very dependent on the individual, the particular medical issue, and of course the practitioner and the technique! Plus, EACH choice HAS risks…just like choosing to do nothing, also….since EVEN with all the BEST care and the best known therapies, poor results…POOR OUTCOMES…can and do still happen!

    This being said…the biggest reason I’m aware of regarding why insurance doesn’t yet pay for PRP and STEM cell injections for therapeutic reasons is the fact that these therapies are also used COSMETICALLY. And most insurances don’t cover elective cosmetic treatments AT ALL! There is also the complicating fact that there is little accumulated data about the effectiveness and the long term success of this therapy, even though it’s been used for quite some time! Yet the widest use previously was cosmetic AND to TREAT PROFESSIONAL ATHELETES…where the main goal wasn’t collecting data…but rather to return them quickly to the field of play!! (Obviously it has some merit, since they continue to use this.)

    However, there is much more interest NOW in collecting data, for the insurance companies to be able to weigh this cost against other expensive therapies…like joint replacements and surgeries…and also to see just how effective long term this therapy will prove to be! So the insurance choice of not covering this therapy isn’t likely because it doesn’t work! Like so many things they don’t choose to cover…its more about whatever they can avoid paying for…to increase THEIR PROFITS. Plus, they need solid proof of savings for THEMSELVES…since they don’t tend to just take the doctor’s best case information and his word! Yet if this does to prove beneficial AND represent a cost savings FOR THEM in the long run, to help many patients…(not ALL, as you know yourself)….but many….then I look for our insurance companies to gladly cover the therapeutic use of platelets and stem cells.

    To me, good medical care has always been about having as MANY options as possible for the choices of which treatment MAY be best for the INDIVIDUAL. And then we as patients, along with our doctors….make the best decision at the time, with all the information we have THEN…knowing our outcomes are always, at best, just a crap shoot!! (No matter how excellent all the factors coming together are!). It’s just the way with bodies! I think that’s why the phrasing of ” Do no harm.” was important enough to put into the physican’s oath…because harm is always possible…and the risks must be weighed for each person! By the doctor AND BY THE PERSON…AND EVEN THEIR FAMILY!

    Again, I’m sorry the platelet therapy choice didn’t turn out well for you! I also know what it can be like to have poor outcomes…when we had so hoped for the best! For myself, this was from a surgery…where complications left me five times worse, (or so the doctor said after viewing my second myleogram). It meant an additional, more extensive surgery just two weeks latter,…with all kinds of other medical fallout for years! Plus two additional surgeries….and more pain for my lifetime! Yet for me to say surgery is NOT GOOD…well, it’s just not the truth! Even to say I made a poor decision…which I didn’t…since I didn’t have a crystal ball at the time, and I was already having nerve damage in my leg and foot, and risking more…this wouldn’t be the truth either! Nor is it true my doctor gave poor care, or performed badly!! In fact, the ONLY REAL TRUTH here is…sadly, poor outcomes DO HAPPEN REGARDLESS OF how hard we try and our doctors try to help US! No matter how sound our decisions AT THE TIME are! OR how HELPFUL THE TREATMENT MAY BE FOR many OTHERS!

    I’m glad you’ve shared your experience…it CAN be VERY helpful to tell others of our OWN choices and outcomes. Yet, it’s sort of unfair to neglect to reinforce the fact we are all individuals…and although this was your experience, it possibly won’t be what they experience, or the same outcome they will have! To avoid saying this might just block someone from a path of getting the specific care which could help THEM! Not something I EVER want to do, and I’m doubting whether anyone else would either! I think we must all consider this, when we tell our stories! Especially if our experience has been negative, (yet also if it has been positive, since a person might not have the good results we had either!). We can just REMIND THEM we are all different and unique, AND perhaps tell people to talk to several who have had this treatment…to thoroughly research the treatment, even get a second opinion…since we all vary greatly in our responses!

    From what I’ve found out and the people i have talked with, I do tend to think this type of therapy WILL have a positive effect in the future! For many…although perhaps not all…yet it will help some avoid more invasive and more risky treatments and procedures. I suppose only time will tell…along with good, well designed and honest studies, more data collection, and perhaps some creative funding…so people COULD try this if it WAS appropriate for them and they wished to see if it worked for them!

  2. PainedbyPRP at 4:54 am

    The only agenda for me, Healthy Man, is to ensure that patients understand that PRP is NOT reimbursed by insurance and there is good reason for this. It does not work. There are no long term studies and the injuries from PRP are not published because injured patients are abandoned by their docs or the patient doesn’t return for more PRP after shelling out thousands out of pocket for one of the most painful injections ever, which failed to provide benefit.
    I was permanently injured by PRP. It caused me chronic pain and resulted in me needing 10 surgeries to improve the resulting problems.
    I take it YOU are healthy, so you have. I personal experience with this issue. If given the choice, I pick the treatment that is reimbursed by my insurance rather than paying out of pocket in full for uncovered and painful PRP that’s not backed by insurance providers…and for good reason.

  3. Healthy Man at 7:45 am

    Dina and NoPRPforme,

    Your comments are misinformed and factually inaccurate. Plain and simple. When people like you use message boards to spread false information like you are doing here to promote your own agenda, you steer people away from receiving good treatment, which I believe is wrong.

    Telling someone that surgery trumps regenerative procedures any day of the week is like saying that taking a course of antibiotics will do more for your health than eating nutritious foods. Yes, like antibiotics, surgery is the only option in rare cases. But often, good physicians can intervene with a regenerative procedure and save a patient from experiencing years of post-surgical complications. Look at Coach Steve Kerr and Tiger Woods in the news lately re: complications from several failed spine surgeries…how are they doing?

    As far as PRP being a “money-making proposition,” the last time I checked spinal fusions were a $100K+ procedure, more than 10x the cost of any Intradiscal PRP.

    Your comment re: the potential complications of PRP is just plain inaccurate. Surgical complications are far more likely when considering treatments for the spine…regenerative procedures are some of the safest treatments out there!

  4. Jean Price at 6:31 pm

    Dina…I’m really sorry you had such problems from your treatments!! That can be really more difficult when your hope was to feel better! I’m also very curious about the type of problems you’ve had from this treatment!! I wonder if you would feel comfortable to tell us more details of what your ill effects were?! And what area or problem your treatment was supposed to help! (I’m guessing it was done by an experienced doctors and under fluoroscopy…etc!). For my own understanding AND for others… this WOULD BE be really HELPFUL, since the more we know, the better chance we have of making a good decision for ourselves! I personally know surgery can be disastrous too…and yet it all depends on the individual person AND the situation…and sometimes on their doctors skill level, TOO…and their expertise! Sadly, various areas of the country also have very different medical approaches…and therefore outcomes can vary too! Thanks!

  5. Dina at 12:10 pm

    PRP caused me permanent complications and chronic pain, and the need for numerous surgical interventions. I personally would not recommend it. Doctors have failed to publicize negative outcomes and side effects, and injured patients are often then abandoned. I would put my money on surgical repair having a better outcome over PRP any day.

  6. PRP Worked For Me at 3:16 pm

    Hi NoPRPforme,

    I am not a doctor, but here is what I can offer. Actually, >60% success rate in a double-blind, randomized control trial is incredible, considering this is degenerative disc disease we are talking about. If you do a quick lit search, you will find that no other procedure has even come close to 60% success rates–let alone exceed that percentage– in treating degenerative disc disease-induced low back pain.

    To your point about risks and complications, intradiscal PRP is likely the least risky procedure available to LBP sufferers. Also, when done correctly, it is not a “very painful” procedure; local anesthesia is used, and the best doctors in the field (like Dr. Lutz) put patients under general anesthesia during the procedure, so they feel essentially nothing.

    I am sorry that you went through that difficult ordeal. It is important to choose good doctors when seeking any type of care. While I don’t know what went wrong in your case, multiple failed surgeries and complications suggests a lack of skill and good judgment on your doctor’s part and is not a reflection of the intradiscal PRP treatment itself. (A bad cook is a bad cook–it’s not the food’s fault!) All that being said, it’s hard to believe you experienced “major complications” and “life-altering problems” from an intradiscal PRP!

    To be perfectly honest, your post is not fact-based. Your fear-mongering and listing off a number of false claims against regenerative procedures makes me suspicious of whether you actually had a PRP injection done or are perhaps an angry surgeon who wants to tarnish the field of regenerative medicine!

    Re: the cost of intradiscal PRP, it costs less than 1/10 what a spinal fusion (the archaic surgical alternative) costs, which is almost always fraught with truly life-altering complications. It’s important to do you homework.

  7. Healthy Man at 2:52 pm

    Hi Debbie,

    Great questions. While I am not a doctor, I have had personal experience with regenerative treatments and have researched them extensively. Re: “how long does it work for?” it can depend upon a number of factors, including the patient’s state of health and the doctor’s level of skill and experience performing the procedure. With novel treatments like PRP and autologous stem cell therapy, it is important to seek help from the most qualified and respected doctors.

    I have been treated by Dr. Gregory Lutz (prp in my ac joint) and can attest to his tremendous skill, professionalism, and compassion. I chose to go with Dr. Lutz because I didn’t want to have surgery and because he is widely-regarded as one of the best physiatrists in the world, especially when it comes to regenerative treatments like intradiscal PRP and PRP and stem cell injections for joints and tendons.

    Hope that helps!

  8. Judy at 7:51 am

    This article states the participants in this study had EARLY-STAGE degenerative disc disease, so I can see why they might be helped. But only 60% satisfaction rate is not enough, in my opinion. I’ve been living with DDD for 25+ years, so I seriously doubt this would be helpful to me.

  9. Jean Price at 10:28 pm

    Debbie…Those are great questions, and I think ones others have, too. Yet unfortunately, from what I’ve both read and been told by doctors and patients… it’s so different for everyone. And also depends on what part of the body is being treated! For instance, I personally know a young woman who had severe carpal tunnel in both wrists, so advanced that it woke her up at night. Her neurologist told her to go straight to a surgeon, or risk permanent pain and nerve damage. She instead tried platelet injections because she felt she couldn’t afford to be off work, with the surgeries. At about week five she thought she had wasted her money! She had so little improvement! Yet she said about a week later she realized how much less it seemed to be bothering her…and by eight or nine weeks, she said she “didn’t even think of her wrist and arm pain anymore!” It was totally resolved! And had stayed this way since…which was over six months later, at the point I talked with her!

    I’ve heard, as far as when people see a difference, sometimes it’s relatively soon as in that first week, and yet sometimes not for several weeks, like the woman I mentioned. She didn’t have further injections…yet some do have another, at six weeks, if the discomfort is not resolving yet there is some slight improvement! One woman on a Facebook pain support site talked about having stem treatment for pundal nerve pain and pelvic pain, prepared as a paste which her docor has been the first to use. She was able to see a difference that evening! And her pain overall continued to improve. I’m not sure if she had other treatments or not.

    My doctor told me one of his patients had relief after several days, yet most will take several weeks to improve significantly. Since it is a healing process, it depends in each person’s body! And also can be influenced by a protein known as the growth factor, we have in our blood. I would imagine it also depends on the concentration of the platelets and stem cells, since they check the level to make sure it’s adequate. And everyone’s platelet count does vary.

    If anyone is considering this, I think the the best thing to do is research it…and talk to people who have it done! Some doctors even have patients who would tell about their experiences, especially since it’s not a simple decision cost wise either! And as far as the expense, I think CareCredit is a big plus! It’s easy to apply for and they allow charges for medical and dental and even medication costs, and have interest free programs for twelve months, even 24 sometimes! Plus some doctors do accept monthly pavements, set up with their business office ahead of time.

    Again, it really just depends on each person’s situation…what area is causing the pain and reason there is pain. This is meant to be restorative, more than like steroids…to just treat the symptoms! So I would think multiple injections in a shorter period wouldn’t be a big problem, like it IS for steroids! For this therapy, having a series of three injections is the most I’ve heard of, evaluating after each one. Platelets reduce inflammation plus promote healing of the area and the structures in the area, from what I’ve heard. And there is even evidence seen sometimes on MRIs where platelet/stem cell injections had healed a tear in the meniscus of the knee when the scan was repeated some weeks later..

    One person here commented about the risks, and yet…every treatment has risks and so does having NO treatment! It’s up to each person to do what they think is best for them. Unfortunately, like for all treatments…it doesn’t really matter how good or wonderful it is for others…it matters how it works for you, and what other options might be available to you. On the other hand, it also doesn’t really matter if the risks are a zillion to one…if you are the one who experiences a side effects or untoward effect! That’s why it’s up to the individual and their doctor to explore what’s best!

    I personally think these types of treatments offer hope of less pain and better recovery and more functioning for some of us. And I also believe they will find these treatments are helpful for an even wider variety of issues that people now have few other options to help them with! And they will be less risky than most! I suppose only time and more data collected will tell!

  10. Jean Price at 10:46 am

    This is an exciting option, in my opinion…along with the use of stem cell injections, both of which are being offered more to the general public for treating a variety of different conditions which can cause pain and loss of function. Both PRP AND stem cell injections can use the platelets and stem cells taken from the patient’s own body….the platelets from blood and stem cells from body fat. So any chance of a reaction is alleviated. This helps make the risk factor be even less, although donor cells can also be used, if needed…and also seem to work well with few side effects.

    These therapies actually aren’t brand new. They have been used for some time, mainly by sports teams for treating their professional atheletes, and by more exclusive health care facilities, where those in the movie industry and societies’ wealthy and elite are mainly treated. This is likely because the cost is not only high, (it can be upwards of $1500, and add up to several thousand dollars more, depending on how many injections are needed)…it’s also NOT covered by most insurance companies…yet! Some doctors will do a single treatment and then see how effective it’s been after six weeks. Others will plan a series of three, to be the whole treatment process. Stem cell injections tend to be more expensive than PRP treatments, likely due to how they’re obtained. And it’s the cost of the “kits” to retreive and concentrate these cells that can be the biggest part of the overall expense. Some doctors will use both types of cells for treatments, for the desired effect. I’m sure, since techniques and the type of areas being treated vary, it must be individualized for each patient. The injections are routinely given guided by fluoroscopy….and this IS important!

    Platelets work to help reduce inflammation when injected into areas of pain, and they will also “summon” the body’s own stem cells for repairs or reconstruction that might be needed. Whereas stem cells are like little amazing building blocks, and they can transform into the type of cells of wherever they are injected…to repair and rebuild damaged areas! Some physicians in pain management are beginning to offer these injections, and also some orthopedic doctors, along with clinics devoted specifically to these types of treatments, for what some call “rejuvenation therapy”, are being set up.

    Intervention Orthopedics Foundation is collecting information about the effectiveness of these treatments from patients, among other things they do. Perhaps this data will help insurance companies see the monetary advantage of covering these treatments…versus the cost of pending joint replacements or the extended costs of other types of treatments that are less effective and will keep adding up over time. Something also exciting, just last week, my doctor told me this foundation also works with the Wounded Warriors orgainization, to help those in our military who might benefit receive this type of treatment when it’s appropriate…at NO cost! (**Something to be aware of and maybe check out, if you or someone you know might qualify and be a candidate for these treatments!!)

    He also said one big block for the insurance companies about coverage has been that these same treatments CAN be used for purely cosmetic purposes, like for anti-aging treatments and to help with various types of skin and cosmetic problems. Yet, I would think this could be easily addressed, and sorted out…just by looking at the specialty of the Physician administering the treatment! So hopefully, with more data on the long term effectiveness and overall cost savings…plus more demand for this type of care, especially for those who have few options left…our insurance companies WILL see the advantages to themselves, also. All in all, I think PRP and stem cell injections are both very hopeful areas of care options now…and hold even more promise for the future! For helping those with persistent pain achieve better results in treating our long term, painful conditions…and also helping us return to being more functional and having a better over all quality of life! Plus…since it’s basically a “drug free” therapy…I would think our government would actively support this as a good treatment option…and put their power behind patients having better accesss and coverage for it! At least, it would be reasonable for them to do this, yet I’ll admit we’re not always dealing with reasonable when it comes to pain care these days!

  11. NoPRPforme at 8:42 am

    Only 60% were satisfied? Not good enough odds for me. Plus insurance fails to reimburse for this very painful procedure which left me with major complications and life-altering problems, as well as countless subsequent surgeries. The risks and failures from this procedure are not publicized as they should be. I would never recommend PRP to anyone for any reason. It’s a $$-making proposition and a major gamble for patients with fat wallets. The long term risks and side effects have not been studied. Are you willing to risk infection, blood clot, nerve injury, overgrowth, skin discoloration, non-improvement, excruciating pain at injection site, surgery and more? Moreover, “a variety of factors such as method of preparation, composition, medical condition of the patient, anatomic location of the lesion, and tissue type can alter outcome”

  12. Debbie De Anda at 8:01 am

    How long does it work for? How many injections do you have to have? When you have had bavk pain for 30 years and you’ve had tons and tons of injections and nerve blocks, epidurals, and cortisone injections. Honestly you don’t want to have to continue to have injections. Maybe if it helped tight away and last for months but it’s not fun having injections.