J Yeungnam Med Sci.  2022 Jul;39(3):206-215. 10.12701/jyms.2022.00290.

The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review

• Thu AC

• KMID: 2532073
• DOI: http://doi.org/10.12701/jyms.2022.00290

Abstract

Musculoskeletal pain is the most common pain reported by patients. Platelet-rich plasma (PRP) is widely used to treat musculoskeletal pain. However, the efficacy of PRP to treat this pain remains controversial. This review highlights the application of PRP in the treatment of musculoskeletal pain. PRP treatment appears to reduce pain and improve function in patients with musculoskeletal pain. However, there are limitations to the currently published studies. These limitations include the PRP preparation methods, type of activators, types of pathology to be treated, methods and times of administration, and association of PRP with other treatments.

Keyword

Humans; Musculoskeletal pain; Pain management; Platelet-rich plasma

Reference

References

1. Casser HR, Schaible HG. Musculoskeletal pain. Schmerz. 2015; 29:486–8. 490–5.

2. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81:646–56.

3. Marks R. Qigong and musculoskeletal pain. Curr Rheumatol Rep. 2019; 21:59.

4. Hawker GA. The assessment of musculoskeletal pain. Clin Exp Rheumatol. 2017; 35(5 Suppl 107):8–12.

5. Sepúlveda F, Baerga L, Micheo W. The role of physiatry in regenerative medicine: the past, the present, and future challenges. PM R. 2015; 7(4 Suppl):S76–80.

6. Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J. 2012; 32:150–63.

7. Alves R, Grimalt R. A review of platelet-rich plasma: history, biology, mechanism of action, and classification. Skin Appendage Disord. 2018; 4:18–24.

8. Bos-Mikich A, de Oliveira R, Frantz N. Platelet-rich plasma therapy and reproductive medicine. J Assist Reprod Genet. 2018; 35:753–6.

9. Alves R, Grimalt R. Randomized placebo-controlled, double-blind, half-head study to assess the efficacy of platelet-rich plasma on the treatment of androgenetic alopecia. Dermatol Surg. 2016; 42:491–7.

10. Cao Y, Zhu X, Zhou R, He Y, Wu Z, Chen Y. A narrative review of the research progress and clinical application of platelet-rich plasma. Ann Palliat Med. 2021; 10:4823–9.

11. Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020. Int J Mol Sci. 2020; 21:7794.

12. Linden MD. Platelet physiology. Methods Mol Biol. 2013; 992:13–30.

13. Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014; 16:204.

14. Wu CC, Chen WH, Zao B, Lai PL, Lin TC, Lo HY, et al. Regenerative potentials of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials. 2011; 32:5847–54.

15. Bendinelli P, Matteucci E, Dogliotti G, Corsi MM, Banfi G, Maroni P, et al. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J Cell Physiol. 2010; 225:757–66.

16. Solakoglu Ö, Heydecke G, Amiri N, Anitua E. The use of plasma rich in growth factors (PRGF) in guided tissue regeneration and guided bone regeneration: a review of histological, immunohistochemical, histomorphometrical, radiological and clinical results in humans. Ann Anat. 2020; 231:151528.

17. Gautam VK, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (Hong Kong). 2015; 23:1–5.

18. Kaushik A, Kumaran MS. Platelet-rich plasma: the journey so far! Indian Dermatol Online J. 2020; 11:685–92.

19. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy: future or trend? Arthritis Res Ther. 2012; 14:219.

20. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014; 73:1323–30.

21. Bliddal H. Definition, pathology and pathogenesis of osteoarthritis. Ugeskr Laeger. 2020; 182:V06200477.

22. Block JA, Cherny D. Management of knee osteoarthritis: what internists need to know. Med Clin North Am. 2021; 105:367–85.

23. Cugat R, Cuscó X, Seijas R, Álvarez P, Steinbacher G, Ares O, et al. Biologic enhancement of cartilage repair: the role of platelet-rich plasma and other commercially available growth factors. Arthroscopy. 2015; 31:777–83.

24. Anitua E, Sánchez M, Nurden AT, Zalduendo MM, de la Fuente M, Azofra J, et al. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology (Oxford). 2007; 46:1769–72.

25. Sun SF, Lin GC, Hsu CW, Lin HS, Liou IS, Wu SY. Comparing efficacy of intraarticular single crosslinked Hyaluronan (HYAJOINT Plus) and platelet-rich plasma (PRP) versus PRP alone for treating knee osteoarthritis. Sci Rep. 2021; 11:140.

26. Cook CS, Smith PA. Clinical update: why PRP should be your first choice for injection therapy in treating osteoarthritis of the knee. Curr Rev Musculoskelet Med. 2018; 11:583–92.

27. Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017; 12:16.

28. Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med. 2021; 49:249–60.

29. Zhao J, Huang H, Liang G, Zeng LF, Yang W, Liu J. Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2020; 21:224.

30. McLarnon M, Heron N. Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis. BMC Musculoskelet Disord. 2021; 22:550.

31. Repetto I, Biti B, Cerruti P, Trentini R, Felli L. Conservative treatment of ankle osteoarthritis: can platelet-rich plasma effectively postpone surgery? J Foot Ankle Surg. 2017; 56:362–5.

32. Paget LD, Reurink G, de Vos RJ, Weir A, Moen MH, Bierma-Zeinstra SM, et al. Effect of platelet-rich plasma injections vs placebo on ankle symptoms and function in patients with ankle osteoarthritis: a randomized clinical trial. JAMA. 2021; 326:1595–605.

33. Godoy-Santos AL, Fonseca LF, de Cesar Netto C, Giordano V, Valderrabano V, Rammelt S. Ankle osteoarthritis. Rev Bras Ortop (Sao Paulo). 2020; 56:689–96.

34. Vannabouathong C, Del Fabbro G, Sales B, Smith C, Li CS, Yardley D, et al. Intra-articular injections in the treatment of symptoms from ankle arthritis: a systematic review. Foot Ankle Int. 2018; 39:1141–50.

35. Derwich M, Mitus-Kenig M, Pawlowska E. Interdisciplinary approach to the temporomandibular joint osteoarthritis-review of the literature. Medicina (Kaunas). 2020; 56:225.

36. Zotti F, Albanese M, Rodella LF, Nocini PF. Platelet-rich plasma in treatment of temporomandibular joint dysfunctions: narrative review. Int J Mol Sci. 2019; 20:277.

37. Li FL, Wu CB, Sun HJ, Zhou Q. Comparison of autologous platelet-rich plasma and chitosan in the treatment of temporomandibular joint osteoarthritis: a retrospective cohort study. J Oral Maxillofac Surg. 2021; 79:324–32.

38. Sousa BM, López-Valverde N, López-Valverde A, Caramelo F, Fraile JF, Payo JH, et al. Different treatments in patients with temporomandibular joint disorders: a comparative randomized study. Medicina (Kaunas). 2020; 56:113.

39. Bousnaki M, Bakopoulou A, Koidis P. Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: a systematic review. Int J Oral Maxillofac Surg. 2018; 47:188–98.

40. Haigler MC, Abdulrehman E, Siddappa S, Kishore R, Padilla M, Enciso R. Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis: systematic review with meta-analyses. J Am Dent Assoc. 2018; 149:940–52.

41. Knezevic NN, Candido KD, Vlaeyen JW, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021; 398:78–92.

42. Chou R. Low back pain. Ann Intern Med. 2021; 174:ITC113-28.

43. Xuan Z, Yu W, Dou Y, Wang T. Efficacy of platelet-rich plasma for low back pain: a systematic review and meta-analysis. J Neurol Surg A Cent Eur Neurosurg. 2020; 81:529–34.

44. Sanapati J, Manchikanti L, Atluri S, Jordan S, Albers SL, Pappolla MA, et al. Do regenerative medicine therapies provide long-term relief in chronic low back pain: a systematic review and metaanalysis. Pain Physician. 2018; 21:515–40.

45. Schneider BJ, Hunt C, Conger A, Qu W, Maus TP, Vorobeychik Y, et al. The effectiveness of intradiscal biologic treatments for discogenic low back pain: a systematic review. Spine J. 2022; 22:226–37.

46. Jain D, Goyal T, Verma N, Paswan AK, Dubey RK. Intradiscal platelet-rich plasma injection for discogenic low back pain and correlation with platelet concentration: a prospective clinical trial. Pain Med. 2020; 21:2719–25.

47. Baig MZ, Abdullah UE, Muhammad A, Aziz A, Syed MJ, Darbar A. Use of platelet-rich plasma in treating low back pain: a review of the current literature. Asian Spine J. 2021; 15:117–26.

48. Urits I, Viswanath O, Galasso AC, Sottosani ER, Mahan KM, Aiudi CM, et al. Platelet-rich plasma for the treatment of low back pain: a comprehensive review. Curr Pain Headache Rep. 2019; 23:52.

49. Wu J, Zhou J, Liu C, Zhang J, Xiong W, Lv Y, et al. A prospective study comparing platelet-rich plasma and local anesthetic (LA)/corticosteroid in intra-articular injection for the treatment of lumbar facet joint syndrome. Pain Pract. 2017; 17:914–24.

50. Mohammed S, Yu J. Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain. J Spine Surg. 2018; 4:115–22.

51. Nowak Z, Chęciński M, Nitecka-Buchta A, Bulanda S, Ilczuk-Rypuła D, Postek-Stefańska L, et al. Intramuscular injections and dry needling within masticatory muscles in management of myofascial pain: systematic review of clinical trials. Int J Environ Res Public Health. 2021; 18:9552.

52. Sakalys D, Rokicki JP, Januzis G, Kubilius R. Plasma rich in growth factors injection effectiveness for myofascial pain treatment in masticatory muscles: randomised controlled trial. J Oral Rehabil. 2020; 47:796–801.

53. Yilmaz O, Sivrikaya EC, Taskesen F, Pirpir C, Ciftci S. Comparison of the efficacy of botulinum toxin, local anesthesia, and platelet-rich plasma injections in patients with myofascial trigger points in the masseter muscle. J Oral Maxillofac Surg. 2021; 79:88.

54. Scott A, Docking S, Vicenzino B, Alfredson H, Murphy RJ, Carr AJ, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med. 2013; 47:536–44.

55. Li A, Wang H, Yu Z, Zhang G, Feng S, Liu L, et al. Platelet-rich plasma vs corticosteroids for elbow epicondylitis: a systematic review and meta-analysis. Medicine (Baltimore). 2019; 98:e18358.

56. Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol. 2016; 17:101–12.

57. Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med. 2013; 126:357.

58. Hardy R, Tori A, Fuchs H, Larson T, Brand J, Monroe E. To improve pain and function, platelet-rich plasma injections may be an alternative to surgery for treating lateral epicondylitis: a systematic review. Arthroscopy. 2021; 37:3360–7.

59. Galatz LM, Gerstenfeld L, Heber-Katz E, Rodeo SA. Tendon regeneration and scar formation: the concept of scarless healing. J Orthop Res. 2015; 33:823–31.

60. Chen XT, Fang W, Jones IA, Heckmann ND, Park C, Vangsness CT Jr. The efficacy of platelet-rich plasma for improving pain and function in lateral epicondylitis: a systematic review and meta-analysis with risk-of-bias assessment. Arthroscopy. 2021; 37:2937–52.

61. Varshney A, Maheshwari R, Juyal A, Agrawal A, Hayer P. Autologous platelet-rich plasma versus corticosteroid in the management of elbow epicondylitis: a randomized study. Int J Appl Basic Med Res. 2017; 7:125–8.

62. Kemp JA, Olson MA, Tao MA, Burcal CJ. Platelet-rich plasma versus corticosteroid injection for the treatment of lateral epicondylitis: a systematic review of systematic reviews. Int J Sports Phys Ther. 2021; 16:597–605.

63. Muthu S, Patel S, Selvaraj P, Jeyaraman M. Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: systematic review & meta-analysis of randomised controlled trials. J Clin Orthop Trauma. 2021; 19:96–107.

64. Simental-Mendía M, Vilchez-Cavazos F, Álvarez-Villalobos N, Blázquez-Saldaña J, Peña-Martínez V, Villarreal-Villarreal G, et al. Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials. Clin Rheumatol. 2020; 39:2255–65.

65. Chen X, Jones IA, Park C, Vangsness CT Jr. The efficacy of platelet-rich plasma on tendon and ligament healing: a systematic review and meta-analysis with bias assessment. Am J Sports Med. 2018; 46:2020–32.

66. Ling Y, Wang S. Effects of platelet-rich plasma in the treatment of plantar fasciitis: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018; 97:e12110.

67. Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-rich plasma versus corticosteroids for plantar fasciitis: a systematic review of randomized controlled trials. Orthop J Sports Med. 2020; 8:2325967120915704.

68. Hosny N, Goubran F, BadrEldin Hasan B, Kamel N. Assessment of vascular endothelial growth factor in fresh versus frozen platelet rich plasma. J Blood Transfus. 2015; 2015:706903.

69. Alkhatib N, Salameh M, Ahmed AF, Alkaramany E, Ahmed G, Mekhaimar MM, et al. Platelet-rich plasma versus corticosteroids in the treatment of chronic plantar fasciitis: a systematic review and meta-analysis of prospective comparative studies. J Foot Ankle Surg. 2020; 59:546–52.

70. Fei X, Lang L, Lingjiao H, Wei C, Zhou X. Platelet-rich plasma has better mid-term clinical results than traditional steroid injection for plantar fasciitis: a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2021; 107:103007.

71. Chiew SK, Ramasamy TS, Amini F. Effectiveness and relevant factors of platelet-rich plasma treatment in managing plantar fasciitis: a systematic review. J Res Med Sci. 2016; 21:38.

72. Christian RA, Rossy WH, Sherman OH. Patellar tendinopathy: recent developments toward treatment. Bull Hosp Jt Dis (2013). 2014; 72:217–24.

73. Liddle AD, Rodríguez-Merchán EC. Platelet-rich plasma in the treatment of patellar tendinopathy: a systematic review. Am J Sports Med. 2015; 43:2583–90.

74. Kon E, Filardo G, Di Martino A, Marcacci M. Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Knee Surg Sports Traumatol Arthrosc. 2011; 19:516–27.

75. Tschon M, Fini M, Giardino R, Filardo G, Dallari D, Torricelli P, et al. Lights and shadows concerning platelet products for musculoskeletal regeneration. Front Biosci (Elite Ed). 2011; 3:96–107.

76. de Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, et al. Can platelet-rich plasma enhance tendon repair?: a cell culture study. Am J Sports Med. 2008; 36:1171–8.

77. Smith J, Sellon JL. Comparing PRP injections with ESWT for athletes with chronic patellar tendinopathy. Clin J Sport Med. 2014; 24:88–9.

78. Dupley L, Charalambous CP. Platelet-rich plasma injections as a treatment for refractory patellar tendinosis: a meta-analysis of randomised trials. Knee Surg Relat Res. 2017; 29:165–71.

79. Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A. Platelet-rich plasma versus focused shock waves in the treatment of jumper’s knee in athletes. Am J Sports Med. 2013; 41:795–803.

80. Unlu MC, Kivrak A, Kayaalp ME, Birsel O, Akgun I. Peritendinous injection of platelet-rich plasma to treat tendinopathy: a retrospective review. Acta Orthop Traumatol Turc. 2017; 51:482–7.

81. Fahy KE, Miller EM, Kobayashi Y, Gottschalk AW. Efficacy of platelet-rich plasma on symptom reduction in patellar tendinopathy. Ochsner J. 2021; 21:232–4.

82. Andriolo L, Altamura SA, Reale D, Candrian C, Zaffagnini S, Filardo G. Nonsurgical treatments of patellar tendinopathy: multiple injections of platelet-rich plasma are a suitable option: a systematic review and meta-analysis. Am J Sports Med. 2019; 47:1001–18.

83. Dadgostar H, Fahimipour F, Pahlevan Sabagh A, Arasteh P, Razi M. Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study. J Orthop Surg Res. 2021; 16:333.

84. Dickinson RN, Ayers GD, Archer KR, Fan R, Page C, Higgins LD, et al. Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. J Shoulder Elbow Surg. 2019; 28:833–8.

85. Lo IK, Denkers MR, More KD, Nelson AA, Thornton GM, Boorman RS. Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment. Open Access J Sports Med. 2018; 9:191–7.

86. Lin MT, Chiang CF, Wu CH, Huang YT, Tu YK, Wang TG. Comparative effectiveness of injection therapies in rotator cuff tendinopathy: a systematic review, pairwise and network meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2019; 100:336–49.

87. Zhou Y, Wang JH. PRP treatment efficacy for tendinopathy: a review of basic science studies. Biomed Res Int. 2016; 2016:9103792.

88. Chen X, Jones IA, Togashi R, Park C, Vangsness CT Jr. Use of platelet-rich plasma for the improvement of pain and function in rotator cuff tears: a systematic review and meta-analysis with bias assessment. Am J Sports Med. 2020; 48:2028–41.

89. A Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: a systematic review and meta-analysis. PLoS One. 2021; 16:e0251111.

90. Giovannetti de Sanctis E, Franceschetti E, De Dona F, Palumbo A, Paciotti M, Franceschi F. The efficacy of injections for partial rotator cuff tears: a systematic review. J Clin Med. 2020; 10:51.

91. Lin MT, Wei KC, Wu CH. Effectiveness of platelet-rich plasma injection in rotator cuff tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Diagnostics (Basel). 2020; 10:189.

92. Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther. 2009; 39:135–48.

93. Thu AC, Kwak SG, Shein WN, Htun M, Htwe TT, Chang MC. Comparison of ultrasound-guided platelet-rich plasma injection and conventional physical therapy for management of adhesive capsulitis: a randomized trial. J Int Med Res. 2020; 48:300060520976032.

94. El-Sharkawy H, Kantarci A, Deady J, Hasturk H, Liu H, Alshahat M, et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007; 78:661–9.

95. Karabaş Ç, Talay Çalış H, Topaloğlu US, Karakükçü Ç. Effects of platelet-rich plasma injection on pain, range of motion, and disability in adhesive capsulitis: a prospective, randomized-controlled study. Turk J Phys Med Rehabil. 2021; 67:462–72.

96. Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, et al. Single intra-articular platelet-rich plasma versus corticosteroid injections in the treatment of adhesive capsulitis of the shoulder: a cohort study. Am J Phys Med Rehabil. 2019; 98:549–57.

97. Shahzad HF, Taqi M, Gillani SF, Masood F, Ali M. Comparison of functional outcome between intra-articular injection of corticosteroid versus platelet-rich plasma in frozen shoulder: a randomized controlled trial. Cureus. 2021; 13:e20560.

98. Kearney RS, Ji C, Warwick J, Parsons N, Brown J, Harrison P, et al. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021; 326:137–44.

99. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014; 2014:CD010071.