Physical Therapy for Pain Management

Physical Therapy for Pain Management

Up to 50 million Americans suffer from chronic or long-term pain. Missing work, the inability to do recreational activities, lack of concentration, and poor mental health are all side effects of living with chronic pain. However, one of the last things pain sufferers want to do may be the most effective treatment for chronic pain: exercise, and more specifically, physical therapy. Physical therapy for pain management can increase strength, mobility, and overall wellness for those suffering from chronic pain. 

Chronic Pain 

Doctors consider pain present for more than 12 weeks to be chronic pain. Some of the most common conditions causing chronic pain include:

Physical therapists typically focus on building strength and mobility when treating pain patients. Additionally, a physical therapist may work with patients to find safe, functional movements that don’t aggravate their pain.

How Physical Therapy Treats Pain

Physical therapists work to treat pain and its source. A physical therapist will look for muscle weakness or stiffness in areas that contribute to chronic pain symptoms. Then, they’ll treat your pain with exercises that help you move better and ease the pain. 

Most physical therapy sessions include a variety of training methods. 

Low-Impact Aerobic Exercises

Your physical therapist may choose an activity like cycling, walking, or swimming to amplify your heart rate, increase your range of motion, and provide fluid to your joints.

Strengthening Exercises

Your physical therapist may use low weights, resistance bands, weight machines, and bodyweight exercises (lunges and push-ups) to strengthen foundational muscles like your core or abdominal muscles.

Pain Relief Exercises

Pain relief exercises specifically target the source of your pain. For instance, a patient with knee pain may strengthen their leg muscles to support the joint better. 

Stretching

Gentle stretches are a fundamental part of physical therapy, as specific stretches can help to reduce pain, make muscle contraction more efficient, and work to release entrapped nerves.

Maintaining a consistent exercise routine can also help you retain the ability to move and function properly, rather than letting your pain render you immobile. 

Further Pain Support

When meeting with your physical therapist, discuss further treatment options to mitigate your pain. These treatments may include massage, heat and cold therapy, and transcutaneous electrical nerve stimulation (TENS), which many physical therapists offer in-office. 

Lack of movement and exercise worsens chronic pain. However, you can take charge of your pain symptoms by working with a physical therapist to build strength and mobility while lessening your chronic pain. Some patients are exploring stem cell therapy for chronic pain to help manage inflammation and pain. Mesenchymal stem cells (MSCs) are one specific type of stem cell that has the ability to differentiate into different types of cells. They are essentially the raw materials used to generate new tissues. This new alternative option may help patients manage their chronic pain along with conventional methods. If you are interested in learning more about physical therapy for pain management call us today and speak with. a care coordinator.

Efficacy of DMSA and EDTA in Chelation of Toxic Metals and Improvement of the Number of Stem Cells in Circulation

Efficacy of DMSA and EDTA in Chelation of Toxic Metals and Improvement of the Number of Stem Cells in Circulation

Metal toxicity, resulting from lead, mercury, aluminum, and arsenic, continues to be a significant public health concern and contributes to a number of serious health issues, including damage to the central and peripheral nervous systems, compromised kidney and liver function, and damage to the cardiovascular system. 

Specifically, toxic metals appear to contribute to oxidative stress in stem cells and endothelial progenitor cells (EPSs), the cells responsible for replenishing aging or damaged cells, and are an essential component for maintaining vasculature and neovascularization. The damage caused to these cells, as a result of metal toxicity, has directly contributed to vasoconstriction, hypertension, and altered gene expression.

Considering the established relationship between oxidative injury, endothelial cell dysfunction, and vascular disease, Mikirova et al. ‘s study examined the response of CD34-positive cells to chelation by DMSA. The study also compared the effectiveness of DMSA and EDTA in the chelation of toxic metals and the excretion of essential metals.

Mikirova et al. also share results related to the toxicity of lead and mercury to mesenchymal stem cells (MSCs), endothelial progenitor cells, and differentiated cells such as endothelial cells and fibroblasts. These results were obtained by comparing data obtained from 160 subjects who received oral DMSA chelation and 250 subjects who received intravenous EDTA chelation.

At the conclusion of this study, the authors were able to draw a number of conclusions, including:

  • Lead and mercury inhibit in vitro metabolism of MSCs and proliferation and adult differentiated cells, with MSCs demonstrating increased sensitivity to both lead and mercury.
  • DMSA demonstrated the ability to increase circulating CD34-positive cell numbers in vivo and is better at extracting lead and arsenic than EDTA – but is also more likely to increase extraction of certain essential minerals.
  • Removal of toxic metals significantly improved the number of stem cells and progenitor cells in circulation.

The authors also point out that DMSA offers improved results when compared to EDTA, for lead and arsenic chelation, but with a cost of higher extraction of essential minerals – including a fifty-five-fold increase in copper extraction (meaning copper levels must be monitored and supplemented for during chelation therapy). On the other hand, clearance of essential metals during chelation by EDTA was increased over twenty-fold for zinc and manganese.

Considering the findings of this study, the authors point out that these findings, along with data published in previous studies, provide some guidelines for the clinical use of DMSA and EDTA as chelating agents. 

Mikirova et al. conclude that chelation therapy demonstrates promise for repairing damage resulting from metal toxicity and for restoring circulating stem cell populations. The authors next plan to embark on a larger scale study with the hopes of gaining more data on changes in white cell and progenitor cell numbers before and after chelation therapy.

Source:  “Efficacy of oral DMSA and intravenous EDTA in chelation of toxic ….” https://www.transbiomedicine.com/translational-biomedicine/efficacy-of-oral-dmsa-and-intravenous-edta-in-chelation-of-toxic-metals-and-improvement-of-the-number-of-stem-progenitor-cells-in-circulation.pdf.

Safety and Clinical Outcomes In Chronic Ischemic Stroke Patients After Implantation of Mesenchymal Stem Cells

Safety and Clinical Outcomes In Chronic Ischemic Stroke Patients After Implantation of Mesenchymal Stem Cells

According to the CDC, stroke continues to be a major cause of serious disability for adults. It is also estimated that nearly 800,000 people in the United States have a stroke each year[1]. While 80% of those experiencing a stroke survive for at least one year following the event, more than 70% will continue to experience long-term disabilities.

Stroke is divided into three distinct phases: acute, subacute, and chronic phases. The acute phase of stroke occurs within 24 hours of the actual ischemic event. The subacute phase starts at 24 hours and lasts up to 3 months. The chronic phase of stroke, by definition, starts at 3 months.

While stroke patients tend to see some response to rehabilitation efforts occurring in the chronic phase, they tend to quickly plateau, leaving many with serious chronic neurological and functional disabilities. To date, there are no approved treatments for the chronic phase of stroke.

For the purposes of this study, Steinberg et al. report the two-year outcomes of their phase 1/2a study examining chronic stroke patients after implantation of mesenchymal stem cells (MSCs).   This study specifically examined the outcomes of 18 patients who were at least 6 months post-stroke onset and had chronic motor deficits secondary to the nonhemorrhagic stroke.

At the 1-year point of this study, the authors reported the implantation of bone marrow-derived MSCs (BMD MSCs) was generally safe, well-tolerated, and associated with significant improvement in clinical outcomes. 

There were no correlations between improvement in clinical outcomes and cell dose, baseline patient age, or baseline stroke severity.  However, two years after implantation of MSCs, those enrolled in this study experienced significant improvement in motor impairment scales as indicated by a number of scores, including the ESS, NIHSS, F-M total, and FMMS scores.

Although all enrolled patients experienced at least one Treatment-Emergent Adverse Event (TEAE), with headache and nausea being the most common, 94.4% of the TEAEs were determined to be unrelated and no one withdrew from the study.  

Interestingly, the authors reported that there also appears to be a significant correlation between the size of newly appearing transient lesions primarily in or adjacent to the premotor cortex – a finding that remained consistent at month 12 and month 24 of this study.

While Steinberg et al.’s reported findings are encouraging, the authors point out that the small scale and uncontrolled study design mean the findings should also be interpreted with caution. 

Steinberg et al conclude that their findings associated with this completed, open-label, single-arm phase 1/2a study was consistent with the data at the 1-year  point and indicated that treatment of chronic stroke with BMD MSCs after 2 years continued to be safe and was associated with sustained and significant improvements in clinical outcomes.

Given the findings of this study, the authors highlight the potential of MCSs, and specifically SB623 cells used in this study, as a potential treatment for patients with chronic ischemic stroke.

Source: “Two-year safety and clinical outcomes in chronic ischemic stroke ….” 23 Nov. 2018, https://pubmed.ncbi.nlm.nih.gov/30497166/.


[1] “Stroke | cdc.gov.” https://www.cdc.gov/stroke/index.htm.

Evaluating Stem Cells As A Treatment Option For Kidney Disease

Evaluating Stem Cells As A Treatment Option For Kidney Disease

Current estimates indicate that kidney disease currently affects over 37 million US adults and over 10% of the global population[1]. Characterized by gradual loss of function, kidney disease generally progresses over time and culminates in the inability to remove waste and excess fluid from the blood[2].  

Often demonstrating little to no symptoms in its early stages, chronic kidney disease tends to demonstrate increasing and dangerous symptoms as the condition advances.

To date, treatment for chronic kidney disease has been centered around causal control as a way of slowing the progression of the condition. However, these therapeutic treatment efforts, including multidrug therapy, have demonstrated an inability to reverse the condition from progressing to end-stage renal disease (ESRD) and requiring additional therapy, dialysis, or kidney transplantation. 

Considering the high cost and disruption to normal life function associated with dialysis and the severe shortage of viable kidney donors, neither dialysis nor transplant has proven to be ideal or often recommended treatment strategies. As a result, there has been renewed interest in new and more effective therapeutic options to alleviate, cure, or prevent kidney disease and to improve a patient’s survival and quality of life.

Evaluating the numerous and growing therapeutic applications associated with stem cells’ ability for self-renewal, proliferation, and differentiation, Liu et al.’s review explores the potential benefits offered toward improving renal function and supporting structural repair in those afflicted with kidney disease.

Despite the promising benefits of using stem cells to kidney repair and disease treatment demonstrated through prior preclinical study, the authors point out that certain ethical issues regarding the origin of stem cells, and specifically embryonic stem cells (ESCs) need to be addressed and overcome before clinical application of SCs.

Regardless of the stated drawbacks, Liu et. al concludes that the existing evidence demonstrates that stem cell therapy appears to be a clinically viable alternative for kidney disease, specifically for restoring normal kidney function and for progressing understanding about tissue regeneration, drug screening, and disease modeling.   

Although stem cells demonstrate promise in this regard and while the immunomodulatory properties of mesenchymal stem cells (MSCs) appear to make them the most promising SC for treating kidney disease, the authors also point out that further research is needed before definitively concluding which source of SC is best suited for this application.

As a result of this review, and in an effort to realize these findings into clinical applications in the future, the authors call for larger rigorously designed clinical trials to further assist in determining the clinical efficacy of SC therapy in kidney disease – including the appropriate selection of cell types, number of SCs required, and the appropriate route of administration.

Source: “Stem cells: a potential treatment option for kidney diseases.” 25 Jun. 2020, https://stemcellres.biomedcentral.com/articles/10.1186/s13287-020-01751-2.


[1] “Chronic Kidney Disease Basics – CDC.” https://www.cdc.gov/kidneydisease/basics.html.

[2] “Chronic kidney disease – Symptoms and causes – Mayo Clinic.” 3 Sep. 2021, https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521.

The Efficacy Of Wharton’s Jelly Mesenchymal Stem Cells For Treating Type 2 Diabetes

The Efficacy Of Wharton’s Jelly Mesenchymal Stem Cells For Treating Type 2 Diabetes

According to recent data from the CDC, an estimated 30 million Americans currently have type 2 diabetes mellitus (T2DM), and another 88 million are considered to be prediabetic[1]

Occurring most often as a result of being overweight and/or sedimentary and often resulting in severe kidney, heart, or vision issues, T2DM has demonstrated to be difficult to treat, often resulting in life-long insulin therapy as the primary method of treatment.

Considering the negative impacts associated with insulin treatment, and T2DM in general, Liu, et al.’s research explores the potential of specific mesenchymal stem cells (MSCs) in the treatment of the condition.

Recently, stem cell therapy has been shown to be beneficial in improving glycemic control and beta function. Building off of these findings, Liu, et. al designed this study to specifically examine the efficacy and safety of Wharton’s Jelly mesenchymal stem cells transplantation (WJ-MSC) as a therapeutic option for those with T2DM. 

The authors’ single-center phase I/II study involved observing 22 patients with T2DM for 12 months after receiving two injections of WJ-MSC (one intravenously and one intrapancreatic endovascularly). Over the course of the 12-month observation period, the participants were monitored with primary endpoints observed including changes in the levels of glycated hemoglobin and C-peptide and secondary endpoints including insulin dosage, fasting blood glucose, post-meal blood glucose, inflammatory markers, and T lymphocyte counts.

At the conclusion of this study, Liu et al. found that both glycated hemoglobin and fasting glucose levels demonstrated a progressive decline after WJ-MSC transplantation and over the course of the 12-month follow-up period, the suggested potential of long-lasting effects of the WJ-MSC treatment. Researchers also observed a general improvement in fasting C-peptide levels. Secondary endpoint observations over the course of the 12-month follow-up included improved beta-cell function and reduced markers of systemic inflammation and T lymphocyte counts.

While there were no significant adverse observed effects associated with either of the WJ-MSC injections, the authors did note isolated and separate incidences of mild fever, nausea, and headache in a very small number of participants – all of which spontaneously resolved within a week of onset. The authors also noted a temporary decrease in levels of C-peptide and beta-cell function one month after treatment, possibly related to the intrapancreatic endovascular injection.  As a result of these observations, the authors call for further investigation of the safety of intrapancreatic endovascular delivery of WJ-MSC. 

As a result of this research, Liu et al. concluded that their findings suggest the possible therapeutic potential of WJ-MSC transplantation for treatment of T2DM and specifically with improved beta-cell function, systemic inflammation, and immunological regulation.  The authors also call for further large-scale placebo-controlled clinical studies to fully understand the safety and efficacy of WJ-MSCs in the treatment of T2DM. Source: “PMC – NCBI.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055092/


[1] “Type 2 Diabetes | CDC.” https://www.cdc.gov/diabetes/basics/type2.html. Accessed 22 Jan. 2022.

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