Authored by Dr. Myrdalis Diaz-Ramirez
One of the most amazing advances in modern medicine comes from regenerative medicine. This idea that we have medicinal capabilities to help ourselves in our own healing is incredible.
Stem cells are cells that can procreate other cells or help with the inflammatory process depending on the specific cell type and stage of life of the person. It has been discovered that different products from our own bodies can help with inflammation or regeneration in different situations and could potentially help with pain and healing, thus opening this newer area of medicine called regenerative medicine.
For years, athletes have crossed the oceans to get treated for their different injuries with regenerative medicine. In the last ten years, we have been using more of these therapies in the US. Although the hype is high, it is very important to understand that there are no big studies to demonstrate all the claims. Patients should make every attempt to receive these therapies from physicians who have been educated in regenerative medicine specifically, if they want to have access to the whole myriad of treatments in the safest manner available to date. The three main type of products used these days are platelet rich plasma, the so-called stem cells, and placental tissue graft.
- Platelet rich plasma (or PRP) is obtained with just a simple blood draw. Your own blood is processed in a centrifuge and parts of it can be used to help with pain. Knee pain, for example, has been shown to respond to PRP in different series of studies. There is also some evidence that it can help tendons, other areas of arthritis, and spinal pain. They provide “food or building blocks” the stem cells or MSC’s use to do their job.
So, PRP can be injected on its own or in combination with MSC’s. It has also been used in the knees in combination with viscosupplementation. This last is an injection of hyaluronic acid, which serves as cushion and helps knees with pain from osteoarthritis.
- MSC’s, Medicinal Signaling Cells, or best known as mesenchymal stem cells, are in almost every tissue of our bodies. They vary in function depending where they are. When we use these cells in pain management in the USA they will, most likely, be obtained from the pelvic bone via a bone marrow aspiration. They will require isolation from the other tissues and PRP will be used as food to help them in the regenerative process.
These are the real so-called stem cells that come from your own body and that, ideally, patients should strive to get treated with when indicated. As we age, we have a decrease in the number of MSC’s. These cells are better used in combination with PRP. This can be considered the best treatment in this line, but is not always needed or available.
- Placental grafts might be used as an alternative in generative medicine. One must understand there have been no independent studies capable of showing that these off the shelf or frozen products have any live cells at all. They still have some healing factors that can promote some regenerative functions, which will be present in less amounts when compared to PRP.
They are not a real live stem cell treatment, but have stem cell components. The importance of having these components is unknown. These grafts can be used when PRP or autologous stem cells are not an available alternative for the patient. They can also be used or in conjunction with PRP or stem cells to heighten their effects.
- Steroids versus PRP or “Stem Cells” – When we provide a steroid injection, most of the time, patients will get almost immediate relief of pain and inflammation, no longer than a week. However, every time we inject steroids, we can cause more harm to the tissues.
Also, there is a limit to steroid injections, as higher amounts can predispose to other problems like: bone death, issues with blood pressure, blood sugar, and healing, among others.
When we use regenerative therapies, the relief will not be immediate. Patients will experience a temporary increase in inflammation. This will be followed by the regenerative process which can take months. As a patient, you have to understand the process and expectations need to be discussed in detail. One thing is for sure, regenerative medicine physicians will always prefer to use these therapies over steroids, if no contraindications, because of the more natural process and lesser potential effects in other systems.
The best physician for applying these therapies will have experience with all the modalities available. Discuss with your doctor if you are a candidate for these therapies.
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