Platelet-rich plasma therapy for low back pain: A comprehensive systematic review and meta-analysis

Abstract

Background

Low back pain (LBP) is a major global disability, yet the promise of regenerative medicine using platelet-rich plasma (PRP) remains debated.

Objective

To systematically evaluate the efficacy of PRP injections in reducing pain intensity and pain-related disability in patients with LBP.

Methods

A systematic search of PubMed, Embase, and the Cochrane Library identified randomized controlled trials evaluating the effects of PRP on low back pain. The primary outcomes were changes in pain intensity, measured by the Visual Analog Scale (VAS) or Numeric Rating Scale (NRS), and pain-related disability, assessed using the Oswestry Disability Index (ODI) or the Roland–Morris Disability Questionnaire (RMDQ), at follow-ups of 1 week and 1, 2, 3, 4, and 6 months. A random-effects model was applied for the meta-analysis.

Results

This meta-analysis of 15 RCTs (740 patients) showed that PRP injections significantly reduced pain (SMD: −1.32; 95% CI: −2.06 to −0.59; P = 0.001) and reduced pain-related disability (SMD: −1.04; 95% CI: −1.66 to −0.41; P < 0.001) compared to controls. Significant benefits were observed at 1, 2, 3, and 6 months. Subgroup analysis showed significant improvement in discogenic pain at 1 month, but later effects were inconsistent, whereas non-discogenic pain improved consistently across all time points.

Conclusions

PRP injections reduced LBP and reduced pain-related disability for up to 6 months. For discogenic pain, a significant benefit was detected at 1 month, whereas longer-term effects could not be reliably demonstrated due to high heterogeneity, while non-discogenic pain improved consistently at 6 months. However, these findings should be interpreted cautiously due to substantial heterogeneity across studies.