This article has been updated with new research findings on PRP injections and low back pain.
In 2019 we published our study on the effectiveness of PRP treatments for the patient for chronic low back pain. The study appears in the journal Cogent Medicine.(1)
This research gives an insight into what level of treatment success we can have with certain back pain conditions and how many PRP treatments the patient should expect towards achieving their treatment goals.
At our practice we utilize Platelet-Rich Plasma as one of our injection treatments for the patient with chronic low back pain. We may also utilize bone marrow derived stem cell therapy. The decision as to which one of these treatments to use is based on an examination in the office and an assessment of the person’s pain and functional difficulties along with the patient’s goal of treatment. Someone who needs to return to work as a landscaper will have a different treatment priority than a retired individual with lesser physical demands on his/her back.
In this study, we demonstrated PRP outcomes in 67 of our patients.
Let’s get to our study:
In our research, Treatment of Chronic Low Back Pain with Platelet-Rich Plasma Injections, we wrote:
- Platelet-Rich Plasma (PRP) is a non-invasive modality that has been used to treat musculoskeletal conditions for the past two decades. Based on our research, there were no publications that studied the effect of PRP on unresolved lower back pain. The aim of this study was to report the clinical outcomes of patients who received PRP injections to treat unresolved lower back pain.
- 67 patients underwent a series one, two, or three PRP injections into the ligaments, muscle, and fascia surrounding the lumbar spine.
- Patients who received two treatments received injections a mean 24 days apart and patients who received three treatments received injections a mean 20.5 days apart.
- Baseline and post-treatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared to baseline and between groups.
- Patients who received one PRP injection reported 36.33% overall improvement and experienced significant improvements in active pain relief. These same patients experienced improvements in resting pain and functionality score, yet these results were not statistically significant.
- Patients who received a series of two and three treatments experienced significant decreases in resting pain and active pain and reported 46.17% and 54.91% total overall improvement respectively. In addition, they were able to perform daily activities with less difficulty than prior to treatment.
The learning points of our study: Patients returning to everyday activities, Patients reporting immediate clinical benefit
Our results demonstrated that PRP injections may be a viable conservative approach to treat lower back pain in regards to getting patients back to their everyday activities and improving pain and function.
- Patients quickly returning to everyday activities:
- Our study demonstrated that one, two or three PRP treatments were effective in significantly reducing active pain in the lower back. Additionally, functionality scores were significantly increased showing that patients were able to quickly return to everyday activities.
- An immediate clinical benefit:
- Patients experienced an improvement in resting pain and functionality score after the one treatment, however, statistical significance was demonstrated only after the second and third treatments. Yet, self-reported mean total improvement was 36.33%, 46.17%, and 54.91% at the first, second and third treatments, respectively, suggesting an immediate clinical benefit.
Our explanation of how PRP works
- PRP is fast, non-invasive procedure that has been studied as an alternative treatment for low back pain and musculoskeletal injuries in the recent decade.
- The treatment invokes immunomodulatory effects (it activates the immune and repair response and as well as angiogenic (formation of new blood vessels) properties that facilitate healing.
- The exact mechanism of PRP is not known, but current research points to cytokines (small cells that set up communications between cells to coordinate the healing response), growth factors and other proteins as the main medium through which PRP works.
To learn more about PRP visit our page on Platelet Rich Plasma Research
Demonstration of PRP treatment
There is no sound on this video. The video demonstrates PRP injection into the lower back. The procedure is well tolerated, simple and in the hands of an experienced physician is a multiple injection treatment given in rapid succession. In our many years of experience, this type of PRP treatment offers the patient reliable and effective results such as those demonstrated in our study above.
By injecting PRP into the muscles, ligaments, and fascia surrounding the lumbar spine, we can improve the stability of your spine. This has been shown not only in the research discussed in this article, but in additional published studies. PRP injections can relieve lower back pain and may prevent future spinal disc problems.
Supportive research on PRP for low back pain
Despite our own findings and that of other researchers, many patients who visit us say that their doctors told them PRP would not help their back back. A study from May 2020 addressed this issue in the Journal of neurological surgery.(2)
“Platelet-rich plasma (PRP) may be beneficial for patients with low back pain. However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the efficacy of PRP for low back pain.”
The research team examined three randomized clinical trials involving 131 patients. Overall, compared with control intervention for low back pain, PRP injection was found to reduce pain scores significantly, improve the number of patients with more than 50% pain relief at 3 months, and offer relatively good patient satisfaction.
Research in the Journal of spine surgery (3) featured these findings which may help confirm that PRP injections are a viable option to low back pain.
- Clinical studies presented in this research clearly demonstrate the growing interest in offering PRP injections for treating back pain
- These same clinical studies examined PRP injections as a therapy for discogenic low back pain and reported good results overall.
- A major and notable advantage of the therapy is the safety of the autologous PRP itself, which does not cause any major complications.
- Because autologous PRP is obtained from the patient’s own blood, PRP therapy carries low risks of disease infection and allergic reaction.
Clinical benefits reported:
- Research on PRP therapy has demonstrated remarkable improvements in pain intensity according to a variety of pain scores.
- The clinically-beneficial effects have enabled patients to return to normal physical activity.
Clinical concerns reported:
- PRP therapy will be more efficient if applied before disc degeneration reaches an advanced stage.
Conclusion of this research:
“(the authors of this study) described clinical evidence from the literature and presented an update on the use of PRP therapy for the treatment of discogenic low back pain. It is evident from our review that PRP is a safe, effective and feasible treatment modality and is evolving as a powerful therapy for the treatment of discogenic back pain. Considering the remarkable progress made already, and the other potential aspects which remain for further investigation, PRP therapy undoubtedly offers new and exciting prospects for the treatment of degenerative disc disease and other musculoskeletal disorders.”
The possible application of PRP injection as a safer alternative to steroid.
A May 2021 study (4) comparted the use of PRP vs Transforaminal steroid injection.
“Transforaminal steroid injection is extensively used as a treatment in cases of herniated disc, but it is associated with complications. In comparison, platelet-rich plasma (PRP) injection has been used in musculoskeletal disorders and could be another option. This study is aimed at comparing the efficacy and safety aspects between ultrasound-guided transforaminal injections of PRP and steroid in patients who suffer from radicular pain due to lumbar disc herniation. In a randomized controlled trial, ultrasound-guided transforaminal injections of either PRP (in 61 patients) or steroid (in 63 patients) were administered to a total of 124 patients who suffer from radicular pain due to lumbar disc herniation. . . No complications were reported. The results showed similar outcome for both transforaminal injections using PRP and steroid in the treatment of lumbar disc herniation, suggesting the possible application of PRP injection as a safer alternative.”
PRP injections not into the disc but into the supporting spinal ligament structures
In my article, When is back pain a disc problem? When is back pain a spinal ligament problem? I discuss the challenges patients may find themselves facing when it comes to understanding if their back pain is coming from the dics, or, is actually coming from spinal instability caused by the degenerative condition of the many spinal ligaments that are no longer holding the vertebrae in the proper alignment. In this article I discuss a paper from doctors at the Mayo Clinic where the researchers suggest a clear distinction between two problems affecting low back pain patients.
- First, that pain could be coming from the discs.
- Second that pain could be coming from the spinal ligaments.
The Mayo researchers suggest that recognizing how the spine moves is essential for distinguishing between the many different types of spinal disorders, and a diagnosis which may ultimately, and erroneously lead to back surgery.
- If a patient has instability, excessive movement, and decreased stiffness, doctors should examine for ligament damage.
- If the opposite, less movement, more stiffness, the doctor should look for disc disease.(5)
In our own recently published and companion research: Treatment of Lower Back Pain with Bone Marrow Concentrate (6) we discuss the injections of bone marrow cells not directly into the discs, but into the supportive spinal ligaments. This is what we documented:
- The patients in the present study were injected with Bone Marrow Concentrate into the muscles, fascia, and ligaments surrounding the lumbar spine.
- It has been well documented in literature that stem cells and platelets in the concentrate enhance tendon and ligament healing.
- In patients who were diagnosed with ligament and fascial (connective tissue) sprains, we hypothesize that we can reduce patients’ low back pain by strengthening these anatomical areas.
In that same study we referenced the research that suggest that the spinal ligaments should be a main focus of treatment for back pain.
In a November 2018 study (7) titled: Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain? Offered this assessment:
“The findings of this systematic review and single-arm metaanalysis shows that MSCs (stem cells) and PRP may be effective in managing discogenic low back pain, radicular pain, facet joint pain, and sacroiliac joint pain, with variable levels of evidence in favor of these techniques.”
- In Orthopaedic Knowledge Update from the American Academy of Orthopedic Surgeons tells its surgeon members that muscle strains, ligament sprains, and muscle contusions account for up to 97% of low back pain in the adult population (8)
- Additionally, researchers wrote in the Spine Journal that spinal ligaments are often neglected compared to other pathology that account for low back pain (9). This could be due to the over reliance of MRIs to guide physicians to correct diagnoses. They write: “The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint pain are described being related to these ligaments. When these ligaments are damaged or weakened, they serve as generators of low back pain.
- Two studies illustrate that patients without symptomatic back pain displayed MRI abnormalities including degenerative disc changes [10,11].
- In the first study researchers wrote that “imaging findings, including degenerative changes, reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant. . . Many treatments (therefore) have proven inefficacious, and some have proven counterproductive, (because of erroneous interpretation)
- In the second study, researchers wrote that in making treatment decisions, “patients overemphasize the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management. These misconceptions have the potential to alter patient expectations and decrease satisfaction, which could negatively impact patient outcomes and subjective valuations of physician performance.”
- Yet patients with these same diagnoses are recommended for surgery without a thorough understanding of their pain generator.
- Canadian researchers found that 55.7% of lumbar spine MRIs were considered inappropriate or of uncertain value to diagnosis [12).
What the research shows us is that surgeons to be on the lookout, the MRI can be misleading and send a patient to surgeon with a “disc problem.”
Do you have questions? Ask Dr. Darrow
Marc Darrow, MD. JD., discusses the treatment philosophy of the Darrow Stem Cell Institute. Transcript of video
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
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Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.
1 Marc Darrow, Brent Shaw, Schmidt Nicholas, Xian Li & Gabby Boeger. Tsai-Ching Hsu (Reviewing editor:) (2019) Treatment of unresolved lower back pain with platelet-rich plasma injections, Cogent Medicine, 2 Xuan Z, Yu W, Dou Y, Wang T. Efficacy of Platelet-rich Plasma for Low Back Pain: A Systematic Review and Meta-analysis [published online ahead of print, 2020 May 21]. J Neurol Surg A Cent Eur Neurosurg. 2020;10.1055/s-0040-1709170. doi:10.1055/s-0040-1709170
3 Mohammed S, Yu J. Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain. J Spine Surg. 2018;4(1):115-122.
4 Xu Z, Wu S, Li X, Liu C, Fan S, Ma C. Ultrasound-Guided Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar Disc Herniation: A Prospective, Randomized, Controlled Study. Neural Plasticity. 2021 May 27;2021.
5 Ellingson AM, Shaw MN, Giambini H, An KN. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Comput Methods Biomech Biomed Engin. 2015 Sep 24:1-10.
6 Marc Darrow, Brent Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461.
7 Sanapati J, Manchikanti L, Atluri S, et al. Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis. Pain Physician. 2018;21(6):515‐540.
8 An HS, Jenis LG, Vaccaro AR (1999) Adult spine trauma. In Beaty JH (Eds.). Orthopaedic Knowledge Update 6. Rosemont, IL: American Academy of Orthopedic Surgeons pp. 653-671
9 Hammer N, Steinke H, Lingslebe U, Bechmann I, Josten C, Slowik V, Böhme J. Ligamentous influence in pelvic load distribution. Spine J. 2013 Jun 5. pii: S1529-9430(13)00402-6. doi: 10.1016/j.spinee.2013.03.050.
10 Kovacs FM, Arana E (2016) Degenerative disease of the lumbar spine. Radiologia 58(1): 26-34.
11 Franz EW, Bentley JN, Yee PPS, et al. (2015) Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine 22(5): 496-502.
12 Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE (2013) Overuse of Magnetic Resonance Imaging. JAMA Intern Med 173(9): 823-825.