Platelet-Rich Plasma for Back Pain: Help or Hype?

If platelet-rich plasma, or PRP, is good enough for pro athletes, it should be good enough for your back pain, right? Truth is, it’s more complicated than that. Read what our experts think.

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If you follow professional sports, you know some athletes get platelet-rich plasma (PRP) shots to help heal their joint and soft tissue damage. Golf champ Tiger Woods and baseball icon Alex Rodriguez are just a few of the A-listers who’ve used PRP. But what, exactly, is this trendy treatment?

PRP for back painCan PRP help your back pain?

PRP is a form of regenerative medicine, meaning it can help your body heal and regrow your tissue. (Some even use it for hair regrowth and non-invasive facelifts.) Put simply: With PRP therapy, you get an injection of your own blood plasma, supercharged with a high concentration of platelets after a spin in the centrifuge. Those platelets trigger tissue healing and growth.

At least, that’s what supporters and proponents claim. If PRP is good enough for pro athletes, you may wonder if it can help your regular-person back pain. The unsatisfying answer: It’s too early to know for sure.

Benefits of PRP for Back Pain

Many of the studies on PRP for back pain have been done in animals. That’s part of what we mean when we say research is “early.” Positive results in animal studies are a good basis for more studies in humans, but it’s hard to draw any firm conclusions. After all, humans are not mice, or lionfish, or even chimps, and compounds that behave one way in animal subjects may act very differently in humans. This early research is promising, though, especially for back pain due to disc degeneration.

A 2019 review in the Journal of Pain Research highlights studies that suggest PRP may restore both structure and function in spines affected by disc degeneration. In 2017, Asian Spine Journal published results of a preliminary clinical trial of 14 people with chronic low back pain and some evidence of disc degeneration. After PRP treatment, all participants reported less pain one month and even six months later.

“Growth factors produced by the concentrated platelets in PRP may restore the integrity of [important substances in] degenerating discs,” says Anis Mekhail, MD, a spine surgeon at Parkview Orthopaedic Group outside Chicago. “The antiapoptotic effects and anti-inflammatory effects of PRP may contribute to disc repair and symptom relief in patients.” (Something that is antiapoptotic, or anti-apoptotic, means it prevents a certain type of cell death.) 

PRP has a longer and more robust record of success for other musculoskeletal problems, including rotator cuff tears, Achilles tendon injuries, and chronic tendinosis. Orthopedic surgeon Nirav Shah, MD, a colleague of Dr. Mekhail at Parkview Orthopaedic Group, uses PRP frequently – but he’s a sports medicine specialist, not a spine surgeon.

“In the younger athletic population, I find PRP useful for some acute injuries, including hamstring injuries, patellar tendon strain, or partial patellar tendon tear,” Dr. Shah says. “It also works in some other conditions [that often affect] the middle-aged population, such as tennis elbow and golfer’s elbow.”

Is PRP Effective for Back Pain?

PRP is an experimental treatment for back pain, but you wouldn’t know it judging by the number of providers who offer it. Some of their websites even make claims like, “PRP heals spinal damage from the inside-out.”

The disconnect between likely benefits and fanciful claims troubles some health professionals. They’ve voiced their concerns everywhere from the medical literature to the exam room.

The whole situation confuses patients: One doctor says PRP can help and is ready to schedule injections.  Another doctor says it’s unnecessary and won’t. It’s hard for the average patient to know who to believe about PRP. Often, the doc touting pain relief from an exciting new therapy has the advantage.

“There's a lot of hype, with professional athletes and celebrities publicizing PRP.  It is [not covered by insurance,] which means that anyone who is willing to pay for it will be able to get it, regardless of whether it's appropriate,” says Ai Mukai, MD, a physical medicine and rehabilitation specialist at Texas Orthopedics in Austin and SpineUniverse Editorial Board member.

Dr. Shah knows this scenario well. Recently, he saw a patient with no knee symptoms, but some minor cartilage loss visible on an MRI. The patient wanted PRP injections to prevent knee osteoarthritis. “I explained there is no evidence that PRP helps prevent or slow down the progression of an arthritic condition in the knee,” says Dr. Shah. “He still wanted the injections and said if I wouldn’t do them, he would find someone else who would.” Dr. Shah wished the patient well.

PRP Therapy: What to Expect

Do you feel compelled to try PRP therapy despite its limited evidence for spine conditions? If you’re willing to roll the dice and spend the money (potentially, anywhere from $300 to $2500), here’s what to expect.

  • Prep: Dr. Mukai says you’ll probably have to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen for about two weeks. “We think that the inflammation is provoking the body to heal so we don’t want to suppress that,” she says.
  • Procedure: Expect the PRP treatment to last about 30 minutes. First, you’ll have blood drawn from your arm. Then, your doctor will use a machine that separates platelet-rich plasma from the rest of the blood components. The PRP goes back into your body, guided by ultrasound and injected into  deep structures such as ligaments, tendons, and joints.
  • Post-treatment: You can likely return to normal activities after the procedure, with some simple caveats – like don’t wash or apply lotions to the treatment area for about 48 hours. For tendon injections, you’ll need to avoid strenuous exercise or activity for at least two to three weeks, and may need a post-PRP physical therapy regimen. You’ll probably be sore for a couple days, but if you have severe pain, call your doctor.

PRP back pain centrifugeYour blood will be spun in a centrifuge to separate the platelets.

Even if you don’t get the relief you hoped for, it probably won’t cause physical harm. PRP has a solid safety record. But Dr. Mukai cautions that the procedure isn’t risk-free. “With any injection, there's risk of infection,” she says. If the injection is not put in the proper place, it can cause tissue damage and nerve injury.

“Unfortunately, PRP can be a lucrative, ‘cash’ business, which means there are many financially motivated people out there without the proper knowledge and training,” Dr. Mukai adds. To help ensure the best possible outcome, seek a physician who “does the whole spectrum of care, not just a physician or practice that only does regenerative medicine.”  

Updated on: 02/11/21
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Ai Mukai, MD
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