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  • Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

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Chronic and interventional pain
Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial
  1. David J Allison1,2,
  2. Sanam Ebrahimzadeh1,
  3. Stephanie Muise2,
  4. Steven Joseph2,
  5. Alexandria Roa Agudelo1,
  6. Arden Lawson1,
  7. Nicole Billias2,
  8. John Tran1,
  9. Ashley Smith3 and
  10. Eldon Loh4
  1. 1Lawson Research Institute, London, Ontario, Canada
  2. 2Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
  3. 3University of Calgary, Calgary, Alberta, Canada
  4. 4Parkwood Institute, London, Ontario, Canada
  1. Correspondence to Dr David J Allison; David.Allison{at}sjhc.london.on.ca

Abstract

Objective The study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated disability, pain self-efficacy, and the safety of the procedure between groups.

Methods A single-site randomized double-blind controlled trial with 40 participants assigned to receive either leucocyte-poor, low-concentrate platelet-rich plasma injections or corticosteroid injection without local anesthetic into the cervical facet joint under fluoroscopy. Outcomes were collected via telephone at 1, 3, and 6 months to determine treatment effectiveness.

Results Low-concentrate platelet-rich plasma and corticosteroid injections had similar effects on cervical facetogenic pain intensity over a 6-month period post injection as demonstrated by a non-significant group-by-time interaction for Numeric Rating Scale scores (p>0.05). However, both groups showed a statistically significant decrease in cervical facetogenic pain intensity 1 month post treatment compared with baseline (p=0.02), while the platelet-rich plasma group also demonstrated a clinically significant decrease in pain intensity at the same time point. There was a significant interaction at 1 month post intervention for pain self-efficacy (p=0.04), with the platelet-rich plasma injection group showing a larger increase in pain self-efficacy compared with the corticosteroid injection group. No significant interaction was observed for self-rated disability; however, significant reductions were shown at 3 and 6 months post treatment compared with baseline in both groups (p<0.01). No significant differences between groups were reported for adverse events; however, those receiving platelet-rich plasma injection reported significantly less procedural pain (p=0.02).

Conclusion Both platelet-rich plasma and corticosteroid injections induced similar improvements in cervical facetogenic pain intensity (1 month post) and self-rated disability (3 and 6 months post). Pain self-efficacy demonstrated a significant interaction with platelet-rich plasma injection showing greater improvement 1 month post. Additionally, both treatments exhibited a similar low prevalence of adverse events; however, those receiving platelet-rich plasma injection reported less procedural pain.

  • CHRONIC PAIN
  • Pain Management
  • Neck Pain

Data availability statement

Data are available upon reasonable request. N/A.

https://doi.org/10.1136/rapm-2024-105889

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    Data availability statement

    Data are available upon reasonable request. N/A.

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    Footnotes

    • X @LohEldon

    • Contributors DJA and SE contributed to data analysis and writing/editing of the manuscript. SM contributed to study conceptualisation/methodology and data collection. SJ and JT contributed to study conceptualisation/methodology. ARA and AL contributed to recruitment, data collection/management and project administration. NB contributed to data collection/management and project administration. AS contributed to study conceptualisation/methodology, data analysis and manuscript writing/editing. EL contributed to conceptualisation/methodology, funding acquisition, supervision, manuscript writing/editing and is acting as the guarantor.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.