Steroid vs. Platelet-rich plasma in US guided SIJ injections

Steroid injections are still commonly used in the clinical setting in the treatment of sacroiliac joint (SIJ) pain. A common issue is that steroid injections only provide short-term relief. With the rise in popularity of platelet-rich plasma (PRP) injections, the authors of the current study investigated the efficacy and safety in administering PRP injections for SIJ-related low back pain. It was hypothesised that if beneficial, then PRP injections could potentially enhance tissue healing and may provide longer-term pain relief.

A prospective randomised open blinded study was used to compare steroid injections to ultrasound-guided PRP injections amongst 40 patients (20 in each group) with chronic low back pain diagnosed with SIJ pathology.

Primary outcome measures included Visual Analogue Scores (VAS), Modified Oswestry Disability Questionnaire (MODQ) scores, Short Form (SF-12) Health Survey scores, and complications were evaluated at between 2-weeks and 3-months.

The PRP group recorded a significantly lower VAS at 6-weeks and 3-months. The efficacy at 3-months was 25% and 90% for steroid injection and PRP injection, respectively. 

Despite these positive findings for PRP injections, serious caution must be exercised. Steroid injections can hardly be considered a sensible control, as they have been shown to negatively impact healing in multiple musculoskeletal conditions, and can have detrimental long-term consequences. A better-designed study would have compared PRP injections within this cohort to a placebo injection. This would clarify whether or not PRP injections offer any significant therapeutic benefit over no treatment at all.

> From: Singla et al., Pain Pract 27 (2016) (Epub ahead of print). All rights reserved to Wiley Online Library. Click here for the Pubmed summary.