Common joint soreness questions have practical answers

Sources

1. Medicare's national coverage policy states that CMS covers autologous platelet-rich plasma only for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only inside an approved coverage-with-evidence-development clinical research study. There is no Medicare national coverage for PRP in osteoarthritis or any other joint indication, which is why these injections are billed to the patient as cash-pay.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.

2. A systematic review and meta-analysis of five US retrospective studies comparing direct access to physical therapy against physician-first referral for musculoskeletal disorders found reduced physical therapy costs (d = -0.23, 95% CI -0.35 to -0.11) and reduced total health care costs (d = -0.19) with direct access, alongside improved or equivalent functional outcomes and fewer visits.

   Hon S, Ritter R, Allen DD — Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis.. Physical Therapy, 2021. DOI: 10.1093/ptj/pzaa201.

3. A matched cohort of 405,965 Veterans Affairs primary care episodes of non-specific low back pain without red flags compared those who had lumbar MRI within 6 weeks against those who did not. Early MRI was associated with more back surgery (1.48% vs 0.12%), more prescription opioid use (35.1% vs 28.6%), a higher final pain score (3.99 vs 3.87) and higher acute care costs ($8,082 vs $5,560), all p<0.001. The association held in a system largely free of fee-for-service incentives.

   Jacobs JC, Jarvik JG, Chou R, et al. — Observational Study of the Downstream Consequences of Inappropriate MRI of the Lumbar Spine.. Journal of General Internal Medicine, 2020. DOI: 10.1007/s11606-020-06181-7.

4. The FTC's Health Products Compliance Guidance sets out the standard every health claim in advertising must meet. Advertising must be truthful and not misleading, and before an ad runs the advertiser must hold adequate substantiation for every objective claim it conveys expressly or by implication. As a general rule, claims about the health benefits or safety of foods, dietary supplements, drugs and other health-related products require substantiation in the form of 'competent and reliable scientific evidence'. The guidance explicitly covers websites, social media, influencer marketing, press interviews, seminars, and claims made indirectly through healthcare practitioners.

   Federal Trade Commission, Bureau of Consumer Protection — Health Products Compliance Guidance. FTC Business Guidance, 2022.

5. FDA states verbatim that of the products marketed as regenerative medicine - stem cell products, stromal vascular fraction from adipose tissue, umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products - 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells from umbilical cord blood, approved only for disorders of blood production, and there are currently no FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2024.