Platelet Rich Plasma: What, When, Where?

Regenerative therapy is kind of on the forefront of new technologies that are being developed to help people with chronic pain. What you're really trying to do is heal damaged tissue, which is kind of a novel approach. In our field, we're used to giving a molecule to help with pain. And what we're trying to do now with these biomolecules--which is basically what they are--is to restore, repair, and heal damaged tissues. Platelet-rich plasma is acquired via venipuncture with the patient. The whole blood is then centrifuged usually twice to get the platelet-rich plasma. It's usually recombinated with bovine or calcium serum to activate it before it's injected. Typically, where we're seeing it used is in orthopedics via injections into tendons that have been damaged such as rotator cuff tears, ACL tears, things of that nature. It is usually done under direct ultrasound guidance to make sure we're injecting into the tendon rather than into the joint space. In terms of application for chronic pain conditions, the data provide some support for its use for chronic tendinopathies. In terms of injection into spinal disc material, that's still kind of on the forefront and we're still making advances in that area. A lot of the data that's coming out concerns injecting into disc material for patients with radiculopathy from disc bulges or disc herniations and seeing what the long-term effectiveness of that procedure is. Some contraindications to injection of platelet-rich plasma would be patients who have any thrombocytopenia, low platelet counts, history of active hematological cancers such as leukemia, lymphoma and patients who are on anticoagulants, like heparin or Coumadin.

Looking to future applications for PRP, it's really been shown to help with diabetic ulcers, non-healing chronic ulcers, whether they be diabetic or venous stasis ulcers. Currently the CMS has approved its use for patients with those conditions as long as they're enrolled in an active clinical trial. As of right now it's not covered by any major healthcare plan. It's still considered investigational and acquiring it is time-consuming. The venipuncture procedure, drawing of the blood, centrifuging it, takes on average 20 to 30 minutes before you're able to actually do the injections so it is time-consuming and it is pricy with patients paying out of pocket currently.