05/26/2026
Cortisone has been the default epidural injection for decades. But the data is starting to shift, and so is the conversation in interventional pain.
In this clip from the NMSK Podcast, Dr. Haroon Andar shares his clinical experience using leukocyte-poor PRP for epidural injections instead of corticosteroids in select patients.
The reasoning? The literature increasingly supports PRP outcomes that match or exceed cortisone for the right patient profile. And in his own practice over the last year, he’s seeing roughly 80% of patients respond very well to epidural PRP, with results that match or outlast what they were getting from steroids.
A few important caveats he emphasizes:
Patient selection matters enormously. Someone with multi-level spondylosis, facet hypertrophy, severely desiccated discs, and decreased disc height is not the same candidate as a 35-year-old with an annular tear and back pain.
This is still an emerging clinical territory. Not every patient responds, and the data, while encouraging, has caveats as all research does.
Cost is a real factor. Insurance still covers the steroid. PRP usually doesn’t.
The point isn’t that cortisone is wrong. The point is that for the right patient, there’s now a credible alternative worth discussing.
Are you offering epidural PRP in your practice yet? Curious what other physiatrists are seeing.
Featuring Drs. Haroon Andar and Yasha Magyar on the NMSK Podcast.
