I wanted to spend a little bit of time talking to you about regenerative treatments. The field of regenerative medicine has seen unprecedented growth, and I am sure all of you have read or seen some ad or have heard of somebody who has tried stem or regenerative cell therapies. Those of you who haven’t already don’t worry, you will!
Those of us who have dedicated substantial time, resources, and energy to these therapies, like we have, cannot help but be amused by all the claims everybody makes these days. The truth is, because this is a lightly regulated industry at this time, everybody can claim to be an expert. And lots of people do.
I want to take less than 5 minutes of your time and try to clarify some concepts and maybe dispel some commonly claimed myths. I will limit myself to our field, musculoskeletal and sports injuries, including painful spinal disorders. Stem cells are used in many conditions, from diabetes to brain injury, which are outside the scope of our practice.
So what is regenerative medicine?
For years, the medical community has addressed any musculoskeletal injury with the “RICE” mantra: rest, anti-inflammatories, compression, and elevation. This was supplemented by the use of steroid injections, then by various forms of surgeries such as “clean-up” arthroscopic surgeries for knee or shoulder pain, or disc fusion surgeries for back or neck pain.
Regenerative medicine turns this type of approach on its head: scientists have now discovered that the body has the capacity to naturally repair and regenerate tissue on its own accord under the right conditions, whether it’s torn rotator cuff tendons in the shoulders, meniscus injuries in the knee, or disc fissures in the spine. Regenerative medicine uses tissues in the patient’s own body (autologous) to heal these injuries or prevent the progress of degeneration and arthritis.
What are stem cells, or regenerative cells?
The building blocks that start regeneration and repair are small protein molecules called growth factors. These growth factors kickstart the regeneration process and enable our regenerative and stem cells to start repairing and replacing damaged tissues. Various sources of growth factors and regenerative cells are found in the blood, the bone marrow, and even the adipose, or fat, tissue. All these tissues are within easy reach. In our clinic, we use state-of-the-art techniques for collecting not only blood, but also bone marrow and adipose. Our procedures for extraction and concentration of platelet-rich plasma, bone marrow and adipose regenerative cells are individualized to every patient. It has become pretty evident that in patients over age 45, adipose or fat tissue is the best source for regenerative cells. Because of that, we partnered with some of the best scientists and technology companies to offer our patients the most advanced, efficient, and painless bone marrow and lipo-aspiration systems available today.
Apart from patient’s own regenerative cells, we also use FDA-cleared, commercially available amniotic fluid-derived growth factor concentrate. This is a good alternative for our older patients as our own healing mechanisms are compromised as we age and we need to go to a more “youthful” source of growth factors.
Myth number 1: all platelet-rich plasma, or stem cell preparations, are the same.
Most physicians practicing regenerative medicine use commercially available preparations and methods of extracting regenerative cells from blood, bone marrow and adipose. While these commercial kits have improved recently, they are still a “one size fits all” therapy. In our clinic, we have spent years perfecting a truly individualized therapy, be it for platelet-rich plasma, bone marrow concentrate or adipose regenerative cells. Our staff considers each patient’s cell numbers and types, and we strive to deliver the maximum quality and quantity of cells to each patient. This is a time-consuming process, but we believe it generates results commensurate to our efforts.
Myth number 2: the sources for stem cells are the same, and they do not make any difference in treatment outcomes.
As I said before, after age 45, there is a precipitous drop in the stem cell numbers in bone marrow and there are not many stem cells found in your blood after you are born. But adipose, or fat tissue, has many regenerative cells (including stem cells) which seem to maintain their numbers in spite of aging according to scientific research. Sometimes, a combination of both adipose and bone marrow adult regenerative cells may be the best solution for joint or soft tissue repair. In our clinic, we offer the whole gamut of regenerative cell treatments, and we tailor it to the individual patient.
Myth number 3: stem cells are for everybody, regardless of their age and diagnosis.
Let’s face it: the promise of stem cells is seductive. Listening to the ads out there, one would be forgiven if they believed that we can magically turn back time and cure everything with a shot. You name it, we can fix it! The reality is different. Regenerative medicine is a very new field. For most of the procedures we perform, there is still little to no hard science proving that they work. Just because somebody can buy a platelet-rich plasma kit, that does not mean that all the “old fashioned” steps are now obsolete. The patient still needs to be examined and diagnosed carefully. Pain mapping still needs to be done correctly. In the presence of a correct diagnosis, patients can be offered the appropriate treatments. In some cases, these treatments can incorporate regenerative treatments. However, in some cases, they do not. In addtion, it’s not only important to use the right cell types, processing protocols, and treatment regime, but to also inject the cells in the right manner and location.
In conclusion, we at Precision Pain Consultants are incredibly excited about the promise of regenerative treatments. There are new regenerative treatments that we begin performing all the time. For example, alpha-2-macroglobulin is a whole blood product that shows tremendous upside in the treatment of osteoarthritis due to its ability to decrease inflammation. However, please make sure you choose wisely when deciding who, what and where to have these treatments performed. We would be more than happy to talk to you in case you have questions.
This blog is written by Caleb Greer, FNP-C There is a plethora of information available on the Internet about the contr...
We read almost weekly articles in the popular press about regenerative medicine, extolling the virtues (or the follies) ...
~This blog series is about my approach to mental health and the integration of ketamine therapy with a psychodynamic and...