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Efficacy of intradiscal injection of platelet-rich plasma in the treatment of discogenic low back pain: A single-arm meta-analysis
Peng B, Xu B, Wu W, Du L, Zhang T, Zhang J
Medicine. 2023;102(10):e33112
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Abstract
BACKGROUND Discogenic low back pain (DLBP) has been influencing people's quality of life. Research on platelet-rich plasma (PRP) for DLBP has increased in recent years, but systematic summaries are lacking. This study analyzes all published studies related to the use of intradiscal injection of PRP for the treatment of DLBP and summarizes evidence-based medicine for the efficacy of this biologic treatment for DLBP. METHODS Articles published from the inception of the database to April 2022 were retrieved from PubMed, the Cochrane Library, Embase, ClinicalTrial, the Chinese National Knowledge Infrastructure, Wanfang, Chongqing VIP Chinese Scientific Journals, and the Chinese Biomedicine databases. After the rigorous screening of all studies on PRP for DLBP, a meta-analysis was performed. RESULTS Six studies, including 3 randomized controlled trials and 3 prospective single-arm trials, were included. According to this meta-analysis, pain scores decreased by >30% and >50% from baseline, with incidence rates of 57.3%, 50.7%, and 65.6%, and 51.0%, 53.1%, and 51.9%, respectively, after 1, 2, and 6 months of treatment. The Oswestry Disability Index scores decreased by >30% with an incidence rate of 40.2% and by >50% with an incidence rate of 53.9% from baseline after 2 and 6 months, respectively. Pain scores decreased significantly after 1, 2, and 6 months of treatment (standardized mean difference: 1 month, -1.04, P = .02; 2 months, -1.33, P = .003; and 6 months, -1.42, P = .0008). There was no significant change (P > .05) in the pain scores and the incidence rate when pain scores decreased by >30% and >50% from baseline between 1 and 2 months, 1 and 6 months, and 2 and 6 months after treatment. No significant adverse reactions occurred in any of the 6 included studies. CONCLUSION Intradiscal injection of PRP is effective and safe in the treatment of DLBP, and there was no significant change in the patient's pain 1, 2, and 6 months after PRP treatment. However, confirmation is required by additional high-quality studies due to the limitations of the quantity and quality of the included studies.
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Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: A meta-analysis of randomized controlled trials
Ye Y, Zhou X, Mao S, Zhang J, Lin B
International Journal of Surgery (London, England). 2018;53:279-287
Abstract
BACKGROUND This study aims to compare the efficacy of intra-articular injection of hyaluronic acid (HA) and platelet-rich plasma (PRP) for treating hip osteoarthritis (OA). METHODS We performed systematic searches in PubMed, EmBase, ScienceDirect Web of science and the Cochrane Library for relevant literature published in or before February 2018. Only randomized controlled trials (RCTs) were included. The risk of bias assessment was performed using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We used STATA 14.0 (College Station, TX, USA) to analyze the data. RESULTS A total of 287 records were identified by the initial database search. Finally, 4 RCTs were included in our study. The present meta-analysis indicated that PRP was associated with a significant reduction of VAS score at 2 months compared with HA. However, it did not show significantly better outcomes at 6 and 12 months. There was no significant difference regarding the WOMAC and HHS at a 12-month follow up. No increased risk of adverse effects were observed. CONCLUSION Intra-articular injection of PRP was associated with a significant reduction of VAS at 2 months. Both of them showed comparable results in terms of functional recovery. Further studies were still necessary.
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Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials
Dai WL, Zhou AG, Zhang H, Zhang J
Arthroscopy.. 2016;33((3):):659-670 e1
Abstract
PURPOSE To use meta-analysis techniques to evaluate the efficacy and safety of platelet-rich plasma (PRP) injections for the treatment knee of osteoarthritis (OA). METHODS We performed a systematic literature search in PubMed, Embase, Scopus, and the Cochrane database through April 2016 to identify Level I randomized controlled trials that evaluated the clinical efficacy of PRP versus control treatments for knee OA. The primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores. The primary outcomes were compared with their minimum clinically important differences (MCID)-defined as the smallest difference perceived as important by the average patient. RESULTS We included 10 randomized controlled trials with a total of 1069 patients. Our analysis showed that at 6 months postinjection, PRP and hyaluronic acid (HA) had similar effects with respect to pain relief (WOMAC pain score) and functional improvement (WOMAC function score, WOMAC total score, International Knee Documentation Committee score, Lequesne score). At 12 months postinjection, however, PRP was associated with significantly better pain relief (WOMAC pain score, mean difference -2.83, 95% confidence interval [CI] -4.26 to -1.39, P = .0001) and functional improvement (WOMAC function score, mean difference -12.53, 95% CI -14.58 to -10.47, P < .00001; WOMAC total score, International Knee Documentation Committee score, Lequesne score, standardized mean difference 1.05, 95% CI 0.21-1.89, P = .01) than HA, and the effect sizes of WOMAC pain and function scores at 12 months exceeded the MCID (-0.79 for WOMAC pain and -2.85 for WOMAC function score). Compared with saline, PRP was more effective for pain relief (WOMAC pain score) and functional improvement (WOMAC function score) at 6 months and 12 months postinjection, and the effect sizes of WOMAC pain and function scores at 6 months and 12 months exceeded the MCID. We also found that PRP did not increase the risk of adverse events compared with HA and saline. CONCLUSIONS Current evidence indicates that, compared with HA and saline, intra-articular PRP injection may have more benefit in pain relief and functional improvement in patients with symptomatic knee OA at 1 year postinjection. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.Copyright © 2016. Published by Elsevier Inc.
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A prospective study comparing platelet-rich plasma and LA/corticosteroid in intra-articular injection for the treatment of lumbar facet joint syndrome
Wu J, Zhou J, Liu C, Zhang J, Xiong W, Lv Y, Liu R, Wang R, Du Z, Guizhen Z, et al
Pain Practice : the Official Journal of World Institute of Pain. 2016;17((7):):914-924
Abstract
OBJECTIVES To compare the effectiveness and safety between autologous platelet-rich plasma (PRP) and LA/corticosteroid in intra-articular injection for the treatment of lumbar facet joint syndrome. METHODS Forty-six eligible patients with lumbar facet joint syndrome were randomized into group A (intra-articular injection with PRP) and group B (intra-articular injection with LA/corticosteroid). The following contents were evaluated: pain visual analog scale (VAS) at rest and during flexion, and the Roland-Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI), and modified MacNab criteria for pain relief and applications of post-treatment drugs. All outcome assessments were performed immediately after and at 1 week, 1 month, 2 months, 3 months, and 6 months after treatment. RESULTS No significant difference between groups was observed at baseline. Compared with pretreatment, both group A and group B demonstrated statistical improvements in the pain VAS score at rest or during flexion, the RMQ, and the ODI (P < 0.01). And there were significant differences between the 2 groups on the above-mentioned items (P < 0.05). For group B, subjective satisfaction based on the modified MacNab criteria and objective success rate were highest (80% and 85%) after 1 month, but only 50% and 20% after 6 months. However, for group A, they increased over time. In addition, there were no treatment-related complications in either group during follow-up. CONCLUSIONS Both autologous PRP and LA/corticosteroid for intra-articular injection are effective, easy, and safe enough in the treatment of lumbar facet joint syndrome. However, autologous PRP is a superior treatment option for longer duration efficacy. This article is protected by copyright. All rights reserved.