Platelet-Rich Plasma for Treating Chronic Noncancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Introduction: Chronic noncancer pain represents a significant global health challenge, contributing to disability, lost productivity, diminished quality of life, and substantial socioeconomic burden. Platelet-rich plasma (PRP) has emerged as a promising therapeutic option for managing chronic pain. However, a comprehensive assessment of its efficacy and the evidence supporting its use remains limited. This study aimed to systematically evaluate the analgesic effectiveness of PRP compared with placebo or active drug treatments across a wide range of chronic noncancer pain conditions using a rigorous meta-analytic approach. The goal is to provide evidence-based insights to inform clinical decision-making and improve patient outcomes.

Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in the PubMed, Embase, MEDLINE, and Cochrane Library databases to identify randomized controlled trials (RCTs). Studies were screened according to predefined inclusion and exclusion criteria. A random-effects model was applied to account for heterogeneity among studies. The primary outcome, pain scores in patients with chronic noncancer pain, was assessed using the standardized mean difference (SMD). The risk of bias of the included studies was evaluated using the Revised Cochrane Risk-of-Bias Tool (RoB 2). The quality of evidence was rated by the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: A total of 691 RCTs were screened, and 56 studies (comprising 103 comparisons and 7142 patients) were eligible for analysis. PRP was associated with a statistically significant reduction in pain scores compared with both active drug treatments and placebo (SMD = -0.37, 95% confidence interval (CI) -0.59 to -0.15, p = 0.001). No significant differences were observed in pain scores for follow-up periods shorter than 3 months (SMD = 0.12, 95% CI -0.16 to 0.40, p > 0.05). A statistically significant and moderate reduction in pain score was found for follow-up durations of at least 3 months (SMD = -0.69, 95% CI -0.98 to -0.40, p < 0.001). Meta-analyses of subgroups revealed statistically significant and moderate pain reduction in favor of PRP versus active drug treatments for osteoarthritic knee pain (SMD = -0.59, 95% CI -1.01 to -0.17, p = 0.009) and rotator cuff tendinopathy/tear (SMD = -0.60, 95% CI -1.01 to -0.19, p = 0.01), but no significant differences for plantar fasciitis (SMD = 0.03, 95% CI -0.98 to 1.04, p > 0.05). PRP was associated with moderate pain reduction when compared with corticosteroid (SMD = -0.53, 95% CI -0.98 to -0.08, p = 0.02) and hyaluronic acid injection (SMD = -0.55, 95% CI -0.89 to -0.21, p = 0.004).

Conclusions: PRP injections appear to effectively reduce pain in various chronic noncancer pain conditions and show superior analgesic efficacy compared with corticosteroid and hyaluronic acid injections. These findings suggest that PRP may be a preferred treatment option for managing chronic noncancer pain, offering a more sustainable alternative for long-term pain relief.

Systematic review registration: PROSPERO CRD42023441115.