The Clinical Efficacy of Platelet-Rich Plasma Injection Therapy versus Different Control Groups for Chronic Low Back Pain: A Network Meta-Analysis of Randomized Controlled Trials

Xue Zhang; Aili Zhang; Hao Guan; Li Zhou; Jiao Zhang; Wenjie Yin

doi:10.2147/JPR.S444189

The Clinical Efficacy of Platelet-Rich Plasma Injection Therapy versus Different Control Groups for Chronic Low Back Pain: A Network Meta-Analysis of Randomized Controlled Trials

J Pain Res. 2024 Mar 14:17:1077-1089. doi: 10.2147/JPR.S444189. eCollection 2024.

Authors

Xue Zhang^#¹, Aili Zhang^#², Hao Guan¹, Li Zhou¹, Jiao Zhang³, Wenjie Yin¹

Affiliations

¹ Department of Pharmacy, Kunming Yan'an Hospital, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650051, People's Republic of China.
² Department of Scientific Research, Kunming Yan'an Hospital, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650051, People's Republic of China.
³ Department of Basic Medicine, Zhaotong Health Vocational College, Zhaotong, Yunnan, 657000, People's Republic of China.

^# Contributed equally.

Abstract

Objective: Low back pain is one of the main causes of disability in the world. Although regenerative medicine may represent breakthroughs in the management of low back pain, its use remains controversial. Therefore, we conducted a meta-analysis to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection therapy versus different control groups for chronic low back pain during 4 weeks, 3 months, and 6 months.

Methods: Different electronic databases were searched for randomized controlled trials up to August 2023. Mean changes from baseline in pain and Oswestry Disability Index (ODI) scores at 4 weeks, 3 months, and 6 months and standard deviations of outcome were recorded.

Results: Four articles with 154 cases were finally included in this meta-analysis. After 4 weeks, corticosteroid (CS) was the optimal treatment option for chronic low back pain in terms of improvement in pain and disability index (surface under the cumulative ranking curve [SUCRA]=71.3%, SUCRA=57.8%, respectively). After 3 months, radiofrequency (RF) emerged as the best therapy in pain (SUCRA=100%) and disability index (SUCRA=98.5%), followed by PRP (SUCRA=62.3%, SUCRA=64.3%, respectively), CS (SUCRA=24.6%, SUCRA=25.9%, respectively) and lidocaine (SUCRA=13.1%, SUCRA=11.3%, respectively). At 6 months, RF was most likely to be the best treatment in pain (SUCRA=94.9%) and disability index (SUCRA=77.3%), followed by PRP (SUCRA=71.2%, SUCRA=79.6%, respectively). However, compared with the last follow-up, there was a slight downward trend in improvement pain and disability index with RF, while PRP was still an upward trend.

Conclusion: This study demonstrated better short-term improvement of chronic low back pain with CS after 4 weeks. PRP and RF improvement effects matched, but follow-up of at least 6 months showed that PRP seemed to be more advantageous in improvement in disability indices. Considering the limitations of this study, these conclusions still need to be verified by more comparative RCTs and a longer follow-up period.

Keywords: chronic low back pain; clinical efficacy; meta-analysis; platelet-rich plasma; randomized controlled trial.

Grants and funding

This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.