By Phillip Steele, MD RMSK CAQ Sports Medicine
Performance Injury Care & Sports Medicine
The virtues of PRP for osteoarthritis have been well researched and have shown tremendous results in terms of decreasing pain, increasing function and regeneration of cartilage. The association of PRP and growth factors to stimulate a healing response has been shown in multiple applications and some previous studies have showed benefit for neural tissue (nerve) disorders. A 2014 article reviewed all current research in regards to the use of PRP and peripheral neuropathy found the results to be very encouraging. However they concluded that more research needed to be completed.
Treatment for nerve entrapments prior to the development of ultrasound guided neuro-hydrolysis (hydrodissection) techniques mainly revolved around oral pain medications and surgical release. With the advent of newer hydrodissection techniques many researchers are now suggesting combining PRP with these techniques. As we learn more about regenerative therapy we now can use biologic therapy instead of just injecting steroid near the nerve. Although steroids work by decreasing inflammation of tissues, higher concentrations can be injurious to nerves and other soft tissue if done too frequently or at too high of a concentration. Some experts are now advocating the use of PRP or releasate (platelet lysate) instead of steroids or more traditional combinations. Although hydrodissection techniques can use low concentrations of sterile normal saline (salt water), dextrose water solution 5%, lidocaine and/or small amounts of dexamethasone (steroid) many experts are using a biological approach by using either PRP or releasate.
Prolotherapy using 5% dextrose solution has a mild neuropathic anti-inflammatory effect whereas PRP and releasate have a strong regenerative effect by supporting mesenchymal stem cells (MCSC) with numerous growth factors found in both PRP and releasate. As white blood cells (WBC) may inhibit recovery, many researchers are advocating for the use of releasate as compared to PRP as releasate has no WBC fraction in the solution. Simply, the WBC’s have been removed as part of the centrifuge processing. Using releasate which is basically your plasma plus concentrated beta transforming growth factor, vascular endothelial growth factor, platelet-derived growth factor, fibroblast growth factor, insulin growth factor (EGF), and epidermal growth factor we can facilitate regenerative recovery after hydrodissection.
Although just performing hydrodissection my be beneficial to peripheral neuropathy, by adding releasate we hope to magnify the recovery process allowing for enhanced nerve recovery. In summary, if you suffer from chronic neuropathy you should benefit from hydrodisseciton therapy, but for those suffering from long standing chronic neuropathy you should consider adding either PRP or releasate for an enhanced recovery.