When it comes to back pain, the fact is that there are many conditions that could contribute. Most patients with back pain will be able to point to a specific incident of acute injury or be able to accurately explain the chronic condition contributing to the pain, but for many patients back pain can be elusive and difficult to understand. One such condition that many do not understand is what’s known as a herniated, slipped, bulged, or ruptured disc. All of these terms refer to the same or similar condition and instance that brought the condition about but for the purposes of this article, we will be referring to the condition as a herniated disc. Understanding the occurrence and pathogenesis of a herniated disc is a patient’s first step in seeking proper diagnosis and treatment for the pain.
For patients with a herniated disc, the pain can seem insurmountable and preclude any necessary physical activities. It has often been reported that the symptoms include general back pain and weakness but what some patients may not know is that a herniated disc can also affect arms and legs in the same way. One may wonder how a herniated disc in the spine could affect these other areas, however it is essential that they do. If patients are unable or unwilling to understand how a herniated disc can contribute to arm/leg weakness and pain, they may attribute these symptoms to other conditions that can lead to misdiagnosis and potentially improper treatment.
The first thing to understand about any level of pain is that it is all directly tied to our central nervous system that runs along the spine. Pain nerves (or fibers) that run along the central nervous system also extend to the lengths of our legs and arms, what is also known as our peripheral nervous system. It is for this reason that many patients who suffer from diabetes also experience peripheral neuropathy– a condition that contributes to lasting hand and feet numbness and pain. It is common for one injury to spur other issues and pain conditions across the body. A similar condition that originates in the spine and extends to other areas of the body is sciatica. Patients with sciatica will typically feel pain along their hip or leg not knowing that the pain is a result of a pinched nerve in their spine. Because of improper understanding of the condition, a herniated disc sits alongside these conditions as one that is typically misdiagnosed and inadequately treated. So, what exactly is a herniated disc and why does it affect these outlying areas.
Dr. Wai Weng Yoon of the Spinal Surgery Unit in Leicester, UK, surmises the condition of a herniated disc as, “a localized displacement of disc material beyond the normal margins of the intervertebral disc space” (2021). Simply put, a herniated disc occurs when the cushion of disc that sits between the vertebrae to provide flexibility and protection ruptures. This rupture pushes part of the disc outside of its typical circumference.
Dr. Yoon continues to explain that “[t]he pain pathway originates in impingement [pinching] of the nerve root by the herniated disc, which may in turn lead to nerve damage both by mechanical and chemical pathways. Mechanically, compression of the nerve likely leads to localized ischemia [blood flow blockage] and nerve damage”. If there is one condition to which patients could look for similar understanding, it is the previously mentioned condition of sciatica. When a patient understands the central nervous system and how conditions along the spine contribute to other areas of pain in the body, they will more frequently and accurately diagnose these conditions and seek proper treatment.
One of the most promising treatments for pain, including pain from a herniated disc, is the treatment of platelet rich plasma. Many patients have not heard of platelet rich plasma and are understandably wary of any treatment that might be novel, perhaps fearing that it is not tried and true. But for platelet rich plasma, the evidence for its treatment capability is clear. In a study examining the effects of platelet rich plasma as an intradiscal (spinal disc) treatment, Dr. Tuakli-Wosorno and his associates concluded that, “[p]articipants who received intradiscal PRP showed significant improvements in FRI [Functional Rating Index], NRS [Numeric Rating Scale] Best Pain, and NASS [North American Spine Society] patient satisfaction scores over 8 weeks compared with controls. Those who received PRP maintained significant improvements in FRI scores through at least 1 year of follow-up” (2016). Even with these results, patients might maintain a healthy skepticism surrounding platelet rich plasma as a treatment for herniated discs. In this case it may be necessary for patients to examine which treatment options are available and how they compare with platelet rich plasma.
In a more recent study examining the efficacy of platelet rich plasma against steroid injections, doctors Zhen Xu and her associates determined that their intentions were, “ . . . aimed at comparing the efficacy and safety aspects between ultrasound-guided transforaminal injections of PRP and steroid in patients who suffer from radicular pain due to lumbar disc herniation” (2021). The study included, “a total of 124 patients who suffer from radicular pain due to lumbar disc herniation. Patients were assessed by the visual analogue scale (VAS), pressure pain thresholds (PPTs), Oswestry disability index (ODI), and the physical function (PF) and bodily pain (BP) domains of the 36-item short form health survey (SF-36) before operation and 1 week, 1 month, 3 months, 6 months, and 12 months after operation”. While it was eventually concluded that PRP has a similar level of efficacy when compared to steroid injections, the physicians ultimately determined that, “. . . ultrasound-guided transforaminal PRP injections yield similar effect as transforaminal steroid injections in treating lumbar disc herniation with radicular pain and that it may be a safer alternative in comparison”. With all this in mind, patients may still be apprehensive to seek platelet rich plasma as a treatment for their herniated disc. Understanding how platelet rich plasma treats this condition may help assuage some of this hesitation.
Before concluding that PRP is comparable to steroid injections and likely safer, doctors Zhen Xu and her associates explained the development and efficacy of platelet rich plasma: “In recent years, PRP has been widely used in treating musculoskeletal diseases due to its anti-inflammatory properties and ability in promoting the processes of endogenous healing by delivering a high concentration of growth factors and cytokines. These growth factors, such as vascular endothelial growth factor (VEGF), transforming growth factor β-1 (TGFβ-1), platelet-derived growth factor (PDGF), and insulin-like growth factor-1 (IGF-1), are contained within the α-granules of platelets. Within 10 minutes after PRP injection, the platelets aggregate and clot at the targeted site with almost 95% of the α-granules load being secreted within 1 hour. Studies have shown that these growth factors are effective in promoting proliferation, angiogenesis, and synthesis of extracellular matrix proteins. Therefore, the key rationale behind the application of PRP is to increase the concentration of platelets at the targeted sites so that cytokines and GFs may be released. This will consequently allow the regulation of inflammation and immunological responses of tissue healing”. Because platelet rich plasma facilitates and aggregates these growth factors along a herniated disc, it is one of the most requested forms of treatment available today. It is also popular because it is a solution provided by the patient’s own blood.
In an evaluation of PRP conducted by the China-Japan Union Hospital of Jilin University, researchers explain that “[p]latelet-rich plasma (PRP) is a platelet concentrate extracted from autologous blood by centrifugation, which is a kind of bioactive substance” (2022). Patients might wonder how this works and whether it is safe– especially when hearing Dr. Wang refer to it as a “bioactive substance”. It is likely that many would be unwilling to apply a “bioactive substance” to treat a herniated disc. However, as is always the case, further evaluation and a deeper understanding of platelet rich plasma will help patients understand its legitimacy as a treatment for a herniated disc. With the advancement of medical technology, Orthagenex is now able to assist the body in treating herniated disc pain through high dose platelet rich plasma.
From autologous blood (a patient’s own blood), Orthagenex is able to take platelets in a concentrated form. When blood is taken from us and put in a centrifuge, it is spun around quickly to separate red blood cells from white blood cells as well as concentrate the number of platelets together. These concentrated platelets, once extracted and applied to a herniated disc, act as a supplemental regrowth. With Orthagenex High Dose PRP, patients with herniated discs will have options and hope through high dose platelet rich plasma. Orthagenex offers the treatment, education, and follow-up that patients need to return to and maintain a renewed level of confidence and understanding in their condition. Without the worry of invasive procedures or unpredictable medications, patients can have hope and confidence in their ability to find how treatments like High Dose PRP, platelet rich plasma, work for them.