PRP, STEM CELL & PROLOTHERAPY Injections for Pain – Real or Insane?
Regenerative medicine (RM) is a fast-growing field of treatment targeting different areas/tissues of the body, including musculoskeletal injuries in hopes of repairing/replacing damaged structures and restoring function. High profile elite athletes and famous public figures have traveled out of the country and paying tremendously high dollar amount, to receive repeated local chemical injections to help them heal better and quicker, in order for them to return to life/sports faster. So, is it really worth the expense-or just a waste of time/money? This concept of RM (injected solutions) began back in the 1930s, and has gradually expanded into different sources of material delivered locally into muscles/tendons/joints afflicted with disease or injury.
Regenerative medical treatments started with prolotherapy, initially was named sclerotherapy (injections causing formation of scar for stabilization of an injured structure), more recently referred to as “regenerative injection therapy” (RIT). This method evolved into injecting a solution containing some sort of irritating substance (most commonly dextrose) directly into a damaged area, causing bleeding/inflammation, which in turn initiates the healing cascade and stimulates soft tissue proliferation/partial regeneration. Scientists have studied RIT for patients with knee arthritis, ACL laxity, Achilles tendon tear, elbow tendinitis, plantar fasciitis; groin/tailbone/pelvic/neck/back pain, with some success in relieving symptoms and improving function. However, this theory remains largely speculative, since the exact mechanism and inciting response at the injected site has not been elucidated or backed up by research thus far. Medical professionals therefore, continue to search for other substances to successfully treat painful musculoskeletal conditions.
In the 1980s, fifty years after RIT surfaced, PRP (platelet-rich plasma) was discovered as an improved, nonsurgical modality for management of orthopedic disorders/trauma. This solution is drawn from venous blood using a hypodermic needle; platelets are then extracted and concentrated further (more than normally found within the body) by centrifugation prior to injection. How PRP works to augment soft tissue regeneration/healing is theorized to be mediated through growth factors and other bioactive proteins. Similar to RIT, even though PRP injections for knee, elbow, and heel pain have had positive results, but only with limited scientific studies available to support mainly anecdotal evidence.
The latest wave of discovery, again as an attempt to help the body heal itself involves using mesenchymal stem cells (MSCs), isolated from bone marrow or other sites in the body such as adipose tissue (fat). These stem cells are harvested by aspiration or surgical extraction, then cultured to grow in abundance with added nutrients/trophic factors, before injecting into injured/diseased body parts. Supposedly, MSCs are capable of differentiating into various tissue types after delivery through a liquid medium. Clinical results so far are promising, but only include laboratory/animal studies and series of human case reports. The US Food and Drug Administration (FDA) has not approved stem cell injections to regularly treat musculoskeletal conditions, though more and more centers for “off label use” of stem cell therapy are sprouting across America, especially in larger metropolis areas. These sites advertise their products as superior in “growing new tissue to replace old/damaged bodily structures”.
In summary, using prolotherapy, PRP, and stem cell injections for treatment of musculoskeletal issues/injuries can be somewhat efficacious. These are fairly widely used for pain from arthritis and/or tendinitis. However, most medical insurance will not cover the cost (averaging at least thousands of dollars per shot) so it must come out of pocket from those who seek to be treated. To date, results of symptomatic improvement are preliminary at best. No large clinical trials exist to prove that these improvements are long lasting, or that potential side effects are not ultimately harmful. Centers for stem cell therapy are abundant in Asia and Europe, much more so than in the US.
So, if you get hurt and have a lot of extra money laying around, you can book a flight to the Bahamas for a therapeutic vacation by buying a stem cell injection. Just remember, though that what you pay isn’t necessary what you may get, since regulations outside of America are not as stringent, you may end up with an adverse reaction and fly home “empty handed”…
You’re better off sticking to the old-fashioned method of medical management: PRICE=Protect the injured part, relative Rest, Ice the area for inflammation, use ace wrap for Compression, and Elevate the limb for swelling. This way, you can save money and not waste time on something futuristic. Let’s all face it, be patient and stay realistic!