Within the maze of Stem Cell and Non-Stem Cell Regenerative Medicine treatments, there is a continuum, from very expensive to affordable options. The most cost-effective options include Prolotherapy, Platelet Rich Plasma and Neural Prolotherapy. These treatments are each effective and bring about repair and/or regeneration in different ways. Let’s discuss how these affordable treatments can help improve orthopedic conditions (low back, neck, or disc related pain and sciatica, arthritis, meniscal, tendon and ligament strains and sprains) and how they compare with traditional non-surgical orthopedic interventions.
The mainstream non-surgical approach to pain often involves analgesic and anti-inflammatory medications, muscle relaxants and steroid injections. These treatments can often be very helpful in relieving acute pain but may do nothing to correct the underlying condition. In fact, by reducing the pain, there is no feedback mechanism to let you know about ongoing damage. This may result in worse tissue damage and longer-term pain.
Anti-inflammatory medications may be very helpful in reducing the inflammation, but inflammation is not the problem. It is a necessary part of the healing process. Inflammation is like the contractors who come to the scene to repair damaged structures. Blaming the pain on inflammation is like blaming contractors for doing their job. If these factors are minimized with an anti-inflammatory medication, repair may be compromised. This can result in worse tissue damage. What may have been short term pain may become a chronic and more painful necessitating ongoing medication and invasive procedures.
For these reasons and because anti-inflammatory medications can result in a bleeding gastric ulcer, heart attack or stroke that can lead to death, their long term use is generally not recommended for chronic pain. Unless supervised by your doctor and unless your doctor believes that the benefits of taking these medications outweigh the risks, Regenerative Medicine interventions may be a better option.
The most basic Regenerative Medicine treatment is Prolotherapy. Prolotherapy involves injecting a proliferant solution into targeted locations that are causing the pain. This stimulates specialized cells called fibroblasts to promote regeneration and repair. Prolotherapy essentially works like a poorly paid, but very efficient contractor. Prolotherapy is very effective for the same conditions for which steroids are used; however, instead of causing the many side effects associated with steroids, there are virtually no side effects. Instead of degeneration of the underlying structures associated with steroids, prolotherapy stimulates tissue repair. It is backed up by over 70 years of supportive clinical studies including five gold standard – double-blind studies. Some of these studies report cartilage regeneration, reduced pain, improved functional abilities and an 80-90% success rate1.
The next level of sophistication is Platelet Rich Plasma or PRP. This treatment involves taking blood from a vein. The blood is spun down in a special centrifuge which isolates the platelet rich portion. This portion of the blood has growth factors as well as anti-inflammatory and anti-microbial properties. It is also believed to work as a scaffolding material and as a reservoir to deliver certain growth factors to the site of application.
The repair process for Prolotherapy and PRP can be thought of as taking place through the use of contractors and general contractors. Initially after an injury, the contractors automatically get right to work to repair the injured structure as soon as it occurs. This can continue for weeks to several months. This is often all that is necessary to finish the repair.
People with chronic pain, however, have contractors that have not finished the job. Their contractors had essentially gotten tired. Instead of completing the task, they go home and go to sleep. Doing Prolotherapy and PRP is like having the general contractor call up the contractors to get them back to work.
But it’s not always that easy. As long as the road is open, the contractors are able to make their way to the job site. If there are impassable roads as a result of flooded roadways (blocked ganglia, interference fields or scars, blocked qi, etc.) or severe traffic congestion (caused by poor circulation to the area), these blockages need to be cleared.
If they are unable to be cleared; the contractors may need to be helicoptered to the worksite. This transplantation of the contractors to the worksite is essentially how Stem Cell therapy works. These Stem Cells are taken from adipose tissue or bone marrow and transplanted where they are needed. But in addition to merely sending in contractors, the theory is that the Stem Cells are able to transform themselves into the normal version of the surrounding structures.
This sounds very nice in theory, but the medical literature supporting the efficacy for Stem Cell treatments is still not very impressive. One study showed that Dextrose Prolotherapy “provides equal or superior short-term, intermediate-term, and long-term results to alternative treatment modalities” including PRP2.
Another study showed that although the use of Stem Cells has potential as an efficacious treatment for patients with knee arthritis, the safety and efficacy must be evaluated with a more rigorous, larger sample size validation before Stem Cell therapy can be used in clinical practice3.
A Systematic review of the literature for the use of Stem Cells for knee arthritis showed “Six trials with high risk of bias showed level-3 or level-4 evidence (low-level evidence) in favour of Stem Cell injections in knee osteoarthritis.” It concluded that “In the absence of high-level evidence, we do not recommend Stem Cell therapy for knee osteoarthritis4.”
Overall, there are several things to consider when deciding whether to undergo Stem Cell, PRP or dextrose prolotherapy. One is the cost. Stem Cell is most expensive followed by PRP. Prolotherapy is the least expensive.
The advantage of Stem Cell Therapy and PRP over Prolotherapy is that they are considered by some to be more effective. They believe that even though Stem Cell Therapy and PRP are more expensive, it may be more cost effective to use because fewer treatments may be necessary. This is also a factor for people with limited time.
Although there are no studies indicating that Stem Cell Therapy is more cost-effective than Prolotherapy, and although the literature is not strongly supportive of Stem Cell treatments at the current time, it is possible that in the future Stem Cells Therapy will be found to be better than PRP and PRP better than Prolotherapy. So if the cost is not a concern, Stem Cells Therapy may be considered.
There are some drawbacks regarding Stem Cells and PRP. The optimal way to process the cells is not clear. Also, different people with different conditions may need very different preparations. Another drawback to the use of Stem Cell and PRP is the limited area able to be treated due to the limited amount that can be produced with one draw.
One way to minimize the problem of limited size is by cautiously combining Stem Cells and/or PRP with Dextrose Prolotherapy in a special way as to not interfere with the biological activity of the PRP and Stem Cells.
If you decide to undergo PRP for arthritis it is important to make sure the physician is using a technique that minimizes the number of white blood cells. Studies currently show that this achieves the best results with the least discomfort5.
Overall Prolotherapy and Neural Prolotherapy (which will be discussed in another article) can very successfully treat the vast majority of complex pain problems. The key is to conduct a careful examination and to perform a complete treatment on all the affected areas and all the lax ligaments responsible. Most patients who have failed regenerative injection treatments, do so because of those factors.
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Disclaimer: All information provided by Dr. Bloom is for educational purposes only It is not intended to prevent, diagnose, treat, or cure any disease or injury. Individual results may vary. No results are guaranteed.
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