Fibromyalgia translates to pain in the body. Often it’s long term, especially in the joints, muscles and tendons. Although no one knows it’s root cause, we believe it’s the result of lack of sleep, fatigue, anxiety and depression. Upon closer look, we can see the obvious links of the disease to various other degenerative diseases like osteoarthritis, repetitive use damage and problems with connective tissues. Meaning, people who have fibromyalgia experience all or any of the other degenerative disease symptoms.
Probably. Now tissue degeneration can occur due to a lot of reasons. Major one being medications such as NSAIDS and narcotics that block inflammatory response and complete healing. Unfortunately, these are the first remedies that comes to most physician’s mind when they hear the term fibromyalgia. These might help in the short term but for long term we need safe regeneration of tissues.
We know that the primary content in connective tissues like tendons and ligaments is collagen—the substance that literally holds the body together. It’s the scaffold that provides strength and structure. So when we talk of regeneration, it’s primarily regeneration of collagen. And that’s what Platelet-Rich Plasma is good at—it stimulates the cells with growth factors the result of which is healthy production of natural collagen.
For one, Platelet-Rich Plasma (PRP) contains significant concentration of platelets, which when activated releases growth factors. These growth factors are the known to trigger proliferation of tenocytes, fibroblasts, chondrocytes, osteoblasts, and other protein-rich cells. The fibroblast is the one that creates collagen. So injecting PRP into any area results in natural production of new collagen.
The basic steps for preparing platelet-rich plasma involve drawing one or two vials (20-40cc) of blood and spinning it in a centrifuge for 4 minutes. Adjustments may need depending on the patient’s hemoglobin rate. Prior to injecting the PRP, the physician can also perform local anesthesia with lidocaine or something similar. Additionally, ultrasound imagery may be needed for joints so the physician can guide the needle into the right spot.
Repeated injections are definitely helpful. And they are best done with 2-4 weeks interval in-between. And standard rates are between $600 and $800 per injection area.
Although PRP doesn’t offer immediate relief like that offered by narcotics and NSAIDS, in the long run, the story about the pain is a much more pleasant one. We don’t have specific cases of dramatic recovery from fibromyalgia because it’s not easy to quantify the results. On the other hand, hundreds of pain management physicians thank PRP for many of their patient’s success. Here’s what one patient from Kaplan Center for Integrative Medicine has to say:
“Dr. Gary suggested a course of PRP (platelet rich plasma) injections to reduce the pain and swelling in my knees. I began once-a-month treatments in September, 2011, and by the time I went on a vacation in December, I noticed a dramatic improvement in pain and mobility! I hardly took any over-the-counter pain medications during the trip.”
That’s just one of the hundreds of thousands of patients who’ve benefitted from PRP. But certainly it’s not a one-size-fits-all magic bullet either. Sometimes the effect is less dramatic. One major factor for this is hormone levels. Sometimes an excess of hormones like estradiol can completely block connective tissue regeneration. If that’s the case, supplements need to be taken to counter this effect. Dietary adjustment also helps.
What else is PRP good at? According to Active Life Physical Medicine & Pain Center, PLLC, which has administered PRP therapy to more than 400 patients for various tendinopathies, ligament strains, meniscal tears, degenerative joint disease, and various other non-healing painful areas, “The most widely used application for PRP, however, is in treating lateral epicondylitis (tennis elbow). One study of 140 patients with elbow epicondylar pain showed a 60% improvement of pain 8 weeks after PRP injection, compared with a 16% improvement in control patients; the PRP-treated patients reported an 81% improvement at 6-month follow-up.”
Back to fibromyalgia, one of the most influencing factor lies in the patient’s mind. Anxiety, depression and lack of sleep has to be improved. Because without proper sleep and proper relaxation, the body simply refuses to slip into its growth phase where growth factors are abundantly generated. The underlying stress releases cortisol hormone which can lead to proteolysis (breakdown of proteins and growth factors) and muscle wasting.
According to International Cellular Medicine Society (ICMS) PRP must not be administered when existing conditions of platelet dysfunction, thrombocytopenia, hemodynamic instability, or septicemia are present.
At the end of the day, the verdict is still in favor of Platelet-Rich Plasma for Fibromyalgia—a condition where our body’s own natural healing process is in dysfunction. But clinically, we have seen a variety of factors affecting the outcome. Younger, non-smoking patients with a specific condition tend to enjoy better healing response. People who’re older with much diffused problems obviously will have less benefit but there will be benefits nevertheless. Especially when it comes to bones, ligaments and joints where PRP is the first-line healing treatment. That being said, there still is a very minority of cases where patients experience zero improvement (about 0.1%).
With such dramatic odds stacked in your patient’s favor, why wouldn’t you recommend it?