Allison David J, Loh Eldon, Burnham Robert, Burnham Taylor, Smith Ashley
Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.
Department of Physical Medicine and Rehabilitation, Schulich Medicine and Dentistry, Western University, London, ON, Canada.
Interv Pain Med. 2025 Mar 9;4(1):100566. doi: 10.1016/j.inpm.2025.100566. eCollection 2025 Mar.
This study aimed to compare the effectiveness and safety of leukocyte-poor platelet-rich plasma (LP-PRP) and leukocyte-rich platelet-rich plasma (LR-PRP) for the treatment of cervical facetogenic pain through a pooled analysis of two independent studies. The goal was to provide preliminary evidence comparing the effect on pain relief and functional improvement over time to help inform future research.
The pooled analysis integrated data from two studies: a prospective case series of LR-PRP (n = 36) and a randomized controlled trial (RCT) comparing LP-PRP (n = 21) with corticosteroid injections. Participants in both studies had chronic cervical facetogenic pain confirmed through medial branch blocks and were assessed at baseline, 3 months, and 6 months post-injection. Pain intensity was measured using the Numerical Pain Rating Scale (NRS), and functional disability was assessed using the Neck Disability Index (NDI). Linear mixed-effects models evaluated treatment effects over time, controlling for age, sex, and pain duration. Clinically important differences in pain and disability were determined. Adverse events were also recorded.
Both PRP groups exhibited significant improvements in pain and functional outcomes. However, LR-PRP demonstrated superior efficacy at 6 months, with a greater reduction in NRS scores (β = -1.68, p < 0.01, Cohen's d = -1.15) and NDI scores (β = -3.66, p = 0.02, Cohen's d = -0.94) compared to LP-PRP. A higher proportion of LR-PRP participants achieved clinically significant pain relief (≥2-point NRS reduction) and functional improvement (≥10 % NDI reduction) at 6-months. No significant differences were observed at 3 months. Adverse events were more common in the LP-PRP group, with 11 documented cases, including increased pain and muscle spasms, whereas the LR-PRP group reported no adverse events.
These preliminary findings suggest that LR-PRP appears to provide greater long-term benefits for cervical facetogenic pain compared to LP-PRP, with superior pain reduction, improved function, and a favorable safety profile. These findings suggest the higher leukocyte concentration in LR-PRP may enhance therapeutic outcomes for cervical pain. Further large-scale, randomized trials are necessary to confirm these results and establish standardized PRP preparation protocols.
本研究旨在通过对两项独立研究的汇总分析，比较少白细胞富血小板血浆（LP-PRP）和多白细胞富血小板血浆（LR-PRP）治疗颈椎小关节源性疼痛的有效性和安全性。目的是提供初步证据，比较随着时间推移对疼痛缓解和功能改善的影响，以指导未来的研究。
汇总分析整合了两项研究的数据：一项LR-PRP的前瞻性病例系列研究（n = 36）和一项比较LP-PRP（n = 21）与皮质类固醇注射的随机对照试验（RCT）。两项研究的参与者均通过内侧支阻滞确诊为慢性颈椎小关节源性疼痛，并在注射后基线、3个月和6个月进行评估。使用数字疼痛评分量表（NRS）测量疼痛强度，使用颈部功能障碍指数（NDI）评估功能障碍。线性混合效应模型评估随时间的治疗效果，同时控制年龄、性别和疼痛持续时间。确定疼痛和功能障碍方面具有临床意义的差异。还记录了不良事件。
两个PRP组在疼痛和功能结局方面均有显著改善。然而，与LP-PRP相比，LR-PRP在6个月时显示出更高的疗效，NRS评分降低幅度更大（β = -1.68，p < 0.01，Cohen's d = -1.15），NDI评分降低幅度更大（β = -3.66，p = 0.02，Cohen's d = -0.94）。在6个月时，更高比例的LR-PRP参与者实现了具有临床意义的疼痛缓解（NRS评分降低≥2分）和功能改善（NDI评分降低≥10%）。在3个月时未观察到显著差异。LP-PRP组的不良事件更为常见，记录了11例，包括疼痛加剧和肌肉痉挛，而LR-PRP组未报告不良事件。
这些初步研究结果表明，与LP-PRP相比，LR-PRP似乎为颈椎小关节源性疼痛提供了更大的长期益处，具有更好的疼痛减轻、功能改善和良好的安全性。这些结果表明LR-PRP中较高的白细胞浓度可能增强颈椎疼痛的治疗效果。需要进一步的大规模随机试验来证实这些结果并建立标准化的PRP制备方案。
