Low back pain (LBP) is one of the most common health problems worldwide, affecting nearly 60 to 80 percent of adults at some point in their lives. It’s the second most frequent reason people visit a doctor and one of the leading causes of work disability. For many, the costs aren’t just personal—they include substantial healthcare expenses and lost productivity. A large portion of chronic low back pain is linked to problems with the intervertebral discs, the soft cushions that sit between the vertebrae. When these discs degenerate, they can lose height, dry out, and develop tears, leading to persistent pain and reduced function.
Traditionally, people with disc-related LBP have relied on a mix of pain medications, physical therapy, and sometimes surgery. While these approaches can help, they often provide only temporary relief and may come with unwanted side effects. Medications, especially opioids, can lead to dependency or other complications. Physical therapy offers modest benefits for many, and surgeries like discectomy or spinal fusion have inconsistent outcomes and may involve long recovery periods.
This study provides initial evidence of the safety and efficacy of low-dose autologous adipose-derived mesenchymal stem cells (ADMSCs) for discogenic LBP.
Mesenchymal Stem Cells and Disc Regeneration
Stem cells, particularly mesenchymal stem cells (MSCs), have gained attention for their ability to support tissue repair. MSCs can be obtained from several sources, including bone marrow, umbilical cord tissue, and fat (adipose tissue). They release growth factors, cytokines, and other molecules that can reduce inflammation, prevent cell death, and stimulate the body’s natural repair processes. Rather than becoming new disc cells themselves, MSCs create an environment that promotes healing within the damaged disc.
Bone marrow-derived MSCs were some of the first to be studied for disc degeneration, but harvesting them can be painful and yield relatively few stem cells. Adipose tissue, by contrast, provides an abundant source of MSCs that are easier to collect and expand for therapy. Early research using bone marrow and adipose-derived MSCs has shown promise in improving pain and function in people with disc-related low back pain. However, questions remained about the safety of these treatments and whether lower doses of adipose-derived stem cells could still be effective.
The Study: Testing Low-Dose Adipose-Derived MSCs
This study by Bates et al. aimed to evaluate the safety and effectiveness of low-dose autologous adipose-derived mesenchymal stem cells (ADMSCs) for the treatment of discogenic low back pain. “Autologous” means that the stem cells come from the patient’s own body, reducing the risk of rejection or other immune reactions. The study included nine participants with chronic low back pain caused by degeneration of a single lumbar disc.
Each participant received an intradiscal injection of 10 million ADMSCs, with the option to repeat the injection six months later if needed. Over the following year, participants were closely monitored for any adverse effects and changes in pain, function, and quality of life. MRI scans were also used to examine the discs themselves.
Safety and Tolerability of ADMSC Injections
One of the most important findings from this study was safety. None of the participants experienced unexpected or serious adverse events related to the treatment. Only one participant experienced a temporary flare in pain after the injection, which was managed with standard pain medications. Overall, the procedure was well tolerated and demonstrated a strong safety profile, which is critical for any new therapy.
Pain Relief and Functional Improvements
The majority of participants reported meaningful improvements in their pain levels. After 12 months, seven out of nine participants (78%) reported reductions in average pain, and six participants (67%) reported improvements in their most severe pain episodes. Clinically significant improvements—those that made a real difference in daily life—were observed in most participants.
Functionally, the benefits were clear as well. Five participants (56%) reported being able to work more effectively, and three participants were able to reduce their use of pain medications. Measures of quality of life, including the ability to perform daily activities and self-care, also improved for most participants. Importantly, none of the participants reported any worsening of their condition during the study period.
MRI Findings and Disc Health
MRI scans at 12 months showed that the treated discs remained stable. There was no further loss of disc height or progression of degenerative changes in the vertebrae. In some cases, annular fissures—the tears in the outer layer of the disc—had partially or fully healed. Two participants also showed a reduction in disc protrusion, in which part of the disc protrudes outward. While it’s unclear whether these changes were directly caused by the stem cell therapy or natural healing processes, the stabilization of the discs was a positive finding.
Who Benefits Most?
Interestingly, the study suggested that certain characteristics might predict better outcomes. Participants with Modic type 2 changes (a type of vertebral bone change seen on MRI) and no annular tears seemed to respond particularly well. Those with annular tears or other types of changes did not experience as much benefit. While the study was small, this finding suggests the potential for more targeted treatment in the future, in which patients are selected based on specific disc characteristics.
Comparing Stem Cell Therapy to Traditional Treatments
Compared to conventional approaches, stem cell therapy offers several potential advantages. Medications, particularly opioids, provide limited relief and carry significant risks. Physical therapy can be helpful, but improvements are usually modest. Surgical interventions can be effective for severe cases, but they are invasive, carry risks, and often require long recovery periods. Stem cell therapy, by contrast, is minimally invasive and may offer both pain relief and functional improvements, with a strong safety profile.
Other studies have explored similar approaches, using higher doses of MSCs or combining them with carriers such as hyaluronic acid. This study’s use of a lower dose in a simple isotonic solution is significant because it shows that even a relatively small number of stem cells can produce meaningful results without additional substances. This could make treatment faster, simpler, and more cost-effective.
Limitations and Considerations
While the results are promising, it’s important to recognize the study’s limitations. The sample size was small, and there was no control group, so it’s difficult to make definitive conclusions about efficacy. The study also excluded participants with more severe or multi-level disc degeneration, so the findings may not apply to all patients with chronic low back pain.
Another consideration is the variability in response. Not all participants experienced the same level of benefit, and some improvements were modest. The timing of additional doses may also matter; in this study, those who did not achieve significant improvement after six months generally did not see large gains at 12 months, even with a second injection.
The Potential of ADMSC Therapy
Despite these limitations, the study provides encouraging evidence that low-dose ADMSC therapy is safe and has the potential to reduce pain and improve function in people with discogenic low back pain. The therapy was well-tolerated, and most participants experienced meaningful improvements in pain, daily function, and quality of life. MRI results also suggested that disc health could be maintained or even partially restored.
For patients with specific characteristics, such as Modic type 2 changes without annular tears, stem cell therapy may be particularly beneficial. Future studies with larger participant groups, control arms, and longer follow-up will help to confirm these findings and better define which patients are most likely to benefit.
Clinical Implications and Future Directions for ADMSC Therapy in Discogenic Low Back Pain
Chronic low back pain remains a challenging condition with limited effective treatments. Current approaches, including medication, physical therapy, and surgery, often provide only partial relief and can come with significant risks. Stem cell therapy, particularly using adipose-derived mesenchymal stem cells, offers a new avenue for treating discogenic pain.
This study demonstrated that low-dose ADMSC injections are safe and well tolerated, and are associated with meaningful improvements in pain, function, and quality of life for most participants. MRI scans suggested stabilization and partial healing of the discs, and certain patient characteristics may help predict who will benefit most.
While more research is needed, the findings are promising. Stem cell therapy could become a valuable treatment option for patients with discogenic low back pain, offering relief without the risks and limitations of traditional approaches. For individuals struggling with chronic disc-related pain, ADMSC therapy represents a potential step toward better function, less pain, and improved quality of life.
Source: Bates D, Vivian D, Freitag J, Wickham J, Mitchell B, Verrills P, Shah K, Boyd R, Federman D, Barnard A, O’Connor L, Young JF. Low-dose mesenchymal stem cell therapy for discogenic pain: safety and efficacy results from a 1-year feasibility study. Future Sci OA. 2022 Apr 21;8(5):FSO794. doi: 10.2144/fsoa-2021-0155. PMID: 35662742; PMCID: PMC9136638.
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