What Is PRP? Inside the Conversation With Dr. Margaret Boltja, MD

"Platelet-rich plasma" gets thrown around a lot, but Dr. Margaret Boltja, MD spent this conversation with Mark Anthony explaining what it actually is, how it's prepared differently depending on what's being treated, and where — in her own practice — the evidence for it is strongest and where it isn't.

Boltja's path to interventional pain medicine ran through general neurology, where she practiced for several years and became certified in Botox injection before completing an interventional pain fellowship. She's also certified in medical acupuncture and, more recently, trained in transcranial scalp acupuncture under Dr. Jason Hung in Phoenix, Arizona. Today she runs Mid GA Pain MD, seeing patients across Macon, Warner Robins, and Dublin, Georgia — describing her practice's focus as treating pain "head to toe," from migraines down to neuropathy.

What PRP Actually Is — And How BMAC Goes Further

Boltja walked through the mechanics in plain terms: a patient's blood is drawn, placed in a tube, and spun down in a centrifuge to concentrate the platelets, which contain growth factors. That concentration is then injected back into the injured area — tendon, muscle, nerve, or joint — to trigger the body's own healing response and help calm inflammation. She was specific that this isn't a single fixed protocol: depending on the tissue being treated, she may use platelet-rich plasma or platelet-poor plasma, and sometimes spins the sample down more than once to maximize the growth factors delivered.

For more significant cases, she also uses BMAC — bone marrow aspiration concentrate — drawn from the iliac crest of the hip and processed with a different filtering method than PRP. She described it as more potent, with a greater concentration of growth factors, and said she uses it for knee, hip, and spinal areas where MRI imaging shows abnormal findings. A third option she mentioned is adipose (fat)-derived tissue, which she called "extremely potent" with these stem cells. All three fall under the broader umbrella of what she calls orthobiologic or regenerative medicine — and PRP, specifically, is the one she focuses on most because, in her words, it's "extremely expensive" as a category to build a practice around.

Where the Evidence Is Strongest, and Where It Has Limits

Asked what's surprised her most, Boltja pointed to disc discogenic disease in the spine, where she said a combination of stem cells or PRP has produced results she can see not just in patient improvement but on follow-up MRI imaging. She listed other conditions where she's seen results: tennis elbow, hip bursitis, knee joint pain, neck and back pain, and carpal tunnel syndrome — the last of which, she said, some patients are able to use to avoid surgery altogether. Subacromial bursitis and shoulder impingement syndrome were two more she named specifically as areas that respond well.

Pressed on where the actual data is best, she was direct that it's currently strongest for knee osteoarthritis and tennis elbow, adding that the evidence base is evolving quickly as new studies come out. She was equally direct about the limits.

She also flagged that PRP tends to work less well for patients on antiplatelet therapy or undergoing chemotherapy, and that results depend heavily on age, comorbidities, and how well a patient follows post-injection rehab. Benefits, when they hold, can last "a year, more than that," she said — though she was careful not to promise a fixed timeline for any individual patient.

Headaches, Nerve Pain, and the Rest of the Toolkit

A large part of the conversation moved beyond PRP into the rest of Boltja's practice, which she described as treating pain "head to toe." Neck and back pain are what she sees most, but headaches and migraines came up at length. She explained that many headaches she treats are cervicogenic — caused by arthritis in the neck's facet joints rather than a primary headache disorder — and that once that's identified on MRI, treatments like medial branch blocks and radiofrequency ablation can resolve headaches that started in the neck. For migraine and cluster headache patients who haven't responded to standard preventive medications, she described good results with the sphenopalatine ganglion block, an intranasal catheter procedure done under fluoroscopy, and with Botox — a series of roughly 31 injections that paralyzes the muscles associated with tension-driven migraine, used after patients have already tried anticonvulsants, antidepressants, beta blockers, and CGRP-receptor medications.

She also described tools for less common presentations: sympathetic and stellate ganglion nerve blocks for complex regional pain syndrome, and — for central pain syndrome following a stroke — a combination of antidepressants, anticonvulsants, and transcranial scalp acupuncture, a technique she trained in under Dr. Jason Hung in Phoenix, Arizona. Spinal cord stimulators and peripheral nerve stimulation are options for select candidates with severe pain, and she mentioned IV ketamine as an emerging option for chronic pain and anxiety that she hasn't yet added to her own practice but has seen work well for some patients. On the physical side, she's certified in medical acupuncture but refers most dry needling out to physical therapists, and said she's a "big fan" of shockwave therapy and is considering investing in it for her own practice down the line, though she doesn't offer it currently. She also offers red light therapy on a cash-pay basis, and routinely refers patients dealing with anxiety, depression, or fibromyalgia-linked pain to pain psychology for coping strategies like box breathing.

Who This Conversation Is For

If you're weighing PRP, BMAC, or another regenerative injection for a stubborn joint, tendon, or nerve issue — or you're dealing with headaches that haven't responded to standard medication — this episode is a grounded, specific look at what those options actually involve, from a physician who was equally candid about what they can and can't do.