Differing efficacies of autologous platelet-rich plasma in reducing pain following rotator-cuff injury in a single patient

Abstract

Rotator-cuff tears (RCTs) are typically associated with chronic pain. The most common treatment for reducing pain is the injection of cortisone into the injury site. An alternative and increasingly used technique is the injection of autologous platelet-rich plasma (PRP). A limitation of cortisone is its pain relief is short-lived, while PRP has the limitation of providing pain relief to only about 50% of patients, making its efficacy questioned, although when it is effective, its efficacy is longer than cortisone. Little is known about what accounts for these limitations. This paper presents results from a patient with RCTs causing excruciating pain who received an injection of PRP into that shoulder resulting in complete pain elimination that was ongoing at 2 years and 2 months. When 7-month severe posttrauma pain associated with the RCT developed in the contralateral shoulder, PRP prepared the same way and injected by the same person who performed the first injection provided no pain relief. However, a subsequent single cortisone injection resulted in complete pain elimination, which was ongoing at >15 months. These observations indicate that PRP can have inconsistent effects in reducing pain, not only between patients but also within the same patient. Further, although the pain relief induced by cortisone is normally not long-lasting, when given following a PRP injection, it can induce complete pain relief lasting >15 months. This paper discusses possible reasons for the variability in PRP efficacy on pain relief and addresses the possibility that when administered together, PRP and cortisone may act in a complementary manner, leading to significantly greater and longer-lasting pain relief.

Efficacy of Ultrasound-Guided Glenohumeral Joint Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Controlled Trial

“…42 It has also been shown that PRP, when prepared in the same manner, may elicit different effects in the same individual. 43 Contrary to our study hypothesis that LP-PRP would be more effective than HA, there were no differences in outcomes between LP-PRP and HA groups at the follow-up time points. Improvements in outcomes after either single injections of LP-PRP or HA were sustained up to 12 months postinjection.…”

“…42 It has also been shown that PRP, when prepared in the same manner, may elicit different effects in the same individual. 43…”

Efficacy of Platelet-Rich Plasma Injection in the Management of Rotator Cuff Tendinopathy: A Review of the Current Literature

“…Kuffler published an interesting case report in 2018 about the differing efficacies of PRP injection for rotator cuff tendinopathy in the same patient at different periods [33]. The patient in the case report was a 67-yearold gentleman with ongoing symptoms in his right shoulder for almost three months.…”

Variables affecting the potential efficacy of PRP in providing chronic pain relief

“…The patient suffered from severe chronic pain associated with rotator cuff tears (RCTs) in one shoulder, which was rapidly and permanently eliminated by an injection of PRP. However, when 7 months later similar pain developed in the contralateral shoulder due to RCTs, an injection of PRP had no influence on the pain 12. Thus, despite no apparent variables in the patient, PRP preparation, or application, PRP may or may not be effective as an analgesic.…”

“…A number of clinical studies concluded that PRP provides little or no pain relief for tendinosis6 or rotator cuff tears 6–8. However, other clinical studies found that PRP reduces or eliminates pain, such as that associated with tendinosis,9–11 rotator cuff tears,12,13 osteoarthritis,14 plantar fasciitis,15 and muscle injuries 16. PRP is also reported to act as an analgesic in animal pain models, such as rat tendinosis,17 rotator cuff injury,18 and dog tendon injury 19.…”