What is platelet-rich plasma (PRP) therapy?

Platelet-rich plasma (PRP) is a concentrate of your own blood containing 3 to 5 times the normal concentration of growth factors and healing proteins, injected into the area of injury or pain.

What is PRF and how does it differ from PRP?

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that forms a fibrin matrix releasing growth factors over 7 to 10 days, unlike standard PRP. University Pain Consultants offers both.

What conditions can PRP treat?

PRP treats osteoarthritis (knee, hip, shoulder), tendon injuries, ligament sprains, chronic low back pain, sacroiliac joint pain, degenerative disc conditions, plantar fasciitis, and chronic bursitis.

How many PRP injections will I need?

Most patients improve after 1 to 3 injections spaced 4 to 6 weeks apart. Many experience relief lasting 12 to 18 months or longer.

How is PRP different from cortisone injections?

PRP stimulates tissue regeneration and collagen production rather than just suppressing inflammation. Results are more durable and avoid the risks of repeated steroid exposure.

Does insurance cover PRP therapy?

Most insurance plans classify PRP as investigational. Self-pay pricing is available and HSA or FSA funds are generally eligible.

What happens during the PRP procedure?

The visit takes 45 to 60 minutes. Blood is drawn, centrifuged for 10 minutes, and injected under ultrasound guidance. Most patients resume light activity the same day.

Am I a good candidate for PRP?

Ideal candidates have musculoskeletal injury or degenerative joint disease without adequate relief from physical therapy or traditional injections. Dr. Guiang reviews your history at the initial consultation.

What should I avoid before a PRP injection?

Stop NSAIDs (ibuprofen, naproxen, aspirin) and fish oil 5 to 7 days before the procedure. These suppress platelet function. Stay hydrated and do not fast.

How does ketamine relieve chronic pain?

Ketamine is an NMDA receptor antagonist that blocks receptors driving central sensitization. At sub-anesthetic doses it resets aberrant pain signaling, providing relief that outlasts the infusion by weeks to months.

What chronic pain conditions does IV ketamine treat?

IV ketamine treats CRPS, fibromyalgia, neuropathic pain, refractory migraines, central sensitization syndromes, chronic low back pain, post-surgical pain, and treatment-resistant depression co-occurring with chronic pain.

How many ketamine infusions will I need?

The standard protocol is 4 to 6 infusions over 2 to 3 weeks. Most responders notice improvement by the third or fourth infusion. Maintenance infusions follow every 6 to 12 weeks.

What should I expect during a ketamine infusion?

Each infusion runs 40 to 60 minutes with continuous monitoring. Most patients experience mild dissociation that resolves within 30 minutes. A driver is required on infusion days.

Is IV ketamine the same as Spravato (esketamine)?

No. Spravato is intranasal esketamine approved for depression. IV racemic ketamine is the full molecule with a larger evidence base for chronic pain and more precise dosing.

Is ketamine infusion therapy safe?

At sub-anesthetic doses in a monitored setting, IV ketamine has a well-established safety profile. Dr. Guiang is board-certified in anesthesiology. Side effects at pain doses are mild. Addiction risk is very low.

Does insurance cover IV ketamine for pain?

Coverage is limited. Most payers do not cover IV ketamine as a primary pain treatment. Self-pay pricing is available.

Can ketamine treat both chronic pain and depression?

Yes. Ketamine acts on overlapping neurobiology of pain and depression simultaneously. Up to 50 percent of chronic pain patients meet criteria for depression. Dr. Guiang coordinates with your mental health provider.

Who is not a candidate for IV ketamine?

Contraindications include uncontrolled hypertension, active psychosis or schizophrenia, recent stroke, and active ketamine or PCP use disorder. A full intake evaluation is completed before scheduling.

What is low dose naltrexone (LDN)?

Low dose naltrexone (LDN) uses naltrexone at 1.5 to 4.5 mg per day, one-tenth the standard addiction dose. It transiently blocks opioid receptors to upregulate endorphin production and reduce microglial activation, producing anti-inflammatory and pain-relieving effects.

How is LDN different from standard naltrexone?

Standard naltrexone (50 mg) fully blocks opioid receptors to treat addiction. LDN uses intermittent partial blockade to reduce neuroinflammation. LDN does not cause sedation, weight gain, or physical dependence.

What is the evidence for LDN in fibromyalgia?

Double-blind, placebo-controlled Stanford trials showed statistically significant reductions in fibromyalgia pain, fatigue, and quality of life, with approximately 30 percent symptom reduction in responders. Additional UK and Israeli trials support these findings.

What other conditions can LDN help with?

LDN has emerging evidence for Crohn's disease, multiple sclerosis, CRPS, lupus, chronic Lyme disease, and long COVID, due to its mechanism of reducing central neuroinflammation.

How long does it take for LDN to work?

LDN typically requires 4 to 12 weeks for meaningful pain relief. A minimum 3-month trial is recommended. Dosing starts at 1.5 mg and titrates upward by 1.5 mg every 2 to 4 weeks.

What are the side effects of LDN?

LDN is very well tolerated. Vivid dreams in the first few weeks is the most common side effect, usually resolving with continued use. It does not cause sedation, cognitive impairment, weight gain, or dependence.

Can I take LDN if I am on opioid pain medication?

No. LDN cannot be taken with opioids or tramadol because it can precipitate acute withdrawal. A supervised opioid taper is required first.

Is LDN covered by insurance and where is it obtained?

LDN is compounded and not covered by insurance. Monthly cost is approximately $30 to $60. University Pain Consultants provides prescriptions to trusted compounding pharmacies.

Naltrexone is FDA-approved at 50 mg. LDN at 1.5 to 4.5 mg is prescribed off-label, which is legal and common. The FDA has not disapproved LDN; no large approval trial exists because naltrexone is generic.

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Low Dose Naltrexone for Fibromyalgia: What a Pain Specialist Wants You to Know

May 24, 2026 No Comments

Pain specialist Dr. Rainier Guiang explains how low dose naltrexone (LDN) works for fibromyalgia — the mechanism, the evidence, dosing protocol, side effects, and who is a good candidate.

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