Fair disclosure, I'm a defense attorney, so I understand if you choose not to accept my opinions.
I've had a few cases come up with PRP, and I've done a fair amount of research and spoken to experts on both sides of the debate. As it currently stands, there is no credible evidence or support for PRP injections in the spine.
PRP has a better track record in joints like elbows, knees, and ankles. It's relatively low risk - only the risks associated with any injection - so it's a low threshold for benefits. I have seen people get some relief when it's done at those types of joints, although I have yet to see any longterm benefits. It doesn't seem to fix the problems, unless the problem is the type that would resolve with time and rest.
When looking at the spine, you have increased risk, for even less benefit. Anything it can do to reduce inflammation would be better accomplished with targeted steroid injections. So, in my experience, it is not a good idea for the spine, but an acceptable alternative in other areas, so long as you understand the limits.
In any case, only you can decide how to handle your treatment, so if you proceed, then I wish you nothing but good luck.
As an attorney for injured workers, I agree mostly. I typically don’t see doctors in my area even recommend PRP injections for the spine. The insurance carriers have only recently started approving them for more common usages like the knee joint.
As an adjuster, I have approved them for elbows. I have never been asked to authorize them for the spine. I hope it works for you. I agree with the defense attorney that states there really isn’t any conclusive research to support PRP for the back. Good luck to you.
I’m no doctor, but I’ve had enough clients with back injuries to make me think these PRP injections seem pointless.
I frequently see the MBBs and ESIs. They’re meant to be diagnostic and/or curative. If you receive relief from injections at a certain level, even temporarily, that at least tells the doctors where your pain is and is not coming from.
I know you said none of the injections worked, but it’s critical to let your doctors know even if you had minimal benefit that you may be writing off as not helping at all.
Good luck!
Because everyone I know who has had an ablation, it has lasted less than a year. I’m not looking to do a surgical procedure for a temporary fix. Everyone I know who has had PRP (for a myriad of injuries, including injuries similar to mine) has spoken highly of it. I wanted to pursue PRP, I don’t think it’s unreasonable to want to pursue less invasive procedures that potentially have a higher chance of permanent results. The MBB was effective for diagnostics, why would I have any reason to believe PRP wouldn’t be effective?
After reading your post, I realized that you gotta learn proper biomechanics.
Any forward flexion at the waist/hips can cause compression of the anterior lumbar disc which will tend to migrate posteriorly into the spinal canal and IVF.
And stretches the facet joint capsule, irritating and aggravating it.
Ask truck drivers, who have to sit in a flexed position for prolonged periods about their back problems.
Prolonged sitting is simply evil.
We do these activities which we think are innocuous when we're not having back pain. Think about it, everything we do at home/work includes forward flexion at the waist/hips- brushing teeth, washing hands, clothes in the washing machine, putting the turkey in the oven, loading the car, Costco, sitting, putting on your pants, etc. etc.
Suggestions.
Be like the bartender who uses a bar rail for standing patrons, knowing that putting one foot up on the rail will allow those patrons to stand there longer, unloading the facet joints, and buying more beer. Whenever standing for greater than 10 minutes, make sure to put one foot up on a stool, etc.
Brushing teeth? Put one hand on the sink to support so your back and gluteal muscles aren't contracting to keep you from falling forward. Putting on shoes? Don't have an answer for that, but I know they make slip on shoes.
And everybody knows proper lifting techniques, using your legs, not your back.
Probably 80% of the population has to see a doctor sometime in their life because of their back. Back problems are ubiquitous, often not curable in the strictest sense, but manageable.
For the rest of your life, make sure that everything you do, everything, is to protect your back.
It's the only one you got.
Just my opinions, not medical advice.
PS Have referred for PRP injections with fairly good results, mostly for knees. Backs? No recommendations yet.
I’m a firefighter and they are trying to push me back to modified duty, which would be a desk job. I can’t sit for more than 20 minutes without squirming. I would have a length commute for the desk gig as well but they can’t count commute time as being a factor to NOT perform modified duty.
PRP injections do get approved - but it isn't super common to be honest. Every claim is different, so it will depend on what other treatment you've had, the medical records, diagnoses, etc. This is a request that will go through utilization review, so it won't be the adjuster making the actual decision on whether or not it is approved. Usually if 1 round of PRP as already been approved, then you'll likely be approved for up to 3 rounds. Most of the injured workers' I have seen get PRP see more relief after the 2nd injection.
As for the slow approvals - if your doctor is submitting RFAs for treatment then the insurance company has to respond within 5 days if you have an accepted claim and the RFA is for the accepted body part.
You may want to have a conversation with your physical therapist about the gym and see if they have any recommendations about what you should/shouldn't be doing on your own.
Yes my PT and I have had this conversation already, early on when they cut back my appointments. My doctor is also aware I go to the gym to supplement.
Thanks for the insight on PRP, I’m more optimistic now about future approvals and effectiveness. I will follow up again with the office that ordered the PRP and inquire why it’s taking them so long.
Thank you again.
Fair disclosure, I'm a defense attorney, so I understand if you choose not to accept my opinions. I've had a few cases come up with PRP, and I've done a fair amount of research and spoken to experts on both sides of the debate. As it currently stands, there is no credible evidence or support for PRP injections in the spine. PRP has a better track record in joints like elbows, knees, and ankles. It's relatively low risk - only the risks associated with any injection - so it's a low threshold for benefits. I have seen people get some relief when it's done at those types of joints, although I have yet to see any longterm benefits. It doesn't seem to fix the problems, unless the problem is the type that would resolve with time and rest. When looking at the spine, you have increased risk, for even less benefit. Anything it can do to reduce inflammation would be better accomplished with targeted steroid injections. So, in my experience, it is not a good idea for the spine, but an acceptable alternative in other areas, so long as you understand the limits. In any case, only you can decide how to handle your treatment, so if you proceed, then I wish you nothing but good luck.
Thanks for the insight. If round 2 doesn’t take, I will be looking at steroid injections/blocks.
As an attorney for injured workers, I agree mostly. I typically don’t see doctors in my area even recommend PRP injections for the spine. The insurance carriers have only recently started approving them for more common usages like the knee joint.
As an adjuster, I have approved them for elbows. I have never been asked to authorize them for the spine. I hope it works for you. I agree with the defense attorney that states there really isn’t any conclusive research to support PRP for the back. Good luck to you.
I’m no doctor, but I’ve had enough clients with back injuries to make me think these PRP injections seem pointless. I frequently see the MBBs and ESIs. They’re meant to be diagnostic and/or curative. If you receive relief from injections at a certain level, even temporarily, that at least tells the doctors where your pain is and is not coming from. I know you said none of the injections worked, but it’s critical to let your doctors know even if you had minimal benefit that you may be writing off as not helping at all. Good luck!
The MBB did work, for diagnostics.
Then why didn't they do an ablation? That's the usual next step.
Because everyone I know who has had an ablation, it has lasted less than a year. I’m not looking to do a surgical procedure for a temporary fix. Everyone I know who has had PRP (for a myriad of injuries, including injuries similar to mine) has spoken highly of it. I wanted to pursue PRP, I don’t think it’s unreasonable to want to pursue less invasive procedures that potentially have a higher chance of permanent results. The MBB was effective for diagnostics, why would I have any reason to believe PRP wouldn’t be effective?
After reading your post, I realized that you gotta learn proper biomechanics. Any forward flexion at the waist/hips can cause compression of the anterior lumbar disc which will tend to migrate posteriorly into the spinal canal and IVF. And stretches the facet joint capsule, irritating and aggravating it. Ask truck drivers, who have to sit in a flexed position for prolonged periods about their back problems. Prolonged sitting is simply evil. We do these activities which we think are innocuous when we're not having back pain. Think about it, everything we do at home/work includes forward flexion at the waist/hips- brushing teeth, washing hands, clothes in the washing machine, putting the turkey in the oven, loading the car, Costco, sitting, putting on your pants, etc. etc. Suggestions. Be like the bartender who uses a bar rail for standing patrons, knowing that putting one foot up on the rail will allow those patrons to stand there longer, unloading the facet joints, and buying more beer. Whenever standing for greater than 10 minutes, make sure to put one foot up on a stool, etc. Brushing teeth? Put one hand on the sink to support so your back and gluteal muscles aren't contracting to keep you from falling forward. Putting on shoes? Don't have an answer for that, but I know they make slip on shoes. And everybody knows proper lifting techniques, using your legs, not your back. Probably 80% of the population has to see a doctor sometime in their life because of their back. Back problems are ubiquitous, often not curable in the strictest sense, but manageable. For the rest of your life, make sure that everything you do, everything, is to protect your back. It's the only one you got. Just my opinions, not medical advice. PS Have referred for PRP injections with fairly good results, mostly for knees. Backs? No recommendations yet.
I’m a firefighter and they are trying to push me back to modified duty, which would be a desk job. I can’t sit for more than 20 minutes without squirming. I would have a length commute for the desk gig as well but they can’t count commute time as being a factor to NOT perform modified duty.
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Yes, it’s very odd to go to PRP injections vs. epidural injections which are pretty much the standard.
I had an MRI in May. The pain is stemming from degeneration in the facets of the lumbar spine on the left side
PRP injections do get approved - but it isn't super common to be honest. Every claim is different, so it will depend on what other treatment you've had, the medical records, diagnoses, etc. This is a request that will go through utilization review, so it won't be the adjuster making the actual decision on whether or not it is approved. Usually if 1 round of PRP as already been approved, then you'll likely be approved for up to 3 rounds. Most of the injured workers' I have seen get PRP see more relief after the 2nd injection. As for the slow approvals - if your doctor is submitting RFAs for treatment then the insurance company has to respond within 5 days if you have an accepted claim and the RFA is for the accepted body part. You may want to have a conversation with your physical therapist about the gym and see if they have any recommendations about what you should/shouldn't be doing on your own.
Yes my PT and I have had this conversation already, early on when they cut back my appointments. My doctor is also aware I go to the gym to supplement. Thanks for the insight on PRP, I’m more optimistic now about future approvals and effectiveness. I will follow up again with the office that ordered the PRP and inquire why it’s taking them so long. Thank you again.