A Randomized Double-Blind Controlled Pilot Study Comparing Leucocyte-Rich Platelet-Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain
Clinica Vertebra Barcelona Spine and Pain Surgery Center, Barcelona, Spain. Department of Anesthesiology and Center of Pain Management, E-Da Cancer Hospital, Kaohsiung, Taiwan. School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan.
OBJECTIVES To compare the efficacy and safety between leucocyte-rich platelet-rich plasma (LR-PRP) and corticosteroid in fluoroscopically guided caudal epidural injection for patients with complex chronic lumbar spinal pain. Study Design A prospective randomized controlled double blinded study METHODS Fifty eligible patients with complex chronic degenerative spinal pain were randomly assigned with 1:1 allocation ratio to receive caudal epidural injection of
corticosteroid (triamcinolone acetonide, 60mg) or LR-PRP (isolated from 60 ml autologous blood) under fluoroscopic guidance. Levels of low back pain, quality of life, and complications (or adverse effects) were evaluated at 1, 3, and 6 months after treatment. Pain levels and quality of life were assessed using the visual analog scale (VAS) and short form SF-36, respectively. RESULTS No significant difference was shown at baseline between two groups. Compared with the pretreatment values, there were significant reduction in the VAS score in both groups. Significantly lower VAS score at 1-month follow-up was detected in patients who received corticosteroid injection. However, the scores were lower in the LR-PRP group at 3- and 6-month follow-up. SF-36 questionnaires measured at 6-month showed significant improvement at all domains in the LR-PRP group. There were no complications or adverse effects related with treatment during 6-month follow-up in either group. CONCLUSIONS Both autologous LR-PRP and corticosteroid for caudal epidural injections under fluoroscopic guidance are equally safe and therapeutically effective in patients with complex chronic lumbar spinal pain. However, LR-PRP is superior to corticosteroid for longer pain-relieving effect and improvement in quality of life.
Additional Material
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Letter in: ‘Pain practice: The Official Journal of World Institute of Pain’ (2020) PMID: 33300209, DOI: <a href="http://dx.doi.org/10.1111/papr.12984">http://dx.doi.org/10.1111/papr.12984</a> Letter in: ‘Pain Practice’ (2020) PMID: 33300195, DOI: <a href="http://dx.doi.org/10.1111/papr.12977">http://dx.doi.org/10.1111/papr.12977</a>
Credits
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Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
