Six main reasons why platelet-rich plasma injections fail (2023)

Published: 10/20/2017

We got an email the other day from someone who received a platelet-rich plasma (PRP) injection that didn't produce any results. “I wasn't impressed, it didn't work for me. They did it behind my back," he said. Comments like these are fraught with emotion, as nearly all of these patients paid for their PRP injections out of their own pockets. That's why the same patient also later added "...but I emptied my wallet" For us, your comment was one of the kindest. Others, who were genuinely angry to see their money wasted, called it fraud, quackery and "ways for doctors to make money". the fact that these treatments may have been a failure.

But the fact is, very few people, including some medical experts, understand why these PRP injections fail.

What does the tremendous popularity of PRP mean?

In the 1990s, there were about 150 new research papers on platelet-rich plasma each year. At least in the Pubmed database. At that time, only a select group of physicians who really understood the treatment offered it to their patients.Now, this year alone, there were more than 600 novelties.The trendline has gone from a gradual rise to a "U-curve" or explosive popularity.

And so did the number of doctors offering this treatment.

Money certainly wasn't the goal of these doctors, because if it were, the best way to do it would be to prescribe a battery of tests, drugs and surgeries approved by insurance. Instead, physicians began offering it as soon as they became well aware of the inherent benefits of an autologous interventional drug like platelet-rich plasma.

The problem is that not all doctors were passionate about it.

Some did so because patients asked for it. Some did it because everyone else was doing it. Others just wanted to try it casually.

So not all platelet-rich plasma injections worked. That's why, as the treatment has exploded in popularity, we've seen a small portion of these treatments turn out to be a waste of the patient's money, and this is talked about a lot because, as I mentioned earlier, the patient usually has a great emotional response to the outcome.

But, on the other hand, most patients are satisfied with the results.

"I did this on my injury and BOY DOES IT REALLY WORK!!!"

This is another response we received THE SAME DAY this woman told us it didn't work for her. Another doctor also told us on the same day,“The PRP works really well. We have had fantastic results in patients in the office.”

So what's making the difference?

Why do some PRP treatments work spectacularly while others fail?

This is what we will explain in the rest of this post here. There are six main reasons why it might fail. Another seventh not-so-common reason. Let's see them one by one.

1. Incorrect selection of patients

As much as platelet-rich plasma injection enthusiasts would like to beat the drum on its universality of application, there are certain instances where a PRP injection may be unnecessary. The classic case is demonstrated in2015 double-blind, randomized, placebo-controlled trialwhich proved that PRP injections are NOT beneficial.

According to expert researchers to whom we subscribe, it is clear that this study selected the WRONG PATIENTS!!!

That's what it means. This study, conducted by researchers at Rowan University Cooper School of Medicine in New Jersey, was conducted in the emergency care department, where patients who had just suffered an ankle sprain were given an injection of platelet-rich plasma.

Firstly, ankle sprains are a relatively acute medical condition, usually occurring due to overstretching and tearing of the muscle or tendon. And they usually heal on their own. What emergency doctors usually do for this condition is to apply ice packs or local anesthesia to numb the pain so that the patient can rest. For patients who are very active, their bodies can heal very quickly from most of these types of ankle sprains. For them, a PRP injection may not accelerate healing. On the other hand, because injections break down tissue and open holes, they can cause unnecessary complications.

This is why successful studies of platelet-rich plasma injections are almost always done on chronic wounds and injuries that do not heal on their own.If you want to test the effectiveness of PRP, the "control group" not treated with PRP must not be curable for us to clearly determine the effects of PRP.

Therefore, platelet-rich plasma injections are definitely not ideal for emergency care.

The same is true for patients on the other end of the spectrum. This is the category of patients who have been taking steroids and drugs for a long time and are in very advanced stages of the disease. While there may be hope, platelet-rich plasma may not be enough to turn the tide here.

The ideal candidate for platelet-rich plasma injection is a patient who has a relatively new chronic musculoskeletal condition and whose only other option is surgery or heavy steroid/drug use.

2. Use of certain drugs

One of the other reasons why platelet-rich plasma may not be ideal for emergency care patients is that when patients come in with severe pain, it is common practice for the emergency physician to administer strong local anesthetics and/or steroids at high rates. doses. The problem with both is that they are known to be toxic to stem cells and growth factors, as shownhere,hereyhere. Therefore, if you are using these steroids, anesthetics or medications, it is recommended to wait until the patient can wean them off before applying Platelet Rich Plasma. Otherwise, the toxicity of the chemicals can limit the platelet-rich plasma's ability to recruit stem cells to the area.

For example, the local anesthetic Marcaine has been found to be extremely harmful to stem cells, even in small amounts. So, as a general practice, the patient should avoid steroids, anesthetics, and harmful medications at the time of or up to 48 hours prior to PRP injections.

3. Lack of rehabilitation

It was reported thatPRP injection works well when combined with physical therapy.for sports injuries. However, some doctors mistakenly see PRP injections as an alternative to physical therapy. Hence comparisons like these wherePRP is presented as a rival of physical therapy. The fact is that platelet-rich plasma can only complement the effects of an adequate rehabilitation program.as illustrated in this studywho demonstrated that PRP + Physical Therapy is more effective than Dry Needling + Physical Therapy for patellar tendonitis.

However, there is one thing we must add to this. Most PRP injections are done in such a way as to break down the scar tissue and trigger a new healing response that the platelets can respond to. Therefore, the best rehabilitation program after platelet-rich plasma treatment is one that treats patients as if they had just suffered an acute injury. That is, the physiotherapeutic regimen after PRP injection must aim at the starting point: the stimulation of blood flow to the injured area to provoke the inflammatory response. This is a different approach than the usual one where the PT tries to attenuate the inflammatory response.

4. Low dosage

Underdosing is a serious problem in this field. If you are using PRP with a platelet concentration below 3X, you are underdosing your patients. An example is theEstudio PT vs PRPwe highlighted earlier. Not only did they erroneously conclude that Platelet Rich Plasma could be an alternative to Physical Therapy, but they were severely dosing patients using PRP with a platelet concentration of 2.1-2.5X.

Studies have shown that a concentration ofat least 1,000,000 platelets/µL are required for optimal therapeutic benefit.This is 5X the concentration of platelets in normal whole blood.Here is one such study..

This is the reason why we do not recommend using the gel-based PRP kit for PRP separation. The problem with the gel-based kit is that most of the platelets are trapped in the gel. instead of a teamlike the DrPRP kitprovides 5X-9X platelets because it uses a mechanical separation process while providing the same 1-step convenience as gel separators.

5. Using PRP as another injection

There is a fundamental difference between platelet-rich plasma-based orthopedic intervention and typical modern surgical and pharmacological treatment. And this is surgery, and drugs are designed to eliminate the symptoms of diseases. For example, pain is one of the many symptoms that occur when a certain part of the body is out of balance. By taking a medication, a steroid, an NSAID, or even undergoing surgical correction, the doctor hopes that the pain will go away. This approach has led to all the problems we face in modern orthopedic medicine. Because when we treat the symptoms, the underlying problems usually don't go away.

But dozens of doctors look at platelet-rich plasma with the same attitude. They inject platelet-rich plasma hoping the symptoms will go away.

That is NOT what Platelet Rich Plasma is for.

Platelet Rich Plasma is a HEALING AGENT. Is different. It is not designed to eliminate symptoms like a medicine. The only thing PRP can do is use the body to heal itself.

Therefore, the first task, whether you are an orthopedic surgeon or someone treating a musculoskeletal problem, is to IDENTIFY precisely what is causing your symptoms. This means looking at the connection between various muscles, tendons and ligaments. Understand how they work in unison and find out what is causing stress in the system. All muscles, ligaments and tendons are like different pieces of a jigsaw puzzle: they pull weights in sync with their functions. So if there is an anomaly throughout the image, then one of the puzzle pieces may not be able to do its job.

For a simple example, a hamstring strain could be the result of a sprained ligament or bone in the back caused by poor sitting posture. So, in addition to injecting PRP into your tendon, you may also need to inject it into your back bone or ligament. And advise the patient to change position.

This is the definition of Interventional Orthopedics.

And it requires extensive experience in anatomy, AND precise injections into the weakest links in the musculoskeletal system to improve overall body function. This means using image-guided technologies such as fluoroscopy (ultrasound guidance is not enough) to precisely place platelet-rich plasma in areas that require healing. These types of injections allow for efficient tissue regeneration and healing and are typically not taught in medical school, residency, or scholarship.

That's why we encourage doctors who offer PRP injections to make sureone of the courses of the non-profit Interventional Orthopedics Foundation.

Getting certified in advanced injection practices will make your platelet-rich plasma results more consistent. It is mandatory for all doctors offering PRP injections. It will also educate you on the different ways regenerative medicine is currently being used.

6. Thinking only about relieving pain

We touched on this a bit in the previous section, but this is a broad topic that deserves an explanation of its own. Platelet-rich plasma as a healing tool is not something you should use when your patients are in pain. Instead, PRP is used for a wide variety of conditions that don't involve pain, includingwound healing,reversal of skin aging,wrinkle correction,dry eye syndrome,nerve regeneration,bone union,capillary regenerationand even as a womanfertility restorationystrengthening the uterus.

The bottom line is... Platelet Rich Plasma is not just a tool to contain pain from sports injuries. Those days are long gone from us now. Today, all physicians, from family physicians to neurologists and cardiologists, fertility specialists and optometrists, dermatologists and hair restoration specialists... all use Platelet Rich Plasma.

Also, more and more apps are being discovered every day.

Platelet-rich plasma on its own, without funding from Big Pharma or the government, has become an integral part of modern medicine.

BONUS: The 7th Reason PRP Injections Fail

7. Platelet Superconcentration

We know that all analogies are imperfect, but we like to use the espresso analogy when it comes to platelets. Platelets are like espresso shots for healing. But just like espresso shots, your body cannot function on espresso shots alone. He needs food. That's why studies like this one by Giusti have shown that platelets with overfocusing can not only be useless, but also harmful. What they did was completely isolate platelets and platelets alone, and apply them in different concentrations to tendon cells to see if the higher concentrations hurt or helped. This is not platelet-rich plasma. That's just platelets.

And platelets alone cannot do the job. In fact, it has nothing to support cell survival.

Instead, platelet-rich plasma is rich in platelets and also includes a small portion of red blood cells, white blood cells, and the plasma serum that contains the nutrients cells need to survive.

This is why research shows that taking concentrations above 1,000,000 platelets/µL does not necessarily increase therapeutic benefits and, as Giusti's study pointed out, can actually have a detrimental effect.

This may not be a problem for the average doctor, but it is possible to make the mistake of thinking that a higher concentration is better. That's why we believechoosing the right platelet-rich plasma kitIt has an important role.

Because the kit has to produce platelet-rich plasma at the optimal concentration, not just platelets, for it to work every time it's given to the patient.

Patent application by Allan K Mishra

Discussing the composition of platelet-rich plasma, famed Stanford researcher and platelet-rich plasma pioneer Allan K. Mishra has recently filed a patent application titled "PLATELET-RICH PLASMA FORMULATIONS"what can be found here. In it, Mishra claims that he has identified a specific concentration of platelets, red blood cells, and white blood cells to treat damage to connective tissue and/or heart tissue. It's worth checking out if you're curious.

Add regenerative medicine to your practice

If you need help getting started with Platelet Rich Plasma, please don't hesitate to call us at(844) 377-7787for a quick reference. We can help you not only with providing all the necessary equipment, but also with the information you need to be a confident pioneer in this field. We look forward to having you as part of our family.

You can also send us an email via[email protected]ovisit our storeto order directly.

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