Episode 31: PRP Update for 2026

Platelet-rich plasma (PRP) injections are the most commonly used regenerative medicine injections for chronic pain conditions in Canada. In this episode, Dr Karmy discusses what PRP is, how it works, and whether or not you would be a good candidate for this treatment 

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Transcript

Dr Karmy: [00:00:00] Also unlike some of the other treatments such as nerve blocks, typically you have to only do it once, and then either it helps or it doesn't help. If it does help, it tends to help for longer than say, cortisone injections.

It can also be used to treat a very wide variety of pains, including muscle pain, tendon damage, osteoarthritis, nerve pain, and so on. 

Raveena: Welcome to Chronic Pain Chronicles with Dr. Karmy, where today we explore platelet rich plasma, aka PRP, and its role in chronic pain management. I'm Raveena your host and advocate for informed balanced conversations about living with and treating chronic [00:01:00] pain. In this episode, Dr. Karmy breaks down PRP, what it is, how it's made from your own blood, and how it's used to treat conditions like osteoarthritis, tendon injuries, and joint pain.

Does it really help the body heal? What does the research say and what should patients realistically expect from treatment? Joining us is Dr. Karmy, a chronic pain focused doctor with over 20 years of medical experience who will guide us through the science behind PRP, his clinical approach and how it fits into a broader evidence-based treatment plan. 

Dr Karmy: This is Dr. Karmy for Chronic Pain Chronicles, and today I wanted to discuss PRP injections. PRP injections is the best categorized as a regenerative, treatment for pain. There's other regenerative medicine treatments out there, including prolotherapy, [00:02:00] prolozone, nStride and, stem cell injections.

However, for various reasons PRP by far is the most common regenerative medicine injection used in Canada.

What is PRP?

PRP is a product made out of your own blood. We take your blood, we spin it in a centrifuge. We concentrate fragments of cells called platelets, which are involved in clotting. So under normal circumstances, when you have a cut initially the cut bleeds, but then the bleeding stops. And the reason it stops is that the clot forms over the cut and these little fragments of cells called platelets are responsible for forming the clot.

[00:03:00] Obviously, after a clot is formed, the cut starts to heal. And the way that the cut heals is that cells around the cut, including platelets, release various growth factors.

There has been quite a bit of research done on PRP injections, and although has most things in pain medicine there is no absolute proof that it works. There is a lot of evidence for knee osteoarthritis and tennis elbow suggesting that it helps. As with other regenerative medicine treatments, most of the research studies focused on pain reduction and functional improvement rather than regeneration.

However, there are [00:04:00] a few studies, particularly in animals suggesting that regeneration also takes place. Is a little bit of debate also about how PRP works. Unlike a drug which has just one ingredient, PRP contains a soup of chemicals, and it is possible the soup differs from patient to patient. Some of the chemicals released by PRP reduces inflammation and some of the chemicals released by PRP can stimulate healing.

And as mentioned earlier, there is some debate as to which of these is more important for the pain improvement.

 What are the advantages of PRP? Well, first of all, it's made out of your own blood. Therefore, it's very safe.

Dr Karmy: Also unlike some of the other treatments such as nerve blocks, [00:05:00] typically you have to only do it once, and then either it helps or it doesn't help. If it does help, it tends to help for longer than say, cortisone injections.

It can also be used to treat a very wide variety of pains, including muscle pain, tendon damage, osteoarthritis, nerve pain, and so on. Most other regenerative medicine treatments do not have such a wide range of pathologies that can be treated.

The downside to PRP is primarily financial. It is generally speaking, not covered under OHIP. It's not covered under private plans. The only plan that it can be covered under is something called health [00:06:00] spending account. This is in part because it doesn't fit into any category. It's not a physiotherapy treatment.

So it's not covered on the physiotherapy. It's not a dental treatment, so it's not covered on the dental coverage. And it's not a drug, it does not have a DIN number.

The other disadvantage is that it has a slow onset of action. It can take anywhere from two weeks to two months before you see the benefit. That is one of the reasons why it's not a great treatment for sudden onset of excruciating pain. Typically if there is sudden excruciating pain due to inflammation or nerve compression, I use cortisone injections, which kick in much sooner, anywhere from two days to two weeks after the treatment.

And of [00:07:00] course with PRP, like with all treatment, it doesn't help everybody. Depending on the pathology, the response rates vary with knees having the best response rate of around 60% of patients, and the duration of response typically is a year. Or more. I have had a number of patients who are still doing well five years after the treatment.

Other, areas which respond almost as well include achilles tendon and shoulders.

Areas That have lower response rates are areas that are much more complex, such as spine, where you have lots of possible sources of pain. This also includes fibromyalgia And patients with headaches , which again tends to have a lot of possible sources of [00:08:00] pain. I suspect the reason for lower response rates is that we don't have a reliable way of determining which of these multiple targets we should inject, and we cannot inject them all.

So taking this into consideration, response rate drops to about 30%. In other words, about one in three patients will respond, and the duration of response also drops to three months to a year.

The other comment I wanted to make about PRP is the type of PRP you inject does make a difference. PRP is one of those treatments where more is more, and the latest research suggests that the more platelets you inject into a given target, the more likely the patient is to respond to the treatment.

They even have recommended [00:09:00] numbers of platelets for different areas. For knees and hips, they recommend five to 10 billion platelets per joint, whereas for other smaller joints and tendons, the recommended number of platelets, a score is lower, closer to four to 5 billion.

So what are my final thoughts on platelet rich plasma? I think that whether or not it is worth a try depends on your financial situation. If you are financially comfortable, I think it can make a great deal of difference sometimes to the point of letting patients go back to work who couldn't work.

Before PRP injections,

typically it works that way in patients with localized pain in one [00:10:00] specific area. For people with widespread pain, it can still help, but it is not likely to have such a big effect and will typically have to be combined with other approaches. If money is tight, then it becomes a little bit more questionable because about half the time it does not help.

Thank you.

Raveena: Thank you for listening to this episode of Chronic Pain Chronicles with Dr. Karmy, where we explored platelet rich plasma and its role in chronic pain management. As we've discussed, PRP is part of a growing field of regenerative medicine, offering a different approach that focuses on supporting the body's natural healing processes.

But like any treatment, it's not a one size fits all solution and understanding who it may benefit and what to realistically expect is key. At Chronic Pain Chronicles with Dr. Karmy, our goal is to bring you clear evidence-based [00:11:00] insights so you can make informed decisions about your care. I'm Raveena Aujla.

Until next time .

 When it comes to your health always consult with your own physician or healthcare provider for personalized advice and guidance. The information provided in this podcast is for educational and informational purposes only, and should not be considered medical advice or a substitute for professional medical care.