Exploring Stem Cell Therapy’s Developing Role In Pain Medicine

Exploring Stem Cell Therapy’s Developing Role In Pain Medicine

As researchers continue to uncover potential health and medical benefits associated with the regenerative properties of stem cells, there is growing interest in the field of stem cell medicine and specifically for use as an alternative therapeutic treatment of pain.

Of particular recent interest in this area is the differentiation ability of stem cells classified as totipotent, pluripotent, and multipotent.  Stem cells that can differentiate into and form cells and build organs are known as totipotent stem cells. Pluripotent stem cells are able to differentiate into various types of cells. Multipotent stem cells can differentiate into several limited forms of cells. Of the three different types, only multipotent stem cells are found as adult cells in the body, including in organs, placenta, and bone marrow.

Recently, stem cell transplantation has been used as an alternative treatment for pain associated with severe osteoarthritis, neuropathic pain, and intractable musculoskeletal pain that does not respond to traditional or conventional medication.

Osteoarthritis

Although stem cells are thought to be a potential treatment approach for repairing and regrowing cartilage required for treating severe osteoarthritis, to date, regeneration of damaged cartilage has proven to produce limited results. One of the significant issues associated with using stem cells to regenerate cartilage is that cartilage contains no blood vessels or nerves, making cartilage regenerations very difficult once it is damaged. Making the process even more difficult, cartilage regeneration can only occur when the entire layer of cartilage and the layer of bone directly below the cartilage is damaged.

As such, therapeutic stem cell treatment possibilities for osteoarthritis include individual or combination treatment(s) of surgical intervention, tissue engineering, and intra-articulation injection of cultured stem cells; of these possible treatment options, intra-articulation injection of cultured cell therapy would be the preferred method as it is the least minimally invasive and most convenient for clinical use.

There have been mixed reviews as to the effectiveness of these treatments and, to date, there have been no reliable and convincing clinical human students with a high level of evidence conducted specifically on the efficacy in functional improvements and cartilage repair surrounding the application of intra-articular stem cell injection therapy. Although some who have had this treatment expressed improvements.

Neuropathic Pain

Stem cells have demonstrated the ability to release neurotrophic factors that enhance the growth and survival potential of neurons, secrete anti-neuroinflammatory cytokines, and provides a cellular source for replacing injured neural cells; this makes the application of stem cells a prime option for regulating and potentially even reversing intractable neuropathic pain.

Studies have confirmed that relieving neuropathic pain is possible through the administering of stem cells, both through intravenous injection and when directly administered to a specific injured site. However, while stem cells do not need to make direct contact with injured cells to produce a neuroprotective effect, stem cells applied directly to an injured site, as opposed to those intravenously injected appeared to better target and relieve neuropathic pain associated with a specific area.

In addition, while a further clinical human study is required, animal models of both diabetic neuropathic pain and spinal cord injury demonstrate that stem cell therapy, and specifically mesenchymal stem cells (MSCs), demonstrated improved blood circulation and nerve conduction velocity, reduced pain, and regeneration of the affected nerve. 

Intervertebral Disc Disease

Patients diagnosed with degenerative disc disease who were treated with MSCs injected directly into the nucleus pulposus, or inner core of the vertebral disc demonstrated a reduction in pain and disability comparable to spinal fusion surgery. 

Research has yet to identify an adequate, effective dosage of stem cells and further research on specific stem cell type, dosage, safety, and implantation rate is required. As research into the use of stem cell therapy in pain medicine progresses, it is important to see the development of evidence-based standardized methods of treatment.

While still in the early stage of clinical application, the use of stem cells in the treatment of pain appears to be very promising.

Reference: (2019, October 1). Stem cell therapy in pain medicine – PubMed. Retrieved December 11, 2020, from https://pubmed.ncbi.nlm.nih.gov/31569916/

Exosomes from Mesenchymal Stem Cells Show to Protect Cartilage and Relieve Osteoarthritis Pain

Exosomes from Mesenchymal Stem Cells Show to Protect Cartilage and Relieve Osteoarthritis Pain

Osteoarthritis is the most common form of arthritis.  In osteoarthritis, the cartilage of the joints breaks down, bone spurs form, the synovial linings become inflamed, and the ligaments around the joint calcify. All of these pathological changes combine to cause joint pain, swelling, and stiffness. The breakdown of the joint also means that it does not function properly. The arthritic joint may “lock up,” “give out,” or simply not be able to move through its normal range of motion. Early in the disease, the pain of osteoarthritis may be brought on by movement. Later, the pain is more or less constant with severe pain flares.

Initially, the treatment for osteoarthritis is pain medications, exercise, braces, and physical therapy. Joint injections may be helpful for 4 to 6 weeks, but recent research suggests that repeated steroid injections may break down cartilage and speed up joint destruction. Unlike treatments for rheumatoid arthritis, there are no disease-modifying treatments for osteoarthritis. The disease tends to get worse over time until surgery is required. Joint replacement surgery is usually the treatment of last resort.

Since osteoarthritis is a degenerative joint disease, a reasonable approach to therapy is to try to rebuild or regenerate the joint tissues. This would not only stop the disease progression of osteoarthritis but perhaps even heal the damaged joint. For this reason, regenerative medicine, also known as stem cell therapy, is drawing the attention of many scientists who are looking for alternative therapeutic treatments for osteoarthritis.

Researchers tested the ability of mesenchymal stem cells to relieve pain and treat the damage of osteoarthritis. More specifically, they used the exosomes that the mesenchymal stem cells produce. Exosomes are tiny packets of substances like RNA and peptides that support tissue growth and repair. Exosomes contain most of the molecules that make mesenchymal stem cells helpful.

The scientists found that giving exosomes from mesenchymal stem cells to animal subjects with experimental osteoarthritis had some remarkable effects. Not only did the stem cell-derived treatment substantially reduce pain in the rats with osteoarthritis, but microscopic and molecular evidence also showed that the exosomes were able to repair cartilage in the affected joints. This is truly impressive when you consider that other treatments for osteoarthritis only reduce symptoms—they do not repair cartilage or stop the progression of the disease.

While this work will need to be replicated in human clinical studies (and that work has already begun), this is an exciting finding for the millions of Americans who struggle with osteoarthritis.

Reference: He, L., He, T., Xing, J. et al. Bone marrow mesenchymal stem cell-derived exosomes protect cartilage damage and relieve knee osteoarthritis pain in a rat model of osteoarthritis. Stem Cell Res Ther 11, 276 (2020). https://doi.org/10.1186/s13287-020-01781-w

What are the Benefits of Stem Cell Therapy Exosomes for Osteoarthritis

What are the Benefits of Stem Cell Therapy Exosomes for Osteoarthritis

Osteoarthritis is a disease in which joint cartilage degenerates and the bony edges of the joint rub against each other. The disease causes pain and disability in the affected joint. There is no cure for osteoarthritis, except perhaps for artificial joint replacement surgery. Patients who are not candidates for surgery must get by with pain medications, braces, and physical therapy.

Given that osteoarthritis affects millions of people and there are limited options for long-term treatments other than major surgery, researchers are working very hard to find additional ways to manage this condition. One of the most exciting developments has been in the field of regenerative medicine, also known as stem cell therapy.

Stem cells injected into arthritic knees, for example, may help reduce the patient’s pain, protect cartilage, or even slightly heal the joint damage. Many patients feel relief and see improvements from just one therapy. Some with more advanced conditions may require a more maintenance plan. But today, researchers are now focused on the mesenchymal stem cell secretome.

What is a mesenchymal stem cell secretome? A mesenchymal stem cell secretome is the total of all of the molecules that mesenchymal stem cells secrete or release to support, restore, and regenerate tissue. The molecules released from mesenchymal stem cells, mostly through stem cell exosomes, exert many powerful benefits on joints.

From laboratory experiments in animals, we know the mesenchymal stem cell secretome is anti-apoptotic, which means it protects joint cells from committing programmed cell suicide. The secretome is also anti-fibrotic, and fibrosis can be damaging to joints and make them stiff. The secretome is pro-chondrogenic and pro-angiogenic, which means it helps build cartilage and blood vessels, respectively.

Lastly, the mesenchymal stem cell secretome modulates the immune system. While rheumatoid arthritis is considered the major inflammatory joint disease, inflammation also takes place in osteoarthritis. So, the mesenchymal stem cell secretome can modulate the immune system and reduce joint inflammation.

The main way that patients can reap the potential benefit of the mesenchymal stem cell secretome is through exosomes. Exosomes are small particles that contain most of the substances released in the secretome. Exosome treatment does not require stem cell infusions, and many, many more exosomes can be administered during a treatment session than stem cells, mainly because they are physically much smaller.

The concept of mesenchymal stem cell secretome is rather new, but it is a powerful concept in the treatment of osteoarthritis. As more human clinical studies are done, we should be able to unlock the power of the secretome for patients with osteoarthritis.

Reference: Mancuso P, Raman S, Glynn A, Barry F, Murphy JM. Mesenchymal Stem Cell Therapy for Osteoarthritis: The Critical Role of the Cell Secretome. Front Bioeng Biotechnol. 2019;7:9. Published 2019 Jan 29. doi:10.3389/fbioe.2019.00009

Exosomes Protect Joints from Osteoarthritis Damage

Exosomes Protect Joints from Osteoarthritis Damage

Odds are, you or someone you know has osteoarthritis—it is that common. Osteoarthritis is a chronic inflammation and destruction of one or more joints. Osteoarthritis is the kind of arthritis most people think of when they think of “arthritis.” The disease usually causes joint pain, stiffness, and limited joint motion. Common sites of osteoarthritis are the hands, knees, feet, spine, and hips.

Unlike rheumatoid arthritis, there are few good treatments for osteoarthritis. Most people with advanced disease must take analgesics (painkillers) each day to dull the pain. Unfortunately, each painkiller comes with its own problems. Aspirin increases the risk of bleeding. NSAIDs like ibuprofen wreak havoc on the gastrointestinal system and affect the kidneys. Chronic acetaminophen can be harmful to the liver. Opioids come with the risk of dependence and addiction. The only definitive treatment for osteoarthritis is surgery, which is expensive and usually requires a long recovery period.

Mesenchymal stem cells, also known as stromal cells, have shown remarkable promise in the treatment of osteoarthritis. For example, mesenchymal stem cells taken from bone marrow or fat tissue (adipose) that are then injected into joints can protect the joint from degeneration and slow the progression of osteoarthritis. However, there are some limitations with stem cell treatment.  One issue is that only so many cells can be injected in a space at once. For these reasons, scientists have pivoted some of their focus from stem cells to the tiny packets of information stem cells release called exosomes.

Exosomes contain millions of beneficial molecules including small proteins, cytokines, RNA, microRNA, and DNA. One stem cell can release thousands of exosomes. Since the exosomes are so small, many more exosomes can be collected and injected than stem cells themselves.

Researchers recently showed that exosomes collected from mesenchymal stem cells were able to provide the same benefits against osteoarthritis in mice as bone marrow stem cells did themselves. Stem cells slowed down the clinical signs of arthritis in mice just as whole stem cells did. Exosomes also protected cartilage and other joint structures from destruction.

This research demonstrates the developing science to use exosomes to treat osteoarthritis instead of the stem cells themselves. This gives doctors (and patients) considerably more flexibility in how they approach treatment. Exosomes tend to find their way to sites of disease, meaning they may be able to be injected into a vein instead of injected in the diseased joint. In addition, patients may be able to receive a higher “dose” of exosomes when simply purified exosomes are injected. This exciting research will need to be extended to humans, but clinical trials are in the planning phase.

Reference:  Cosenza, S., Ruiz, M., Toupet, K. et al. Mesenchymal stem cells derived exosomes and microparticles protect cartilage and bone from degradation in osteoarthritis. Sci Rep 7, 16214 (2017).

PRP Therapy – Post Management Care

PRP Therapy – Post Management Care

Many studies support platelet-rich plasma (PRP) to help benefit patients with chronic pain and injuries. This article will cover the major aspects of post management care and the best tips to optimize results.

Important tips to keep in mind:

·   Avoid Taking any anti-inflammatory drugs after the procedure avoid for 14 days following the procedure

·   Apply heat only for 10-14 days , you may experience some soreness and swelling in this time period.

·   Avoid any strenuous activities, exercising and physical therapy for the week following treatment

·   Stay hydrated

·   Improvements typically begin after 2 weeks

About a week after the procedure, patients should start physical therapy, which involves myofascial release, gentle stretching, engaging the articular range of motion, and core stabilizing exercises.

Other activities (e.g., stationary bike, swimming) are also an appropriate choice during the recovery phase. Interventional imaging techniques such as stimulation therapy and Transcutaneous electrical nerve stimulation (TENS) should not be used at this stage.

Once 4-8 weeks have passed, patients can gradually engage in more intense activities, including yoga, Pilates, and light weight lifting. However, forceful rotation and manipulation are not recommended.

Following the correct guidelines during the first few weeks of recovery is crucial for the success of the procedure. The injected cells are quite delicate, hence the need to avoid strenuous physical activities that may cause irreversible damage to the cells.

Patients should also keep in mind that the side effect profile is diverse and can only be evaluated on a case-to-case basis. In other words, one patient might experience pain and inflammation after the procedure, while another presents with no symptoms.

The severity and extent of these symptoms are also dependent on the site of injection, with articulations being the most susceptible to traumatic injuries and side effects.

Recovery by weeks

Weeks 1 & 2

During this phase, you should restrict your movements and physical activity to avoid putting too much tension on your body. However, this doesn’t mean giving up to a sedentary lifestyle as it’s not the best approach.

Expect to experience pain, inflammation, and soreness.

Moreover, remember to avoid running, weight lifting, or any other strenuous exercise. Other activities, such as gentle stretching, are still allowed.

If you experience serious inflammation, consider using ice bags on the affected area , but try to avoid ice and NSAIDS until after the 14 day period. You can also use natural compounds that have potent anti-inflammatory properties, such as turmeric, CBD, and arnica.

Weeks 3 & 4

At this stage, the pain and inflammation should slightly subside, which allows you to practice more intense activities, but do not attempt to lift heavy weights or perform high-impact exercises. An appropriate number would be to keep the intensity of the workouts under 50% of what you’re used to. This will allow the stem cells to implant themselves in the damaged tissue and kick start the healing process.

Weeks 5 & 6

In this stage, focus on core-stabilizing exercises to strengthen your core muscles and give time for the joints to get used to the new routine. Activities such as stationary bike, elliptical, stretching, yoga, Pilates, and swimming exercise are permitted.

Weeks 7 & 8

Inflammation and pain might be gone at this time; however, you should still be careful about the type of exercises you’re performing. For patients who are still dealing with pain and swelling, you can use ice bags to accelerate the healing process.

Months 3–6

During this period, stem cells have reached their peak healing potential, which should not get interrupted with intense physical activity. Instead, settle down for less-strenuous workouts that do not involve any compressive, twisting, or pivoting movements. Avoid uneven ground. Contact a Care Coordinator today for a free assessment!

4 FAQs About Stem Cell Therapy for Knees

4 FAQs About Stem Cell Therapy for Knees

Knee issues are among the most common musculoskeletal injuries and can occur in individuals of all ages. The complex joint is made up of bone, cartilage, ligaments, and fluid, as well as muscles and tendons which allow for movement. When any of these structures becomes injured or diseased, discomfort and limited range of motion may ensue. Knee problems can create significant strain on an individual’s life, from preventing participation in sports to making it difficult to get out of a chair. Here 4 FAQs about stem cell therapy for knees.

There are many causes for knee issues, the most common of which is osteoarthritis. In this condition, the cartilage in the joint erodes over time, leading to inflammation and pain. Sports injuries are also common culprits; even a simple, sudden twisting movement can tear or sprain structures like the anterior cruciate ligament (ACL), leading to severe pain.

Depending on the severity of a knee condition, prescribed treatment could include rest, rehabilitation, or surgery. Yet, knee problems don’t always improve with these methods, and many patients understandably want to avoid invasive surgery if possible. Fortunately, stem cell therapy is an emerging solution many experts support — find out more about what it entails below.

4 Commonly Asked Questions About Stem Cell Therapy for Knees

What Is Stem Cell Therapy?

Stem cell therapy is a form of regenerative medicine which uses the body’s natural healing mechanism, stem cells, to rebuild compromised tissue at the cellular level. For knee injuries, the goal of the treatment is to alleviate pain, improve mobility, and delay or prevent the need for surgery.

What Knee Issues Can It Address?

Stem cells may be used to address a number of knee issues. In degenerative conditions, such as osteoarthritis, stem cell therapy can help slow the destruction of cartilage and even rebuild it, due to the stem cells’ ability to self-renew and mature into specialized cell types. The cells also have anti-inflammatory properties and may therefore aid in quicker, more thorough healing of acute knee issues, such as injuries to the ACL, meniscus, and other knee structures.

What Does The Process Entail?

The process for stem cell therapy is fairly simple. The cells are extracted, either from the patient themselves or a donor, and then inserted directly into the injured tissue. Thereafter, they’ll begin the healing process. Depending on your condition, your practitioner may recommend several sessions to achieve the best possible results.

What Is The Success Rate?

As with any type of treatment, success rates will vary from one patient to the next. With that being said, research has shown that patients who have received stem cell therapy for knee issues still felt better than their baseline five years after treatment. For patients who have responded poorly to previous treatment methods or want to avoid major surgery, stem cell therapy is certainly an option worth exploring. 

If you are tired of dealing with the everyday pain and want relief that lasts then contact us today!

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