Musculoskeletal pain is the most common pain reported by patients. Platelet-rich plasma (PRP) is widely used to treat musculoskeletal pain. However, the efficacy of PRP to treat this pain remains controversial. This review highlights the application of PRP in the treatment of musculoskeletal pain. PRP treatment appears to reduce pain and improve function in patients with musculoskeletal pain. However, there are limitations to the currently published studies. These limitations include the PRP preparation methods, type of activators, types of pathology to be treated, methods and times of administration, and association of PRP with other treatments.
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Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.
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Ketamine has used as a dissociative anesthetics from 40 years ago. Its mechanism of action is an antagonism of the N-methyl-D-aspartate (NMDA) receptors, which has an important role into the central sensitization during pain states. The role of ketamine, in lower sub-anesthetic doses, has recently gained increasing interest in pain management. There are considerable numbers of trials to use ketamine in acute or chronic pain states. Recently, Hocking et al. summarized their recent reviews of the evidence concerning ketamine’s clinical use on PAIN: Clinical Updates. In this review, the author introduce their summery with personal experience. Based on their summary, the primary role of ketamine in such subanesthetic doses is as an ‘anti-hyperalgesic’, ‘anti-allodynic’ or ‘tolerance-protective’ agent rather than as a primarily ‘analgesic’. However, to support the evidence-based clinical guideline using a ketamine in pain management, there will be needed numerous high-quality studies that access both immediate and long-term outcomes.