Platelet-Rich Plasma Injections: Pharmacological and Clinical Considerations in Pain Management


Purpose of review: Regenerative medicine through interventional pain procedures is evolving with data demonstrating efficacy for a number of pain states in recent years. Platelet-rich plasma (PRP), defined as a sample of plasma with a platelet concentration 3 to 5 times greater than the physiologic platelet concentration found in healthy whole blood, releases bioactive proteins which can restore anatomical function in degenerative states. PRP is dense in growth factors, such as platelet-derived growth factor, transforming growth factor-beta1, basic fibroblastic growth factor, vascular endothelial growth factor, and epidermal growth factors.

Recent findings: To date, well-designed case-control or cohort studies for the use of PRP have demonstrated efficacy in lumbar facet joint, lumbar epidural, and sacroiliac joint injections. At present, there is only level IV evidence indicating the need for larger and more carefully controlled prospective studies. PRP is utilized autogenously in order to facilitate healing and injection and has been studied in the long-term management of discogenic low back pain. In this regard, numerous studies have evaluated PRP to steroid injections in chronic pain states with favorable results. PRP represents an opportunity for a new strategy in the therapeutic treatment of degenerative states of spines, joints, and other locations throughout the body with evolving data demonstrating both safety and long-term efficacy.

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What Is a Platelet-Rich Plasma (PRP) Facial?


As we age, we notice many changes in our bodies. Many obvious changes take place in our skin. Do you have wrinkles and facial lines that you want to get rid of without surgery? Well, the vampire facial or plasma-rich protein (PRP) facial may be your answer. It triggers collagen production and, via micro-needling, it improves skin tone and texture.

Platelet-rich plasma (PRP) facials became popular with plastic surgery because of their role in wound healing. PRP has a high concentration of platelets. which allows for the formation and release of growth factors and active proteins that promote healing. It is widely used in facial skin rejuvenation.

What is the PRP Procedure for the Face?

PRP facials are not cosmetic procedures, but rather medical procedures. The person doing the procedure takes a sample of your blood and isolates the protein-rich plasma and platelets to create the PRP.

A centrifuge is spun around to extract protein-rich plasma. The platelets are also removed. The sample is then concentrated and called platelet-rich plasma (PRP). The high levels of growth factors in the PRP help the body to heal. Dermatologists began using PRP to promote the growth of collagen. Orthopedics inject PRP to heal joints of the knees, ankles, and elbows.

The full effect of PRP facial treatments appears in a few weeks to months. PRP is given to enhance someone’s appearance, so the cost is not covered by medical insurance.

How Does the PRP Facial Work?

There are different ways to get the PRP facial. In the first option, the plasma is spread on your face, after which micro-needling across the forehead and cheeks helps the face absorb proteins. Microneedling is a procedure that makes a series of superficial, tiny holes using sterile needles. Both the micro-needling and the PRP stimulate collagen growth.

PRP Benefits for Face

The PRP facial can be beneficial to people who have wrinkles, sun damage, or scars. By placing PRP back into the skin, cell proliferation is encouraged. This leads to an increase in elastin and collagen production. As a result, the skin will look tighter, fuller, and smoother.

In the areas with deeper wrinkles and lines, the doctor may also choose to use hyaluronic acid fillers or neuromodulators. These are Botox®-like wrinkle relaxing injections. Fillers restore the volume to the face that is naturally lost with aging. Facial muscles are kept from contracting by the neuromodulators. The neuromodulators help to reduce lines that occur from muscle overuse. This is inclusive of crow’s feet surrounding the eyes. These products can be used together to treat the whole face.

For more information, please contact Miami Stem Cell (305) 598-7777 to schedule a free consultation with one of our US-Board Certified physicians.

Evaluation of Platelet-Rich Plasma Therapy for Peripheral Nerve Regeneration: A Critical Review of Literature

From the Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, China

Peripheral nerve injury (PNI) is a common disease in clinic, and the regeneration process of peripheral nerve tissue is slow, and patients with PNI often suffer from the loss of nerve function. At present, related research on the mechanism of peripheral nerve regeneration has become a hot spot, and scholars are also seeking a method that can accelerate the regeneration of peripheral nerve. Platelet-rich plasma (PRP) is a platelet concentrate extracted from autologous blood by centrifugation, which is a kind of bioactive substance. High concentration of platelets can release a variety of growth factors after activation, and can promote the proliferation and differentiation of tissue cells, which can accelerate the process of tissue regeneration. The application of PRP comes from the body, there is no immune rejection reaction, it can promote tissue regeneration with less cost, it is,therefore, widely used in various clinical fields. At present, there are relatively few studies on the application of PRP to peripheral nerve regeneration. This article summarizes the literature in recent years to illustrate the effect of PRP on peripheral nerve regeneration from mechanism to clinical application, and prospects for the application of PRP to peripheral nerve.


Peripheral nerve injury is a common nervous system condition associated with a high disability rate. Currently, the best treatment for nerve injury is restoring nerve continuity through microsurgical tension-free anastomosis or autogenous nerve transplantation. This treatment approach does not improve slow nerve regeneration and incomplete postoperative functional recovery. Thus, regeneration and repair of peripheral nerve injury is the focus of intense research.

Although injured nerve can be reconstructed the continuity, this, however, does not create a suitable microenvironment of nerve regeneration (Fowler et al., 2015). Platelet rich plasma (PRP) is a concentration of autologous platelets that releases various growth factors, hence promoting tissue regeneration. PRP has many applications. For example, in stomatology, a randomized controlled clinical trial showed that PRP and its derivatives prevent alveolar bone atrophy and enhance alveolar tissue regeneration (Ucak Turer et al., 2020). A multicenter, double-blind, randomized controlled trial in foot and ankle surgery showed that PRP injection outperforms traditional glucocorticoid injection in plantar aponeurosis treatment (Peerbooms et al., 2019). In sports medicine, a double-blind randomized control study showed that PRP injection can effectively improve healing of old meniscus injury (Kaminski et al., 2019). In chronic sports injury treatment, it is reported that pain relief and functional recovery of lateral humeral epicondylitis (tennis elbow) patients receiving PRP are better relative to controls (Mishra et al., 2014Merolla et al., 2017). In joint surgery, local PRP injection effectively relieves pain in patients with knee joint osteoarthritis, promoting functional recovery and its effects are superior to traditional hyaluronic acid (Duymus et al., 2017Lisi et al., 2018). In ophthalmology, PRP can be used to treat secretory dry eye (García-Conca et al., 2019). PRP is also reported to significantly accelerate wound healing (Mohamadi et al., 2019Zhang et al., 2019). PRP applications are summarized in Table 1.

Table 1

www.frontiersin.orgTABLE 1. Summary of clinical application of PRP.

In conclusion, decades of clinical practice show that PRP promotes tissue repair and regeneration. Moreover, this approach does not need special equipment and training, and is cost effective, making it of great value in regenerative medicine (Etulain, 2018). Here, we comprehensively review the effects of PRP on peripheral nerve regeneration, the mechanisms underlying PRP promotion of peripheral nerve regeneration, and PRP clinical applications for peripheral nerve regeneration.

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The second phase of a clinical trial for patients to regain their sense of taste and smell is about to begin, and it is showing promising results.

Otolaryngologist Dr. David Rosen has been helping patients restore their sense of taste and smell after respiratory infections for two decades. When the COVID-19 pandemic hit, a concerning number of people were experiencing this overwhelming side effect. Traditional therapy to treat this condition can require a painful injection directly up the nostril to the olfactory nerve. But, Dr. Rosen began trying a less invasive treatment using a topical application of platelet-rich plasma (PRP) into the nose to stimulate cell regrowth and restore taste and smell. This therapeutic approach, which shows some success, is now entering into phase II clinical trial. Nancy, a patient suffering from persistent anosmia after a COVID diagnosis in 2021, shared how this trial has helped her senses begin to return.

We spoke with Dr. Rosen and otolaryngologists, Drs. Glen D’Souza and Alexander Duffy, about how the clinical trial is helping patients.

How is COVID causing loss of taste and smell?

Rosen: COVID is directly binding to the lining of the nose through a particular receptor called the ACE-2 receptor. The nose lining gets damaged, along with the cells it supports called the olfactory cells, commonly known as the smell cells. Because they lose the supporting cells, the olfactory cells can’t function properly.

How does treatment to regain taste and smell begin?

Rosen: First, we prescribe an oral steroid, work with patients through olfactory training (smell training), and suggest they begin taking supplements, such as V vitamin A, alpha-lipoic acid, sodium citrate, or omega 3. They can also use an over-the-counter nasal steroid. If they don’t recover within six months, we start trying more aggressive treatments, such as the one used in our clinical trial.

Can you tell us more about the treatment offered in the clinical trial?

Rosen: We are taking a patient’s blood and spinning it down to remove the red cells and saving the plasma, which has all the platelets in it. We take the PRP, and we apply that topically into the nose. This helps the cells regenerate because PRP can help cell regeneration throughout the body, for example, hair regrowth.

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Doctors Feel Hopeful About Restoring Taste and Smell Loss After COVID

Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome



Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1–2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.


Carpal tunnel syndrome (CTS) can be treated by both conservative (Klauser et al., 2009) and surgical interventions. Surgical decompression of the median nerve through the incision of the transverse carpal ligament (either open or mini-open or under ultrasound guidance) is the most cost-effective therapeutic option (Hui et al., 2005). However, mild to moderate CTS can be treated by conservative interventions, like functional braces and local infiltrations (Prime et al., 2010) in the carpal tunnel, mainly with corticosteroids. Local infiltration of corticosteroids easily leads to atrophy of the median nerve, subcutaneous fat, and systematic complications, such as hair loss and Cushing syndrome (Lambru et al., 2012). This treatment option is clearly inferior to surgical intervention despite the fact that it can improve clinical condition. There is evidence that local infiltration of corticosteroids is not superior to local injection of anesthetic (Karadas et al., 2012). To the best of our knowledgement, use of corticosteroids in the clinical practice has not been studied. However, a surgical treatment decision is always taken by the patient who sometimes wants to delay or avoid the surgery because of psychological or medical concerns including allergy to local anesthetic and immune deficiency and prefers a conservative treatment in the initial stage. A conservative treatment has been considered insufficient for CTS. In vitro and in vivo clinical and laboratory studies (Allampallam et al., 2000; Farrag et al., 2007; Cho et al., 2010; Anjayani et al., 2014; Park and Kwon, 2014) have demonstrated that platelet-rich plasma (PRP) has therapeutic action in several neuropathies. It would be interesting if a PPP injection is used as an alternative conservative treatment of CTS. The purpose of this study was to investigate if, and to what extent, a PPP injection, under ultrasound guidance, can improve the clinical condition of patients with CTS.

Materials and Methods

Fourteen patients were selected from initial 32 patients who received treatment in the Department of Orthopedics of “Konstantopouleio” General Hospital, Greece because of mild to moderate CTS, with a minimum of 3-month duration of symptoms, regardless of age and gender. Patients were rejected if they had one of the following items: thrombopenia, platelet dysfunction, local infection, NSAID use (less than 48 hours prior to injury), recent illness, malignancy, hemoglobin (Hb) level < 100 g/L, pregnancy, rheumatologic disease, uncontrolled hormonal disorder, vibrating caused neuropathy, systematic inflammatory disease, polyneuropathy, inability to complete questionnaires (due to language unawareness or mental disability), addicted to alcohol or drugs, total loss of sensation in the fingers, prior corticosteroid injection in the same wrist, had undergone a surgical intervention for CTS in the same hand, neurological deficit, cervical radiculopathy and/or cervical spinal stenosis and/or intervertebral disc herniation, nerve entrapment syndrome in the same hand.


PRP injection proved to be well tolerated, with no side effects, infections or complaints for persistent pain. We achieved well defined ultrasonographic mobilization, hydrodissection and hydrodisolution (Figure 2B) of the compressed median nerve through PRP simple injection.

At the end of the first month after PRP injection, the mean reduction in VAS (%) was 48.6 mm out of 100 mm in comparison to rates prior to injection. At that time, we found eight patients with full or almost full recovery (VAS: 0 – 20 mm) and three patients with great improvement (VAS decline: more than 30 mm). The mean decline of the Q-DASH score was calculated just a little less than 70% compared to the pre-injection rates (from mean Q-DASH 56.42 prior to injection to mean Q-DASH17.5 one month after). These rates slightly more improved 3 months later (Table 1).

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