February 17, 2023
Recent research has examined the role of regenerative medicine, particularly biologic therapies such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs), in many applications, including: regenerating cardiac tissue; islet regeneration for potential diabetes treatments; neuroregeneration for treatment of stroke, spinal cord injuries, and degenerative neurological diseases; and the regeneration of liver tissue, perhaps reducing the need for liver transplants. Might regenerative medicine also be useful for conditions that cause chronic pain?
PRP for Low Back Pain
Evidence for the role of PRP in the treatment of back pain is sparse, according to Dr. Kaye’s team, primarily because the approach is still new. Studies are smaller and often lack standardized PRP protocols. However, they did cite several clinical trials, including one with a 40-patient cohort that compared steroid treatments with PRP and found a greater efficacy for PRP. A separate RCT on PRP demonstrated that the treatment group experienced significant improvement in ratings of pain and function.
An RCT of epidural PRP injections was also promising, finding that while patients in the control group had lower pain scores at 1 month (as determined by a visual analog scale), the treatment group did better at 3- and 6-month follow-up, suggesting that PRP may be most effective as a long-term analgesic.
MSCs for Low Back Pain
The team’s review uncovered that studies on MSCs are likewise small and scarce, but the results of available research are encouraging. Of the four studies described in the paper, all showed that treatment was effective, with no major adverse effects, although the team called for studies with larger sample sizes and for more RCTs.
Regenerative Medicine Compared to Interventional Treatments
The potential advantages of regenerative medicine makes it worth pursuing, particularly given that current treatments are not always ideal. Dr. Kaye pointed out that steroids can have undesirable side effects and their therapeutic effects are limited. Nerve blocks and radiofrequency ablation, however, have been shown to be efficacious for low back pain. Still, he said, PRP might be an improvement even over these methods. “The use of PRP and MSCs is a novel approach that has the potential to assist in healing through a different mechanism, since the components have the capacity to help healing,” he said.
At the moment, however, the cost is still too high for these treatments to be standard of care. The potential for biologics to become a routine clinical treatment option, wrote Dr. Kaye’s team in their paper, depends on “the standardization of their use, consistency of outcomes, and a decrease in overall healthcare costs.” They added that, “Further high-quality studies can aid in this goal by providing more data and providing more predictability in the use of biologics. This will require commitment from all levels of participants to better utilize biologic therapies and regenerative medicine going forward.”³
