Comparative Study: Platelet Rich Fibrin versus Steroid Injection for Sacroiliac Joint Pain

Case Diagnosis: Comparing effectiveness of PRF versus steroid injections in reducing pain and improving functional outcomes in patients with refractory SI joint pain.

Case Description or Program Description: Platelet-Rich Fibrin is an advanced autologous therapy from a patient’s blood, processed to create a fibrin matrix rich in platelets and growth factors. PRF may promote long-term tissue healing and pain relief.

Setting: A single-center, prospective, double-blinded, randomized controlled trial (RCT) conducted in an orthopedic clinic using PRF centrifuge machines and fluoroscopic guidance.

Assessment/Results: Pain Relief: At 12 months, 85% of PRF recipients reported >85% reduction in VAS scores, compared to 42% in the steroid group (p < 0.001, 95% CI: 78%-92%)
Relief Duration: PRF provided sustained pain relief exceeding six months, whereas steroid efficacy declined significantly by the 3- to 6-month mark (p < 0.05, 95% CI: 70%-86%).
Functional Improvement: ODI scores improved in 88% of PRF patients vs. 46% in the steroid group (p < 0.001, 95% CI: 80%-94%).
Safety: PRF demonstrated a favorable safety profile with no reported adverse events. The steroid group experienced a 6% adverse event rate, including transient pain flares (lasting 3–5 days) and mild injection site irritation (resolved within 7 days).
Sedation and Recovery: PRF required no sedation, whereas steroid injections were associated with transient post-procedural discomfort requiring additional pain management in 12% of cases.
Mechanism Considerations: PRF’s regenerative potential is hypothesized to stem from its sustained release of growth factors, platelet-derived bioactive molecules, and fibrin scaffolding, facilitating cellular repair and neuroprotection.

Discussion (relevance): Intra-articular PRF injection is a safe and effective treatment for chronic SI joint pain, demonstrating prolonged pain relief and functional improvement compared to steroid injections. Given its favorable safety profile and durability, PRF may serve as an alternative or adjunct to conventional treatments.

Conclusions: Comparative studies involving alternative interventions, such as radiofrequency neurotomy or SI joint fusion, could further advance pain management strategies.