Pain Relief With Regenerative Medicine
Regenerative medicine is an advanced branch of translational research enabling the management of acute or chronic pain conditions. The research in tissue engineering and molecular biology creates an environment in which the regeneration of human cells is achieved to restore or establish normal physiological functioning. The science applies findings from tissue engineering that dates back to 1962 with the first synthetic skin used in grafting procedures. Regenerative medicine for pain is rapidly growing, offering benefits to individuals who suffer from a number of different medical conditions.
Chronic pain associated with physical injury or deformity is responsible for numerous damaging effects on a person’s ability to function through daily activities and job responsibilities. The primary cause of physical disability in the United States is a result of musculoskeletal pain following injury, disease, or illness. Chronicity of pain increases the rate of physician appointments, disability claims, and loss of productivity. Using estimates from both acute and chronic pain conditions, back pain alone accounts for a significant measurement of pain in approximately 100 million adults.
While not approved for all instances of pain management, regenerative medicine can be considered as an appropriate measure of treatment in specific individual circumstances. Regenerative treatment processes are a result of the alliance of research in chemistry, medicine, robotics, biology, computer science, genetics, and engineering to construct a biologically compatible structure for many different tissues found in the body. The idea behind tissue engineering for regenerative medicine in pain treatment is that research is used from science and technology to develop a biologically sound substitute for the body that will restore or improve function of any lost or damaged tissue.
Although relatively new in the field of acute and chronic pain management, regenerative medical procedures do date back as early as 1962 when scientists developed the first synthetic skin substitute. There are a number of misconceptions about regenerative medicine or cell therapy, including the origination of the cells, how clinically viable treatments may be, and that cell therapy or regenerative medical procedures always use stem cells. Fortunately, technological advancements have permitted the development of new processes for the treatment of orthopedic conditions without requiring an operative procedure.
In point of fact, many of these new processes are a minimally invasive means of using regenerative medicine for the treatment of pain. The more common conditions that have been successfully treated using regenerative medical procedures include arthritic bodily changes resulting in pain, and injuries to cartilage, tendons, muscle, bone, spinal discs, and other tissue types. Successful treatment goals include the reduction of pain, the return to activities of daily living, and greater productivity in the work place.
History Of Regenerative Medicine For Pain
Regenerative medicine emerged from a number of different advances in complementary scientific and technological fields. These processes are also known as tissue engineering, which utilizes living tissue and other biocompatible substances. Growth factor found in the body and other physical elements can be used to generate substances that will repair tissue that was damaged as a result of injury, or even to replace an organ that is failing as a result of the aging process.
The vast majority of early regenerative procedures were tissue-based, being developed for skin grafting. The first successful tissue that was engineered for grafting procedures was finalized in the 1970s, a mere eight years after the first synthetic tissue was developed. Howard Green and colleagues from Harvard Medical School began by harvesting a skin biopsy, later perfecting the practice of growing skin epidermis. This particular technological advancement has been applied in clinical practice to help individuals with a number of other conditions. Following these advancements, regenerative medical improvements have developed from technology in stem cell research, enabling successful bone marrow transplantation for individuals suffering from leukemia.
Regenerative Medicine For Pain Principles
Having discovered the ability of the body to organize and regenerate tissue after cell death, researchers aimed their future studies at the goal of regenerative medicine and tissue engineering to replace tissue that had been damaged, lost through injury, or deteriorating with advanced age. Many diseases and injuries that result from failing tissue could potentially be successfully treated using regenerative medicine therapies. However, the research and application has both ethical and legal considerations.
Pain Conditions Treated With Regenerative Medicine
Individuals interested in using regenerative medicine treatment options to provide pain relief for their specific conditions should undergo a consultation with an expert physician in regenerative medicine. These consultations are necessary to determine if a regenerative medicine therapy is an appropriate treatment protocol for the patient’s pain condition. The consultation often includes an in-depth evaluation of the underlying condition, previously attempted treatments, and an evaluation of the potential for using regenerative medicine techniques for pain treatment. The physician will offer guidance about the procedures involved and what patients may expect from any protocols used. Because of many misconceptions about the use and application of stem cell therapy, this appointment can serve to afford the patient with information about both the process and answer questions.
During this initial consultation the physician will perform a brief but detailed personal history to ensure an accurate diagnosis of pain. Because there are numerous different musculoskeletal conditions that result in pain and could benefit from regenerative medicine therapies, an accurate diagnosis to determine the most appropriate regenerative therapeutic procedure. There is no one regenerative medicine therapy that fits all musculoskeletal chronic pain conditions. In cases where a precise cause of pain cannot be identified, a prerequisite of treatment is to ensure that certain other diagnoses are ruled out. Although the side effect profile of most regenerative medicine therapies is low, your physician will generally assess for your specific degree of risk for persistent difficulties.
Chronic pain can be the result of a number of different causes. Pain that lasts for more than three months, which may be progressive or recur intermittently, and usually outlasts the typical healing time, is defined as chronic pain. Damaged muscles, ligaments, or joints that make up the spinal region can also be a source of both acute and chronic pain conditions. Approximately 100 million people in the United States suffer from chronic pain conditions that can range from mild to excruciating and can be simply inconvenient or completely incapacitating. Chronic pain not only results in physical disability, but long-term can result in significant psychological and emotional suffering that can limit an individual’s ability to function fully.
Generally, chronic back and neck pain is characterized by pain that will arise from the back but may radiate out toward the limbs. Specific symptoms are varied and can include experiences of shooting, burning, spasms, radiating pain, tingling, or aching. Other symptoms can be more generalized feelings of soreness, tightness, stiffness, weakness, or discomfort. However, there are specific clusters of symptoms that generally depend upon the underlying cause of the chronic pain. It is expected that the pain will fluctuate, sometimes dependent upon the environment in which the patient finds themselves. The emotional tax of chronic pain can increase the perception of pain. Negative feelings, such as anxiety, stress, depression, or fatigue, may increase the perception of pain. There is also sizeable evidence that chronic pain in combination with negative emotions can compromise the immune system.
Pain is thought to be an indicator of tissue damage or an underlying injury. A number of existing treatments are designed to help the patient cope with the chronic pain without addressing the underlying damage or injury to the musculoskeletal system. However, new regenerative medicine therapies have provided physicians with advancements that target the underlying problem and promote the ability of the body to heal itself through the use of undifferentiated stem cells. Patients who experience the following list of conditions are potentially viable candidates for regenerative medicine treatment protocols.
Osteoarthritis is a chronic joint condition that causes degenerative cartilaginous changes. It is believed that the damage can be the result of wear and tear on the joint through a number of years or as a direct result of a specific injury. With enough damage to the cartilage that protects the joint, there is a high risk opposing bones will rub directly against each other. This direct contact causes damage to the ends of the bones and a significant inflammatory response and pain. Treatment options that do not include regenerative medicine will only help to manage the pain and not cure the condition. Stem cell therapy is believed to be more fitting since the goal is to repair the condition and reduce the bone-on-bone contact.
This is a degenerative condition of the individual bones of the spine, called vertebrae. Most commonly, spondylolisthesis occurs when the vertebrae slips over one another or becomes dislocated. Patients may experience nonspecific low back pain because a large number of individuals with this anatomical distortion do not present to their physician with related symptoms, including pain. With spondylolisthesis the nerves around the weakened vertebrae can become compressed, resulting in pain and potentially muscle weakness. These symptoms can include pain in the back or buttocks, pain that travels down one or both legs, which may or may not be associated with numbness or weakness, difficulty walking, or in rare cases, loss of bladder or bowel control. Estimates are that 12% of the population has had difficulties with spondylolisthesis.
This common condition is characterized by a narrowing of the spinal canal. With spinal stenosis there is a restriction from this narrowing that results in neurogenic claudication. The spine is a row of 26 bones that allows movement and bending. Through the center is an opening, or canal, that protects the spinal cord. The narrowing with spinal stenosis can occur in the center, in the canals, or the spaces between the vertebrae. This narrowing puts pressure on the nerves in the spinal cord and can result in pain or numbness in the legs or shoulders, depending upon where the restriction is located.
Spinal stenosis is more common in individuals over the age of 50 years, but may occur in younger people who suffer an injury to the spine or are born with a narrowing of the spinal canal. General recommendations are that patients attempt more conservative forms of treatment before starting regenerative medicine protocols.
Spinal deformities are genetically linked issues that are related to the natural curvature of the spine. They generally involve the entire length of the spinal column and are relatively uncommon. Conditions can affect the cervical, thoracic, or lumbar spinal regions and symptoms will vary widely depending upon the location. Some of these conditions are visible at birth, while others are only diagnosed when signs and symptoms develop.
A compression fracture is typically caused by osteoporosis and has a higher prevalence rate among post-menopausal women and in those individuals with a long history of corticosteroid use. These fractures result in a decrease in height of the vertebrae of at least 15 to 20%. In one study, which examined 7,000 women over the age of 65, researchers found that 5% had suffered a compression fracture over a four-year period. Previous studies have suggested that nearly 4% of adults evaluated in a primary care setting could attribute back pain symptoms to a compression fracture.
Degenerative Disc Disease
Degenerative disc disease is a condition that results in symptoms from changes to the vertebral discs in adults as they age. It is believed that the aging process increases the risk of tears to the disc, which is a likely cause of the pain associated with this condition. Spinal discs are soft and compressible that helps cushion the spinal column, which allows the spine to flex, twist, and bend. Although it can occur anywhere along the spine, it most often occurs in the lower back and neck. The pain can occur throughout the spine but in some instances has been reported to be localized to the affected intervertebral disc.
Treatment modalities have been limited to physical therapy, pain medications, spinal fusion surgery, and steroid injections. Each of these treatments is done with the goal of pain management. New advances in regenerative medicine and stem cell therapy have led to treatment options for patients suffering from degenerative disc disease. Following extraction of the patient’s stem cells, usually from the bone marrow in the hip, the cells are engineered, concentrated, and injected into the site of the injury.
A herniated disc is characterized by damage to the intervertebral discs, which cause them to bulge from the intervertebral space or to rupture completely. The daily stress of movement, poor posture, injuries, and age can cause them to bulge, rupture, or herniate. The expansion of the disc material puts pressure on the surrounding nerves and spinal column, which is believed to be the source of pain. Herniated discs are more commonly found in aging people. Treatments include physical therapy, which has shown promise in relieving pain and improving the ability to function daily, however, it requires a significant time commitment in the therapist’s office and in daily home exercises.
Surgical treatment options may be suggested to cut out or remove the bulging or herniated material from the spinal column. The removal of the herniated disc carries a number of different risks related to the area of the spinal column where the disc is located and the weakened area of the column following surgery. Surgery is not always successful and there is a slight risk of damage to the spine or nerves, and risk of infection. New techniques being used in the area of regenerative medicine using a patient’s own stem cells has shown good results with regeneration and rebuilding of the network of cells that make up the injured disc.
This is a common form of chronic foot pain found between the ball of the foot and the heel. There is a thick connective tissue on the bottom of the foot, called the plantar fascia, which connects the ball of the foot to the heel. This plantar fascia supports the arch of the foot and can become strained from a number of different sources, including overuse, tight calf muscles, and poor foot placement. The damage forms tiny tears along the ligament, which is the likely source of pain. Treatments usually target the symptoms of pain once the underlying cause of the condition has been corrected.
Regenerative medical treatments are an ideal choice for patients who have chronic pain in the plantar fascia and have corrected the underlying biomechanical issue that caused the initial condition. These therapies will promote healing of the damaged tissue. In fact, several studies provide realistic support for the use of platelet rich plasma therapy as an effective method of treatment to reduce the pain associated with plantar fasciitis.
Sacroiliac Joint Pain
The sacroiliac joint is a large joint area that is located at the base of the spine. The joint connects the spine to the hip, or pelvis. In many cases, the individual can identify an injury that transpired previous to the onset of pain. Degenerative arthritis, pregnancy, abnormal walking patterns, and leg length discrepancy are other causes of sacroiliac joint dysfunction that results in pain. There is limited evidence that current treatments, such as steroid injections, radiofrequency neurotomy, and pulsed radiofrequency, are successful. Once the underlying causative issue is relieved, there is limited evidence that regenerative procedures can affect some degree of pain relief. This pain relief appears to last longer than that of steroid injections.
Also known as sciatica, lumbar radiculopathy occurs when a herniated disc, often between L5 and S1, pushes against the nerve. Patients experience pain that travels down the leg. The primary goal is to reduce the size of the disc and reduce the compression on the nerve root, thus reducing the pain. There are a number of different treatment options for patients who suffer from lumbar radiculopathy. However, if they are unsuccessful, or if patients do not receive relief from their pain, they can be a candidate for stem cell repair.
In cervical radiculopathy, patients experience chronic pain originating from the cervical spine, or the neck area. When a disc in the neck pushes against a nerve root exiting the cervical spine, it causes pain to travel down the arms. Radiculopathy in younger individuals can be from a herniated disc or neck injury. Older adults may suffer but physicians expect to also find osteophyte formation causing narrowing of the foramen, a reduced disc height and degenerative changes in the intervertebral joints.
Failed Back Surgery
There are a small number of patients who experience such severe, unremitting back pain that they choose to undergo surgery to gain relief. Some patients may continue to suffer pain following surgical repair, which is recognized as a failed back surgery. In these cases the pain can be caused by scar tissue that develops around the surgical site as the patient heals, disc herniation, post-operative pressure on the spinal nerve, or altered joint mobility in the spine. Individuals with a history of other emotional disturbances, such as difficulty falling or staying asleep, depression, or anxiety are at an increased risk of developing chronic pain conditions following a back surgery.
Pain symptoms of a failed back surgery are usually dull, aching pain that is diffuse across the back and legs. Some patients do suffer from stabbing, pricking, or sharp pain in the limbs. When other treatments have failed to relieve pain following a failed back surgery, regenerative medicine treatment options might be considered.
Regenerative Medicine Procedures For Pain
Regenerative medicine for pain procedures take approximately 30 minutes. The patient is usually seen in an outpatient clinic and able to undergo the procedure without general anesthesia. Regenerative medicine treatment protocols are done on an outpatient basis and require little to no recovery period. Oftentimes individuals are able to return to work directly following the procedure.
The majority of the time, regenerative medicine involves using the patient’s own stem cells and other supporting cells. The harvested material is concentrated, purified, and injected into the damaged area where the expected results include regeneration and repair of damaged tissue. The concentration of the stem cell therapy should not be altered in any way. Most patients report very little discomfort during or after the procedure, although some report minor soreness or bruising at the site of the injection.
Benefits Of Regenerative Medicine For Pain
Using stem cell therapy or tissue engineering, physicians expect that patients will achieve a number of different benefits, including:
- Faster recovery time following the procedure
- Improvements in joint, ligaments, and tendon function
- No significant incisions or trauma to the area
- Very little pain or discomfort during the procedure
- No general anesthesia
- Renewal and repair within the joint
- Very low side effect profile and little risk of allergy or adverse reaction