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.

PRP & PRF Therapy for Pain | University Pain Consultants

University Pain Consultants • Biologic Therapies

Platelet-Rich Plasma & Platelet-Rich Fibrin PRP & PRF for Pain Relief

Harness your body's own healing power. Biologic injections derived from your own blood deliver concentrated growth factors directly to damaged tissues — stimulating natural repair without surgery or synthetic drugs.

100% Autologous — Your Own Blood No Steroids No Surgery Physician-Performed

Book a Consultation See If You Qualify

All injections are physician-performed under image guidance. Our board-certified anesthesiologist and pain specialist brings decades of precision injection experience to every procedure.

Background

A Brief History of PRP

70s

1970s — First Described

Platelet-rich plasma was first described in the hematology literature as a product to treat thrombocytopenia. Researchers noted its exceptional concentration of platelets and growth factors.

80s

1980s — Surgical Use Begins

Surgeons began using PRP in open heart surgery and oral/maxillofacial procedures to accelerate healing. Early results demonstrated significantly faster tissue regeneration.

90s

1990s–2000s — Sports Medicine Adoption

Elite athletes began receiving PRP for tendon and ligament injuries. High-profile sports medicine applications brought PRP into the mainstream and spurred clinical research.

2000s — PRF Emerges (2nd Generation)

Dr. Joseph Choukroun developed Platelet-Rich Fibrin (PRF) in France as a next-generation biologic. Without anticoagulants, PRF forms a natural fibrin matrix that releases growth factors more slowly and sustainably than PRP.

Now

Today — Expanding Evidence Base

Hundreds of peer-reviewed studies now support PRP and PRF for joint pain, spine conditions, tendon injuries, and more. Both are recognized as first-line regenerative options at major academic medical centers worldwide.

Platelet-rich plasma is prepared by drawing a small amount of the patient's own blood — typically 30–60 mL — and placing it in a centrifuge. Spinning separates the blood into layers: red blood cells settle at the bottom, a thin layer of platelets and white blood cells forms in the middle (the "buffy coat"), and platelet-poor plasma sits on top.

The platelet-rich layer is extracted and concentrated. The resulting PRP contains 3–8 times the normal concentration of platelets found in whole blood, delivering a powerful payload of growth factors including PDGF, TGF-β, VEGF, IGF-1, and EGF — all of which play key roles in tissue repair and regeneration.

Because PRP is derived from the patient's own blood, it is completely autologous — carrying no risk of disease transmission, rejection, or allergic reaction.

Understanding Your Options

PRP vs. PRF — What's the Difference?

Both are derived from your own blood and concentrate powerful healing growth factors. PRF represents the next generation of biologic therapy — offering a more natural preparation and a sustained-release profile that many clinicians now prefer for musculoskeletal conditions.

Platelet-Rich Plasma (PRP)First Generation

Preparation Blood drawn with anticoagulant; centrifuged to separate platelets from red blood cells

Consistency Liquid form — injectable directly

Growth factor release Rapid — most growth factors released within the first hours to days

Fibrin scaffold Minimal — does not form a natural fibrin matrix

Additives Requires anticoagulant (e.g. sodium citrate) and sometimes activating agents (thrombin, calcium chloride)

Platelet concentration 3–8× baseline; highly variable by system

Best for Intra-articular joint injections, tendon injections, epidural/spinal applications

Platelet-Rich Fibrin (PRF)Second Generation — Advanced

Preparation Blood drawn without anticoagulant; slow centrifugation allows natural polymerization

Consistency Forms a natural fibrin gel/membrane or injectable liquid (i-PRF)

Growth factor release Sustained — slow release over 7–14 days from fibrin matrix

Fibrin scaffold Rich 3-D fibrin scaffold supports tissue regeneration and cell migration

Additives None — completely natural, no anticoagulants or activators needed

Platelet concentration Lower platelet count but higher leukocyte and growth factor retention

Best for Intradiscal injections, sacroiliac joint, soft tissue, and any application benefiting from sustained release

Which is right for you? Our physician will recommend PRP, PRF, or a combination protocol based on your specific diagnosis, the anatomical target, and the latest clinical evidence. Many patients receive a tailored protocol combining both biologics for maximum benefit.

The Procedure

What to Expect During Treatment

The entire procedure is performed in-office and typically takes 45–90 minutes. No general anesthesia is required. Most patients return to light activity the same day.

Blood Draw

30–60 mL of your own blood is drawn from a vein in your arm — similar to a standard lab draw.

Centrifugation

Your blood is spun in a centrifuge to separate and concentrate the platelet-rich fraction.

Preparation

PRP or PRF is prepared under sterile conditions. No synthetic additives are used in PRF preparation.

Image-Guided Injection

Using fluoroscopy or ultrasound guidance, the biologic is precisely delivered to the target tissue.

Conditions Treated

What Can PRP & PRF Treat?

PRP and PRF have demonstrated clinical benefit across a wide range of musculoskeletal and spine conditions.

Knee Osteoarthritis

Strongest evidence base — multiple RCTs and meta-analyses support superior outcomes vs. cortisone and hyaluronic acid at 12 months.

Hip Osteoarthritis

Significant pain reduction and functional improvement in mild-to-moderate hip OA.

Shoulder — Rotator Cuff

Partial thickness tears, tendinopathy, and subacromial impingement respond well to ultrasound-guided PRP.

Lateral Epicondylitis (Tennis Elbow)

PRP outperforms cortisone in multiple RCTs for chronic lateral epicondylitis at 6 and 12 months.

Plantar Fasciitis

Strong evidence for PRP in chronic plantar fasciitis unresponsive to conservative care.

Achilles Tendinopathy

PRP promotes tendon healing and pain reduction in chronic Achilles tendon pathology.

Sacroiliac Joint Dysfunction

PRF has shown superior results vs. PRP for SI joint pain at 6-month follow-up in published trials.

Discogenic Low Back Pain

Intradiscal PRP and PRF promote nucleus pulposus regeneration and reduce discogenic pain.

Lumbar Facet Joint Pain

Intra-articular PRP for facet-mediated spinal pain shows meaningful improvement in published case series.

Ankle Sprains & Instability

PRP accelerates ligament healing and reduces recovery time in chronic ankle ligament injuries.

Patellar Tendinopathy

PRP provides durable pain relief in jumper's knee, outperforming dry needling and cortisone.

Trochanteric Bursitis

PRP for greater trochanteric pain syndrome demonstrates sustained benefit beyond cortisone at 12 months.

Focus: Knee Osteoarthritis

Why PRP Is the New Standard for Knee Pain

Knee osteoarthritis affects over 650 million people worldwide and is one of the leading causes of disability. For decades, corticosteroid injections and hyaluronic acid have been the standard of care — but a growing body of high-quality evidence now positions PRP as the superior choice for durable pain relief and functional improvement.

A landmark 2024 meta-analysis by Di Matteo et al. published in the American Journal of Sports Medicine analyzed randomized controlled trials and found that PRP produced clinically meaningful improvements in pain and function at 1, 3, 6, and 12 months — exceeding the minimum clinically important difference at multiple time points — while placebo injections did not achieve these thresholds.

Di Matteo et al. 2024 — Am J Sports Med Prost et al. 2024 — Regen Ther (PMC) Hou et al. 2024 — Meta-analysis, Ann Med Surg Frontiers Physiology 2025 — Retrospective KOA Mende et al. 2024 — Military Med (Oxford) Singh et al. — PRP vs. Corticosteroid RCT Meta-analysis

>12 mo

Duration of pain relief with PRP — significantly longer than cortisone (typically 4–8 weeks) or hyaluronic acid

300+

Peer-reviewed studies on PRP for knee osteoarthritis published in the last decade

~80%

Of patients in recent meta-analyses reported meaningful improvement in pain and function following PRP treatment

Why We Recommend Against Long-Term Cortisone

The Problem With Cortisone Injections

Emerging evidence strongly suggests that repeated corticosteroid (cortisone) injections cause measurable cartilage damage and may accelerate the progression of osteoarthritis. A 2025 study presented at the Radiological Society of North America found that a single cortisone injection led to significantly greater structural cartilage damage over two years compared to hyaluronic acid injections. A 2023 editorial in Osteoarthritis and Cartilage (Orchard, J W) concluded: "In the longer term, intraarticular corticosteroid injections offer only harm for knee osteoarthritis."

⚠ Cortisone (Corticosteroids)

Provides short-term pain relief (typically 4–8 weeks) with no disease modification

Suppresses collagen synthesis — directly inhibiting cartilage repair mechanisms

Catabolic effect on cartilage matrix: reduces proteoglycan and collagen II production

Repeated injections associated with cartilage thinning, tendon weakening, and increased risk of joint replacement

Can cause elevated blood glucose — problematic for diabetic patients

Systemic effects include adrenal suppression, avascular necrosis (rare but serious)

Rapidly progressive osteoarthritis and femoral head collapse reported following hip injections

Pain relief does not persist at 6–9 month follow-up in multiple large trials

✓ PRP / PRF (Biologic Therapy)

Stimulates tissue repair using your body's own growth factors — addresses the cause, not just the symptom

Anabolic effect: promotes chondrocyte proliferation and cartilage matrix synthesis

Anti-inflammatory without the catabolic consequences of steroids

Pain relief typically peaks at 3–6 months and is sustained beyond 12 months in most patients

No systemic side effects — 100% autologous, derived from your own blood

No risk of blood sugar elevation, adrenal suppression, or avascular necrosis

May slow or partially reverse cartilage degeneration in early-to-moderate osteoarthritis

Superior outcomes vs. cortisone at 6 and 12 months in multiple head-to-head RCTs

References: Orchard JW. Osteoarthritis Cartilage. 2023;31(2):142-143. | RSNA 2025 Annual Meeting (Upadhyay Bharadwaj et al.) | Donovan et al. meta-analysis | Purcell et al. Bone Joint J 2020 (increased arthroplasty risk).

Spine Applications

PRP & PRF for Spinal Pain

Spinal pain — whether from disc degeneration, facet joint arthritis, or sacroiliac dysfunction — responds to biologic therapy through the same tissue-regenerating mechanisms as joint pain. Our physician performs all spinal injections under fluoroscopic guidance for precision and safety.

Intradiscal PRP & PRF

The intervertebral disc is avascular — it has almost no blood supply and therefore very limited natural healing capacity. Intradiscal injection of PRP or PRF delivers growth factors directly into the nucleus pulposus, where they can stimulate disc cell (annulocyte and chondrocyte) proliferation and matrix repair.

Published research demonstrates that intradiscal PRP can:

Reduce discogenic low back pain scores significantly vs. placebo
Improve disc hydration (T2 signal intensity on MRI) suggesting partial disc regeneration
Reduce functional disability and improve quality of life
Delay or defer the need for surgical disc intervention

Ref: Platelet-Rich Plasma for Degenerative Spine Disease — PMC 2024 | Zielinski et al. Pain Physician 2022 (multicenter RCT)

Facet Joint Injections

Lumbar and cervical facet joints are a major source of axial spinal pain. PRP delivered into facet joints provides anti-inflammatory and regenerative effects that outlast cortisone injections significantly, without the catabolic risks.

Effective for lumbar, thoracic, and cervical facet-mediated pain
Superior duration of relief compared to corticosteroid facet injections
Can be combined with medial branch blocks for diagnostic clarity
No limit on frequency unlike cortisone (safe to repeat as needed)

Sacroiliac Joint (SIJ)

Sacroiliac joint dysfunction is a frequently overlooked cause of low back pain accounting for up to 25% of cases. A published comparative trial found PRF superior to PRP for SI joint pain at 6-month follow-up, making PRF our preferred biologic for this indication.

Ref: Mohi Eldin et al. — Intradiscal PRF vs PRP comparative study | PubMed PMID 30958332 (SIJ PRF vs PRP)

Clinical Overview

Benefits & Risks of PRP / PRF Therapy

Potential Benefits

Meaningful pain reduction lasting 6–18 months in most responders

Improved joint function, mobility, and quality of life

Disease-modifying potential — may slow cartilage degeneration

100% autologous — no synthetic drugs, no foreign biologics

No systemic side effects — safe for diabetic and immunocompromised patients

Can be repeated safely without cumulative joint harm

May delay or eliminate the need for surgery

Minimal recovery time — most patients return to activities within days

Complementary with physical therapy and other conservative treatments

No limit on number of treatments unlike corticosteroids

Risks & Limitations

Temporary pain flare at injection site lasting 2–5 days (common, expected)

Swelling, bruising, or stiffness at the injection site (typically resolves in 1–2 weeks)

Infection — rare (<0.1%); sterile technique minimizes risk

Nerve or vascular injury — rare with image-guided technique

Non-response in approximately 20–30% of patients; results are not guaranteed

Results may take 4–8 weeks to fully manifest as tissue repair progresses

Multiple treatments may be needed for optimal benefit

Generally not covered by health insurance — out-of-pocket cost applies

Evidence strongest for knee OA; emerging for some other indications

Patient Safety

Contraindications

PRP and PRF have an excellent safety profile due to their autologous nature, but the following conditions require careful evaluation or preclude treatment.

Active Cancer or Recent Chemotherapy Absolute

Growth factors in PRP could theoretically stimulate tumor cell proliferation. Oncologist consultation required.

Active Infection at Injection Site Absolute

Risk of spreading infection into the joint or disc space.

Platelet Disorders / Thrombocytopenia Absolute

Insufficient platelet count renders PRP/PRF preparation ineffective and may increase bleeding risk.

Anticoagulant Therapy — Severe Absolute

Warfarin, DOAC, or heparin at therapeutic levels may preclude safe injection. Discuss with your prescriber.

Pregnancy Relative

Insufficient safety data. Not recommended during pregnancy.

Systemic Autoimmune Disease Relative

Rheumatoid arthritis, lupus, and similar conditions may alter PRP response. Case-by-case evaluation required.

Recent Corticosteroid Injection Relative

Prior cortisone at target site within 4–6 weeks may reduce PRP efficacy. A washout period is recommended.

Severe Anemia or Low Hemoglobin Relative

May affect the quality and yield of the PRP preparation.

NSAIDs and Aspirin Relative

Anti-platelet medications should ideally be stopped 5–7 days before treatment as they may reduce platelet function.

End-Stage Osteoarthritis (Grade IV) Relative

Bone-on-bone disease has limited cartilage remaining; surgical consultation may be more appropriate.

Peer-Reviewed Research

Key Published Evidence

Our treatment protocols are grounded in the best available clinical evidence. The following peer-reviewed publications represent the strongest support for PRP and PRF in pain management.

PRP Meta-analysis — Knee OA | Am J Sports Med 2024

Di Matteo et al. found PRP injections produced clinically meaningful improvements in knee pain and function at 1, 3, 6, and 12 months, exceeding the minimum clinically important difference at multiple time points. Placebo injections did not achieve these thresholds.

View on PubMed

PRP vs. Corticosteroid Meta-analysis | BMC Musculoskelet Disord 2021

Singh et al. systematic review and meta-analysis of RCTs comparing intra-articular PRP vs. corticosteroid injections for symptomatic knee OA. PRP demonstrated superior pain reduction and functional outcomes at 6 and 12 months with a favorable safety profile.

View on PubMed

Long-term PRP for Knee OA | Regenerative Therapy (PMC) 2024

Prost et al. demonstrated sustained improvement in pain and function in knee OA patients following high-volume PRP, with results persisting at long-term follow-up and no serious adverse events reported across multiple centers.

View Full Text (PMC)

Intradiscal PRP — Lumbar Discogenic Pain | Pain Physician 2022

Zielinski et al. multicenter, randomized, double-blind study demonstrating safety and efficacy of intradiscal PRP for lumbar discogenic pain, with significant reduction in pain scores in the treatment group vs. controls.

Pain Physician Journal

PRF vs. PRP for Sacroiliac Joint | PubMed PMID 30958332

Mohi Eldin et al. non-randomized controlled trial (186 patients) comparing PRF vs. PRP for sacroiliac joint dysfunction. PRF showed statistically superior VAS pain reduction at 6-month follow-up compared to PRP.

View on PubMed

Corticosteroids — Long-term Harm in Knee OA | Osteoarthritis Cartilage 2023

Orchard JW editorial in Osteoarthritis and Cartilage concluding that the cumulative evidence supports that corticosteroid injections offer only harm in the long-term management of knee osteoarthritis, supporting a shift to regenerative alternatives.

View on PubMed

Ready to Explore PRP or PRF Therapy?

Schedule a consultation with our physician to determine whether biologic injection therapy is right for your condition.

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Medical Disclaimer: PRP and PRF therapies are autologous biologic procedures. Results vary between individuals and are not guaranteed. This page is for informational purposes only and does not constitute medical advice. Treatment decisions are made on an individual basis following a comprehensive medical evaluation. These services are not covered by insurance in most cases. References to peer-reviewed literature are provided for informational purposes; links are to publicly available abstracts and do not imply endorsement.