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PLATELET-RICH PLASMA (PRP) INJECTIONWhat Is Platelet-rich Plasma (PRP)?Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. How Does PRP Work?Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process. Proper treatment can stimulate the body’s immune response to repair, rebuild and strengthen the injured area through collagen production.What Conditions are Treated with PRP? Some of the conditions that have been reported to benefit from PRP injections include: Neck and Back Pain from arthritis and instability, Sacroiliac Pain from arthritis and instability, Shoulder Pain from rotator cuff tendonosis and arthritis, Elbow Pain (tennis elbow, golfers elbow), Hip/Pelvis Pain (Iliotibial band tendonosis, hamstring sprains/strains/tears), Knee Pain (Arthritis, Ligament instability, Runner’s Knee and other tendonosis), Ankle Pain (Achilles Tendonosis, Plantar Fasciitis).How is PRP performed?Once, the patient’s PRP has been prepared, the patient is brought back to the procedure suite. The injured area is cleaned with antiseptic solution. Then, the injured tissue is identified using anatomical landmarks and if necessary with ultrasound or fluoroscopic (x-ray) guidance. Local anesthetics are used to reduce discomfort. Typically, a small amount (0.5 ml to 1.0 ml) of PRP is injected at each site.Does the procedure hurt?The use of a needle is always accompanied by some degree of discomfort. It varies from patient to patient, but is usually well-tolerated. It helps to stay very relaxed by not tensing the muscles and focusing on deep breathing. A local anesthetic is used to numb the skin and decrease discomfort.What should I do to prepare for my procedure?On the day of your injection, you should adhere to the guidelines provided by your physician or nursing staff as to how long to fast prior to the procedure. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time. It is recommended that you drink plenty of water the day before and up to 2 hours prior to your procedure. Eat a light meal 2 hours prior to the procedure. Water improves cell hydration and lessens the discomfort of the injections, while food reduces the likelihood of dizziness. Also, you may be required to bring a driver in order to have a procedure. Most procedures in our clinic require you to bring a driver to take you home. If you do not bring a driver, then your procedure may need to be rescheduled.If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should (continued) discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox. *SPECIAL INSTRUCTION*: Anti-inflammatory drugs should not be taken 2 weeks prior and leading to the first treatment because these may interfere with the healing process that PRP initiates. This includes medications such as Advil/Motrin (Ibuprofen), Aleve, Full strength Aspirin (325mg), and prescription NSAID drugs like Prednisone, Mobic, Celebrex, and Voltaren. An exception to this is for those who take a baby aspirin for their heart. You may take Tylenol or other approved medications prior to the treatment.Take Vitamin C (1,000mg 3-4 times a day for a total of 3,000mg – 4,000mg) and Vitamin K2 (45mcg-50mcg a day) at least 2 weeks prior to and through 4 weeks after a PRP treatment. Vitamin C and Vitamin K2 are essential in the process of collagen production. Collagen is the building block of new tissues.What should I do after my procedure?Typically, post-injection stiffness and soreness can be expected and is necessary for the healing process to begin. This will last for the first few days. Heat usually soothes the soreness, but ice will slow down the healing process. Refrain from the use of ice during the first week and longer if possible.*SPECIAL INSTRUCTION*: Anti-inflammatory drugs should not be taken during the treatment period (2-6 months) because these may interfere with the healing process that PRP initiates. You may take Tylenol or other approved medications for relief of injection pain following treatment.Keep the injection sites clean and avoid public hot tubs, swimming pools and lakes for 3-5 days following the procedure.How many treatments are needed?Three to six treatments for a given area is about the average needed. A few patients respond quickly to just a treatment or two, but most patients require more to stimulate the healing properly. The longer the duration of pain and disability and the more severe and widespread it is, the more treatment will be needed to stabilize the joints, ligaments or tendons. After the first session, successive treatments follow at intervals of three to six weeks. Staying on a consistent schedule of treatments will decrease the chance that early benefits are lost.Should I exercise following treatments? Controlled exercise and mobilization of the treated area promotes tissue healing and results in faster recovery after the treatment. For this reason, movement and exercise are recommended as soon as possible. Could there be side effects or complications?Anytime a needle is used to penetrate the skin into the deeper tissues, there is always the chance that inadvertent puncture of blood vessels, nerves, spinal fluid or lung tissue may occur. Complications are rare and greatly minimized by the skill of the well-trained physician. Your Pain Management Physician will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed. ................
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