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.

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 FAQ — University Pain Consultants

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are regenerative injection therapies that use concentrated growth factors from your own blood to stimulate tissue repair and reduce pain. Below, Dr. Rainier Guiang, MD, board-certified pain management specialist at University Pain Consultants, answers the most common questions patients ask before their first treatment.

What is platelet-rich plasma (PRP) therapy?

Platelet-rich plasma (PRP) is a concentrate of your own blood that contains 3 to 5 times the normal concentration of growth factors and healing proteins. We draw a small sample of your blood, spin it in a centrifuge to separate the platelets, and inject the concentrated plasma directly into the area of injury or pain. Because PRP is derived from your own blood, the risk of allergic reaction is extremely low.

What is PRF and how does it differ from PRP?

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate. Unlike PRP, PRF is processed without anticoagulants, which allows it to form a fibrin matrix that releases growth factors slowly over time. At University Pain Consultants, we offer both formulations and select between them based on your specific condition and anatomy.

What conditions can PRP treat?

PRP is used most commonly for osteoarthritis (knee, hip, shoulder), tendon injuries (rotator cuff, Achilles, patellar, lateral epicondylitis), ligament sprains, chronic low back pain, sacroiliac joint pain, and degenerative disc conditions. We also offer PRP for plantar fasciitis, chronic bursitis, and post-surgical recovery support.

How many PRP injections will I need?

Most patients with mild-to-moderate conditions see significant improvement after 1 to 3 injections spaced 4 to 6 weeks apart. Severe osteoarthritis or chronic tendon pathology may require a series of 3 to 4 injections. Dr. Guiang will reassess your response after each treatment and adjust the plan accordingly. Many patients experience lasting relief for 12 to 18 months or longer.

How is PRP different from cortisone injections?

Cortisone suppresses inflammation but does not repair damaged tissue and may accelerate cartilage breakdown with repeated use. PRP works by stimulating the body’s own healing cascade, promoting collagen production, reducing destructive enzymes, and encouraging tissue regeneration. PRP results take longer to develop but tend to be more durable and do not carry the risks associated with repeated steroid exposure.

Does insurance cover PRP therapy?

Most commercial insurance plans, including Medicare, currently classify PRP as investigational for musculoskeletal indications and do not cover it. We offer transparent self-pay pricing and can discuss payment options at your consultation. HSA and FSA funds are generally eligible.

What happens during the procedure?

The entire visit takes 45 to 60 minutes. We draw 15 to 30 mL of blood from your arm, process it in our in-office centrifuge for approximately 10 minutes, then inject the PRP under ultrasound guidance for precision. Most patients drive themselves home and resume light activity the same day, with full activity typically resumed within 1 to 2 weeks.

Am I a good candidate for PRP?

Ideal candidates are patients with documented musculoskeletal injury or degenerative joint disease who have not achieved adequate relief from physical therapy, anti-inflammatory medications, or traditional injections. Patients on blood thinners, with active infection, certain platelet disorders, or current cancer treatment may not be candidates. Dr. Guiang reviews your full medical history at the initial consultation to confirm candidacy.

What should I avoid before a PRP injection?

Stop NSAIDs (ibuprofen, naproxen, aspirin) and fish oil 5 to 7 days before your procedure. These medications suppress platelet function and reduce PRP effectiveness. Stay well hydrated the morning of your appointment. Do not fast. If you take prescription blood thinners, consult with Dr. Guiang before stopping them.

Schedule a PRP / PRF consultation

University Pain Consultants serves patients throughout the Inland Empire from our Riverside and Menifee locations. Call 951-900-3253 or request an appointment online with Dr. Guiang.

PRP / PRF Therapy for Pain — Frequently Asked Questions