Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN

A recent paper in the journal Regenerative Medicine (1) reviewed seven previously published papers on PRP interventions on the SIJ or ligaments. Five of the studies demonstrated clinical effectiveness of PRP of more than 50% in their primary outcome measures. The paper also noted “inconsistent and insufficient evidence for a conclusive recommendation for or against SIJ PRP.”

A case history published in the journal Military Medicine, (2) a publication of the Association of Military Surgeons of the United States described a patient who had chronic low back pain localized to the sacroiliac joint and subsequent functional disability managed with high-dose opioids. After the failure of traditional treatments, she was given an ultrasound-guided PRP injection of the Sacroiliac Joint which drastically decreased her pain and disability and eventually allowed for complete opioid cessation. The case continues that the patient had symptom relief more than one year after the injection. The doctors of this case suggested that “this case demonstrates the potential of ultrasound-guided PRP injections as a long-term treatment for chronic low back pain caused by sacroiliac joint dysfunction in military service members, which can also aid in the weaning of chronic opioid use. ”

A March 2023 paper in the Frontiers in Endocrinology (3) gives a summary overview of the use of PRP in SI joint disorders. “Initial treatment of SIJ disease is usually conservative and includes physical therapy, massage therapy, and drug therapy. However, these treatments are often aimed at pain relief, rather than eradication (repairing and alleviating the pain generators). Other treatment options, such as periarticular injection, intraarticular injection, or nerve block, are generally administered if there is no improvement in symptoms after 6 weeks of conservative treatment. Surgery is considered when all treatments fail. PRP can be used as a new treatment modality for the treatment of SIJ disease. (Based on reviewed research in this study) it can be concluded that ultrasound-guided PRP injection is a safe and effective treatment for SIJ disease and can reduce dysfunction and low back pain.”

PRP vs. Corticosteroid Injections

Research from a team of university researchers in India, writing in the journal Pain Practice says that “Despite the widespread use of steroids to treat sacroiliac joint pain, their duration of pain reduction is short. Platelet-Rich Plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain.”

In this research, Forty patients with chronic low back pain diagnosed as sacroiliac joint pain were divided into 2 groups: the steroid group and the PRP group.

• The intensity of pain was significantly lower in the PRP group 6 weeks after treatment as compared to the steroid group.
• The efficacy of steroid injection was reduced to 25% at 3 months while it was 90% in the PRP group.
• A strong association was observed in patients receiving PRP and showing a reduction in pain scores. The researchers concluded: The intra-articular PRP injection is an effective treatment modality in low back pain involving sacroiliac joint pain.”(4)

Doctors at the University of Toronto have published four case studies investigating the long-term benefit of Platelet-Rich Plasma (PRP) injections in reducing SI joint pain, improving quality of life, and maintaining a clinical effect.

At the follow-up, 12 months post-treatment, pooled data from all patients reported a marked improvement in joint stability, a statistically significant reduction in pain, and an improvement in the quality of life.

The clinical benefits of PRP were still significant 4 years post-treatment. Platelet-Rich Plasma therapy exhibits clinical usefulness in both pain reduction and functional improvement in patients with chronic SI joint pain. The improvement in joint stability and low back pain was maintained at 1- and 4 years post-treatment. (5)

A November 2021 paper in the journal Pain Medicine (6) compared patient-reported outcomes with a fluoroscopically-guided intra-articular injection of steroid or platelet-rich plasma injection.

Results: “At one, three, and six months (follow up), both groups improved, however subjects who received steroid injections reported lower pain scores than subjects who received platelet-rich plasma. Using categorical data, we observed significantly more responders (defined as pain scores that improved by 50% or more from baseline) at one and three months in the group that received steroids compared to the group that received platelet rich plasma. Conclusion: While both groups showed improvements in pain and function, the steroid group had a significantly greater response and significantly more responders than the PRP group. “

One PRP injection can be effective for sacroiliac joint pain and improve patient function.

An August 2020 study published in the American Journal of Physical Medicine & Rehabilitation (7) investigated the effectiveness of ultrasound-guided platelet-rich plasma in managing or even reducing sacroiliac joint pain and improving patient function.

• Platelet-rich plasma injections into the sacroiliac joint under ultrasound guidance. The patients were measured for treatment outcomes at baseline, two weeks, four weeks, three months, and six months after injection. (Please note after “injection.”)

These researchers found that standard pain and disability self-reported scoring was significantly reduced at six months after injection compared with the baseline value. All survey scoring taken at two weeks, four weeks, three months, and six months after injection showed a significant reduction of self-reported pain and disability compared with baseline. But overall improvement tapers off after four weeks with no statistically significant reduction from the four-week survey score to 3 months or three to six months. Conclusion: “Ultrasound-guided platelet-rich plasma injections in the sacroiliac joint are effective at reducing disability and pain with most improvement seen within 4 weeks after injection and with sustained reduction at 6 months.”

More than one PRP injection can be more effective.

Many of the “PRP failures” from other clinics that we see at Caring Medical are not because of the wrong diagnosis but because the treatment not being thorough enough. Since anatomically there is a continuous connection from the iliolumbar-sacroiliac-sacrotuberous-sacrospinous ligaments it is important to treat these ligaments thoroughly with Prolotherapy and PRP in order for the whole ligament complex to regain its tautness and strength.

References

1 Rothenberg JB, Godha K, Civitarese DM, Malanga G, Singh JR, Panero A, Everts P, Dididze M, Jayaram P. Pain and functional outcomes of the sacroiliac joint after platelet-rich plasma injection: a descriptive review. Regenerative Medicine. 2021 Jan;16(01):87-100. [Google Scholar]
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3 Wang H, Zhu J, Xia Y, Li Y, Fu C. Application of platelet-rich plasma in spinal surgery. Frontiers in Endocrinology. 2023 Mar 15;14:1138255. [Google Scholar]
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6 Chen AS, Solberg J, Smith C, Chi M, Lowder R, Christolias G, Singh JR. Intraarticular Platelet Rich Plasma vs Corticosteroid Injections for Sacroiliac Joint Pain—a Double Blinded, Randomized Clinical Trial. Pain Medicine. 2021 Nov 24. [Google Scholar]
7 Wallace P, Wallace LB, Tamura S, Prochnio K, Morgan K, Hemler D. Effectiveness of ultrasound-guided platelet-rich plasma injections in relieving sacroiliac joint dysfunction. American journal of physical medicine & rehabilitation. 2020 Aug 1;99(8):689-93.  [Google Scholar]