As a board-certified physical medicine and rehabilitation (PM&R) physician, I have guided patients through musculoskeletal care. Recently, my focus has shifted toward regenerative medicine, particularly platelet-rich plasma (PRP) therapy. What began as curiosity is now a strong commitment to understanding these therapies for patients who have exhausted conventional treatments.
This new focus led me to attend an intensive weekend course with experts from orthopedics, sports medicine, PM&R, rheumatology, and pain medicine. The course included intensive eight-hour days of anatomy, ultrasound, procedural techniques, and case discussions.
A key insight was, surprisingly, the general lack of consensus among leading experts. This misalignment has significant implications for patient care and clinical decision-making.
When ten leaders in the field are asked about pre-procedure NSAID restrictions, the resulting diversity of opinions is striking. Similar variation exists in the timing of supplements, modalities, and physical therapy. These are the field’s authorities, but consensus remains elusive.
Upon reviewing institutional protocols and patient handouts, I observed the same pattern of inconsistency. As one review noted, variability persists in areas such as cryotherapy use and supplementation. Patients recognize these discrepancies immediately. They often arrive at my clinic with materials from other practices, questioning why instructions differ. Their confusion is entirely understandable.
The main consensus is found on the topic of inflammation. PRP is effective because it induces controlled inflammation to promote healing. Still, I see patients who have taken ibuprofen before their injection, who were told it would “help with soreness.” All guidelines discourage NSAID use before and after PRP, but timelines vary, from five days to six weeks. When clinics advise NSAID avoidance for either 48 hours or six weeks, patients question whether recommendations are evidence-based or traditional.
Corticosteroids pose a similar issue. Most clinicians agree steroids diminish PRP’s intended healing response, yet washout periods range from two weeks to two months. Supplement guidance is even less consistent; some clinics advise stopping fish oil, turmeric, and vitamin E, while others ignore supplements. A few recommend vitamin C or K2 to “support collagen synthesis,” though supporting evidence is limited. Patients must reconcile these conflicting directions, undermining the clarity they need.
Lifestyle recommendations also show broad variation. Hydration is universally encouraged, but guidance ranges from general to specific. Alcohol and smoking are discouraged for their impact on healing, yet not all protocols mention them. Differences in caffeine advice further highlight inconsistency, which can reduce patient adherence.
Day-of-procedure instructions also differ. Most clinicians recommend that patients eat beforehand to reduce the risk of vasovagal symptoms during blood draws, though not all do. Some advise against applying lotions or topical agents to the injection site, while others do not mention this precaution. Although these may appear to be minor details, they significantly impact the patient experience. Standardization is clearly needed.
Post-treatment care presents the greatest degree of confusion. Pain management is generally straightforward (acetaminophen is preferred, and NSAIDs are avoided), yet the recommended duration for NSAID avoidance varies. Cryotherapy remains the most contentious issue. Some clinicians prohibit ice entirely to prevent inflammation suppression, while others permit its use after 48 hours. A few recommend alternating heat and ice. Patients frequently ask, “If inflammation is good, why does my physical therapist want me to ice it?” They deserve clear, evidence-based explanations rather than uncertainty.
Activity and rehabilitation usually involve brief rest, gradual mobility, and structured therapy starting at about two weeks. Yet specifics differ: Some clinics start therapy at 1 week, others at 3; some allow light exercise at 48 hours, others after 1 week. Rehabilitation is essential to PRP’s success; regrettably, it is often treated as negotiable.
Wound care guidance also varies across practices. Some guidelines prohibit submersion for two days, others for five. Showering is allowed after 24 hours in some protocols, 48 hours in others. Though minor, these contribute to patient uncertainty. Patients obviously expect the best protocols, and they deserve clear guidance.
To a large extent, this variability in PRP protocols undermines patient trust and complicates clinical decisions, as practitioners rely on experience and opinion due to limited high-quality research. A 2022 systematic review highlighted significant heterogeneity in peri-procedural recommendations, emphasizing that the lack of consensus impedes outcome comparisons and standardization. Without robust data, institutions and experts create guidelines based on tradition, which is understandable but ultimately unsustainable and unfair to patients. As PRP use expands, inconsistency becomes a central problem, eroding patient trust, muddying clinical outcomes, and making it challenging for clinicians, especially those new to the field, to distinguish evidence-based practices from tradition.
Standardized, evidence-based peri-procedural guidelines are essential to improve clinical outcomes, reduce patient confusion, and strengthen the credibility of regenerative medicine. Developing clear, unified protocols will also facilitate better coordination among physicians, physical therapists, and care teams, providing patients with a consistent and transparent care pathway. This step is critical to advancing the field and ensuring patient trust.
Achieving standardization requires collaboration among specialty societies to develop interdisciplinary consensus statements informed by systematic reviews and expert panels. Regular updates as new evidence emerges, along with the implementation of clinical pathways and decision-support tools, will promote consistent adherence across diverse settings. Dissemination through continuing education and integration with electronic health records is vital to support widespread adoption and uniform practice.
Nonetheless, potential challenges include variability in institutional resources, differences in practitioner training, and resistance to change from established protocols. Overcoming these barriers will require targeted education, resource allocation, and open dialogue among physicians to ensure successful implementation and the intended benefits of standardized care.
PRP’s promise in musculoskeletal care can only be fully realized through consistent, evidence-based protocols. There is an urgent need for unified, collaboratively developed guidelines from specialty experts to enable alignment in both care delivery and patient communication. Until such standards exist, clinicians must provide transparent, evidence-based explanations for their recommendations, ensuring clarity despite existing variability.
Patients deserve recommendations that are consistent, clear, and rooted in science. To fulfill PRP’s potential, standardizing peri-procedural care is both the most immediate and essential step.
Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.
Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.
Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.
