PRP for SI Joint Pain? New Trial Shows Promise
Platelet-rich plasma, better known as PRP, has been getting attention across orthopedics and pain medicine for years. But when it comes specifically to SI joint pain, the evidence has remained fairly limited.
A new randomized controlled trial published in the American Journal of Neuroradiology gives us something worth paying attention to. Researchers directly compared CT-guided PRP injections with CT-guided steroid/anesthetic injections in adults with chronic SI joint-mediated low-back pain. Both groups improved, but the pattern of improvement was different, and that’s where things get interesting.
🧪 What exactly did the study look at?
The trial enrolled 44 adults with chronic SI joint pain. Importantly, researchers did not simply enroll people based on symptoms alone. Participants first had to demonstrate at least 50% pain relief following an anesthetic SI joint block, providing stronger evidence that the SI joint was actually contributing to their pain.
Participants were then randomly assigned to receive either a PRP injection or a steroid/anesthetic injection, with both procedures performed using CT guidance. Forty patients, 20 in each group, remained in the study through the three-month evaluation. Researchers tracked pain along with disability, physical quality of life, functional mobility, and opioid use.
🩸 What is PRP?
PRP is made from a patient’s own blood. Blood is drawn and processed to create plasma with a higher concentration of platelets, which is then injected into the treatment area. PRP has been investigated for a variety of musculoskeletal conditions because platelets contain biologically active substances involved in tissue signaling and inflammatory processes.
That does not mean PRP has been proven to regenerate, repair, or mechanically stabilize a dysfunctional SI joint. That’s an important distinction, particularly because the marketing surrounding regenerative medicine can sometimes move considerably faster than the research. This study was specifically investigating whether PRP could reduce pain and improve function in patients with confirmed SI joint-mediated pain.
📊 So what happened?
Both groups experienced significant reductions in pain. At three months, average pain scores had decreased by approximately 3 points in the PRP group and 1.8 points in the steroid/anesthetic group. The difference between the two groups was not statistically significant, with a p-value of .24.
There was, however, an interesting difference in the pattern over time. Steroid/anesthetic injections produced greater relief earlier, while PRP showed a slower response that appeared more sustained at the three-month evaluation. Researchers also reported greater improvements in disability and physical quality-of-life measures in the PRP group at three months.
👀 The number that’s going to get attention
At three months, 60% of patients in the PRP group achieved at least a 50% reduction in pain, compared with 35% of patients in the steroid/anesthetic group. That’s certainly interesting, but it’s also exactly where reading beyond the headline matters.
The difference had a p-value of .11, meaning it did not meet the conventional threshold for statistical significance. In practical terms, the PRP group looked better numerically, but this study was too small to confidently establish that PRP was responsible for the difference rather than some portion of that difference occurring by chance. So 60% vs. 35% sounds impressive, but it is not the same thing as proving PRP works better than steroid injections.
🔎 This isn’t the only PRP study we have
There’s another reason to be cautious about declaring a winner. An earlier double-blind randomized trial compared PRP with corticosteroid injections in patients whose SI joint pain had been confirmed by a diagnostic block producing greater than 80% relief. That study included only 26 patients, but its results went in the opposite direction: steroid injections produced lower pain scores than PRP at one, three, and six months, with significantly more steroid responders at one and three months.
A 2026 systematic review and meta-analysis has now also examined randomized and quasi-randomized trials comparing PRP with corticosteroids for facet and SI joint pain. That growing body of research is useful, but it also reinforces why we shouldn’t allow one encouraging trial to settle the question. Different studies use different patient-selection criteria, PRP preparations, injection techniques, outcome measures, and follow-up periods.
⏳ Three months is not long-term evidence
The new AJNR study followed participants for only three months, so even though the PRP group’s response appeared more sustained within that window, we don’t yet know whether that advantage continues. For a chronic condition like SI joint pain, longer follow-up will be especially important.
Some of the questions future research still needs to answer include:
How long does PRP-related pain relief last?
What happens at six months, one year, or beyond?
Are certain types or causes of SI joint pain more likely to respond?
Does the way PRP is prepared affect outcomes?
Would repeated PRP injections produce different results?
How does PRP ultimately compare with other treatments available for SI joint pain?
The study authors themselves concluded that larger trials with longer follow-up are needed before these findings can be validated and used to inform clinical guidelines.
💰 There’s also a very practical issue
PRP can represent a significant out-of-pocket expense for patients, depending on the provider and insurance coverage. That’s another reason understanding the quality of the evidence matters. Patients deserve to know the difference between a treatment that has promising early evidence and one that has been established through multiple large, high-quality trials.
When someone is living with severe chronic pain, “maybe this will help” can be incredibly compelling. That makes careful, accurate communication about emerging treatments even more important.
💚 What should SIJD patients take from this?
This is genuinely encouraging research, but it isn’t a verdict. The new randomized trial found that both steroid/anesthetic injections and PRP improved SI joint-mediated pain. PRP showed a potentially slower but more sustained response, and 60% of PRP patients reached at least 50% pain relief at three months compared with 35% receiving steroid/anesthetic injections. However, that difference was not statistically significant, only 40 patients completed the study, and follow-up lasted three months. Earlier randomized research has also produced results favoring steroid injections.
So we’re not ready to say “PRP is better than steroid injections.” What we can say is that PRP continues to be studied as a potential treatment for SI joint pain, this new trial produced encouraging results, and the evidence is becoming interesting enough that larger and longer studies are absolutely worth watching.
And that’s exactly what we’ll do.
Sacroiliacly yours,
Trish Powers
Founder, SIJD Hub
Research
2026 Randomized Controlled Trial
Peckham ME, McCormick ZL, Safazadeh G, et al. Comparison of CT-guided platelet-rich plasma versus steroid/anesthetic injection for treatment of sacroiliac joint pain: a randomized, single-blinded, controlled trial. American Journal of Neuroradiology. 2026.
PubMed: https://pubmed.ncbi.nlm.nih.gov/41876223/
DOI: https://doi.org/10.3174/ajnr.A9307
Earlier Randomized Controlled Trial
Chen AS, et al. Intra-Articular Platelet Rich Plasma vs Corticosteroid Injections for Sacroiliac Joint Pain: A Double-Blinded, Randomized Clinical Trial. Pain Medicine.
PubMed: https://pubmed.ncbi.nlm.nih.gov/34850180/
Full article: https://academic.oup.com/painmedicine/article/23/7/1266/6438014
2026 Systematic Review & Meta-Analysis
Platelet-rich plasma versus corticosteroid injections for facet and sacroiliac joint pain: a systematic review and meta-analysis with trial sequential analysis. Pain Medicine. Published June 15, 2026.
Study page: https://academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pnag072/8708340
DOI: https://doi.org/10.1093/pm/pnag072
