When Blood Is a New Alternative Medicine for Pain Relief at Chula Pain Clinic

BANGKOK,April 11,2023 --Chula Medicine researchers have successfully published an article on the injection of patient's own platelets rich plasma into the shoulder ligaments resulting in painreduction,heal torn ligaments and restore torn muscles as an alternative to surgery while reducing the side effects of prolonged use of pain medications.

"Pain"is a condition that no one wishes to experience. And when it occurs,people want to heal as soon as possible. This can be achieved through taking painkillers or alternative medical approaches such as acupuncture,massage,using heat compression,etc. But today,Chula Pain Clinic,King Chulalongkorn Memorial Hospital,The Thai Red Cross Society has a new proven treatment for pain derived from the person's own "platelets" to offer.

"Platelet-Rich Plasma (PRP) injectionfor shoulder ligament injuries or "rotator cuff tears" is one of the treatments we have been doing for over 5 years." ExplainsAssistant Professor Marvin Thepsoparn,MD,an anesthesiologist and pain management specialist at the Pain Clinic,The Thai Red Cross Society. "This approach helps to reduce the side effects of painkillers and is very safe because the patient's own platelets and plasma are used to inject back into patient's injury site to stimulate self-repair," Dr. Thepsoparn is discussing how to relieve pain with platelets.

This research was conducted in collaboration with the Orthopaedic Sports Unit of King Chulalongkorn Memorial Hospital to study pain care for people who have suffered injuries from work,sports,and abnormal body movements. These are the causes of muscle injuries and torn ligaments,which can lead to lifelongchronic pain.

"In this study,we compared the efficiency of treatments by performing an MRI of the shoulder of patients who had already received platelet injection for 6 months,and those who did not use this method to treat torn shoulder ligaments. We found that injecting of the concentration of platelets into the shoulder ligaments significantly reduced pain within 1 – 2 months and also helped repair the tear,resulting in better healing of the ligaments and a reduction in size of the tear. As a result,patients did not have to suffer from chronic pain,avoided surgery,and eliminate the risk of continuously taking painkillers for an extended period."

The concentration of platelets — a new option for pain relief

Dr. Marvin explains the two commonnon surgicalapproaches to pain treatment today: medication and non-drug treatment.

1. Pain treatment with standard analgesic drugs that are commonly used include:

Paracetamol –This group of drugs can relieve mild to moderate pain. However,patients should not take too much of it or use it continuously for extended period as it can cause liver damage.

Non steroidalanti-inflammatorydrugs –While this group is often effective in relieving pain,it can cause side effects such as stomach pain or ulcers. Patients who take this group for an extended period may be at risk of kidney disease or heart disease. Therefore,they should not be taken continuously for extended period.

Morphineis not recommended by doctors in Thailand for the treatment of pain in patients who are not suffering from cancer.

2. Pain Management without medication can be divided into two groups:pain intervention procedures such as radiofrequency ablation of nerves,steroid injection and PRP injection. Secondly,physical therapy by Rehabilitation Medicine which can be done in various ways,including shock wave therapy,ultrasound therapy,warm compress,cold compress,acupuncture and music therapy,etc.

"PRP Injection for body regeneration is considered an alternative medicine that has been practiced abroad for over 10 years. Platelets have various substances that the body produces for self-repair. Therefore,platelet injection has been studied both for cosmetics purposes and for pain management in the knees,shoulders,and other organs in the body," explained Dr. Marvin. He added that many hospitals in Thailand now use this approach as an anti-aging medicine.

Blood quality: efficiency for pain relief

Because this method uses the patient's own platelets,the effectiveness of treatment varies depending on the patient's physical condition,age,lifestyle,habits,andblood quality of the individual patient.

"If the patient is strong,exercises enough,or is an athlete,the blood quality will be good,and so is the body repair effect."

Dr. Marvin cited a foreign study of platelet injections which indicated that the effectiveness of platelet injections in body repair would be very effective for patients under the age of 55.

"This method is very safe because it uses the patient's own blood for treatment,so there are no side effects like using conventional painkillers. Often,patients over 60 years old come to seek treatment using this method,and the doctor agreed to do it,but informs the patient that the effects may not be as good as those who are under 55 years old."

"The treatment is done by taking about 15-30 ml of venous blood and then running it through a centrifuge to concentrate the platelets and splitting the plasma and red blood cells. Then take the plasma with platelets to be used for immediate treatment."

Who is PRP not suitable for?

Though very effective,PRP injection is not suitable for all patients,especially the following two groups:

Cancer patients– because their blood may be cancerous. So,injecting back the patients' concentration of platelets into the body can cause the spread of cancer to other organs.

People with coagulation disorders cause the injection wound to bleed excessively which can be harmful to the patients.

Shoulder ligament problems — trending ailments in urbanites

Until recently,Chula Pain Clinichas taken care of many patients suffering from chronic pain caused by shoulder ligament problems.

"We found that shoulder ligament problems are mostly the result of heavy lifting,work related injuries,and sports injuries. These injuries often take a long time to heal and recover from. PRP injections are therefore beneficial for athletes,office workers,and anyone wanting to recover from injuries in a shorter time so that they can get back to work,compete in sports and live a high-quality life as soon as possible," explained Dr. Marvin briefly.

"We atChula Pain Clinichave a comprehensive approach to patient care,where doctors including surgeons,orthopedic specialists in shoulder surgery,and rehabilitation doctors work together to restore the shoulder function." Dr. Marvin explained

"The doctors begin by selecting the appropriate treatment for the best results that can improve the patients' quality of life. If an ultrasound or MRI shows shoulder ligament injury or frozen shoulder and the team diagnoses that surgery is not required nor suitable,exercise would not help alleviated the pain,an PRP injections should be administered. The patient will be referred to receive PRP injections.Most Patients will receive one or at most two injections,and the pain should have expected to decrease by 80 percent. The remaining 20 percent of the pain will go away with time and rehabilitation exercises.

Dr. Marvin further added,"the cost of treatment is around 9,000 baht per session (procedure)."

The Future of Research on Pain Management with Patients' Own Blood

Dr. Marvin explained the progress of clinical research "in medicine,we do not stop researching to help relieve patients from pain and suffering. This research has also been extended to other organs,such asthe study of PRP injections to suppress pain in fused vertebrae (Ankylosing Spondylitis) cases. The study has reached the 50 percent progress milestone,and we are still looking for patients to participate in the study." Dr. Marvin invited those interested to make an appointment at the Chula Pain Clinic to be examined and diagnosed by physicians to see if they have Back pain and if eligible,patients can choose to participate in the study voluntarily,free of charge.

Stop the pain at the Chula Pain Clinic

"Nobody wants to be in pain,but when ill,they need to be healed. Would it be better if the patients don't need to suffer from pain which is a side effect of their long period of treatment and rehabilitation? This is the concept of the Pain Clinic," Dr. Marvin concluded.

Interested parties suffering from rotator cuff pain,or pain in other parts of the body can receive an examination for correct diagnostics and treatments atPain Clinic,17th floor,Phor Por Ror Building,The Thai Red Cross Society during Monday – Friday from 8.00 a.m. – 4.00 p.m. by making an appointment in advance or by calling +66 2256 5230.

Information Box

Open for volunteers to participate in pain management research project to improve quality of life

Chula Pain Clinic also has two other clinical research projects on pain management to develop better pain relief and pain management options for patients. We are accepting volunteers to participate in the projects,which require patients with physical pain as follows:

Herniated disc patients –The condition has two distinct symptoms:back pain and pain that radiate to the legs. Traditional treatment involved taking pain killers and,if symptoms persisted over time,undergoing surgery. However,a new medical technology now existed that used radiofrequency energy to alleviate pain. By inserting a needle into the affected disc and heating it,the herniated disc shrinks resulting in reduced pain for the patient.

Chronic facial pain and chronic toothache patients,Trigeminal neuralgia –Many patients experience ongoing facial pain and toothaches,which can lead to difficulty eating,rapid weight loss from pain when chewing. While dentists often attempt to alleviate this pain through tooth extraction,this approach id frequently ineffective because the pain does not originate in the teeth themselves. Recent medical research has identified two groups of nerves beneath the skull base that are responsible for the facial pain. Injecting botulinum toxin (known commercially as "botox") into these facial nerves has been shown to reduce pain levels. Currently,the research has come halfway. We have found that 80 percent of patients reporting almost complete pain relief,a reduction in painkiller usage,and a return to normal eating habits. Despite this progress,more research is needed to fully understand the mechanisms behind this treatment and to expand its accessibility.

Individuals who are interested in taking part in the aforementioned study may request an appointment at Chula Pain Clinic to undergo a pain diagnosis for any disease. If deemed eligible,patients have the option to voluntarily participate in the study and receive treatment free of charged. Those interested in participating in the above study can request an appointment at theChula Pain Clinicfor a diagnosis of pain from any disease. If eligible,patients can choose to participate in the study voluntarily to receive treatment free of charge.

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Chulalongkorn University sets the standard as a university of innovations for society and is listed in the World's Top 100 Universities for Academic Reputation,in the Quacquarelli Symonds (QS)World University Rankings 2021-2022.

If you would like more information about this topic,please contact Miss Thanita Wangvanichapan at (+66) 2218 3280 or email thanita.w@chula.ac.th