A perspective and case demonstration of what cellular products may bring to the future of pain care.

Pages 36-37

The field of regenerative medicine has garnered a great deal of interest, even exuberance, over the past few years. The possibility of achieving pain relief while avoiding surgical intervention is very appealing. In fact, the intense desire to seek out regenerative options has led to the establishment of many dishonest and undertrained “stem cell” treatments and centers, leading the public and the media to assess the specialized field as either a fad or a fraud. However, when performed correctly, regenerative medicine can offer great value to the future of medicine, including for patients seeking pain prevention and pain management.

Today’s regenerative medicine encompasses a wide variety of treatments and technologies that include but are not limited to stem cells. Products may be split into two categories: healing environmental products (eg, NSAIDs, steroids, synthetic hyaluronic acid, platelet-rich plasma, amniotic fluid, and Wharton’s jelly liquid suspension) and cellular products (eg, lipoaspirate concentrate, bone marrow aspirate concentrate, umbilical cord blood, and umbilical cord mesenchymal stem cells).

Herein, five unique, retrospective patient examples are presented which demonstrate the current and potential power of regenerative medicine. As with any treatment, individual outcomes may vary and further research is needed in large populations to demonstrate long-term efficacy.

Example #1: Female Teen with CRPS

A 19-year-old female with a history of Complex Regional Pain Syndrome (CRPS) presented with a sesamoid fracture of the right big toe. She had fractured the sesamoid bone approximately 2 years prior and had tried multiple conservative options, including rest, heat, ice, physical therapy, anti-inflammatories, steroid medications, and injections, as recommended by her podiatrist. Most recently, she had worn a boot and a bone stimulator for over 1 year. None of the approaches eased her foot pain, which was causing gait issues and significant lower back pain. Her podiatrist had recommended as a last option the surgical removal of bone or fixation with hardware, both of which could have a high chance of failure in improvement. In addition, her pain was likely to increase after such a procedure due to her CRPS.

After discussions with the patient, we performed a carefully guided stem cell and growth factor deployment via fluoroscopic guidance using a small gauge needle that reached the fracture point. Two months after the procedure, the patient noted significant pain reduction and was able to walk longer distances. After 3 months, x-rays demonstrated fracture healing. The patient is considering repeating the procedure to continue facilitating the fracture healing.

Example #2: Middle-Aged Male with MS

A male in his 50s presented with a 4-plus year history of multiple sclerosis (MS). Prior to his diagnosis, he was a highly functional professional. He expressed progressive diffuse fatigue and increased pain. He had tried multiple conservative treatments, such as physical therapy, muscle relaxants, steroids, and immunosuppressants, without a remarkable improvement and came to our clinic seeking an autologous lipoaspirate derived stem cells procedure (IRB approved). The cells were washed in accordance to protocol to remove red and white blood cells, as well as adipose and other cells. The cells were deployed to the patient intravenously and intrathecally using fluoroscopic guidance and pencil point needles. The patient reported a reduction in his MS pain-related symptoms for approximately 1 year post-deployment.

To the author’s knowledge, this was the first anesthesiologist/interventional pain physician-led deployment of lipoaspirate derived stem cells using this protocol for MS in the United States. (The procedure was conducted under the approved IRB protocol with informed consent; data were collected through the Cell Surgical Network online registry.) Other patients in our clinic, and at other clinics around the world, have demonstrated what they call a “remission of MS” with this procedure. The NIH has stated for years that stem cells offer a promising MS treatment.

Example #3: Elderly Male with Comorbid Knee Pain and ED

A male in his 80s presented with chronic, severe knee pain due to significant degenerative changes as well as erectile dysfunction (ED). He had tried multiple options for both conditions and, due to his age, did not want to undergo surgery. His knee pain prevented him from exercising and being active, a lifestyle he had for many years. His ED was causing him to feel anxious and depressed. He was interested in non-autologous stem cells and growth factors for the knee and non-autologous stem cells for the erectile dysfunction.

After deployment of appropriate cellular products using fluoroscopic guidance, the patient noted improvement of his knee pain and ED at his 2-month follow-up call (the patient was located in another country). In the author’s view, this case represents a good example of how pain management that treats both peripheral (knee) and central (depression) conditions may positively impact the entire quality-of-life experience.

Example #4: Middle-Aged Male with Severe Knee Degeneration

A male physician in his 60s with no significant past medical history presented with severe degenerative changes in his knee. He had tried many conservative options and was well educated about the management of knee degeneration. He had sought an orthopedic consultation and was told that he was a good candidate for a total knee replacement, however, he wanted to avoid surgery. He was interested in autologous stem cells and growth factors for the knee degeneration.

After undergoing lipoaspirate harvesting and receiving deployment via fluoroscopic guidance, the patient reported improvement of his knee pain between 1 and 2 months post procedure. He was able to run a 5k race 2 months after the procedure. Prior to his procedure, he had been unable to walk without resting during a routine workday.

Example #5: Athlete with Knee Injuries

A male professional athlete in his 40s with no significant past medical history, except for significant damage to his right knee after years of impact and injuries from competing, presented to our clinic. He was still competing with an ACL tear along with severe degeneration of the right knee and joint space. He had tried other conservative options, such as rest, heat, ice, exercise, physical therapy, knee braces, topical medications, anti-inflammatories, steroid medications, and knee joint injections, and battled through the pain while competing. Knee joint replacement surgery and ACL reconstruction was an option, however, he thought it would have spelled the end to his competitive career. He sought our opinion on regenerative medical options. We decided to deploy

non-autologous stem cells and growth factors using fluoroscopic guidance. The patient reported improvement of knee pain at 2 months post-procedure. By month 3, he was able to compete in a national tournament, winning his bracket.

The Takeaway Message

Despite the stigma around regenerative medicine, the field remains promising, with exciting technologies and products emerging daily. Careful, approved regenerative medicine, as demonstrated herein, has already produced positive results that will only improve in the years to come. The ability to offer more natural, minimally invasive solutions to reduce pain and create a healing environment for damaged tissues is real and available today. By the end of the next decade, clinicians may look back at many of our conservative pain treatments and surgeries as barbaric.

Last updated on: April 12, 2019

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