PRP: Cost, Side Effects, and Recovery

Platelet-rich plasma, or PRP, is a substance thats thought to promote healing when injected. Plasma is a component of your blood that contains special factors, or proteins, that help your blood to clot. It also contains proteins that support cell growth. Researchers have produced PRP by isolating plasma from blood and concentrating it.

The idea is that injecting PRP into damaged tissues will stimulate your body to grow new, healthy cells and promote healing. Because the tissue growth factors are more concentrated in the prepared growth injections, researchers think the bodys tissues may heal faster.

The treatment hasnt been definitively proven. It also hasnt been approved as a treatment by the U.S. Food and Drug Administration. However, famous athletes like Tiger Woods and tennis star Rafael Nadal have been known to use these injections to help heal injuries.

Researchers are trying out PRP injections across a number of applications. Examples of these include:

Hair loss: Doctors have injected PRP into the scalp to promote hair growth and prevent hair loss. According to research from 2014, PRP injections are effective in treating androgenic alopecia, which is also known as male pattern baldness.

Tendon injuries: Tendons are tough, thick bands of tissue that connect muscle to bone. They are usually slow to heal after injury. Doctors have used PRP injections to treat chronic tendon problems, such as tennis elbow, Achilles tendonitis at the ankle, and jumpers knee, or pain in the patellar tendon in the knee.

Acute injuries: Doctors have used PRP injections to treat acute sports injuries, such as pulled hamstring muscles or knee sprains.

Postsurgical repair: Sometimes doctors use PRP injections after surgery to repair a torn tendon (such as a rotator cuff tendon in the shoulder) or ligaments (such as the anterior cruciate ligament, or ACL).

Osteoarthritis: Doctors have injected PRP into the knees of people with osteoarthritis. A 2015 study found that PRP injections were more effective than hyaluronic acid injections (a traditional therapy) for treating osteoarthritis. However, the trial was a small group of 160 people, so larger trials are needed for this to be conclusive.

Its important to note that none of these uses have been definitively proven to provide results.

Read more: 5 exercises for rotator cuff pain

Generally speaking, there are few steps to preparing for PRP injections.

However, PRP can be injected in different ways. For example, sometimes a topical numbing lidocaine solution is applied to your scalp before injection. You may have to arrive early to a treatment session for this to be applied.

Other times, a local anesthetic is mixed with the PRP to reduce any discomfort. Sometimes, your doctor will inject or apply PRP during a surgery. In this instance, preparation for PRP injections would involve following your surgeons recommendations presurgery.

Heres what to expect from a typical PRP injection process:

According to Emory Healthcare, this process usually takes around one hour.

According to the American Academy of Orthopaedic Surgeons, very few insurance plans will provide any reimbursement for PRP injections. The costs must largely be paid out-of-pocket. The costs can also vary from location to location and on how the injections are used. Some of the reported costs nationwide include the following:

Insurance companies consider PRP an experimental treatment. More scientific research will have to conclude its effectiveness before it is more widely covered.

Because PRP involves injecting a substance into the skin, there are potential side effects. PRP is autologous, which means it contains substances that come directly from your own body. This reduces the risks for an allergic reaction that can occur from injecting other medications, such as cortisone or hyaluronic acid. However, there are risks from the injection itself, including:

You should discuss these potential risks with your doctor, as well as the steps your doctor will take to minimize these risks.

When PRP is injected following injury, your doctor may recommend that you rest the affected area. However, these recommendations are more related to the injury and less to the PRP injections. Most people can continue their daily activities following PRP injections.

Because PRP injections are intended to promote healing or growth, you may not notice an immediate difference after receiving the injections. However, in several weeks or months, you may observe that the area is healing faster or growing more hair than you would have expected if you hadnt received PRP injections.

See the rest here:
PRP: Cost, Side Effects, and Recovery

Platelet-Rich Plasma: Does It Work? – www.PainScience.com

An interesting treatment idea for arthritis, tendinopathy, muscle strain and more

PaulIngraham, updated Jan 25, 2020

Give your blood toyourself!

Blood therapy, anyone? Platelet-rich plasma (PRP) injections bathe troubled cells in a concentrated mixture made from your own blood. Hopefully this stimulates healing where it is otherwise failing especially stubborn, slow-motion injuries like tendinitis1 but no one really knows for sure yet.

Despite all the not-knowing, its easy to pay someone to do this for you these days: extract some of your blood, spin it in a centrifuge to get the platelets, and then pump them back into you. Its not cheap, but PRP injections have become super popular, particularly with elite athletes (ever the guinea pigs for unproven, expensive new treatments for musculoskeletal injuries). It sounds perfect for injuries like patellofemoral pain, an extremely common pseudo-arthritis of the knee in runners,2 or IT band syndrome, another kind of common runners knee a huge potential market, in other words. In the fall of 2009, ScienceBasedMedicine.org scathingly criticized the marketing of PRP:3

Without any clear evidence of benefit beyond placebo, PRP is now being marketed aggressively as a cure-all for sports injuries. And at about $300 per injection (the NYT reports $2000/treatment), theres plenty of money to be made. a nation-wide marketing initiative has begun, using sports celebrities as guinea pigs.

~ A Case Study In Aggressive Quackery Marketing, Jones (ScienceBasedMedicine.org)

At that time, the problem was that the marketing was irresponsible in light of the lack of evidence. It was a short wait for more. Today, the marketing is irresponsible in light of the evidence we now have

Cynics can stop reading here. You know this doesnt end well. Theres a section summarizing all the major highlights from the literature further along here, but the bottom line is clear: if it works at all, its tricky and unreliable, probably heavily dependent on factors we dont understand and cannot control.

Stem cells are generic cells that do not yet have a job. In theory, they can become what we need them to be, which is a potentially powerful tool in medicine. Stem cell therapy is a broad concept in regenerative medicine, and it is a hot hot hot topic right now.

Stem cell therapy is identical in spirit to the other two main regenerative therapies in musculoskeletal and pain medicine: platelet-rich plasma and autologous chondrocyte implantation. But neither PRP or ACI is technically a stem cell therapy they use mature, specialized cells, so they are just cell therapies.

But regeneration is the goal of all of these methods, and the topic of stem cell therapy overlaps so much with PRP and ACI that they are practically the same thing regards to safety, efficacy, and the concerns of skeptical consumers and regulators. They are biologically intriguing treatments that might amount to something someday after all, we know regeneration is possible, thanks to salamanders! but its a depressing mess so far, instead of being inspiring and promising. These treatments are all being rushed to market in the same way, all sold as high-tech medicine to desperate consumers long before the science is done.

Meet the Clotters! Platelets are the major clotting tool in your blood, and they are curious critters, neither cells nor molecules, but a strange hybrid often called cell fragments: platelets are to blood cells what wood chips are to a log if the chips were extremely clever. Platelets have a bunch of interesting biological features, but they are best known for their work in clotting and thats mainly what gives them that healing mystique.

There are countless biochemical factors that regulate healing its complex, to say the least. Platelets are part of that equation, playing a critical role in tissue repair and regeneration; specifically they regulate fundamental mechanisms involved in the healing process including cellular migration, proliferation, and angiogenesis.4 Since they are involved in healing, more of them must be good, right?

That is the basic rationale for PRP.

The ruffled white one in the middle is a platelet an activated platelet, specifically. When calm, they are smaller &smoother.

In fact, PRP is often called regenerative medicine, because the idea of genuinely accelerated healing is so tantalizing, happy science fiction. But its more marketing than biology, surprise surprise.5 You could probably talk people into drinking a platelet smoothie if you told them it would regenerate them.

But it is not safe to assume a soup of platelets is regenerative. In fact, its not even safe to assume its safe

Health Canada isnt a fan, and notably they have safety concerns:6

Many emerging autologous cell therapy products may eventually prove to be safe and effective. However, most of these products are currently at the investigational stage of development with an on-going need to gather supporting scientific evidence.

Injecting medications into muscles might not be harmless. (No ones surprised by that, right? Good!) Anaesthetics and NSAIDs probably are a little myotoxic poisonous to muscles and theres conflicting evidence about PRP. It might be fine, but its important to bear in mind that faddish new injection treatments are never risk free.

Like a salad spinner

To make PRP, blood is spun in a centrifuge. Different blood components separate intolayers.

Who says more platelets stimulates healing? Is that in the Platelet User Guide? For extra healing, generously apply platelets to wound. Dosage is critical with many medicines. More is not only not always better, its usually worse. Do other cells like being bathed in ten times the normal number of platelets? Or is it a suffocating mess that throws everything off kilter?

Or is it just kind of ho hum?

In PRP marketing and hype, its common to see claims that its a natural treatment because its your own blood being returned to you, see? and what could be safer and healthier than you-stuff? But this is bio-illogical: theres lots of stuff inside of me that I do not want to be extracted, concentrated, and returned! Pick any hormone, for instance: many of those are just as involved in healing as platelets, but too much of most of them is just a disaster.

For instance, there is a disease of excessive iron, hemochromatosis a major component of red blood cells, essential to life, something you could easily think you want a lot of for vitality and healing. And indeed you do, if youre anemic. But chronically absorb too much, and its a serious disease.

What you want in biology is just-right amounts of everything, rarely lots of extra anything. Its really quite odd to assume that a platelet-rich sauce o blood is natural and safe and helpful just because the stuff came from you. Which is why this treatment needs to be tested, not assumed like every treatment.

In a 2018 podcast, I listened to a really credible expert guest boldly state that theres very strong evidence for platelet-rich plasma in osteoarthritis. Thinking I must have missed something, I checked the primary reference in the show notes, which is also still the most recent review of PRP for osteoarthritis. Did it back up the expert?

Not even close!7 As far as I can tell, there is just zero justification for what she said: its not very strong, its actually very weak. It exists, and its technically positive, but its just not compelling.

PRP fans and purveyors will tell you there is good evidence that PRP works, but they are cherry picking from a few studies that worked out in their favour one way or another. A few positive studies never not mean much; indeed, most positive study results are actually just bogus.8

Taken as a whole, the evidence is somewhere between inconclusive and discouraging. Although more research is needed (of course!) enough decent studies have now been done that the evidence reviews have started to come out.They all warn that most of the evidence is poor quality, and they are all basing their conclusions on just barely enough good data. They all emphasize that PRP methods are not standardized there are many versions of PRP, all based on speculation, not data.

The bad news got rolling in 2010. The New York Times reported9 (very) bad science news:

Now, though, the first rigorous study asking whether the platelet injections actually work finds they are no more effective than saltwater.

Nothing has improved significantly since. Highlights from the literature since then:

Three high-quality studies (75%) and two low-quality studies showed no significant benefit at the final follow-up measurement or predefined primary outcome score when compared with a control group. One high-quality study (25%) showed a beneficial effect of a PRP injection when compared with a corticosteroid injection (corticosteroid injections are harmful in tendinopathy). Based on the best evidence synthesis, there is strong evidence that PRP injections are not efficacious in chronic lateral epicondylar tendinopathy.

In early 2018, the journal Sports Medicine piled on with a review of six (crappy) studies of PRP for muscle injury (pulled muscles, strains).16 Even the optimistic expert I mentioned above expressed her doubts about PRP for muscle injury.

The promising biological rationale, the positive preclinical findings, and the successful early clinical experience of PRP injections are not confirmed by the recent high-level RCTs.

Meta-analysis is the research technique of pooling data from many studies to boost their statistical power. While often thought of as the pinnacle of scientific credibility, in fact meta-analysis is notoriously fallible. It particularly suffers from the garbage in, garbage out problem: its tough to extract meaningful results from pooled data when all the data sucks. The statistical complexity of such analysis also provides plenty of opportunity for bias-powered abuse and statistical jiggery pokery.

Meta-analysis just aint all its cracked up to be, and must be subjected to the same kind of critical analysis as any other kind of study/paper.

I used to rely on meta-analysis, but they are worse than laws & sausages, ceasing to inspire respect in proportion as we know how they are made.

~ Dr. Mark Crislip, "I Never Meta Analysis I Really Like"

Most of the good news coming from isolated or flawed studies. Isolated positive evidence about over-hyped treatments is a huge red flag, which usually means researchers made errors in their favour. Its the pattern of evidence that counts, and so far the pattern is distinctly bad.

Any hope? Maybe a little. There are different ways of doing PRP, and there different conditions in different stages may respond better or worse. Its biologically plausible that PRP could fail with chronic tendinitis but still succeed with an acute muscle strains, for instance, or even fail with one kind of muscle strain and succeed with another. Hammondetal, an experiment on rats rats were harmed and treated for our edification reported a difference between two kinds of muscle strain. It worked better on a more serious injury, where regeneration of muscle tissue was part of the healing process. PRP might assist with that regenerative process, but have no effect on a less serious strain where no regeneration is occurring.20

But these are faint hopes. In general, one would hope that the methods and conditions tested so far are at least in shouting distance of being the right formula close enough to be at least a little more encouraging.

Initially promising in principle, I predict that PRP will now be mired in trumped-up controversy for years. It will die a slow death, only beaten into submission over many years by a growing pile of underwhelming evidence, while its proponents continue to overconfidently sell the service and defend it from detractors, mainly by betting with dwindling odds that just the right formula can still be proven effective for just the right kind of patient. If so, great: I will be pleased to admit that my prediction was wrong! But Im betting against them for now.

After the centrifuge treatment, platelets are separated from the other components of blood.

My final word on this topic has to be placebo PRP is a perfect storm for it. Its got everything! Bearing in mind that its been thoroughly demonstrated that people get stronger placebo effects from treatment features trivial as a more potent pill colour

I can hardly imagine a better formula for a powerful expectation effect or relief from belief. Unfortunately, despite placebos weirdly good reputation, its powers are quite limited.21 The next time you hear a positive anecdote about PRP, remember: its probably the placebo talking.

The bar for worth a try is fairly high for normal folks. No invasive treatment can qualify for it without being proven at least safe. And you really need clear, consistent evidence of non-trivial benefit across several good trials before anything injected is worth a try. Before that its more like hey, its your knee, dont stab it!

The equation is always different for elite athletes, of course: the slightest edge could be a big deal. But that sword cuts both ways! It might help just a little, and that might matter a lot or it might hurt just a little, and that might matter a lot. Every athlete and coach is going to have a different opinion on whether that risk is worth it.

Five updates have been logged for this article since publication (2014). All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. more

I log any change to articles that might be of interest to a keen reader. Complete update logging started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.

See the Whats New? page for updates to all recent site updates.

January Added references to a pair of recent meta-analyses plus a sidebar about the problems with meta-analysis.

January Science update. Added a couple new references and did a little organizing and editing while I was at it. PRP for muscle strain is now clearly a big fat nothing burger. I suspect other indications will follow suit as the evidence quality continues to accumulate.

2019 General editing and minor updates. Spelled out the relationship to other cell and stem cell therapies much more clearly than before.

2018 Cited Mascarenhasetal on PRP for osteoarthritis (and its the usual story: garbage in, garbage out, no conclusion, no compelling evidence).

2018 Science update, added new meta-analysis of PRP for muscle strain, Grassietal.

2014 Publication.

Tendinitis versus tendonitis: Both spellings are acceptable these days, but the first is the more legitimate, while the second is just an old misspelling that has become acceptable only through popular use, which is a thing that happens in English. The word is based on the Latin tendo which has a genitive singular form of tendinis, and a combining form that is therefore tendin. (Source: Stedmans Electronic Medical Dictionary.)

Tendinitis vs tendinopathy: Both are acceptable labels for ticked off tendons. Tendinopathy (and tendinosis) are often used to avoid the implication of inflammation that is baked into the term tendinitis, because the condition involves no signs of gross, acute inflammation. However, recent research has shown that inflammation is actually there, its just not obvious. So tendinitis remains a fair label, and much more familiar to patients to boot.

The full text of this paper concludes:

Recent systematic reviews on the topic conclude that there is still a paucity of high-quality data providing sufficient evidence to support or disprove the clinical utility of PRP in symptomatic osteoarthritis of the knee. There is even less clinical evidence supporting its use in other joints or in the treatment of focal osteochondral defects despite the basic science evidence in favor of its use. In addition, not all basic science and clinical studies on PRP have concluded it has positive effects.

So garbage in, garbage out, no real conclusions possible: not enough good data even for the knee, even less for other joints. And theres contradictory evidence.

Read more from the original source:
Platelet-Rich Plasma: Does It Work? - http://www.PainScience.com

Can fasting reverse your ‘biological’ age? It can, according to Goop Lab experts – CNET

Gwyneth Paltrow gets a vampire facial in the fourth episode of Goop Lab.

Netflix's The Goop Lab follows Gwyneth Paltrow and the team that runs her wellness brand, Goop, as they experience various alternative wellness practices, from meeting with a psychic to taking aworkshop about how to orgasm. In The Goop Lab's fourth episode, The Health Span Plan, Paltrow, chief content officer Elise Loehnan and Goop's marketing VP Wendy Lauria explore the societal obsession with antiaging and the often expensive lengths many go to avoid it.

In their quest for eternal youth, members of the Goop staff try several different diets reported to reduce the risk of age-related disease, including fasting, veganism and pescatarianism. Paltrow and her team also set out on a quest to find "more natural" alternatives to plastic surgery and fillers, like facials and acupuncture.

Aging is one of many things that medicine can't stop, so that raises the question: Is there any validity to these diets and treatments? Can you really slow down the aging process with food? That's what The Goop Lab sets out to determine and the results are, surprisingly, somewhat valid.

The Health Span Plan episode explores diets and skincare treatments that claim to have antiaging benefits.

The Goop team chats with Valter Longo, the director of the University of Southern California's Longevity Institute, about the practice of fasting and how it can have positive effects on health. He promotes his fasting mimicking diet in the episode (for which he has a book and a $250 diet kit that Paltrow tries). Notably, the group doesn't talk about other forms of fasting -- such as intermittent fasting or alternate-day fasting -- which can have the same health benefits as Longo's diet.

Paltrow also talks with Morgan Levine, who studies aging at the Yale Department of Pathology. Levine developed a method of calculating a person's "biological age," based on several factors that intend to predict how likely you are to get age-related diseases or be at risk for early death.

Paltrow, Loehnan and Lauria are tested for their biological age before starting a new diet for three weeks. Lauria followed a vegan diet and Loehnan did a pescatarian diet, while Paltrow uses Longo's kit (which includes a nut bar, soup packets and kale crackers -- appetizing, huh?) for a five-day fast.

At the end of the three weeks, all three have their "biological ages" retested. The only person whose age did not "lower" was Lauria.

To round out this antiaging episode, all of the women try three different facial treatments -- acupuncture, facial threading and a vampire facial -- that are supposed to be more natural than using typical dermatological treatments such as skin fillers and Botox injections.

Loehnen tries facial acupuncture, which is reported to boost collagen production. Lauria gets a "facial threading" treatment that involves sewing a plastic thread that dissolves after nine months into her face in an effort to boost collagen and lift the face.

A Goop employee tries facial threading, a less invasive way to get the effect of a face lift.

Finally, Paltrow gets a "vampire facial," which is when a facialist extracts platelet rich plasma from your blood, and then microneedles it into the skin on your face. The PRP is supposed to help the skin resurface and look rejuvenated. Paltrow seems a bit weirded out by the process but notes that there's an "overuse of that stuff," (referring to injections, fillers and plastic surgery), and at least "this is your own blood and not a toxin, it's a more natural way."

Right now, there is a lot of hype surrounding fasting, intermittent fasting and ketosis and how those diets might benefit our overall health. It's not all hype -- there's definitely some sound science here and it's likely to keep expanding.

During the episode, Longo presents his fasting mimicking diet, which involves "tricking" the body into a fasting state while allowing specific amounts of food for at least five days. The idea is to give your body just enough nutrients that it thinks it's fasting, but not so few that you encounter the negative effects of prolonged fasting like a weakened immune system and nutritional deficiencies.

Fasting can help improve your overall health, some studies have shown.

Longo says that his clinical trials on the fasting mimicking diet showed to "reduce risk factors for multiple age-related diseases." That's not totally bunk -- science shows that when you restrict calories for certain periods of time, it does promote longevity. A study on this type of fasting did show that it can be effective in improving health markers that put you at risk for age-related diseases such as BMI, body fat percentage and blood pressure. Fasting can also lower inflammation levels in the body, improve cognitive impairment in miceand can decrease insulin-like growth factor, a hormone linked to cancer. The research is promising.

While Longo's diet might be scientifically sound, I found it hard to wrap my mind around the idea that eating processed, packaged foods for five days could actually be better for you than eating whole, unprocessed foods. Surely you can hit the same macronutrient targets (low carb, low protein and a total of 750-1,000 calories per day) he cites is necessary to "trick your body that it's fasting" with real food?

I'd be interested in seeing studies on groups who do the fasting mimicking diet versus groups that follow a pescatarian diet (as Loehnan did in the show). Also, I'd like to see results in a study of participants who follow the fasting mimicking diet with Longo's food packets and bars versus the same exact macronutrients in whole food form. My guess is that the results could be pretty different.

The facial treatments in the episode are pretty extreme. While they are touted as "more natural" alternatives to plastic surgery or fillers, Goop did not provide much information on why these treatments are "better" for you.

When each practitioner did each treatment, it sounded more like an infomercial about why you should do it, rather than a scientifically backed procedure. The episode lacked real information or science on if these treatments are actually safe, and how they compare to fillers or Botox. No one (at least that we could see) challenged the practitioners about the safety or quality of what was going on.

Facial acupuncture is said to help stimulate the production of collagen in the skin.

The science behind facial acupuncture is promising, but there's still a lot of work to be done. As for the facial threading, aka the noninvasive face lift, a study published in JAMAconcluded that the results of the threading face lift are not effective enough to justify the patient's risk of potential complications from the procedure.

I would describe the facial threading procedure more as a cosmetic procedure and less of a facial treatment. Even though the Goop staff say it's more "natural" than a face lift, it seems pretty invasive to me. You see the doctor literally sew a plastic thread into her face and if that isn't invasive plastic surgery, I don't know what is. Nothing about this treatment says "natural alternative" to me. It just says, "here is another way to get a face lift, and it's temporary."

Goop has long been criticized for presenting highly inaccessible treatments, and that's the same in this episode. The vampire facial costs over $1,000, and the facial threading pricing can start at $1,500 and go up to over $4,000. Facial acupuncture is typically less expensive, but it depends on where you go and how many treatments you get.

There's nothing wrong with showing what these extreme treatments are like, it makes for entertaining television. But if Goop wanted to better serve its audience, perhaps it would have been more helpful to show more accessible options for natural beauty products, regimens or other useful skincare advice.

This episode of The Goop Lab presents a few valid and several questionable antiaging practices for your body and face. While fasting to improve your overall health is backed up by science, there are plenty of other more accessible and doable ways to improve your health through nutrition, exercise and lifestyle alone.

Focusing on the basics like sleep, drinking water, moving more and lowering stress seems more realistic, and then you can experiment with fasting if you think it could help you. Fasting is not a very accessible wellness trend in that it's difficult to do, you should do it under the supervision of a specialist, certain health conditions can prevent you from doing it and it can be really triggering for someone who has a history of eating disorders.

Because of this, fasting is not my favorite wellness topic to explore, and I would have loved to see Goop cover more of the actual science on the benefits other diets such as pescatarianism and veganism, or even better the benefits of eating more plant-based diet versus a restrictive plan like veganism or vegetarianism.

As for the facial treatments, I found it interesting to see the different procedures on the market, but unrelatable for someone who can't afford to drop $1,000 and up on a treatment. It would have been much more interesting to me if Goop had talked to skincare experts, dermatologists and other pros in the space who can teach people about good skincare regimens, habits, ingredients and explain what clean or natural beauty products can help.

Now playing: Watch this: Impossible Foods CEO talks pork and the future of plant-based...

7:38

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

Continue reading here:
Can fasting reverse your 'biological' age? It can, according to Goop Lab experts - CNET