Daradia Protocol — Regenerative Therapy | Biologic Injections (PRP/PL/PRF/BMAC) for Pain Practice

REGENERATIVE THERAPY

REFERENCE & SCOPE OF REGENERATIVE THERAPY:

Prepared from:
• ASPN Consensus Guidelines on Regenerative Medicine in Chronic Pain (2024).
• ISMPM Guideline: “Platelet-Rich Plasma in Patients with Symptomatic Osteoarthritis Knee: Evidence- and Consensus-Based 2023 Guidelines.”

This Daradia protocol is adapted from the above two peer-reviewed publications. The content has been contextualized for OT/OPD workflow at Daradia, aligns with homologous use and minimal manipulation principles, and is intended to assist trained clinicians without replacing individual clinical judgment or applicable regulations.

This page adapts evidence and good-practice points into a practical DARADIA PROTOCOL for routine use in OT and OPD.

ETHICAL & REGULATORY POSITION (Daradia):
• We follow homologous use and minimal manipulation principles.
• We do not offer culture-expanded or enzymatically isolated cellular products (e.g., SVF) for routine care.
• All procedures are individualized, evidence-guided, aligned with product IFUs and applicable local regulations.
• This protocol supports trained clinicians; it does not replace clinical judgment.

LAST UPDATED: 18 Oct 2025

ABBREVIATIONS

PRP = Platelet-Rich Plasma; PL/PLy = Platelet Lysate; PRF = Platelet-Rich Fibrin; ACP = Autologous Conditioned Plasma;
BMAC = Bone Marrow Aspirate Concentrate; MSC = Mesenchymal Stromal/Stem Cells; HA = Hyaluronic Acid;
CSI = Corticosteroid Injection; LP-PRP = Leukocyte-Poor PRP; LR-PRP = Leukocyte-Rich PRP; LA = Local Anesthetic;
NSAID = Non-steroidal Anti-inflammatory Drug; COX-2 = Cyclo-oxygenase-2 inhibitor; ROM = Range of Motion;
SI = Sacroiliac; GH = Glenohumeral; SVF = Stromal Vascular Fraction.

PATIENT SELECTION & CONSENT (GENERAL)

Indications with the most supportive evidence in regenerative therapy

  1. Knee OA: PRP generally outperforms HA/CSI at ~6–12 months. PRP & OA Knee
  2. Shoulder (GH) OA: PRP shows better long-term outcomes than CSI; often similar to HA.
  3. Lateral epicondylitis & plantar fasciitis: PRP > CSI beyond ~3 months.

Reasonable to consider (case-by-case)
• Rotator cuff tendinopathy (target ≥4–5× platelet concentration when used).
• SI joint pain; lumbar facet pain (PRP may outperform CSI).
• Discogenic back pain (intradiscal PRP; preparation and dose vary).
• Radiculopathy (epidural PRP/PL reported; evidence quality variable—use caution).

Generally not routine
• Patellar tendinopathy (no clear advantage over high-quality PT).
• Achilles tendinopathy (inconsistent results).
• Routine biologic augmentation during surgery (overall inconclusive).

Consent
• Benefits/alternatives (PT, HA, CSI, surgery), costs.
• Regulatory status: homologous use & minimal manipulation only.
• Risks: soreness, bruising, infection/bleeding, flare; severe events rare; response varies.

PERI-PROCEDURAL MEDICATION & SUBSTANCE HOLDS

• NSAIDs (incl. aspirin): Hold pre-procedure ≈4–5× drug half-life (aspirin ~7 days). Avoid 4–8 weeks post-procedure.
If analgesia needed, prefer COX-2 selective agents or paracetamol.
• Supplements affecting platelets/bleeding (fish oil/omega-3, vitamin E, turmeric/curcumin): hold ≥1 week pre-procedure.
• DMARDs: no strong evidence to stop/continue—individualize with treating team.
• Tobacco & alcohol: avoid peri-procedurally due to cytotoxic/platelet effects.

LOCAL ANESTHETIC & INJECTATE HANDLING

• Do NOT admix LA with the final biologic (cytotoxic/platelet dysfunction).
• If anesthesia required: minimal field infiltration away from target; ropivacaine appears least cytotoxic but still avoid at the target layer.
• Maintain strict sterility; label syringes; avoid additives beyond IFU.

PREPARATION & PROCESSING

• Follow device/kit IFU (spin speeds, times, volumes; LP vs LR PRP as indicated).
• When relevant (e.g., tendon), target/document platelet fold-increase (commonly ≥4–5×).
• Record: kit/device, lot/batch, baseline platelets (if available), product (LP/LR-PRP, PL/PRF, BMAC), final volume, site(s).

INJECTION TECHNIQUE — GENERAL RULES

• Use image guidance (ultrasound/fluoroscopy), whichever is feasible.
• Standard asepsis: surgical prep, sterile draping, sterile gloves, mask; closed systems preferred.
• Do not dilute/alter the biologic unless mandated by IFU.
• Stop/abort if unexpected resistance, severe pain, or misplacement is suspected.

POST-PROCEDURE ACTIVITY & REHABILITATION

• Days 0–2: Relative rest; avoid NSAIDs; paracetamol/COX-2 if needed.
• Days 2–7 (Phase 1): Gentle ROM and stretching; limit provocative load.
• Weeks 2–3 (Phase 2): Progressive strengthening and proprioception.
• Weeks 4–6+: Graduated return to work/sport if milestones met. Re-assess and repeat the injection if required
• Assistive devices per site/clinician discretion.

CONDITION-SPECIFIC REGENERATIVE THERAPY

• Knee OA: PRP tends to outperform HA/CSI at 6–12 months; many repeat 1–3 injections; assess after 6 weeks and repeat if partial relief; don’t repeat if excellent relief or no relief (this is Daradia’s protocol; local practice may vary).
• Shoulder (GH) OA: PRP better long-term than CSI; similar to HA in some measures.
• Lateral epicondylitis: PRP > CSI beyond ~3 months; ACP often less effective.
• Plantar fasciitis: PRP shows superior long-term outcomes vs CSI/placebo (6–24 months).
• Rotator cuff tendinopathy: prefer PRP prepared to ≥4–5× platelet concentration.
• SI joint / Lumbar facet: intra-articular PRP may outperform CSI.
• Discogenic back pain: intradiscal PRP can help; heterogeneity in PRP type, dose, and technique.
• Radiculopathy: epidural PRP/PL reported; consider evidence quality and patient selection.

KNEE OA (OAK) — DARADIA PRP PROTOCOL

Scope: Adult symptomatic knee OA, especially mild–moderate disease refractory to conventional therapy.
Core recommendation: Prefer IA-PRP over other IA modalities for mild–moderate OAK; safety comparable to HA/CSI; effect typically lasts up to ~12 months. PRP & OA Knee

  1. Patient selection
    • Best responders: mild–moderate OA; younger patients may do better; obesity can blunt response but does not preclude benefit. PRP & OA Knee
    • Advanced OA: may still benefit symptomatically; expectations and timelines should be realistic. PRP & OA Knee
  2. PRP formulation (LP vs LR)
    • Either LP-PRP or LR-PRP is acceptable; no consistent superiority.
    • LR may have more transient post-injection soreness; choose based on kit, experience, and patient factors. PRP & OA Knee
  3. Combination therapy
    • For mild–moderate OA, IA-PRP + HA may yield greater pain/functional improvement than PRP alone at several time points (and may reduce minor AEs vs PRP alone).
    • Use HA grade/form compatible with PRP (avoid very low-concentration HA that disrupts viscoelastic properties). PRP & OA Knee
  4. Outcomes & follow-up
    • Onset: improvement may begin in 2–8 weeks, often peaks by 3–6 months, with benefits observed up to ~12 months in many trials. PRP & OA Knee
    • Tracking: baseline and follow-up at 6–12 weeks and 6–12 months using WOMAC/KOOS/VAS. PRP & OA Knee
    • Re-treatment: consider at 6–12 months based on symptoms/function and shared decision-making.
  5. Practical prep notes
    • Avoid NSAIDs around the peri-procedural window (see Section 2).
    • Do not co-inject steroid or LA in the same syringe/target layer with PRP.
    • Document platelet fold-increase (if known), final volume, kit/lot, side/approach, guidance.
  6. Safety
    • Transient pain/swelling common; infection/bleeding rare; overall AE rates similar to HA and lower than CSI over time in many syntheses. PRP & OA Knee
    • Counsel realistic expectations; PRP does not halt OA progression; aim is pain/function improvement and delay of arthroplasty in appropriate cases.

MINIMUM DOCUMENTATION SET

• Diagnosis/indication and prior treatments tried.
• Consent: benefits/risks/alternatives, costs, regulatory status discussed.
• Product: PRP (LP/LR)/PL/PRF/BMAC; kit/device; lot/batch; platelet fold-increase (if known); final volume.
• Technique: site/approach; imaging guidance; number of passes; any complications.
• Peri-procedural advice: NSAID/supplement holds; tobacco/alcohol advice; rehab plan attached.
• For Knee OA: capture baseline + follow-up WOMAC/KOOS/VAS.

OT CHECKLIST IN REGENERATIVE THERAPY (PRINT & USE)

[ ] Patient ID, indication, side/site verified
[ ] Written consent (incl. risks vs benefits)
[ ] Allergies reviewed; infection screen; anticoagulation plan
[ ] NSAIDs held; supplements held; tobacco/alcohol advice given
[ ] Kit/IFU ready; sterile field; labels; imaging set (US/Fluoro)
[ ] NO LA in final biologic;
[ ] Post-procedure instructions & rehab issued; follow-up booked

OPD PATIENT AFTER-CARE (ENGLISH)

What to expect: 1–3 days of ache/heaviness/swelling is common.
Pain medicines: Avoid NSAIDs 4–8 weeks unless advised; use paracetamol or COX-2 if needed.
Activity plan: Days 0–2 rest → Days 2–7 gentle ROM → Weeks 2–3 strengthening → Weeks 4–6+ graded return.
Red flags — seek care: fever (>38°C), rapidly worsening pain/swelling, redness/discharge, new numbness/weakness.

OPD PATIENT AFTER-CARE (BENGALI)

PRP/PL/PRF/BMAC ইঞ্জেকশনের পর করণীয়

আপনি কী অনুভব করতে পারেন:
• ১–৩ দিন হালকা ব্যথা/ভারী লাগা/সুজে যাওয়া — এটি স্বাভাবিক।

ব্যথার ওষুধ:
• NSAID (ইবুপ্রোফেন/ডাইক্লোফেনাক/অ্যাসপিরিন) ৪–৮ সপ্তাহ খাবেন না (চিকিৎসকের বিশেষ পরামর্শ ছাড়া)।
• প্যারাসিটামল বা চিকিৎসকের দেওয়া COX-2 ওষুধ খেতে পারেন।

কাজকর্ম ও ব্যায়াম:
• দিন ০–২: বিশ্রাম
• দিন ২–৭: হালকা ROM (জয়েন্ট নড়াচড়া) ও স্ট্রেচিং
• সপ্তাহ ২–৩: হালকা স্ট্রেন্থেনিং ব্যায়াম
• সপ্তাহ ৪–৬+: ধীরে ধীরে আগের কাজ/খেলায় ফেরা (ডাক্তারের পরামর্শে)

জরুরি লক্ষণ — সাথে সাথে যোগাযোগ করুন:
• জ্বর (>38°C), দ্রুত বাড়তে থাকা ব্যথা/ফুলে যাওয়া, লালচে/পুঁজ, নতুন অসাড়তা/দুর্বলতা।