Platelet Rich Plasma Injections for Chronic Low Back Pain

Platelet-Rich Plasma Injections for Chronic Low Back Pain

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions using the contact form below. 

Earlier this year we have 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 or combine PRP treatment with Umbilical cord blood derived stem cell treatments. 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.

Methods: 

  • 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.

Results: 

  • 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 PLATELET RICH PLASMA PRP 

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.

There is no sound on this video. The simplicity of the injection treatment is demonstrated. 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

There is a growing body of evidence beyond our own research that suggests patient benefits and the ability to avoid or prolong the knee for spinal surgery with PRP treatments. Here will focus only on research that have appeared within the last 18 months of this article. (March 2018-September 2019)

Research in the Journal of spine surgery (2) 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.”(2)

In November 2018, surgeons realistically discussed the use of PRP and stem cell therapy for the long-term relief of low back pain. These doctors wrote in the journal Pain Physician: (3) “(our) findings . . . shows that MSCs (stem cell therapy) 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.”

PRP injections not into the disc but into the supporting spinal ligament structures

In our own recently published and companion research: Treatment of Lower Back Pain with Bone Marrow Concentrate (4) 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.

Treating these structures with Bone Marrow Concentrate we were able to report:

  • at one-year follow-up, 100% of (4) patients in this study experienced a decrease in resting and active pain in addition to performing daily activities with less difficulty.
  • All four patients experienced sustained or increased improvement at annual follow-up compared to short-term follow-up.
  • On average, patients reported an 80% decrease in resting pain, a 78% decrease in active pain, and a 41% increase in functionality score.

Are these treatments right for you?  We have more than 20 years experience in helping patients with low back pain and we have seen many different types of low back pain. Knowing if these treatments are right for you begins with a conversation:

Are you a candidate for treatment? Ask Dr. Darrow


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300

References:

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, DOI: 10.1080/2331205X.2019.1581449
2 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.
3 Jaya Sanapati MD, Laxmaiah Manchikanti MD, Sairam Atluri MD, Sheldon Jordan MD. Do regenerative medicine therapies provide long-term relief in chronic low back pain: A systematic review and metaanalysis. Pain physician. 2018 Nov;21:515-40.
4 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.

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Stem cell therapy for sacroiliac joint dysfunction

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about this article using the contact form below.

Patients will often come into our office with an MRI, low back pain and a diagnosis of sacroiliac joint dysfunction. They are in our office because they may have been told that they should consider a surgical recommendation to spinal fusion. For many of these people, the MRI was the confirmation that their surgeon needed to go ahead with the surgical recommendation.. For many patients, this may have been the same doctor who had taken them through a course of conservative treatments. These treatments may have included long bouts with anti-inflammatory medications, back braces, physical therapy, and cortisone/epidural injections.

All of these treatments did not help them. Why? A recent study in the Clinical Spine Journal (1) offers the suggestion that sacroiliac joint dysfunction patients do not get treatment relief because they do not have sacroiliac joint dysfunction. This may be somewhat difficult for you to believe because all along you have been told you have SI joint pain.

Look at what the doctors of this study reported: Confusion and a lot of it.

A person goes to the doctor for pain in the pelvic / hip / groin lower back region.

The currently reported incidence of primary sacroiliac joint ranges from 15% to 30%. (In other words 15% to 30% of these people will get a diagnosis of sacroiliac joint dysfunction.)
When they do not get a diagnosis of sacroiliac joint dysfunction, they may get a diagnosis of:

  • pain generated from the lumbar spine, (degenerative disc disease),
  • sacroiliac joint dysfunction, (but not as the primary cause of their pain and therefore not the primary target)
  • and the hip joint.

When these researchers re-examined these patients, with the goal of proving or disproving sacroiliac joint as the primary cause, what they found after a complete diagnostic workup was:

  • 112 (90%) had lumbar spine pain,
  • 5 (4%) had hip pain,
  • 4 (3%) had primary sacroiliac joint dysfunction pain, and
  • 3 (3%) had an undetermined source of pain upon initial diagnosis.

Patients did not have sacroiliac joint dysfunction as the primary source of their pain. In fact the sacroiliac joint was found to be a rare pain generator (3%-6%) in patients complaining of more than 50% sacroiliac joint region related pain. Pain in the sacroiliac joint area is commonly a referral pain from the lumbar spine (88%-90%).

This is why treatments including the use of cortisone will not work in patients with sacroiliac joint dysfunction. The wrong area is getting treated OR the right areas are not getting treated. The right areas may include:

  • The axial low back,
  • buttock/leg region
  • groin/anterior thigh region

Nerve blocks do not work for some patients with sacroiliac joint pain. The reason? The patient does not have primary sacroiliac joint dysfunction

I will often receive an email that will describe to me cortisone injections or nerve blocks that did not help the e-mailer with their low back pain. As we have seen in many patients, the hip-spine-sacroiliac joint complex is a challenging one to differentiate where the pain is coming from. Injections into the hip may not provide relief if the pain is in the sacroiliac joint region. Injections into the sacroiliac joint region may not work if the pain is from the hip or groin.

A study in the medical journal Pain Physician looked at various treatment recommendations for patients suffering from sacroiliac joint pain. These treatments incldued burning the nrves, freezing the nerves, applying cortisone and Botox.

The researchers found the following:

  • “The evidence for cooled radiofrequency neurotomy (freezing the nerve) in managing sacroiliac joint pain is fair.
  • The evidence for effectiveness of intraarticular steroid injections is poor.
  • The evidence for periarticular injections of local anesthetic and steroid or botulinum (Botox) toxin is poor.
  • The evidence for effectiveness of conventional radiofrequency neurotomy (burning the nerves) is poor.
  • The evidence for pulsed radiofrequency is poor.” (2)

Why did they find so many poor results? The chances are the patient did not have sacroiliac joint dysfunction.

Let’s look at another study. This time from June 2017 in the journal Medicine.(3) In this research, doctors from Korea investigated the degree of pain reduction following intra-articular pulsed radiofrequency stimulation of the sacroiliac joint in patients with chronic sacroiliac joint pain that had not responded to corticosteroid injection.

These research too found disappointing results:

  • Intra-articular pulsed radiofrequency stimulation of the sacroiliac joint was not successful in most patients (80% of all patients). Based on our results, we cannot recommend this procedure to patients with chronic sacroiliac joint pain that was unresponsive to corticosteroid injection. 

Here is where treatments that are not helping the sacroiliac joint can become dangerous. How so? Because they will lead to a surgery that will not work either.

Neurosurgeons suggest that treatment for sacroiliac joint pain should not include spinal fusion.

This is the title of a paper published in the journal Neurosurgery clinics of North America : “Sacroiliac Fusion: Another “Magic Bullet” Destined for Disrepute.” (4)

This is what the paper says:

“Pain related to joint dysfunction can be treated with joint fusion; this is a long-standing principle of musculoskeletal surgery. However, pain arising from the sacroiliac  joint is difficult to diagnose. . . Evidence establishing (successful) outcomes (of spinal fusion) is misleading because of vague diagnostic criteria, flawed methodology, bias, and limited follow-up. Because of nonstandardized indications and historically inferior reconstruction techniques, SI joint fusion should be considered unproven. The indications and procedure in their present form are unlikely to stand up to close scrutiny or weather the test of time.”

The challenge of sacroiliac joint dysfunction may be a ligament problem.

Doctors at the Mayo Clinic have published a paper entitled: Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. In this paper the Mayo Clinic researchers wanted to make a clear definition 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.(3)

This information can help determine the true cause of a patient’s sacroiliac joint dysfunction. When nothing is working, look at the ligaments. How do you look at the ligaments? Through physical examination.

A diagnosis which may ultimately, and erroneously lead to back surgery.

In our own published peer-review research appearing in the July 2018 in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018, (5) we examined treating spinal ligaments with low back pain. Below is an explanatory adaption of the introductory paragraph of that study. It gives a good understanding of the importance of understanding that we should be looking at the ligament problems in back pain.

    • An 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 (6)
    • Additionally, researchers wrote in the Spine Journal that spinal ligaments are often neglected compared to other pathology that account for LBP (7). This could be due to the overreliance 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.

Our treatment options

We offer stem cell therapy and Platelet Rich Plasma Therapy 

Darrow Stem Cell Institute research article published in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018. This article presents highlighted portions of that research.

You can read about 4 patient’s cases studies here:

Study’s findings: This is the first reported study treating low back with bone marrow aspirate (BMC) stem cell injections to the ligaments, fascia, and muscles surrounding the lumbar spine. It is promising that at one-year follow-up, 100% of patients in this study experienced a decrease in resting and active pain in addition to performing daily activities with less difficulty.

  • All four patients experienced sustained or increased improvement at annual follow-up compared to short-term follow-up.
  • On average, patients reported:
    • 80% decrease in resting pain,
    • 78% decrease in active pain,
    • and a 41% increase in functionality score.
  • Additionally, patients reported a mean 80% total overall improvement following
    treatment.
  • The two patients who considered surgery prior to BMC treatment no longer felt the need for it.
  • These results provide evidence that appropriately chosen patients with low back pain may find relief with BMC injections.

Ask Dr. Darrow about your sacroiliac joint pain


A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300

1 DePhillipo NN, Corenman DS, Strauch EL, Zalepa LK. Sacroiliac Pain: Structural Causes of Pain Referring to the SI Joint Region. Clinical spine surgery. 2018 Oct.
2 Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3):E247-78.
3 Chang MC, Ahn SH. The effect of intra-articular stimulation by pulsed radiofrequency on chronic sacroiliac joint pain refractory to intra-articular corticosteroid injection: A retrospective study. Medicine. 2017 Jun;96(26).
4 Bina RW, Hurlbert RJ. Sacroiliac Fusion: Another “Magic Bullet” Destined for Disrepute. Neurosurgery Clinics of North America. 2017 Jul 31;28(3):313-20.
5 Marc Darrow, Brent Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-2018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461. 5/
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

There is controversy in the medical community about umbilical cord blood stem cells. Some insist that the injectable solution contains abundant live umbilical cord blood stem cells. Some suggest that the stem cells are not alive. I have seen the flow cytometry showing live stem cells. The research shows that these stem cells release cytokines and growth factors that awaken native stem cells.  I have tried this treatment on myself for both shoulders and knees. After great success, I started using this treatment on patients. I still use PRP and bone marrow depending on the patient’s pathology and requirements. To date the results are excellent for all of these treatments. We are in the process of doing a study on cord blood stem cells (we have done others on bone marrow and PRP) to see which treatments are the most successful. We are awaiting more long term results.