The short answer. Platelet-rich plasma (PRP) and bone marrow concentrate are made from your own blood or bone marrow and injected into the painful part of the spine: a disc, a facet joint or a sacroiliac (SI) joint. In studies of these injections, patients improved in pain and function1,2,3. For the facet and SI joints, a 2026 meta-analysis found PRP reduced pain more than steroid injections at 3 and 6 months4. The American College of Physicians recommends starting chronic low back pain care with exercise and other non-drug treatments5, and at our practice orthobiologics come after that conservative care.
Back pain is called chronic when it lasts longer than 12 weeks6. Several things can contribute at once, including mechanical or structural problems with the spine, inflammatory conditions and other medical conditions6. For most people with low back pain, no specific cause can be pinned down; only a small share have a well understood cause such as a fracture, cancer or an infection7.
Structures that can be involved include:
At one academic spine center, 170 cases of stubborn low back pain were worked up with diagnostic procedures until the source was found. The disc was the source in 42%, the facet joints in 31% and the SI joint in 18%. Disc pain was more likely in younger patients, and facet or SI joint pain in older ones9.
A herniated disc pressing on a nerve can send pain down the leg, which is called sciatica8. See Herniated Disc Symptoms if that sounds like you.
The American College of Physicians (ACP) 2017 guideline says that for chronic low back pain, patients and clinicians should first choose non-drug treatment. The options it lists are exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy and spinal manipulation5. When more is needed, the guideline's next step is medicine: anti-inflammatory drugs (NSAIDs) first, then tramadol or duloxetine. Opioids come later, and only if the potential benefits outweigh the risks for that patient, after a discussion of known risks and realistic benefits5.
Exercise is well studied. A 2021 Cochrane review of 249 trials found that exercise probably reduces chronic low back pain compared with no treatment or usual care, by an amount the authors called clinically important. In their subgroup analysis, exercise was probably more effective for pain than advice or education alone10.
At our practice, orthobiologics come after conservative care such as physical therapy has been tried. The American Academy of Orthopaedic Surgeons (AAOS) advises trying nonsurgical options for 6 months to 1 year before considering surgery for low back pain8. The two can be combined: the 2025 guideline from the American Society of Interventional Pain Physicians (ASIPP) says regenerative therapies may be used alone or alongside structured exercise, physical therapy, behavioral therapy or conventional medical management11.
In this post, "regenerative medicine" means injecting a concentrate made from your own blood or bone marrow into the painful part of the spine.
PRP and bone marrow concentrate are not yet FDA approved for orthopedic conditions, including back pain13.
Several studies have followed patients for months or years after a single injection into the disc. Patients improved in each of the studies below.
| Study | Patients | Injected into the disc | Followed for | What it found |
|---|---|---|---|---|
| Tuakli-Wosornu 2016 [1] | 47 analyzed | PRP | 1 year | Significant improvements in pain, function and satisfaction over 8 weeks; function gains held through at least 1 year |
| Navani 2024 [2] | 40 | PRP or bone marrow concentrate | 12 months | Significant improvement in pain and function with both; no adverse effects, hospital stays or surgery |
| Zhang 2022 [14] | 31 analyzed | PRP | 48 weeks | Pain and lumbar function improved; 71% of patients classed as successes |
| Pettine 2017 [3] | 26 | Bone marrow concentrate | 3 years | 20 of 26 did not go on to surgery and reported average improvements in pain and disability |
The 2016 trial, by a team at the Hospital for Special Surgery in New York, enrolled adults who had moderate-to-severe disc pain for at least 6 months despite conservative treatment. No disc space infection, nerve injury or progressive herniation was reported after the PRP injections1.
The 2025 ASIPP guideline was written by 35 authors, and all 19 of its recommendations reached 100% agreement. It gives consensus-based recommendations for both PRP and bone marrow concentrate injected into the disc11.
Studies of bone marrow concentrate in the disc have reported improvements that lasted for years.
For these joints, the trials compare PRP with a corticosteroid (steroid) injection, and PRP has compared favorably, especially for how long the relief lasts.
A 2026 meta-analysis pooled 10 randomized and quasi-randomized trials of PRP versus steroids in these joints, with 392 patients. PRP reduced pain significantly more than steroids at 3 months, with consistent benefit in both the facet and SI joint groups, and the advantage persisted at 6 months4. The authors concluded that PRP may give better medium- and long-term pain reduction than steroid injections in these joints4. ASIPP also gives a consensus-based recommendation for PRP in the facet joints11.
Describing a PRP injection for a tendon problem, AAOS notes that pain at the injection site may increase for the first week or two, and that it may be several weeks before the patient feels a beneficial effect12. AAOS describes the risks of PRP as minimal: there may be more pain at the injection site, and the rate of other problems, such as infection, tissue damage or nerve injury, appears to be no different from that of cortisone injections12.
In the studies above, the 2024 disc trial reported no adverse effects, hospital stays or surgery through 12 months2, the facet trial reported no treatment-related complications16, and the bone marrow study reported no adverse events from the marrow draw or the injection3. A 2026 review of randomized trials found adverse events were minimal overall17.
ASIPP advises that these treatments be considered after a thorough diagnostic evaluation, with patients fully informed about the potential benefits, risks and costs11. Based on the guidelines above, the questions to work through include:
Not every patient is a candidate, and a proper orthopedic evaluation is essential. At our practice, candidacy is decided at a consultation before any financial commitment. Patients outside the area can have the first consultation by telemedicine, with imaging sent by email.
These treatments are usually paid out of pocket11,19. AAOS notes that few insurance plans provide even partial reimbursement for PRP12, and ASIPP says most regenerative treatments for chronic low back pain are not covered by commercial insurance11.
Published US cost data for the spine are sparse20. These are national figures, not our practice's prices:
The same authors describe regenerative approaches as having higher upfront costs that may offer long-lasting benefits20. The real question is whether a reasonable cost is worth the improvement you can expect. That is a conversation to have with the evidence in front of you, and no one can promise a specific outcome.
If you are in the Santa Barbara area, Dr. Scheinberg can examine your back, review any imaging and talk through the options. See spine and back care or call (805) 682-1394.
Short answers to the questions patients ask most.
Have a question about your own situation?
Call (805) 682-1394Studies have found that patients improved. In a double-blind trial, patients who received PRP in the disc showed significant improvements in pain, function and satisfaction over 8 weeks, and their function gains held for at least a year1. For the facet and SI joints, a 2026 meta-analysis found PRP reduced pain more than steroid injections at 3 and 6 months4.
In a study of 26 patients who were candidates for spine surgery, 20 had not gone on to surgery 3 years later and reported average improvements in pain and disability3. A 2020 review of 7 studies found that pain and disability scores improved after a single disc injection, with low complication rates15.
The ACP recommends non-drug treatment first, such as exercise, multidisciplinary rehabilitation, acupuncture or mindfulness-based stress reduction5.
Reviewed by Dr. Richard Scheinberg, MD, a board-certified orthopedic surgeon in Santa Barbara with 40 years of surgical experience.
