Adding Regenerative medicine to your practice.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
i dont think anyone on this thread was promoting/doing this under MC, but i could be wrong. It's a long thread.
Members don't see this ad.
 
My proposed mechanism of action for PRP or anything with "amnio" or "regen" in the name is that it hurts like hell for a week then returns to baseline, therefore "resetting" a patients perception of what 10/10 pain is and forcing them to rate their baseline pain at a lower value at follow up.
 
  • Like
  • Haha
Reactions: 4 users
MitchLevi said:
Approximately 2 yrs ago, a pt asked if I would see her for fibro, and I declined. I do not see pts with stand alone fibromyalgia.

Since then, she ended up with some form of WC case, and has undergone a few cervical epidural PRP injxns. These have provided "25% relief," and yet the doctor continues offering her these treatments.

Another local physician, someone who teaches courses and is well respected, has also been treating this pt with PRP.

I do not do epidural PRP, but if I did it would be $650 bc that's what I charge for PRP.

Please, one of you PRP epidural gurus explain this to me.

Where did this number come from, and are any of you embarrassed by this?

View attachment 350164
Click to expand...

That’s the Jesus shot
 
Members don't see this ad :)
MitchLevi said:
PRP is dramatically effective for many pts and many diagnoses.

Rotator cuffs, tennis elbow, hip and knee OA, SIJ pain. I use it frequently for those Dx and I've hit far more homeruns with PRP than anything else.

If you're routinely using corticosteroids for those Dx and not offering PRP you're doing your pts a disservice.

Old pts on fixed income and they cannot afford it, I understand that.

I'm $650 for 5-6cc of PRP and that's total cost. I'll spread that PRP into multiple sites and the cost doesn't change.

It's satisfying to me.

I just did an oral maxillofacial surgeon's infraspinatus tear with advanced AC OA. He got 1cc into the AC joint and 3cc at the infraspinatus tendon and told me I "cured" him. $650.

One anecdote in a sea of others.
Click to expand...
Do you concentrate PRP manually or you use some system?
 
Pain doc about an hour from me charges $10,000 for an intradiscal bmac. I know this because the patient brought the bill to me after they had raging discitis>>iv abx>>> surgery… now seeing me with chronic worse low back pain
 
myrandom2003 said:
Pain doc about an hour from me charges $10,000 for an intradiscal bmac. I know this because the patient brought the bill to me after they had raging discitis>>iv abx>>> surgery… now seeing me with chronic worse low back pain
Click to expand...
Wow. Did they sue the first pain doc?

What kind of surgery?
 
bedrock said:
Wow. Did they sue the first pain doc?

What kind of surgery?
Click to expand...
Come on, let's not promote litigation, especially when it's a known complication. Society would be better off being less litigious.
 
  • Like
Reactions: 1 user
RoloTomassi said:
Come on, let's not promote litigation, especially when it's a known complication. Society would be better off being less litigious.
Click to expand...
Known complication of a BS procedure.

Intradiscal BMAC is snake oil until conclusively proven otherwise.
 
  • Like
Reactions: 1 user
MitchLevi said:
Known complication of a BS procedure.

Intradiscal BMAC is snake oil until conclusively proven otherwise.
Click to expand...
How can you take that stance when you just listed off a bunch of PRP procedures you do with equality weak evidence?
 
  • Like
Reactions: 1 user
Members don't see this ad :)
RoloTomassi said:
How can you take that stance when you just listed off a bunch of PRP procedures you do with equality weak evidence?
Click to expand...
Tendons and joint OA are clearly different than the intervertebral disks.
 
@drusso getting quoted on a lecture slide, did not expect to see that at the conference today lol
 
Last edited:
  • Like
Reactions: 1 user
RoloTomassi said:
How can you take that stance when you just listed off a bunch of PRP procedures you do with equality weak evidence?
Click to expand...
I’m not going to personally list all the research, but it there seems to be much more clinical research evidence using PRP for tendons/joints than there is for discs.
 
  • Like
Reactions: 1 user
MitchLevi said:
Known complication of a BS procedure.

Intradiscal BMAC is snake oil until conclusively proven otherwise.
Click to expand...
Discograms do have a known higher infection risk compared to other spinal injections such as epidurals and facet injections.

Is there a known higher risk of infection after injecting BMAC or PRP intradiscal compared to injecting just contrast?
 
bedrock said:
Discograms do have a known higher infection risk compared to other spinal injections such as epidurals and facet injections.

Is there a known higher risk of infection after injecting BMAC or PRP intradiscal compared to injecting just contrast?
Click to expand...
After reading Carragee, is there is a medically-justifiable reason to stick a needle in someone's disk?

Considering the risks of annular defect caused by your needle, why would you inject PRP or SC in the disk?

Even Regenexx says that is a procedure that should be done rarely, and only under very specific circumstances.

The mere fact anyone would even play Devil's Advocate on a procedure like this is annoying to me, and that's BEFORE you mention the absurd price tag.

I can often tell when I meet doctors who never paid taxes prior to internship.

$10k for intradiscal ANYTHING is snake oil.

Edit - Not saying YOU are socially immature or have never had a real job Bedrock.
 
Last edited:
  • Like
Reactions: 1 user
that's steep....and Facebook is going wild with it. I know of a few very good pain physicians doing it frequently. Shiple charges around $12k.....Pauza charges around $20k(both in the ASC i think). Ive done a few intradiscal PRP and they did very well, but i only charge $2000. Discograms arent that expensive.

Dragoo out of Stanford is the last research i read on it. He had some great 2 year outcomes iirc.
 
Last edited:
  • Like
Reactions: 1 user
MitchLevi said:
After reading Carragee, is there is a medically-justifiable reason to stick a needle in someone's disk?

Considering the risks of annular defect caused by your needle, why would you inject PRP or SC in the disk?

Even Regenexx says that is a procedure that should be done rarely, and only under very specific circumstances.

The mere fact anyone would even play Devil's Advocate on a procedure like this is annoying to me, and that's BEFORE you mention the absurd price tag.

I can often tell when I meet doctors who never paid taxes prior to internship.

$10k for intradiscal ANYTHING is snake oil.

Edit - Not saying YOU are socially immature or have never had a real job Bedrock.
Click to expand...

the caraggee literature on discograms isnt that great. they used to use much larger bore needles, and would blow the pressure thru the roof. i dont remember exactly, but i dont think there was much standardization in the procedural portions. and this data was from like 20 years ago.....

that being said: i agree. no real reason to do discogenic ANYTHING until we are better at it or have something that works
 
  • Like
Reactions: 1 user
just had a patient pay $2K for "regennexx PRP" for radicular pain. her MRI is pristine. never had any PT or ESIs
 
SSdoc33 said:
just had a patient pay $2K for "regennexx PRP" for radicular pain. her MRI is pristine. never had any PT or ESIs
Click to expand...
that is really screwed up. Nothing makes me more angry than patients getting PRP for radicular pain, (who never had an ESI) or patients getting PRP for facet OA, who never had RFA.
 
geauxg8rs said:
We didn’t know if there was an opening like in the models until we started jamming 25 g needles up in there
Click to expand...
Crazy right? Can you imagine tracking oral flora into the spine when you don't even know where that needle is going?
 
I’ve had a number of patients see me for other issues, knee, shoulder, hip…who btw had an intradiscal procedure by Greg lutz and did quite well. Don’t get me wrong, I don’t like the guy. Never met him but he’s a car salesman, not a doctor. That being said, just cause I don’t like the salesman, doesn’t mean the car isn’t a good car. For all those who wanna bash regen..all good..my experience is that it does work. Interestingly enough, I’ve had good success with intradiscal PRP, facet PRP, sij prp. Also solid for hip labral tears and partial rotator cuffs. Mind you, these are not first line treatments and my fee schedule is a joke. I’m pretty sure hopd employed docs make more from a 45 minute cervical epidural than I charge for a intra-articular hip PRP…
 
bedrock said:
that is really screwed up. Nothing makes me more angry than patients getting PRP for radicular pain, (who never had an ESI) or patients getting PRP for facet OA, who never had RFA.
Click to expand...
Very true..there are some demographic pockets however, where as the physician you would be slandered for not offering regen. I know specifically some of my colleagues in LA LA land and other markets who almost need to offer it to stay relevant. There are a ton of patients with cash, who don’t care about insurance, that “refuse to put unnatural steroids into their bodies” and their Gucci/Prada girlfriend had PRP into her whole body and it was amaze balls. So much of life is perception, choices, environment, demographics..these are the factors that make decisions, all decisions.
 
  • Like
Reactions: 1 users
Don’t forget the celebs who migrated from fetal ingestion of anything to IV exosomes…..which works btw….albeit temporarily for me. I’ve tried it.
 
Pain Res Manag.
2022 Mar 7;2022:6181478. doi: 10.1155/2022/6181478. eCollection 2022.

Transforaminal Endoscopic Lumbar Discectomy with versus without Platelet-Rich Plasma Injection for Lumbar Disc Herniation: A Prospective Cohort Study

Yi Jiang 1 2, Rujun Zuo 2, Shuai Yuan 2, Jian Li 2, Chang Liu 2, Jiexun Zhang 2, Ming Ma 2, Dasheng Li 3, Yong Hai 2
Affiliations expand
PMID: 35296040 PMCID: PMC8920626 DOI: 10.1155/2022/6181478
Abstract
Objective: Transforaminal endoscopic lumbar discectomy (TELD) is an effective treatment for patients with lumbar disc herniation (LDH) with failure of conservative treatment. However, defects in the annulus fibrosus after TELD usually lead to a recurrence of LDH. Platelet-rich plasma (PRP) injection has shown promising potential for the repair of injured tissues. The combination of TELD and PRP injection has rarely been reported. Hence, this study aimed to evaluate the effectiveness, disc remodeling, and recurrence rate of LDH in TELD with or without PRP in LDH treatment.

Methods: A total of 108 consecutive patients who underwent TELD were prospectively registered between July 2018 and December 2019 (https://clinicaltrials.gov/ct2/show/ChiCTR1800017228). Fifty-one and fifty-seven patients underwent TELD with PRP injections and TELD only, respectively. The visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria were evaluated, and perioperative complications were documented. The disc protrusion, spinal cross-sectional area (SCSA), and disc height were measured on MRI and evaluated preoperatively, postoperatively, and at regular follow-up.

Results: All patients were followed up. Clinical improvement was noted in both groups. There were statistical differences in the VAS scores of back and leg pain and ODI between the two groups at 3 months, 6 months, and 1 year follow-up (P < 0.05); the improvement in the PRP group was significant. The disc protrusion and SCSA on MRI in the PRP group showed better improvement, with lower recurrence rate, than that in the control group at the final follow-up (P < 0.05). No adverse events were reported in our study following PRP injection.

Conclusion: Our study showed that TELD with PRP injection was a safe and effective treatment for patients with LDH in the medium and long-term follow-up. PRP injection was beneficial for disc remodeling after endoscopic discectomy and decreased the recurrence of LDH.

Copyright © 2022 Yi Jiang et al.
 
Last edited:
@Ducttape @lobelsteve

Am J Sports Med.
2022 Mar;50(3):618-629. doi: 10.1177/03635465211072554.

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial

Adam W Anz 1, Hillary A Plummer 1, Achraf Cohen 2, Peter A Everts 3, James R Andrews 1, Joshua G Hackel 1
Affiliations expand
PMID: 35289231 DOI: 10.1177/03635465211072554

Abstract
Background: Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis.

Purpose/hypothesis: The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after injection. It was hypothesized that patients receiving BMC would have better sustained outcomes than those receiving PRP.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: A total of 90 participants aged between 18 and 80 years with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-3) were randomized into 2 study groups: PRP and BMC. Both groups completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and subjective International Knee Documentation Committee (IKDC) questionnaire before and 1, 3, 6, 9, 12, 18, and 24 months after a single intra-articular injection of leukocyte-rich PRP or BMC. A linear mixed-effects model was performed to quantify the effects over time and the difference between the groups. This model has the random effect for time to assess the extent in which the change over time differs from one person to another.

Results: An overall 84 patients completed questionnaires from baseline to 12 months; however, 17 patients (n = 9; PRP group) were lost to follow-up at 18 months and 25 (n = 13; PRP group) at 24 months. There were no statistically significant differences in IKDC (P = .909; 95% CI, -6.26 to 7.03) or WOMAC (P = .789; 95% CI, -6.26 to 4.77) scores over time between the groups. Both groups had significantly improved IKDC (P < .001; 95% CI, 0.275-0.596) and WOMAC (P = .001; 95% CI, -0.41 to -0.13) scores from baseline to 24 months after the injection. These improvements plateaued at 3 months and were sustained for 24 months after the injection, with no difference between PRP and BMC at any time point.

Conclusions: For the treatment of osteoarthritis, PRP and BMC performed similarly out to 24 months. BMC was not superior to PRP.

Registration: NCT03289416 (ClincalTrials.gov identifier).

Keywords: bone marrow aspirate; bone marrow aspirate concentrate; osteoarthritis; platelet-rich plasma; regenerative medicine.
 
  • Like
Reactions: 1 user
drusso said:
@Ducttape @lobelsteve

Am J Sports Med.
2022 Mar;50(3):618-629. doi: 10.1177/03635465211072554.

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial

Adam W Anz 1, Hillary A Plummer 1, Achraf Cohen 2, Peter A Everts 3, James R Andrews 1, Joshua G Hackel 1
Affiliations expand
PMID: 35289231 DOI: 10.1177/03635465211072554

Abstract
Background: Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis.

Purpose/hypothesis: The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after injection. It was hypothesized that patients receiving BMC would have better sustained outcomes than those receiving PRP.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: A total of 90 participants aged between 18 and 80 years with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-3) were randomized into 2 study groups: PRP and BMC. Both groups completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and subjective International Knee Documentation Committee (IKDC) questionnaire before and 1, 3, 6, 9, 12, 18, and 24 months after a single intra-articular injection of leukocyte-rich PRP or BMC. A linear mixed-effects model was performed to quantify the effects over time and the difference between the groups. This model has the random effect for time to assess the extent in which the change over time differs from one person to another.

Results: An overall 84 patients completed questionnaires from baseline to 12 months; however, 17 patients (n = 9; PRP group) were lost to follow-up at 18 months and 25 (n = 13; PRP group) at 24 months. There were no statistically significant differences in IKDC (P = .909; 95% CI, -6.26 to 7.03) or WOMAC (P = .789; 95% CI, -6.26 to 4.77) scores over time between the groups. Both groups had significantly improved IKDC (P < .001; 95% CI, 0.275-0.596) and WOMAC (P = .001; 95% CI, -0.41 to -0.13) scores from baseline to 24 months after the injection. These improvements plateaued at 3 months and were sustained for 24 months after the injection, with no difference between PRP and BMC at any time point.

Conclusions: For the treatment of osteoarthritis, PRP and BMC performed similarly out to 24 months. BMC was not superior to PRP.

Registration: NCT03289416 (ClincalTrials.gov identifier).

Keywords: bone marrow aspirate; bone marrow aspirate concentrate; osteoarthritis; platelet-rich plasma; regenerative medicine.
Click to expand...
Yep.

PRP is also quite a bit cheaper.

I'm doing PRP and do not offer BMAC.
 
drusso said:
@Ducttape @lobelsteve

Am J Sports Med.
2022 Mar;50(3):618-629. doi: 10.1177/03635465211072554.

Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial

Adam W Anz 1, Hillary A Plummer 1, Achraf Cohen 2, Peter A Everts 3, James R Andrews 1, Joshua G Hackel 1
Affiliations expand
PMID: 35289231 DOI: 10.1177/03635465211072554

Abstract
Background: Autologous platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC) are being used clinically as therapeutic agents for the treatment of knee osteoarthritis.

Purpose/hypothesis: The purpose of this study was to compare the efficacy of BMC and PRP on pain and function in patients with knee osteoarthritis up to 24 months after injection. It was hypothesized that patients receiving BMC would have better sustained outcomes than those receiving PRP.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: A total of 90 participants aged between 18 and 80 years with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-3) were randomized into 2 study groups: PRP and BMC. Both groups completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and subjective International Knee Documentation Committee (IKDC) questionnaire before and 1, 3, 6, 9, 12, 18, and 24 months after a single intra-articular injection of leukocyte-rich PRP or BMC. A linear mixed-effects model was performed to quantify the effects over time and the difference between the groups. This model has the random effect for time to assess the extent in which the change over time differs from one person to another.

Results: An overall 84 patients completed questionnaires from baseline to 12 months; however, 17 patients (n = 9; PRP group) were lost to follow-up at 18 months and 25 (n = 13; PRP group) at 24 months. There were no statistically significant differences in IKDC (P = .909; 95% CI, -6.26 to 7.03) or WOMAC (P = .789; 95% CI, -6.26 to 4.77) scores over time between the groups. Both groups had significantly improved IKDC (P < .001; 95% CI, 0.275-0.596) and WOMAC (P = .001; 95% CI, -0.41 to -0.13) scores from baseline to 24 months after the injection. These improvements plateaued at 3 months and were sustained for 24 months after the injection, with no difference between PRP and BMC at any time point.

Conclusions: For the treatment of osteoarthritis, PRP and BMC performed similarly out to 24 months. BMC was not superior to PRP.

Registration: NCT03289416 (ClincalTrials.gov identifier).

Keywords: bone marrow aspirate; bone marrow aspirate concentrate; osteoarthritis; platelet-rich plasma; regenerative medicine.
Click to expand...
Wait: 25 of 84 lost to follow up and conclusion still mentions 2 year data.
 
  • Like
Reactions: 1 user
lobelsteve said:
Wait: 25 of 84 lost to follow up and conclusion still mentions 2 year data.
Click to expand...
1647925658617.png


1647925710533.png
 
why didnt they have a saline control?

that would have made this study so much more complete.

this suggests that there is no role for the more expensive BMAC option if PRP is just as effective....
 
  • Like
Reactions: 1 user
study does shoot down BMAC for knee osteoarthritis though.

The results of this study suggest that there may be little difference between BMC and PRP over a 2-year period, which questions the added morbidity and cost of harvesting BMC.
Click to expand...
 
You must log in or register to reply here.
Next unread thread

Similar threads

drusso
Godfather of Regenerative Medicine Passes..
Replies
2
Views
679
Doctodd
D
bedrock
regenerative medicine key papers
Replies
42
Views
2K
Doctodd
D
oreosandsake
Advanced Regenerative Medicine Institute
Replies
6
Views
1K
oreosandsake
oreosandsake
drusso
Regenerative Medicine Fellowship Opportunities
Replies
21
Views
5K
oreosandsake
oreosandsake
C
fully workers comp/PI practice
Replies
9
Views
609
Doctodd
D
Top