One of the most promising and rapidly developing areas in the treatment of pain is regenerative medicine, in which treatments cause the body to heal or rebuild itself. The body can naturally heal many types of injuries, but newer techniques, such as stem cell therapy, enhance the body’s ability to heal. These techniques are still new and are still being evaluated in clinical research, but we believe these types of regenerative medicine hold great promise. All of us at PainDoctor.com are excited to be on the cutting-edge in researching and evaluating these medical treatments. Many of our PainDoctor.com-certified doctors also offer many of these types of treatments.
Types of regenerative medicine
The regenerative medicine method that will work best for a patient depends on their condition and other circumstances. Regenerative medicine can vary depending on how it’s administered and how those regenerative cells are produced. Let’s take a look at some of the most common types of regenerative medicine, including:
- Stem cell therapy
- Amniotic-membrane derived stem cells
- Platelet-rich plasma therapy (or PRP injections)
- Tissue engineering
Stem cells are body cells that have the potential to become the cells for many types of bodily tissues. Human embryos are a widely recognized and controversial source of stem cells, but stem cells can also be found in the body tissues of adults, such as bone marrow and blood as well as placental tissue. Other adult cells (e.g., skin cells) can be modified through the injection of specific genes or molecules to become stem cells. The various sources of stem cells often have different properties and are generally capable of becoming some, but not all, types of cells.
Various treatments that involve the extraction of stem cells and their injection into damaged tissues have been developed. Some of these treatments involve taking a person’s own stem cells and injecting them into a site of injury. Other treatments rely on stem cells from adult donors.
Though medical research on these types of regenerative medicine is progressing, stem cell treatments are generally considered experimental and are only approved in the United States as a part of clinical trials. These treatments hold great promise because they may be able to treat certain conditions, such as discogenic back pain, that are difficult to effectively relieve with other methods.
Amniotic stem cells
A closely related type of treatment involves amniotic membrane. Human amniotic membrane seems to have some of the key properties of stem cells, such as low immune reactivity and the capability of differentiating into other types of cells. Consequently, amniotic membranes are currently used in treating a number of different conditions. For example, animal research has found that these membranes can improve the healing of damaged tendons and other connective tissues.
During pregnancy, the fetus gestates within the placenta surrounded by amniotic fluid. Amniotic fluid contains a complex mix of nutrients that are critical to fetal development, including:
- Amino acids
It also contains epithelial cells and mesenchymal stem cells that come from the surrounding amniotic membrane. As doctors and scientists have come to appreciate the role played by amniotic fluid in fetal development, there has been a growing interest in its potential use as a regenerative medicine treatment.
Benefits of amniotic stem cells
One advantage of amniotic tissues is that they can be obtained easily at the time of birth without harming the mother or baby and cryopreserved until they are needed. One of the first recorded medical uses of amniotic tissues was in 1910, when physicians at Johns Hopkins Hospital in Baltimore used amniotic tissue to aid in skin transplantations.
Amniotic tissues can benefit transplants in several ways. Not only are the cells found in amniotic tissues very low in the markers that cause rejection when implanted in another patient, but the amniotic cells actually actively suppress the T-cell response that leads to rejection. This means that amniotic tissues can be introduced to the body of a patient without the usual concerns about donor compatibility.
Amniotic tissues have a number of other beneficial properties as well. The epithelial cells in amniotic fluid release a number of antimicrobial proteins that help reduce the chances of infection. When the growth factors found in amniotic fluid are introduced to a wound, they reduce inflammation and help prevent scar tissue from forming.
Perhaps the most beneficial property of amniotic fluid is its ability to stimulate the growth of new tissues and repair damaged tissues. One way amniotic fluid does this is through mesenchymal stem cells. Unlike most cells in the body that have specialized to form a specific type of tissue, such as blood, fat, bone, or organs, mesenchymal stem cells have the potential to become many different kinds of tissue depending on where in the body they are located.
For example, when mesenchymal stem cells are placed in an osteoarthritic knee joint, they will form cartilage cells, potentially reversing the degeneration. In addition to containing stem cells, amniotic fluid contains many other growth factors that benefit healing and regeneration. These growth factors recruit other stem cells to the area, cause the existing cells to divide and stimulate the growth of nerves, blood vessels, and other supporting tissues.
Amniotic stem cell research
Amniotic-tissue based treatments are still regarded as experimental and their cost is generally not covered by insurance. Nevertheless, there is growing research evidence of their potential regenerative medicine benefits for treating certain conditions. Studies have found that amniotic tissue grafts used during spine surgeries lead to improved healing and less subsequent pain. Amniotic tissue grafts applied to flesh wounds have been found to speed up healing and wound closure.
Osteoarthritis of joints, such as the knees, hips, and shoulders affects millions of people in the U.S. and can cause chronic pain and disability. An ongoing study of 170 patients with knee arthritis found that injections of amniotic fluid significantly reduced pain and reduced disability at 13 weeks after injection.
Amniotic tissues are an amazingly complex combination cells and growth factors. Researchers continue to learn about the functions of these various components. Though more research is needed to assess which conditions amniotic fluid injections are effective in treating, there are good scientific reasons to believe that such injections can alleviate the pain and disability associated with certain injuries and chronic degenerative conditions.
One of the other most popular types of regenerative medicine is called platelet rich plasma (PRP) therapy. This technique was developed in the 1970s and has been adopted in a variety of medical practices, such as:
- Orthopedic surgery
- Plastic surgery
- Sports medicine
This treatment gained wider recognition after a number of professional athletes were reported to use it to aid in their recoveries. For example, in 2009, Pittsburgh Steelers wide receiver Hines Ward received PRP therapy before the Super Bowl to help in healing a sprained ligament in his right knee.
Benefits of PRP injections
PRP therapy involves drawing a small volume of blood from the patient and spinning this blood in a centrifuge. This separates the blood into different layers, each containing concentrated amounts of the substances naturally found in blood: serum in the top layer, white blood cells and platelets in the middle layer, and red blood cells in the bottom layer.
The middle layer, known as PRP concentrate, is then separated from the rest of the blood. This PRP concentrate contains three to five times the normal concentration of the platelets and growth factors that are used in the body’s own healing process. This PRP concentrate is then injected back into the patient’s body at the site of their injury, for example, into the site of an injured tendon or ligament. This process is then repeated over the course of weeks with additional PRP concentrate being drawn and injected each time.
The platelets injected release hundreds of different proteins involved in the regeneration of tissues. Though research on this treatment continues, the existing research has shown increased healing of several different types of body tissues. Because the patient is injected only with concentrate from their own blood, PRP therapy avoids safety issues of ensuring donor compatibility when using blood and tissue donation.
As the McEwen Centre for Regenerative Medicine notes on their website:
“Tissue engineering combines the principles of material engineering and bio-medical sciences to develop bio-artificial tissues and organs that can be used as a replacement part to repair or replace damaged or diseased organs. The process generally involves growing various cell types onto three-dimensional scaffolds, which are then implanted into the patient. These scaffolds are carefully designed to allow the cells to develop into tissues that mirror the natural structure and function of the damaged body part.”
Tissue engineering is an exciting new frontier in the treatment of pain related medical conditions, which healthcare professionals are just starting to explore. This, and other types of regenerative medicine, could change the way we treat and manage pain.
The future of regenerative medicine
Because these treatments are new and research on them is ongoing, most are not yet covered by insurance. Some types of regenerative medicine, such as stem cell therapy, are allowed only in clinical trials. However, these treatments have the potential to help many patients, especially in cases where other treatments have not been found to be effective.
To learn more about these types of regenerative medicine, as well as other treatment options, click the button below to find a pain doctor in your area.
Ted Swing has more than 11 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.