Download PDF
J Neurol Surg A Cent Eur Neurosurg 2020; 81(06): 529-534
DOI: 10.1055/s-0040-1709170
Review Article

Efficacy of Platelet-rich Plasma for Low Back Pain: A Systematic Review and Meta-analysis

Zhaopeng Xuan
1   Department of Hand Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
,
Wenjun Yu
1   Department of Hand Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
,
Yichen Dou
1   Department of Hand Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
,
Tao Wang
1   Department of Hand Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background 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.

Methods PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials (RCTs) assessing the effect of PRP on low back pain were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was pain scores within 8 weeks. Meta-analysis was performed using the random-effects model.

Results Three RCTs involving 131 patients were included in the meta-analysis. Overall, compared with control intervention for low back pain, PRP injection was found to reduce pain scores significantly (mean difference: − 1.47; 95% confidence interval [CI], − 2.12 to − 0.81; p < 0.0001), improve the number of patients with > 50% pain relief at 3 months (risk ratio [RR]: 4.14; 95% CI, 2.22–7.74; p < 0.00001), and offer relatively good patient satisfaction (RR: 1.91; 95% CI, 1.04–3.53; p = 0.04). No increase in adverse events was reported after PRP injection (RR: 1.92; 95% CI, 0.94-3.91; p = 0.07).

Conclusions Compared with control intervention for low back pain, PRP injection was found to improve pain relief and patient satisfaction significantly with no increase in adverse events.

Keywords

low back pain - platelet-rich plasma - pain scores - systematic review - meta-analysis


Publication History

Received: 24 May 2019

Accepted: 22 October 2019

Article published online:
21 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Dunn KM, Hestbaek L, Cassidy JD. Low back pain across the life course. Best Pract Res Clin Rheumatol 2013; 27 (05) 591-600
    CrossrefPubMedGoogle Scholar
  • 2 Cassidy JD, Côté P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine 2005; 30 (24) 2817-2823
    CrossrefPubMedGoogle Scholar
  • 3 Opsommer E, Rivier G, Crombez G, Hilfiker R. The predictive value of subsets of the Örebro Musculoskeletal Pain Screening Questionnaire for return to work in chronic low back pain. Eur J Phys Rehabil Med 2017; 53 (03) 359-365
    CrossrefPubMedGoogle Scholar
  • 4 Paige NM, Miake-Lye IM, Booth MS. et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis. JAMA 2017; 317 (14) 1451-1460
    CrossrefPubMedGoogle Scholar
  • 5 Shiri R. Exercise for the primary prevention of low back pain. Br J Sports Med 2017; 51 (06) 551
    CrossrefPubMedGoogle Scholar
  • 6 Frank JW, Brooker AS, DeMaio SE. et al. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine 1996; 21 (24) 2918-2929
    CrossrefPubMedGoogle Scholar
  • 7 Suni JH, Taanila H, Mattila VM. et al. Neuromuscular exercise and counseling decrease absenteeism due to low back pain in young conscripts: a randomized, population-based primary prevention study. Spine 2013; 38 (05) 375-384
    CrossrefPubMedGoogle Scholar
  • 8 Burdorf A, Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health 1997; 23 (04) 243-256
    CrossrefPubMedGoogle Scholar
  • 9 Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1995; 20 (17) 1878-1883
    CrossrefPubMedGoogle Scholar
  • 10 Bell JA, Burnett A. Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review. J Occup Rehabil 2009; 19 (01) 8-24
    CrossrefPubMedGoogle Scholar
  • 11 Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med 2016; 176 (07) 958-968
    CrossrefPubMedGoogle Scholar
  • 12 Wroblewski AP, Mejia HA, Wright VJ. Application of platelet-rich plasma to enhance tissue repair. Oper Tech Orthop 2010; 20: 98-105
    CrossrefPubMedGoogle Scholar
  • 13 Monfett M, Harrison J, Boachie-Adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop 2016; 40 (06) 1321-1328
    CrossrefPubMedGoogle Scholar
  • 14 Drago L, Bortolin M, Vassena C, Taschieri S, Del Fabbro M. Antimicrobial activity of pure platelet-rich plasma against microorganisms isolated from oral cavity. BMC Microbiol 2013; 13: 47
    CrossrefPubMedGoogle Scholar
  • 15 Moussa M, Lajeunesse D, Hilal G. et al. Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res 2017; 352 (01) 146-156
    CrossrefPubMedGoogle Scholar
  • 16 Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med 2007; 35 (02) 245-251
    CrossrefPubMedGoogle Scholar
  • 17 Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM. Use of autologous platelet-rich plasma to treat muscle strain injuries. Am J Sports Med 2009; 37 (06) 1135-1142
    CrossrefPubMedGoogle Scholar
  • 18 Joshi SM, Mastrangelo AN, Magarian EM, Fleming BC, Murray MM. Collagen-platelet composite enhances biomechanical and histologic healing of the porcine anterior cruciate ligament. Am J Sports Med 2009; 37 (12) 2401-2410
    CrossrefPubMedGoogle Scholar
  • 19 Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med 2013; 41 (02) 356-364
    CrossrefPubMedGoogle Scholar
  • 20 Charousset C, Zaoui A, Bellaiche L, Bouyer B. Are multiple platelet-rich plasma injections useful for treatment of chronic patellar tendinopathy in athletes? A prospective study. Am J Sports Med 2014; 42 (04) 906-911
    CrossrefPubMedGoogle Scholar
  • 21 Spartalis E, Athanasiou A, Spartalis M, Moris D, Papalampros A, Nikiteas N. Platelet-rich plasma and peripheral nerve regeneration: a potential contraindication to its use after tumor excision. Expert Opin Biol Ther 2017; 17 (08) 1045-1046
    CrossrefPubMedGoogle Scholar
  • 22 Obata S, Akeda K, Imanishi T. et al. Effect of autologous platelet-rich plasma-releasate on intervertebral disc degeneration in the rabbit anular puncture model: a preclinical study. Arthritis Res Ther 2012; 14 (06) R241
    CrossrefPubMedGoogle Scholar
  • 23 Nagae M, Ikeda T, Mikami Y. et al. Intervertebral disc regeneration using platelet-rich plasma and biodegradable gelatin hydrogel microspheres. Tissue Eng 2007; 13 (01) 147-158
    CrossrefPubMedGoogle Scholar
  • 24 Kon E, Buda R, Filardo G. et al. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18 (04) 472-479
    CrossrefPubMedGoogle Scholar
  • 25 Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. platelet-rich plasma in ultrasound-guided sacroiliac joint injection for chronic low back pain. Pain Pract 2017; 17 (06) 782-791
    CrossrefPubMedGoogle Scholar
  • 26 Levi D, Horn S, Tyszko S, Levin J, Hecht-Leavitt C, Walko E. Intradiscal platelet-rich plasma injection for chronic discogenic low back pain: preliminary results from a prospective trial. Pain Med 2016; 17 (06) 1010-1022
    PubMedGoogle Scholar
  • 27 Tuakli-Wosornu YA, Terry A, Boachie-Adjei K. et al. Lumbar intradiskal platelet-rich plasma (PRP) injections: a prospective, double-blind, randomized controlled study. PM R 2016; 8 (01) 1-10 ; quiz 10 quiz
    CrossrefPubMedGoogle Scholar
  • 28 Wu J, Zhou J, Liu C. 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 (07) 914-924
    CrossrefPubMedGoogle Scholar
  • 29 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
    Google Scholar
  • 30 Higgins JPT, Thomas J, Chandler J. , et al , eds. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. 2011 . Available from: www.training.cochrane.org/handbook
    Google Scholar
  • 31 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 32 Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001; 135 (11) 982-989
    CrossrefPubMedGoogle Scholar
  • 33 Kabiri A, Esfandiari E, Esmaeili A, Hashemibeni B, Pourazar A, Mardani M. Platelet-rich plasma application in chondrogenesis. Adv Biomed Res 2014; 3: 138
    CrossrefPubMedGoogle Scholar
  • 34 Yadav R, Kothari SY, Borah D. Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus. J Clin Diagn Res 2015; 9 (07) RC05-RC07
    PubMedGoogle Scholar
  • 35 Duan X, Sandell LJ, Chinzei N. et al. Therapeutic efficacy of intra-articular hyaluronan derivative and platelet-rich plasma in mice following axial tibial loading. PLOS One 2017; 12 (04) e0175682
    CrossrefPubMedGoogle Scholar
  • 36 Wei LC, Lei GH, Sheng PY. et al. Efficacy of platelet-rich plasma combined with allograft bone in the management of displaced intra-articular calcaneal fractures: a prospective cohort study. J Orthop Res 2012; 30 (10) 1570-1576
    CrossrefPubMedGoogle Scholar
  • 37 Bendinelli P, Matteucci E, Dogliotti G. 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 (03) 757-766
    CrossrefPubMedGoogle Scholar
  • 38 Mazzocca AD, McCarthy MB, Intravia J. et al. An in vitro evaluation of the anti-inflammatory effects of platelet-rich plasma, ketorolac, and methylprednisolone. Arthroscopy 2013; 29 (04) 675-683
    CrossrefPubMedGoogle Scholar
  • 39 Masuki H, Okudera T, Watanebe T. et al. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int J Implant Dent 2016; 2 (01) 19
    CrossrefPubMedGoogle Scholar
  • 40 Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 2016; 32 (03) 495-505
    CrossrefPubMedGoogle Scholar
  • 41 Fukawa T, Yamaguchi S, Akatsu Y, Yamamoto Y, Akagi R, Sasho T. Safety and efficacy of intra-articular injection of platelet-rich plasma in patients with ankle osteoarthritis. Foot Ankle Int 2017; 38 (06) 596-604
    CrossrefPubMedGoogle Scholar
  • 42 Battaglia M, Guaraldi F, Vannini F. et al. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics 2013; 36 (12) e1501-e1508
    CrossrefPubMedGoogle Scholar