We now have a meta-analyis of 10 level 1 studies (level 1 being the highest calibre of studies) showing that platelet-rich plasma (PRP) should be offered for knee osteoarthritis as it is more effective than hyaluronic acid injections (a frequently used treatment) at the 1 year mark. You can find the article about this under our research tab. This is encouraging news for those of us offering and receiving PRP.
The CAOM holds annual conferences in Regenerative Medicine and this year we met in Vancouver. It is always stimulating to listen to excellent speakers in the field, meet old colleagues and new, and exchange information that makes all of us better practitioners. This year we heard an excellent talk on nutrition and its importance by Dr Aileen Burford-Mason - this will have its own blog entry. In addition we had workshops on prolotherapy, platelet-rich plasma and ultrasound-guided techniques. Erik Ouellette, well-respected prolotherapist from Ontario gave a great lecture on injecting the shoulder, and followed up by doing just that. Physicians presented new research studies, some so new they haven't been published quite yet, and our North Vancouver colleague Dr Helene Bertrand discussed her positive shoulder prolotherapy study which has been accepted for publication. Kelowna physician Dr Francois Louw piqued our interest with favourable early trends in his TMJ (jaw) pain study. We came away tired but grateful to belong to such a good organization.
More people are becoming familiar with platelet-rich plasma, or PRP. This is an effective treatment for musculoskeletal pain which involves having your blood drawn, much like a lab test, centrifuging it into red cells, white cells and platelets, and removing the concentrated platelet section containing liquid gold growth factors (and there are many of these!). This PRP is injected into the area of concern (for example the knee joint) to begin the regeneration of healthy tissue needed for recovery. PRP is similar to prolotherapy in that it stimulates tissue repair, but it can speed up the healing process enormously. Our new system provides a whopping 8x concentration of the platelets and we think this leads to its effectiveness. While not guaranteed to work for everyone, it is gratifying for most. For more information see our updated FAQ page; and also our Links page for some studies on platelet-rich plasma.
An interesting study was published recently. Having a knee arthroscopy (a surgical procedure with a "telescope" looking into the knee, and cleaning out any part that is rough or loose) does not improve pain. Many, many people suffer from knee arthritis and so this is helpful in deciding on a course of action. Having a knee replacement may be the eventual answer, but in the mean time regenerative injections (perineural injecting of dextrose, or prolotherapy, or PRP) can be a big help in reducing symptoms, and may even prevent the "kneed" to do surgery at all.
The University of BC regularly sends out articles by physicians who have found some aspect of medicine has changed the way they practice. I have been meaning to send them my views on the subject and here they are! Thank you to the many patients over the years who have taught me so much about the treatment of pain.
We now offer this cutting-edge therapy to our patients. More about platelet-rich plasma, or PRP, can be found under our FAQs tab. This is what the process look like: 15 ml of your blood is withdrawn, then centrifuged to separate it into red cells, platelets, and platelet-rich yellow plasma at the top. The plasma is then re-injected into a painful joint, ligament or tendon junction. This sets off the inflammatory cascade of healing, and once the initial discomfort has settled, growth factors in the plasma stimulate the production of healthy new tissue to facilitate healing. It is a quicker way to stimulate healing than prolotherapy, but it is also a more expensive procedure, although typically fewer PRP treatments are needed than prolotherapy treatments to achieve the same degree of healing. Sometimes PRP is combined with prolotherapy for the best effect. PRP is usually given into the affected joint, with prolotherapy given to the surrounding ligaments for stronger support.
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.