CLINICAL CORNER Regenerative Medicine, PRP, Stem Cells...
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FALL 2016 Regenerative medicine is a growing treatment for a number of medical disorders that deal with using biological materials to stimulate the body’s own repair mechanisms to ultimately heal previously irreparable tissues or organs. Platelet rich plasma (PRP) and stem cells are organic materials which are currently undergoing intensive investigation for the treatment of many disorders ranging from degenerative joint problems to heart disease. These products are taken from one’s blood and bone marrow and are processed prior to administration. PRP is derived from centrifuged blood to concentrate the number of platelets in the sample. The processing results in an increase from 6% to a 94% platelet concentration from a blood sample. PRP stimulates wound healing and tissue regeneration. Growth factors from the platelets promote cell division for tissue growth and repair. PRP has been used in many musculoskeletal disorders such as osteoarthritis and bursitis of the knee, hip and shoulder as well as for tendon injuries as in “tennis elbow” and Achilles tendonitis. Studies support the stance that PRP reduces pain and slows cartilage degeneration in mild to moderate arthritis better than current available treatments. It has been shown that it provides the same benefit in severely arthritic conditions as today’s commonly used remedies. One study by Halpern, B., Chaudhury, S., Rodeo, S., Hayter, C., Bogner, E., Potter, H., & Nguyen, J. (2013), showed that in 73% of patients with early arthritis of the knee injected with PRP a year prior, had no further degeneration as determined by MRI. Previous research shows that a typical arthritis patient can lose up to 5% of their cartilage per year. Stem cells are unspecialized cells found in bone marrow and fat. These cells can self-replicate into bone, muscle, and cartilage tissues. They can fight cell death, reduce swelling, are antimicrobial, induce blood vessel growth, and can remodel injured tissue. Stem cells can function to repair or restore damaged tissue and/or replace older cells. Stem cells can be harvested from the patient or derived from other sources. CLINICAL CORNER Regenerative Medicine, PRP, Stem Cells: What’s the Right Choice for Me? by Kenneth Joel, MD Pain and Spine Center continued
Transcript of CLINICAL CORNER Regenerative Medicine, PRP, Stem Cells...
FA L L 2016
Regenerative medicine is a growing treatment for anumber of medical disorders that deal with usingbiological materials to stimulate the body’s ownrepair mechanisms to ultimately heal previouslyirreparable tissues or organs. Platelet rich plasma(PRP) and stem cells are organic materials which arecurrently undergoing intensive investigation for thetreatment of many disorders ranging fromdegenerative joint problems to heart disease. Theseproducts are taken from one’s blood and bonemarrow and are processed prior to administration. PRP is derived from centrifuged blood toconcentrate the number of platelets in the sample.The processing results in an increase from 6% to a94% platelet concentration from a blood sample.PRP stimulates wound healing and tissueregeneration. Growth factors from the plateletspromote cell division for tissue growth and repair.PRP has been used in many musculoskeletaldisorders such as osteoarthritis and bursitis of theknee, hip and shoulder as well as for tendon injuriesas in “tennis elbow” and Achilles tendonitis. Studiessupport the stance that PRP reduces pain and slowscartilage degeneration in mild to moderate arthritis
better than current available treatments. It has beenshown that it provides the same benefit in severelyarthritic conditions as today’s commonly usedremedies. One study by Halpern, B., Chaudhury, S.,Rodeo, S., Hayter, C., Bogner, E., Potter, H., & Nguyen,J. (2013), showed that in 73% of patients with earlyarthritis of the knee injected with PRP a year prior,had no further degeneration as determined by MRI.Previous research shows that a typical arthritispatient can lose up to 5% of their cartilage per year. Stem cells are unspecialized cells found in bonemarrow and fat. These cells can self-replicate intobone, muscle, and cartilage tissues. They can fight celldeath, reduce swelling, are antimicrobial, induce bloodvessel growth, and can remodel injured tissue. Stemcells can function to repair or restore damaged tissueand/or replace older cells. Stem cells can be harvestedfrom the patient or derived from other sources.
C L I N I C A L C O R N E R
Regenerative Medicine, PRP, Stem Cells:What’s the Right Choice for Me?by Kenneth Joel, MD
Pain and Spine Center
continued
The subject of bad weather affecting joint painhas been controversial for many doctors andscientists over the years. Most of the researcharticles prior to 2000 report that there is no trueconnection between cold/rainy weather and anincrease in joint pain. Interestingly, uponresearching the subject, we have found manymore articles after 2000 that support thecorrelation. Many studies have been performedon patients who suffered from rheumatoidarthritis, osteoarthritis, and fibromyalgia. One ofthe larger studies was recently performed on 810people with osteoarthritis of the knee, hand, orhip. According to the article in the Journal ofRheumatology, there was found to be a directincrease in joint pain with increased humidity thatoccurs during cold/rainy weather (Timermans, et.al., 2015). Another research article described typesof pain being affected by types of weather.Specifically, pain was affected positively byair pressure and temperature inrheumatoid arthritis patients, bytemperature, rain, and air pressurein osteoarthritis patients, and by airpressure in fibromyalgia patients(Weinberger, 1990). Researchers are encouraged by thenew results and are calling for furtherresearch. Their goal is to continuedocumenting the correlation to
pain/inflammation and the possibility of differenttreatment options that respond to weatherchanges. Although substantial evidence fortreatment options are not available yet, it isencouraging that research has taken a new pathwith hopefully beneficial options in the future.
Timmermans, E., Schaap, L., Herbolsheimer, F., Dennison, E.,Maggi, S., Pedersen, N., Castell, M., Denkinger, M., Edwards, M.,Limongi, F., Sánchez-Martínez, M., Siviero, P., Qeuipo, R., Peter, R.,van der Pas, S., and Deeg, D. (2015). The influence of weatherconditions on joint pain in older people with osteoarthritis:Results from the European Project on osteoarthritis. Journal ofRheumotology, 42(10), 1885-1892. doi: 10.3899/jrheum.141594
Weinberger, D (1990). Effect of weather conditions on rheumaticpatients. Annals of RheumaticDiseases, 49, 158-159. doi: 10.116/ard.49.3.158
Weather and Joint Pain: Does Cold or Rain Affect Pain?by Michele Chen, ANP-BC
The combination of stem cells and PRP has beenshown to provide significantly more healing capacitythan using either product used alone. Conditionswhich have been studied, and continue to beinvestigated, where usefulness of the injections areshown to be effective are tennis elbow, kneetendonitis or injury, plantar fasciitis, rotator cuff tear,annular tear of lumbar disc, arthritis of the knee, andbursitis of the hip. Results can take up to 3 to 4 monthsand requires resting the injured area for 1 to 6 weeks. An analogy can be made with the injection ofstem cells and PRP to the growth of healthy crops.The stem cells are the seeds, the PRP the fertilizer,injured tissue the soil, the stimulation of blood vessel formation, the rain, and healing/regenerationof the injured or degenerative tissues to the desiredhealthy crops. Regenerative medicine is in its
infancy, but there has been significant success withthis conservative treatment that has provokedtremendous interest in the medical community.
Halpern, B., Chaudhury, S., Rodeo, S., Hayter, C., Bogner, E., Potter, H.,& Nguyen, J (2013). Clinical and MRI outcomes after Platelet-RichPlasma Treatment for knee Osteoarthritis. Clinical Journal of SportMedicine, 23(3), 238-239. doi:10.1097/JSM.0b013e31827c3846
S P O T L I G H T
Kristen Rahrer, RT (R)Radiologic TechnologistPain and Spine Center
I have been a Radiologic Technologist at Wellstar NorthFulton Pain and Spine Center for almost 5 years. My goalis to further my education in Pain Management. I have lived in Metro Atlanta for 15 years. I was bornin Fort Wayne, Indiana, but I was raised on the MississippiGulf Coast in a small town called Long Beach. I love thehustle and bustle of the big city, but I miss the ocean andbeaches. When I am not at the Pain and Spine Center, I amspending time with my 10-year-old daughter, Savannah.We both love to read and take Bentley, our 110 lbs.American Bulldog, on walks and to the dog park.Between the two of them, I have my hands full.
Clinical Corner (continued from front cover)
Regenerative medicine is a growing
treatment for a number of medical
disorders that deal with using biological
materials to stimulate the body’s own
repair mechanisms to ultimately heal
previously irreparable tissues or organs.
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