Regenerative medicine, where the body regenerates or rebuilds itself, is a relatively new and rapidly evolving front in the field of interventional pain management. Although stem cell therapy has garnered much of the attention over the past several decades, multiple other regenerative medicine modalities also have caught the public’s attention.
How do we treat pain?
We start treatment by first reviewing your pain and what has already been tried. After a history and physical exam, we will come up with a mutually agreeable plan to tackle your pain.
*Please note that we DO NOT offer opioid management.
We use a combination of therapies to reduce or eliminate your pain and improve your functional status. This includes medications such as NSAID's, antidepressants, steroid injections, and referrals to chiropractic care and physical therapy, along with several regenerative injection options.
In the early 2000s, the use of PRP expanded into orthopedics to augment healing in bone grafts and fractures. Success there encouraged its use in sports medicine for connective tissue repair. Mishra and Pavelko, associated with Stanford University, published the first human study supporting the use of PRP for chronic tendon problems in 2006. This study reported a 93% reduction in pain at two year follow up. Then, in 2008, Pittsburgh Steelers’ wide receiver, Hines Ward, received PRP for a knee medial collateral ligament sprain, and the Steelers went on to win SuperBowl XLII. Ward credited PRP for his ability to play in that game and his success with this treatment was discussed on national television.
Since then, other high profile athletes - such as Takashi Saito, closing pitcher for the L.A. Dodgers, and golfer Tiger Woods - credit PRP for helping them return to their sport. PRP continues to gain wider acceptance in the sports world with studies continuing to validate the use of PRP for ligament and tendon injuries, knee osteoarthritis, degenerative knee cartilage, chronic elbow tendonosis, muscle strain and tears, jumpers knee, plantar fasciitis and rotator cuff tendinopathy - albeit some skeptics and controversy remains.
The use of hyperosmolar dextrose (Prolotherapy) has been shown to increase platelet-derived growth factor expression and upregulate multiple mitogenic factors that may act as signaling mechanisms in tendon repair. An interesting study published in the January 2010 JAMA compared PRP versus saline injection (basically saline Prolotherapy) for chronic Achilles tendinopathy. Both groups improved “significantly” by Yellonel et al and the authors conclude there was no statistical difference between the improvement of both groups. Therefore, both PRP and Prolotherapy have been shown to stimulate natural healing and both can be effective and both should be considered in the treatment plan for connective tissue repair. However, PRP may be more appropriate in some cases. When PRP is used as a Prolotherapy “formula” for chronic or longstanding injuries, the PRP increases the initial healing factors and thereby the rate of healing. The Prolotherapy itself (irritation, needle microtrauma) is what is “tricking” the body into initiating repair at these long forgotten sites as well as the PRP, itself, which also acts as an “irritating solution.” This is especially important with chronic injuries, degeneration and severe tendonosis, where the body has stopped recognizing that area as “something to repair.” In these cases, PRP may be more appropriate, however this determination should be made by the physician on an individual basis. PRP can also be used preferentially over dextrose Prolotherapy in the case of a tendon sheath or muscle injury- areas occasionally but not typically treated with dextrose Prolotherapy where the focus is the fibroosseous junction (enthesis). It can also be used preferentially over dextrose Prolotherapy because of patient preference.
The Prolotherapy, PRP therapy has low risk and few side effects. Concerns such as hyperplasia have been raised regarding the use of growth factors, however there have been no documented cases of carcinogenesis, hyperplasia, or tumor growth associated with the use of autologous PRP. PRP growth factors never enter the cell or its nucleus and act through the stimulation of external cell membrane receptors of adult mesenchymal stem cells, fibroblasts, endothelial cells, osteoblasts, and epidermal cells. This binding stimulates expression of a normal gene repair sequence, causing normal healing - only much faster. Therefore PRP has no ability to induce tumor formation. Also, because it is an autologous sample, the risk of allergy or infectious disease is considered negligible. Evidence also exists in studies that PRP may have an antibacterial effect.