One of the most promising and rapidly developing areas in the treatment of pain is regenerative medicine. These treatments help the body heal or rebuild itself. While, the body can naturally heal many types of injuries, newer techniques, such as stem cell therapy, may enhance the body’s ability to heal. But, what is regenerative medicine and how does it work?
What is regenerative medicine?
Regenerative medicine uses cutting-edge therapies to help the body replace, re-engineer, or regenerate human cells, tissues, or organs that were damaged or injured. The most common applications of regenerative medicine are in new organ growth or repair and cellular therapies. These both use a patient’s own cells to stimulate repair tissue and improve function.
The AABB reports that up to one in three people in the U.S. could benefit from regenerative medicine.
Patients with osteoarthritis of the hips and knees can use PRP therapies to stimulate the body’s own healing processes and reduce inflammation. Stem cell therapy could be used to revitalize worn-out intervertebral discs. In the very near future, patients could benefit from lab-grown bladder or heart transplants. These transplants would be derived from the patient’s very own cells to reduce the risk of transplant rejection or infection.
What’s the history of regenerative medicine?
Regenerative medicine began when the first bone marrow and solid organ transplants were done decades ago. The first successful kidney transplant was in 1954. Successful liver, pancreas, and heart transplants took place in the ’60s. From this perspective, regenerative medicine is a fairly established medical practice.
From there, regenerative medicine arose as a truly a cross-disciplinary approach to healthcare. As UPMC notes:
“Regenerative medicine is a new field that brings together experts in biology, chemistry, computer science, engineering, genetics, medicine, robotics, and other fields to find solutions to some of the most challenging medical problems faced by humankind.”
In the following TED talk, Alan Russell talks a bit about the history of regenerative medicine and why so many healthcare professionals are excited about its potential uses.
What are the different types of regenerative medicine?
There are three main types of regenerative therapy, as ARMI explains:
- Organ growth
- Cellular therapies for repairing damaged or diseased tissues or organs
While scientists are working on new types of regenerative medicine that can actually create new body parts from a patient’s own cells and tissues, this research is still in its infancy. Regenerative medicine for self-repair and cellular therapy, however, is performed on patients today.
Regenerative cellular and self-repair therapies use the following processes:
- Stem cell therapy uses stem cells, which are a type of cell that’s able to differentiate, or become, other types of cells. They’re essentially cells that haven’t been assigned a job in the body yet.
- Amniotic membrane therapy is similar to stem cell therapy, except that cells from the amniotic membrane are used instead. The amniotic membrane is the inner layer of the placenta surrounding a baby during pregnancy. Usually the amniotic membrane is discarded, but if properly saved, it can be used later. It’s comprised of two types of cells, stromal and epithelial. Both types are, like stem cells, able to differentiate in to other cell types.
- Platelet-rich plasma utilizes platelets found in the blood. Platelets contain growth factor proteins. These growth factor proteins play a part in clotting blood, stimulating wound healing, and promoting the growth of new soft tissue.
Stem cells in regenerative medicine
When an embryo is developing in the womb, it starts out as a mass of stem cells. As the embryo grows, the stem cells multiply and become the specialized cells that make up a body.
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. They 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. Bone marrow is perhaps the most commonly-accessed source of adult stem cells for regenerative therapies. However, harvesting stem cells from bone marrow is still a surgical procedure requiring anesthesia or sedation.
Though medical research on these treatments is progressing, stem cell treatments are generally considered experimental. They 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.
This video from Mayo Clinic gives a quick primer on stem cells.
Platelet-rich plasma therapy
Another regenerative medicine treatment 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 and sports medicine. This treatment gained wider recognition after a number of professional athletes were reported to use it to aid in their recoveries.
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.
A pain doctor from Arizona explains how platelet-rich plasma therapy works. You can also find out more about PRP therapy in our posts on the subject.
How does regenerative medicine work?
The process for acquiring the cells for regenerative therapy is different for each type, but the application of the therapy is a simple, straight-forward process no matter the cell type.
The acquisition of adult stem cells typically requires surgery. Amniotic cells come from the amniotic membrane of the placenta, so a placenta is required. This can be a patient’s own placenta that’s been saved, or it can be from a family member. Immediate family members are more likely to be a close-enough match to ensure the cells won’t be rejected.
Platelet-rich plasma requires a blood draw. A patient’s blood is spun in a centrifuge to separate the platelets. The concentrated platelets are combined with residual blood, and the resultant compound is injected into the painful location on the body. From beginning to end, the process of drawing and preparing the blood and injecting the platelet-rich plasma takes between one and two hours.
After the regenerative cells have been injected, the patient is usually able to go home immediately. While physicians often suggest avoiding any strenuous activity for a few days, it’s possible to go back to regular day-to-day activities right away. Some irritation, soreness, bruising, or other minor discomforts might be present for a few days, but generally there are few side effects of regenerative therapy.
The injected regenerative cells should stimulate the healing and the growth of new tissue. For instance, in degenerative conditions like osteoarthritis, this may mean the growth of new cartilage around joints. With torn muscles or ligaments, regenerative therapy should support the growth of new tissues to heal the injury.
What about regenerative medicine for chronic pain?
Chronic pain is often the after-effect of degeneration, injury, or illness. Part of the body is left damaged somehow, and that damage causes pain. Most pain therapies concentrate on controlling the pain with medications, injections, or devices that block pain signals in one way or another.
Regenerative therapies are well-suited to treating musculoskeletal pain, or pain that’s caused by something in the muscles or bones. Conditions that can respond well to regenerative therapies include:
- Cervical radiculopathy
- Compression fracture
- Degenerative disc disease
- Herniated disc
- Plantar fasciitis
- Failed back surgery
- Injuries, such as torn ligaments or muscles
Are there risks or side effects?
Compared to other chronic pain therapies, regenerative medicine has an extremely low risk of side effects.
Regenerative therapies typically involve nothing more than an injection to the painful area of the body, making them very safe. Because the injected compound, whether it’s stem cells, amniotic cells, or platelet-rich plasma, is usually from the patient’s own body to begin with, there’s almost no risk of infection.
Additionally, one of the biggest risks in the transplant of biological materials, such as organ transplants, is rejection. This is when the body realizes that the transplanted material is foreign and attacks it. However, since the cells used in regenerative therapy are the patient’s own natural cells, there is no chance at all of rejection.
Stem cell therapy utilizing adult stem cells from the bone marrow is the exception. The harvesting process requires a surgical procedure, which carries the same risks as any other surgery. If, however, the procured stem cells are used on the same person they’re from, this still has the benefit of being extremely low-risk for infection, with no risk of rejection.
It often takes at least two weeks to notice any difference in pain after regenerative therapy, although in some people it may take even longer. In some cases, there may be no discernable pain reduction after regenerative therapy. However, because of its low risk of side effects, it may still be worth discussing this treatment option with a physician.
When will regenerative medicine be available?
Regenerative medicine is already available today, in many different applications. According to the NIH:
- 500,00 people in the U.S. receive transplants every year
- Tissue-engineered skin is being used as temporary wound covers for burns and ulcers
- Cellular therapies are being used to replace damaged knee cartilage and induce bone and connective tissue growth
Nature also keeps a running list of the scholarly articles about current regenerative medicine research and trials.
As to wide-spread availability of these therapies, that depends. Since stem cell and regenerative medicine is still in its infancy, many insurance providers don’t cover the cost of these procedures. That means many procedures are paid out of pocket. You may find discounted options by reaching out to pain clinics and independent medical groups who are performing their own studies and patient trials on regenerative medicine.
Once there is more solid research backing these procedures, regenerative medicine should become more easily available and cost-effective for all patients.
What’s the future of regenerative medicine?
From made-to-order organs to “smart” biomaterials that could help form functional tissues, the possibilities and future of regenerative medicine is endless. The NIH notes:
“Imagine a world where there is no donor organ shortage, where victims of spinal cord injuries can walk, and where weakened hearts are replaced. This is the long-term promise of regenerative medicine, a rapidly developing field with the potential to transform the treatment of human disease through the development of innovative new therapies that offer a faster, more complete recovery with significantly fewer side effects or risk of complications.”
Organizations like the Stanford Medicine Institute for Stem Cell Biology and Regenerative Medicine and Mayo Clinic’s Center for Regenerative Medicine are at the forefront of researching new applications for regenerative medicine.
Where can I find more regenerative medicine articles?
Many healthcare researchers today are grappling with the questions of what is regenerative medicine and what potential uses it can have for patients. To learn more about the future of regenerative medicine, check out the following articles:
- “Regenerative medicine: today’s discoveries informing the future of medical practice” by Nadia Rosenthal and Stephen Badylak
- “What’s Next for Stem Cells and Regenerative Medicine?” by Christine Gorman
- “Growing Organs on Apples” by Jessa Gamble
- “Regenerative medicine: Current therapies and future directions” by Angelo S. Mao and David J. Mooney
Where can I find a regenerative medicine clinic?
Regenerative medicine clinics can be found in larger medical institutions like Mayo Clinic or Stanford Medicine, however there are also local doctors in your area who are running stem cell and regenerative medicine trials for their patients. Pain clinics, in particular, are offering regenerative therapies for conditions like arthritis and back pain.
You can find a pain clinic in your area by clicking the button below. The clinic’s Services page will list which regenerative therapies they offer. Or, you can call their office and ask.