Adding Regenerative medicine to your practice.

IPSIS: Formerly the Spine Intervention Society
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lobelsteve said:
Ok, so give me your CPT code used for SC knee, how many times (1-3?) and show me CMS has that in the fee schedule. If it not, then this is not something we offer. We will do self pay if insurance refuses T MBB or if a patient does not want to fail PT for 6 weeks before getting an ESI. But your treatment is a different entity altogether.
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I think that the CPT codes are the same for everyone in the country. It's the health plan summary of benefits that differs.
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callmeanesthesia said:
How is your experience with Regenexx? I’ve heard variable things. Does a lot of the money for the procedure end up going to them?

I have a partner who does stem cell injections but he sends to a surgeon who does the adipose extraction then sends the cells and some PRP back to him to actually inject. Technically, the patient pays the surgeon for the stem cell treatment and the surgeon pays my partner to do the injection. I would want to do it all myself though if I end up offering it. I’m just not sure I really believe in it enough to suggest it to patients - even the outcomes on Regenexx’s own website aren’t that impressive in terms of %pain relief...
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If you are passing human cellular tissue products back and forth between offices/hospitals, then you're probably breaking the law...
 
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drusso said:
I think that the CPT codes are the same for everyone in the country. It's the health plan summary of benefits that differs.
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So do you call every insurance first? Do you simply give your cash price and have them bill? Do you try to bill the 20611 or whatever then the PRP,etc by cash? How to you realistically try get this stuff covered?
 
Ferrismonk said:
So do you call every insurance first? Do you simply give your cash price and have them bill? Do you try to bill the 20611 or whatever then the PRP,etc by cash? How to you realistically try get this stuff covered?
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Worker's comp and MVA pay, but you have to beg. Our network negotiates with large self-insured employers and those people just have the benefit on the back of their cards--so whatever the third-party administrator negotiated to pay we are contractually obligated to accept. Finally, our group locally has captured some self-insured businesses who have made the procedures available to their employees through their own health plans. The Big Commercial Insurers will come along when there is a critical mass of self-insured health plans paying for it. The rest is just a cash business like Botox, Synvisc, prolo, etc.

The Government payers will never cover it--or I'll be dead by the time they do. So, there's always going to be an Equity issue: For those who most need the therapy, it will always be out of reach to them. But, that's the way it is with everything. In health care, poor people and pensioners just get screwed.
 
drusso said:
Worker's comp and MVA pay, but you have to beg. Our network negotiates with large self-insured employers and those people just have the benefit on the back of their cards--so whatever the third-party administrator negotiated to pay we are contractually obligated to accept. Finally, our group locally has captured some self-insured businesses who have made the procedures available to their employees through their own health plans. The Big Commercial Insurers will come along when there is a critical mass of self-insured health plans paying for it. The rest is just a cash business like Botox, Synvisc, prolo, etc.

The Government payers will never cover it--or I'll be dead by the time they do. So, there's always going to be an Equity issue: For those who most need the therapy, it will always be out of reach to them. But, that's the way it is with everything. In health care, poor people and pensioners just get screwed.
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Are you indicating caid and Medicare patients are the best candidates for PRP/SC therapies? That seems to contradict everything I thought I knew about the ideal candidate for these treatments.
 
cowboydoc said:
Are you indicating caid and Medicare patients are the best candidates for PRP/SC therapies? That seems to contradict everything I thought I knew about the ideal candidate for these treatments.
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No. Just that if a patient is an otherwise good candidate, but for the fact that their health care is government financed, the treatment they need isn't on the table. In my state, if your income is less than 200% of poverty and you have a hot-burner down your leg and a concordant disc, your government health plan won't pay for an ESI. It's not on the menu (but Reiki, acupuncuture, chiropractic, and yoga is on the menu). So, all I can do is offer you a cash discount, Care Credit, and a payment plan for an ESI. Ditto for PRP/SC.

Shopping at Bergdorf's. Screwed.
 
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I get paid a salary and happy to try and help anyone that wants my help. I base decisions on experiences, education, and training. I do not take large risks, I do not innovate. It’s a good and rewarding job. If patient does not want what I offer, they go elsewhere.
 
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lobelsteve said:
I get paid a salary and happy to try and help anyone that wants my help. I base decisions on experiences, education, and training. I do not take large risks, I do not innovate. It’s a good and rewarding job. If patient does not want what I offer, they go elsewhere.
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I applaud charity and love giving away my time to causes I believe in...

But. I can't get that kind of salary subsidy. I tried to give away my services for free once at a Federally Qualified Health Center seeing opioid dependent Medicaid patients and was told that working for the government for free and seeing government beneficiaries for free was illegal. I had to be employed (no 1099 permitted) and had to bill according to clinic policies.

A strange world where the neediest among us can't receive care unless some third-party somewhere gets paid and kicks something back to the doctor.
 
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lobelsteve said:
I get paid a salary and happy to try and help anyone that wants my help. I base decisions on experiences, education, and training. I do not take large risks, I do not innovate. It’s a good and rewarding job. If patient does not want what I offer, they go elsewhere.
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Never to late to make a lateral move...

www.iobx.com

iOBX Careers - | Treatments | Charlotte,NC

Stem Cell Orthopedics and Sports Medicine Hiring: Staff Physicians Staff Physicians Have you been “tinkering” with Stem Cells or Platelet Rich Plasma, just tired of insurance
www.iobx.com www.iobx.com
 
drusso said:
I applaud charity and love giving away my time to causes I believe in...

But. I can't get that kind of salary subsidy. I tried to give away my services for free once at a Federally Qualified Health Center seeing opioid dependent Medicaid patients and was told that working for the government for free and seeing government beneficiaries for free was illegal. I had to be employed (no 1099 permitted) and had to bill according to clinic policies.

A strange world where the neediest among us can't receive care unless some third-party somewhere gets paid and kicks something back to the doctor.
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But as an employee of the group before the hospital bought out the owners, nothing changed for me. I didn’t build that.
 
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bronchospasm said:
Guys I was thinking about adding Regenerative medicine to my practice. Really don’t know where to start. Need some input from others who are in this space.
Maybe just start with PRP and go from there.
Do’s and Dont’s.
Any and all advice is appreciated.

Thanks.


Sent from my iPhone using SDN mobile
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https://regenmeddoctors.com/ June7-9, 2019. in office, small group, hands on training.
 
oreosandsake said:
thanks for the plug.

some reviews. website hasn't been updated in a while

Satisfied Clients
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@oreosandsake a lot to be proud of for sure! It's amazing to see people from this forum stepping up and embracing new models and modalities of pain treatment. No one can just keep doing what they learned 15-20 years ago and not evolve and innovate.

"What got you here, won't get you there!"
 
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SDN discount applies if you send me a message. I offer no nonsense, no upsell. if you want a critical review of regen med, EBM, and conservative physiatric approach to sports med/regen med come to my course.

About

there is solid evidence for PRP in treatment of OA, tendinopathy. Knees better than hips for OA. UE better than LE for tendinopathy. Little published papers on BMC. disc disease has only a handful of papers.

this is NOT pixie dust and magic beans. But it does offer an ANABOLIC approach to MSK pathology when compared to corticosteroids and Local Anesthetics. Not all PRP formulations are created equally. there are many poor PRP widgets on the market. Patient selection is a huge variable. if your only selection criteria for therapy is whether or not you can convince them to pay for it, you will have poor outcomes. injection technique is huge.
check out this "Regenerative Expert" who posted this image onto their website... when this person fails the treatment, who is to blame?
 

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oreosandsake said:
SDN discount applies if you send me a message. I offer no nonsense, no upsell. if you want a critical review of regen med, EBM, and conservative physiatric approach to sports med/regen med come to my course.

About

there is solid evidence for PRP in treatment of OA, tendinopathy. Knees better than hips for OA. UE better than LE for tendinopathy. Little published papers on BMC. disc disease has only a handful of papers.

this is NOT pixie dust and magic beans. But it does offer an ANABOLIC approach to MSK pathology when compared to corticosteroids and Local Anesthetics. Not all PRP formulations are created equally. there are many poor PRP widgets on the market. Patient selection is a huge variable. if your only selection criteria for therapy is whether or not you can convince them to pay for it, you will have poor outcomes. injection technique is huge.
check out this "Regenerative Expert" who posted this image onto their website... when this person fails the treatment, who is to blame?
Click to expand...

I know @lobelsteve is very interested in critical reviews/EBM for RM. He definitely might be interested in this.
 
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oreosandsake said:
SDN discount applies if you send me a message. I offer no nonsense, no upsell. if you want a critical review of regen med, EBM, and conservative physiatric approach to sports med/regen med come to my course.

About

there is solid evidence for PRP in treatment of OA, tendinopathy. Knees better than hips for OA. UE better than LE for tendinopathy. Little published papers on BMC. disc disease has only a handful of papers.

this is NOT pixie dust and magic beans. But it does offer an ANABOLIC approach to MSK pathology when compared to corticosteroids and Local Anesthetics. Not all PRP formulations are created equally. there are many poor PRP widgets on the market. Patient selection is a huge variable. if your only selection criteria for therapy is whether or not you can convince them to pay for it, you will have poor outcomes. injection technique is huge.
check out this "Regenerative Expert" who posted this image onto their website... when this person fails the treatment, who is to blame?
Click to expand...

I wonder if that is considered in plane or out of plane?
 
Can you elaborate more on Ultherapy ?
 
Why do you need a course?

Buy a PRP machine.

Get an AmnioFix rep to come by your office.

Don't pursue stem cells.
 
epidural man said:
Good point.

I am a legit, non-biased source. AmnioFix works as good as anything else and way easier to administer than PRP.
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Are you sure you want to do business with a company like that?? They're like the Insys of Regen...


www.ajc.com

Marietta firm accused of channel stuffing walks back financials

Marietta firm accused of channel stuffing walks back its financials
www.ajc.com www.ajc.com

Also, very different proteinomic profiles between PRP and ground up amnion...

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Drusso -

You are probably right that the biochemical makeup of placenta based tissue, and PRP are different. But maybe the placenta based product is better...or maybe mix them.

Regarding the company - it is a phenomenal and CRAZY story. I hope someone does a documentary on it. It is unbelievable that a single person on TWITTER could cause such a SH&T storm, get people to believe it (including writers at the New York Times) and get the company involved in expensive legal issues - all so this guy on Twitter can make a gazillion dollars by shorting the stock. It is really funny actually.

Having said that - who cares what legal troubles the company is in. Using their product is not like "getting into business" with them. The reps are honest. The product works amazingly well - and has 5 level I evidence studies to back it up with more to come. Why would you care if two reps did some channel stuffing? How does that change anything regarding clinical decision making?
 
Drusso -

You are like my kids who won't go to a new restaurant. I retell Green Eggs and Ham for them. I would say the same to you.

Just try it. If you don't like it- no harm. No biggie.

I have asked all the detractors on Twitter this question. Do placenta-based products work for what they claim? No one will answer that. All they want to talk about is the wrong-doing of management. Who cares. Management comes and goes....but if the product works...that counts.
 
Thoughts on perineural injection treatments?
 
please post the 5 level 1 evidence studies.

if there are 5 level 1 evidence studies, that would make, um, 5 more than are available than steroid epidurals have long term benefit...
 
epidural man said:
Drusso -

You are like my kids who won't go to a new restaurant. I retell Green Eggs and Ham for them. I would say the same to you.

Just try it. If you don't like it- no harm. No biggie.

I have asked all the detractors on Twitter this question. Do placenta-based products work for what they claim? No one will answer that. All they want to talk about is the wrong-doing of management. Who cares. Management comes and goes....but if the product works...that counts.
Click to expand...

I've used it
Ducttape said:
please post the 5 level 1 evidence studies.

if there are 5 level 1 evidence studies, that would make, um, 5 more than are available than steroid epidurals have long term benefit...
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Here's one...


Send to




Arthroscopy. 2019 Jan;35(1):106-117. doi: 10.1016/j.arthro.2018.06.035.
Intra-articular Injection of Platelet-Rich Plasma Is Superior to Hyaluronic Acid or Saline Solution in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Triple-Parallel, Placebo-Controlled Clinical Trial.
Lin KY1, Yang CC2, Hsu CJ3, Yeh ML4, Renn JH5.
Author information

Abstract
PURPOSE:
To prospectively compare the efficacy of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) with a sham control group (normal saline solution [NS]) for knee osteoarthritis in a randomized, dose-controlled, placebo-controlled, double-blind, triple-parallel clinical trial.
METHODS:
A total of 87 osteoarthritic knees (53 patients) were randomly assigned to 1 of 3 groups receiving 3 weekly injections of either leukocyte-poor PRP (31 knees), HA (29 knees), or NS (27 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and International Knee Documentation Committee (IKDC) subjective score were collected at baseline and at 1, 2, 6, and 12 months after treatment. Data were analyzed using generalized estimating equations.
RESULTS:
All 3 groups showed statistically significant improvements in both outcome measures at 1 month; however, only the PRP group sustained the significant improvement in both the WOMAC score (63.71 ± 20.67, increased by 21%) and IKDC score (49.93 ± 17.74, increased by 40%) at 12 months. For the intergroup comparison, except for the first month, there was a statistically significant difference between the PRP and NS groups in both scores throughout the study duration (regression coefficients of 8.72 [P = .0015], 7.94 [P = .0155], and 11.92 [P = .0014] at 2, 6, and 12 months, respectively, for WOMAC score, and 9.1 [P = .0001], 10.28 [P = .0002], and 13.97 [P < .0001], respectively, for IKDC score). There was no significant difference in both functional outcomes between the HA and NS groups at any time point. Only the PRP group reached the minimal clinically important difference in the WOMAC score at every evaluation (15%, 21%, 18%, and 21% at 1, 2, 6, and 12 months, respectively) and the minimal clinically important difference in the IKDC score at 6 months (improvement of 11.6).
CONCLUSIONS:
Intra-articular injections of leukocyte-poor PRP can provide clinically significant functional improvement for at least 1 year in patients with mild to moderate osteoarthritis of the knee.
LEVEL OF EVIDENCE:
Level I, randomized controlled single-center trial.
 
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Ducttape said:
please post the 5 level 1 evidence studies.

if there are 5 level 1 evidence studies, that would make, um, 5 more than are available than steroid epidurals have long term benefit...
Click to expand...
Here is one. I’m on my phone waiting for Avengers to start. I’ll try to look for others. I think three of them are with the sheet product, not the injectable.

All five are with situations and harsh environments much worse than a rotator cuff, or hamstring tendon tear, for example.

Google Scholar

scholar.google.com scholar.google.com
 
drusso said:
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drusso, I really don't think you should be convincing people with data or studies. I wish people like lobesteve don't believe it so that it will never be covered by insurance because there isn't enough "data" to support it..

all I care is my PRP patients keep referring their friends and family members, paying cash out of pocket for this stuff, because it works, period.

I'm just glad I can offer PRP/stem cells injection therapy to my patients and when I need it myself, someone can give it to me.
 
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i believe i mentioned before, but with regards to PRP, i am referring to spine pathology, rather than joint or musculoskeletal injury. ergo my mention of epidural steroid injection.....


drusso - study 1 appears decent, but would like to see if there was clinically significant difference with conservative care such as weight loss/PT. i cannot see the specifics on the second one you posted, so i wont comment.

epidural -
study 1 - not blinded to the proceduralist on the initial injection or the follow up appointment, and study size is small. only 45 out of 270 people were involved in the study. follow up 8 weeks out, pretty short. also, interestingly, all of them got tramadol postprocedure. and why no difference in effect between 0.5 and 1.25 cc? odd....

study 2 - another single blind study. both interestingly are about plantar fasciitis, an orthopedic musculoskeletal condition... enrolled a lot more patients, and most of those screened. 90% power, and good they discussed (most studies do not). VAS is a bad choice for end point, though. 3 month follow up data is good and shows benefit. however, both those who got placebo and amion both showed improvement in FFI-R, but the article attempts to explain that the dHACM got more. kind of a tentative argument.

the article states 12 month follow up, then interestingly notes that that data is not "available" as it is apparently still being collected. article published in 2018, and no follow up articles from any of the principal authors on this injection... i would have expected that follow up study to be posted if it was beneficial.


there were no other studies i saw in that link on the first 3 pages (the rotator cuff one is a case report.)


not as a counterargument, but i do find it interesting that both studies are based in china/taiwan.
 
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Ducttape said:
i believe i mentioned before, but with regards to PRP, i am referring to spine pathology, rather than joint or musculoskeletal injury. ergo my mention of epidural steroid injection.....


drusso - study 1 appears decent, but would like to see if there was clinically significant difference with conservative care such as weight loss/PT. i cannot see the specifics on the second one you posted, so i wont comment.

epidural -
study 1 - not blinded to the proceduralist on the initial injection or the follow up appointment, and study size is small. only 45 out of 270 people were involved in the study. follow up 8 weeks out, pretty short. also, interestingly, all of them got tramadol postprocedure. and why no difference in effect between 0.5 and 1.25 cc? odd....

study 2 - another single blind study. both interestingly are about plantar fasciitis, an orthopedic musculoskeletal condition... enrolled a lot more patients, and most of those screened. 90% power, and good they discussed (most studies do not). VAS is a bad choice for end point, though. 3 month follow up data is good and shows benefit. however, both those who got placebo and amion both showed improvement in FFI-R, but the article attempts to explain that the dHACM got more. kind of a tentative argument.

the article states 12 month follow up, then interestingly notes that that data is not "available" as it is apparently still being collected. article published in 2018, and no follow up articles from any of the principal authors on this injection... i would have expected that follow up study to be posted if it was beneficial.


there were no other studies i saw in that link on the first 3 pages (the rotator cuff one is a case report.)


not as a counterargument, but i do find it interesting that both studies are based in china/taiwan.
Click to expand...

I'm confused: How does PRP help with weight loss, adherence to exercise, or utilization of conservative care? There is no MOA for that. Instead, it initiates tissue repair cascades through cytokine signaling mechanisms...
 
Ducttape said:
i believe i mentioned before, but with regards to PRP, i am referring to spine pathology, rather than joint or musculoskeletal injury. ergo my mention of epidural steroid injection.....


drusso - study 1 appears decent, but would like to see if there was clinically significant difference with conservative care such as weight loss/PT. i cannot see the specifics on the second one you posted, so i wont comment.

epidural -
study 1 - not blinded to the proceduralist on the initial injection or the follow up appointment, and study size is small. only 45 out of 270 people were involved in the study. follow up 8 weeks out, pretty short. also, interestingly, all of them got tramadol postprocedure. and why no difference in effect between 0.5 and 1.25 cc? odd....

study 2 - another single blind study. both interestingly are about plantar fasciitis, an orthopedic musculoskeletal condition... enrolled a lot more patients, and most of those screened. 90% power, and good they discussed (most studies do not). VAS is a bad choice for end point, though. 3 month follow up data is good and shows benefit. however, both those who got placebo and amion both showed improvement in FFI-R, but the article attempts to explain that the dHACM got more. kind of a tentative argument.

the article states 12 month follow up, then interestingly notes that that data is not "available" as it is apparently still being collected. article published in 2018, and no follow up articles from any of the principal authors on this injection... i would have expected that follow up study to be posted if it was beneficial.


there were no other studies i saw in that link on the first 3 pages (the rotator cuff one is a case report.)


not as a counterargument, but i do find it interesting that both studies are based in china/taiwan.
Click to expand...

It's true, the RCT isn't perfect. I haven't yet seen a perfect study though...so there's that.

Second - just a comment on size of the study, and not criticism of your critique - because we all say that ("study was small") - but studies are powered so that they can get the answer with as little patients as possible. In fact, most IRB's won't let you do more if you don't need it. It is a way to protect the public and is considered unethical. So if you can prove the point in 20 test subjects, that is all you should do.

Thirdly, LEVEL I studies only is defined by RCT, not by blinding. LEVEL one has no requirement for blinding. We all agree that blinding is probably better - but unclear how much blinding actually changes outcomes. I guess the people that come up with the hierarchy of evidence didn't think it was that important.
 
I mentioned that the study was powered enough. most studies do not comment about how powered the study is, and we are left to decide if it was powered enough. a simple way of making a study look good is to do a nonblinded study that is insufficiently powered and stop recruiting more test subjects as soon as some clinical significance is found.

you are correct that blinding is not required. however, the lack of blinding can significantly affect the results. and I disagree with your assessment of the importance of blinding. in addition, with respect to history, much of the development of level of evidence occurred in the 1970s and 1980s, when there was not thought to be the same type of influence particularly financial affecting studies.

bias was not as much of a concern then as it is now, when we know that most pseudo studies are laden with bias.


drusso, a control arm that got a sham intervention or no intervention at all.
 
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Ducttape said:
drusso, a control arm that got a sham intervention or no intervention at all.
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Why do you need a sham intervention if you're comparing two active treatments? That's a waste of resources. No one in the field believes PRP is an inert substance. There is science going back to at least the 1970's showing that PRP has biocellular activity.

www.karger.com

A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification

Platelet-rich plasma (PRP) is currently used in different medical fields. The interest in the application of PRP in dermatology has recently increased. It is being used in several different applications as in tissue regeneration, wound healing, scar revision, skin rejuvenating effects, and...
www.karger.com www.karger.com

That's why its used every day in cell biology labs across the world as a growth media. As an undergrad, I had to "feed the plates" with bovine platelet lysate in my professor's lab.

The question the field is grappling with is whether or not orthobiologics are non-inferior to surgery, other injectables, or conservative care.
 
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drusso said:
Why do you need a sham intervention if you're comparing two active treatments? That's a waste of resources. No one in the field believes PRP is an inert substance. There is science going back to at least the 1970's showing that PRP has biocellular activity.

www.karger.com

A Review of Platelet-Rich Plasma: History, Biology, Mechanism of Action, and Classification

Platelet-rich plasma (PRP) is currently used in different medical fields. The interest in the application of PRP in dermatology has recently increased. It is being used in several different applications as in tissue regeneration, wound healing, scar revision, skin rejuvenating effects, and...
www.karger.com www.karger.com

That's why its used every day in cell biology labs across the world as a growth media. As an undergrad, I had to "feed the plates" with bovine platelet lysate in my professor's lab.

The question the field is grappling with is whether or not orthobiologics are non-inferior to surgery, other injectables, or conservative care.
Click to expand...

There are 100 types of magic beans. We should figure out the basic science of whose beans are going to work before we group a lot of different therapies into the same outcome study.

1. PRP: LR or LP and why? Who makes the best widget?
 
lobelsteve said:
There are 100 types of magic beans. We should figure out the basic science of whose beans are going to work before we group a lot of different therapies into the same outcome study.

1. PRP: LR or LP and why? Who makes the best widget?
Click to expand...

People are working on it. Our group is starting potency analysis this year. Interesting results. So many host factors. It should be standard of care...

PM R. 2015 Apr;7(4 Suppl):S53-S59. doi: 10.1016/j.pmrj.2015.02.005.
A call for a standard classification system for future biologic research: the rationale for new PRPnomenclature.
Mautner K1, Malanga GA2, Smith J3, Shiple B4, Ibrahim V5, Sampson S6, Bowen JE7.
Author information

Abstract
Autologous cell therapies including platelet-rich plasma (PRP) and bone marrow concentrate (BMC) are increasingly popular options for soft tissue and joint-related diseases. Despite increased clinical application, conflicting research has been published regarding the efficacy of PRP, and few clinical publications pertaining to BMC are available. Preparations of PRP (and BMC) can vary in many areas, including platelet concentration, number of white blood cells, presence or absence of red blood cells, and activation status of the preparation. The potential effect of PRP characteristics on PRP efficacy is often not well understood by the treating clinician, and PRP characteristics, as well as the volume of PRP delivered, are unfortunately not included in the methods of many published research articles. It is essential to establish a standard reporting system for PRP that facilitates communication and the interpretation and synthesis of scientific investigations. Herein, the authors propose a new PRP classification system reflecting important PRP characteristics based on contemporary literature and recommend adoption of minimal standards for PRP reporting in scientific investigations. Widespread adoption of these recommendations will facilitate interpretation and comparison of clinical studies and promote scientifically based progress in the field of regenerative medicine.
Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
PMID: 25864661 DOI: 10.1016/j.pmrj.2015.02.005
[Indexed for MEDLINE]

Am J Sports Med. 2017 Nov;45(13):NP34-NP35. doi: 10.1177/0363546517737751.
Changing the Paradigm in PRP Characterization: Letter to the Editor.
Magalon J, Velier M, Louis ML, Mattei JC, Ollivier M, Sabatier F.
Comment on

Am J Sports Med. 2017 May;45(6):NP23-NP24. doi: 10.1177/0363546517693989.

Need for Proper Classification of PRP: Letter to the Editor.
Malanga G, Jayaram P.
Comment in
Comment on
PMID: 28459636 DOI: 10.1177/0363546517693989

Am J Sports Med. 2016 Nov;44(11):NP63-NP64.
PRP Therapies-Is It Time for Potency Assays? Letter to the Editor.
Anitua E, Prado R, Orive G.
Comment in
Comment on
 
the fact that we have no idea which aspect of regenerative medicine - PRP, VMC, actually is valid raises concerns in and of itself.

the reason to use sham procedures is because you are not showing that your proported treatment is better than placebo. i would argue that all treatments trying to show that it is better than conservative care should have a sham arm. just having some supposed activity doesnt mean it is helpful.

your example of using PRP as growth media for cells is a circular argument and does not advance the science that cells are actually beneficial for non-inflammatory conditions such as tears.
 
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Ducttape said:
the fact that we have no idea which aspect of regenerative medicine - PRP, VMC, actually is valid raises concerns in and of itself.

the reason to use sham procedures is because you are not showing that your proported treatment is better than placebo. i would argue that all treatments trying to show that it is better than conservative care should have a sham arm. just having some supposed activity doesnt mean it is helpful.

your example of using PRP as growth media for cells is a circular argument and does not advance the science that cells are actually beneficial for non-inflammatory conditions such as tears.
Click to expand...

If you can invent a placebo PRP (an inert autologous serum devoid of growth factors) I'm certain regenerative scientists would embrace it for their research. There is none. Even saline and dextrose have biological activity.

My point is that the bioactivity of PRP is settled science. That ship has sailed. You can't turn time backward. Go get your knee injected with PRP and tell me it didn't produce a biological reaction in your body....

Tissue Eng Part B Rev. 2016 Oct;22(5):408-419. Epub 2016 Jun 27.
Platelet-Rich Plasma Modulates Actions on Articular Cartilage Lubrication and Regeneration.
Sakata R1, Reddi AH1.
Author information

Abstract
Osteoarthritis (OA) is characterized by articular cartilage degeneration in the joints and results in pain, swelling, stiffness, muscle atrophy, and attendant functional disability. The progression of OA cannot be prevented by drugs. Current treatments for OA focus on symptomatic relief of pain. Recently, platelet-rich plasma (PRP) injection has attracted much attention for modulating articular cartilage and synovial membrane in OA. Despite the increasing interest in PRP for the treatment of OA, the precise mechanisms underlying the actions of PRP on OA remain unclear. We have reviewed the known actions of PRP in the joint. The in vitro and in vivo evidence is reviewed concerning the potential of the modulation of PRP on normal articular cartilage and OA progression. PRP modulates the repair and regeneration of damaged articular cartilage in the joints and delays the degeneration of cartilage by stimulation of mesenchymal stem cell migration, proliferation, and differentiation into articular chondrocytes. In addition to the symptomatic relief, PRP is a biological response modifier of inflammatory nuclear factor-κB signaling pathway and PRP reduces the pain by decreasing inflammation and angiogenesis of the synovial membrane where pain receptors are localized. PRP has the therapeutic potential not only to promote tissue regeneration, but also to contribute to articular cartilage lubrication by decreasing the friction coefficient and minimizing wear. Although further refinements and improvements are needed in standardized PRP preparations, PRP may modulate regeneration of articular cartilage and slows the progression of OA by stimulating cell migration, proliferation, differentiation of progenitor/stem cells, joint homeostasis, and joint lubrication.


The question on everyone's mind is whether or not it is non-inferior to "standard of care."
 
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