Adding Regenerative medicine to your practice.

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drusso said:
Tell me about experiences putting stimulators in patients with central sensitization syndrome...do they do well long-term?
Click to expand...

Until the Auto insurance runs out at least. /s
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lobelsteve said:
How do you explain charging thousands of dollars for your magic beans in your office?
Click to expand...

That is my intuitive problem with PRP.

If it is a great option:

1. Why aren’t blood patches therapeutic for back pain?

2. Why are hematomas in joints not therapeutic?

3. Why don’t surgical incisions feel good, instead of cause pain?

I always HOPE that new treatments will be effective, but remain skeptical. I want to keep an open mind and hope that this time it is different and is an effective treatment.
 
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hawkeye2009 said:
That is my intuitive problem with PRP.

If it is a great option:

1. Why aren’t blood patches therapeutic for back pain?

2. Why are hematomas in joints not therapeutic?

3. Why don’t surgical incisions feel good, instead of cause pain?

I always HOPE that new treatments will be effective, but remain skeptical. I want to keep an open mind and hope that this time it is different and is an effective treatment.
Click to expand...
1. Epidural steroids aren't therapeutic for "back pain" either. Let's try to be more specific what you're trying to treat.
2. Microfracture has been used for years to treat chondral defects during knee arthroscopy.
3. Regenerative medicine hurts, it doesn't "feel good". Once it heals, it feels better, much like a surgical incision.
 
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hawkeye2009 said:
That is my intuitive problem with PRP.

If it is a great option:

1. Why aren’t blood patches therapeutic for back pain?

2. Why are hematomas in joints not therapeutic?

3. Why don’t surgical incisions feel good, instead of cause pain?

I always HOPE that new treatments will be effective, but remain skeptical. I want to keep an open mind and hope that this time it is different and is an effective treatment.
Click to expand...

because of the inflammation....well made prp is not inflammatory.
 
If we based our practices on Anecdotes, we are no better than chiropractors
 
Doctodd said:
because of the inflammation....well made prp is not inflammatory.
Click to expand...


A bruise is generally not inflammatory either, just infiltration of blood into tissue, yet is not therapeutic either.

Again, when doing an epidural blood patch, if prp is effective, why don't people get relief of their back pain? I am talking about people with non specific, low back pain, presumably due to degeneration. Lobbing some blood in the epidural space (as it has plenty of plasma) should be therapeutic, but its not. Why not?
 
lonelobo said:
If we based our practices on Anecdotes, we are no better than chiropractors
Click to expand...


Indeed- and prp has pretty poor evidence in the spine.

I want to keep an open mind. Perhaps there will be further studies that will show the merit of prp. I think that patients should just be informed that the treatment is currently under investigation, so that they are properly informed.

Keep in mind that the placebo effect rises with a higher cost of a procedure. One simply has to look at the laser spine centers for this effect.
 
hawkeye2009 said:
A bruise is generally not inflammatory either, just infiltration of blood into tissue, yet is not therapeutic either.

Again, when doing an epidural blood patch, if prp is effective, why don't people get relief of their back pain? I am talking about people with non specific, low back pain, presumably due to degeneration. Lobbing some blood in the epidural space (as it has plenty of plasma) should be therapeutic, but its not. Why not?
Click to expand...
I get what you're saying, but traditional epidural steroids are not effective for nonspecific, presumbably degenerative, low back pain either.
 
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I just got a bolus of referrals requesting PRP for recurrent plantar fasciitis. I'm okay doing it, though not a huge believer in regen med, but wondering about procedural tolerance. My plan was to do US-guided in plane posterior approach through the heel pad. Question is -- should I do a posterior tibial nerve block first or are patients likely to tolerate without?
 
Baron Samedi said:
I just got a bolus of referrals requesting PRP for recurrent plantar fasciitis. I'm okay doing it, though not a huge believer in regen med, but wondering about procedural tolerance. My plan was to do US-guided in plane posterior approach through the heel pad. Question is -- should I do a posterior tibial nerve block first or are patients likely to tolerate without?
Click to expand...
less feeling in the plantar area of the feet, than our other areas; in plane approach lateral to medial, 25 G x 1.25 inch needle will get you there most times; just tell them no NSAIDS, and it can flare their pain after
 
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Baron Samedi said:
I just got a bolus of referrals requesting PRP for recurrent plantar fasciitis. I'm okay doing it, though not a huge believer in regen med, but wondering about procedural tolerance. My plan was to do US-guided in plane posterior approach through the heel pad. Question is -- should I do a posterior tibial nerve block first or are patients likely to tolerate without?
Click to expand...

I do the posterior tibial nerve block. Makes it more tolerable and you can bill for it.
 
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lobelsteve said:
Stem cell complication:
Click to expand...


The truth:

Int Orthop. 2016 Aug;40(8):1755-1765. doi: 10.1007/s00264-016-3162-y. Epub 2016 Mar 30.
A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions.
Centeno CJ1, Al-Sayegh H2, Freeman MD3,4, Smith J5, Murrell WD6, Bubnov R7.
Author information
1Centeno-Schultz Clinic, Regenerative Sciences, LLC, 403 Summit Blvd, Broomfield, CO, 80021, USA. [email protected].2Biostatistician at Boston Children's Hospital, 450 Brookline Avenue, D-155E, Boston, MA, 02215, USA.3Department of Psychiatry, Oregon Health and Science University School of Medicine, Portland, OR, USA.4CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.5Mayo Clinic Rochester, 200 1st St SW, Rochester, MN, 55905, USA.6American Musculoskeletal Wellness Institute, P.C, 6701 Democracy Boulevard Suite 300, Bethesda, Maryland, 20817, USA.7The Centre of Ultrasound Diagnostics and Interventional Sonography, Clinical Hospital "Pheophania" of State Affairs Department, Zabolotny Street, 21, 03680, Kyiv, Ukraine.
Erratum in
Abstract
INTRODUCTION:
The purpose of the present investigation is to report on detailed complications among a much larger group of 2372 orthopaedic patients treated with stem cell injections who were followed in a treatment registry for up to nine years.
METHODS:
All patients underwent an MSC-based, percutaneous injection treatment of an orthopaedic condition between December 2005 and September 2014 at one of 18 clinical facilities. Treated areas of the body included the knee, hip, ankle/foot, hand/wrist, elbow, shoulder, and spine. The patients were followed prospectively via enrollment in a treatment registry. Patients were followed prospectively at one, three, six and 12 months, and annually thereafter, using an electronic system, ClinCapture software.
RESULTS:
A total of 3012 procedures were performed on 2372 patients with follow-up period of 2.2 years. A total of 325 adverse events were reported. The majority were pain post-procedure (n = 93, 3.9 % of the study population) and pain due to progressive degenerative joint disease (n = 90, 3.8 % of the study population). Seven cases reported neoplasms, a lower rate than in the general population. The lowest rate of adverse events was observed among patients injected with BMC alone.
CONCLUSION:
Lowest rate of adverse events was among those patients receiving BMC injections alone, but the higher rate of AEs for BMC plus adipose and cultured cells was readily explained by the nature of the therapy or the longer follow-up. There was no clinical evidence to suggest that treatment with MSCs of any type in this study increased the risk of neoplasm.
KEYWORDS:
Bone marrow concentrate; Complications; Mesenchymal stem cells; Platelet rich plasma; Regist
 
PLEASE LISTEN TO "BAD BATCH" BY WONDERY.

PODCAST
 
SommeRiver said:
PLEASE LISTEN TO "BAD BATCH" BY WONDERY.

PODCAST
Click to expand...
Not to yell, but I have. Don't use 3rd party umbilical cord "stem cells". Also would caution against non-physician "Doctors" injecting you.

It's an awesome series, except for the super-long ads.
 
drusso said:
The truth:

Int Orthop. 2016 Aug;40(8):1755-1765. doi: 10.1007/s00264-016-3162-y. Epub 2016 Mar 30.
A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions.
Centeno CJ1, Al-Sayegh H2, Freeman MD3,4, Smith J5, Murrell WD6, Bubnov R7.
Author information
1Centeno-Schultz Clinic, Regenerative Sciences, LLC, 403 Summit Blvd, Broomfield, CO, 80021, USA. [email protected].2Biostatistician at Boston Children's Hospital, 450 Brookline Avenue, D-155E, Boston, MA, 02215, USA.3Department of Psychiatry, Oregon Health and Science University School of Medicine, Portland, OR, USA.4CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.5Mayo Clinic Rochester, 200 1st St SW, Rochester, MN, 55905, USA.6American Musculoskeletal Wellness Institute, P.C, 6701 Democracy Boulevard Suite 300, Bethesda, Maryland, 20817, USA.7The Centre of Ultrasound Diagnostics and Interventional Sonography, Clinical Hospital "Pheophania" of State Affairs Department, Zabolotny Street, 21, 03680, Kyiv, Ukraine.
Erratum in
Abstract
INTRODUCTION:
The purpose of the present investigation is to report on detailed complications among a much larger group of 2372 orthopaedic patients treated with stem cell injections who were followed in a treatment registry for up to nine years.
METHODS:
All patients underwent an MSC-based, percutaneous injection treatment of an orthopaedic condition between December 2005 and September 2014 at one of 18 clinical facilities. Treated areas of the body included the knee, hip, ankle/foot, hand/wrist, elbow, shoulder, and spine. The patients were followed prospectively via enrollment in a treatment registry. Patients were followed prospectively at one, three, six and 12 months, and annually thereafter, using an electronic system, ClinCapture software.
RESULTS:
A total of 3012 procedures were performed on 2372 patients with follow-up period of 2.2 years. A total of 325 adverse events were reported. The majority were pain post-procedure (n = 93, 3.9 % of the study population) and pain due to progressive degenerative joint disease (n = 90, 3.8 % of the study population). Seven cases reported neoplasms, a lower rate than in the general population. The lowest rate of adverse events was observed among patients injected with BMC alone.
CONCLUSION:
Lowest rate of adverse events was among those patients receiving BMC injections alone, but the higher rate of AEs for BMC plus adipose and cultured cells was readily explained by the nature of the therapy or the longer follow-up. There was no clinical evidence to suggest that treatment with MSCs of any type in this study increased the risk of neoplasm.
KEYWORDS:
Bone marrow concentrate; Complications; Mesenchymal stem cells; Platelet rich plasma; Regist
Click to expand...

Narwal the puppy disagrees with you.
 
drusso said:
The truth:

Int Orthop. 2016 Aug;40(8):1755-1765. doi: 10.1007/s00264-016-3162-y. Epub 2016 Mar 30.
A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions.
Centeno CJ1, Al-Sayegh H2, Freeman MD3,4, Smith J5, Murrell WD6, Bubnov R7.
Author information
1Centeno-Schultz Clinic, Regenerative Sciences, LLC, 403 Summit Blvd, Broomfield, CO, 80021, USA. [email protected].2Biostatistician at Boston Children's Hospital, 450 Brookline Avenue, D-155E, Boston, MA, 02215, USA.3Department of Psychiatry, Oregon Health and Science University School of Medicine, Portland, OR, USA.4CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.5Mayo Clinic Rochester, 200 1st St SW, Rochester, MN, 55905, USA.6American Musculoskeletal Wellness Institute, P.C, 6701 Democracy Boulevard Suite 300, Bethesda, Maryland, 20817, USA.7The Centre of Ultrasound Diagnostics and Interventional Sonography, Clinical Hospital "Pheophania" of State Affairs Department, Zabolotny Street, 21, 03680, Kyiv, Ukraine.
Erratum in
Abstract
INTRODUCTION:
The purpose of the present investigation is to report on detailed complications among a much larger group of 2372 orthopaedic patients treated with stem cell injections who were followed in a treatment registry for up to nine years.
METHODS:
All patients underwent an MSC-based, percutaneous injection treatment of an orthopaedic condition between December 2005 and September 2014 at one of 18 clinical facilities. Treated areas of the body included the knee, hip, ankle/foot, hand/wrist, elbow, shoulder, and spine. The patients were followed prospectively via enrollment in a treatment registry. Patients were followed prospectively at one, three, six and 12 months, and annually thereafter, using an electronic system, ClinCapture software.
RESULTS:
A total of 3012 procedures were performed on 2372 patients with follow-up period of 2.2 years. A total of 325 adverse events were reported. The majority were pain post-procedure (n = 93, 3.9 % of the study population) and pain due to progressive degenerative joint disease (n = 90, 3.8 % of the study population). Seven cases reported neoplasms, a lower rate than in the general population. The lowest rate of adverse events was observed among patients injected with BMC alone.
CONCLUSION:
Lowest rate of adverse events was among those patients receiving BMC injections alone, but the higher rate of AEs for BMC plus adipose and cultured cells was readily explained by the nature of the therapy or the longer follow-up. There was no clinical evidence to suggest that treatment with MSCs of any type in this study increased the risk of neoplasm.
KEYWORDS:
Bone marrow concentrate; Complications; Mesenchymal stem cells; Platelet rich plasma; Regist
Click to expand...

Narwal the puppy disagrees with you.
 
Ferrismonk said:
Not to yell, but I have. Don't use 3rd party umbilical cord "stem cells". Also would caution against non-physician "Doctors" injecting you.

It's an awesome series, except for the super-long ads.
Click to expand...

Haha...It is a piece of reporting that doesn't check all the boxes and leaves some Q unanswered but jeez...Your avg "stem cell guy" is a quack IMO.
 
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SSdoc33 said:
yet you don't post their propaganda. i guess you haven't been franchised out yet.
Click to expand...

IOF is agnostic about technology and purely focused on science. They are Switzerland.

www.cvent.com

IOF2020

<p><span style="font-size: 16px;" face="Arial, Helvetica, sans-serif"><em>Join us as at IOF2020 as we dive into the many controversies surrounding orthobiologics. The Interventional Orthopedics Foundation will once again provide panel discussions and interactive sessions conducted by industry...
www.cvent.com www.cvent.com
 
SSdoc33 said:
yet you don't post their propaganda. i guess you haven't been franchised out yet.
Click to expand...

I had some suspiciousnessocity feelings, but I did learn a few US pearls.
 
maybe im getting them confused with regennex. i trust malanga. centeno? meh.....
 
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...
Click to expand...

I have seen it done a few ways - the adipose tissue extraction via lipo seems to be the most common way, I went to a lecture by a FM guy who used to do the lipo himself in a surgi center, and then inject the cells after he was done with the lipo, and the ortho group where I did residency was in partnership with plastic surgeon guy who would extract adipose tissue and then the patient would get the injection from the sports medicine guy. I have seen it done via BMAC as well - seems much more painful to do BMAC though.
 
So currently listening to Bad Batch podcast by Wondery. Unbelievable! Highly recommend it to everyone on this board. Really exposes how fraudulent and deceitful the industry is. I’m sure there are legit companies out there (Regenexx?) but after listening to this I’d be hard pressed to recommend stem cells for any of my patients. For you guys that offer this, would be interested in hearing your thoughts after listening to the podcast
 
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clubdeac said:
So currently listening to Bad Batch podcast by Wondery. Unbelievable! Highly recommend it to everyone on this board. Really exposes how fraudulent and deceitful the industry is. I’m sure there are legit companies out there (Regenexx?) but after listening to this I’d be hard pressed to recommend stem cells for any of my patients. For you guys that offer this, would be interested in hearing your thoughts after listening to the podcast
Click to expand...

This is a daily event for me in clinic. Patients come in and say, “I paid $7000 for a stem cell injection and it didn’t work.” Ask a few questions and discover it was a placental birth tissue product typically performed by a naturopath or NP. No bone marrow aspiration, no liposuction, no image guidance for injection. Good news is that regulators and lawyers are catching up. I consulted on cases of stem cell fraud this year. Patients need to look for board certified MSK specialists with requisite training in Regen and signers to groups like orthobiologic ethics consortium and/or IOF. IOF partnering with other specialty societies on multi-expert consensus guidelines like CDC 2016 for opioids.
 
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clubdeac said:
So currently listening to Bad Batch podcast by Wondery. Unbelievable! Highly recommend it to everyone on this board. Really exposes how fraudulent and deceitful the industry is. I’m sure there are legit companies out there (Regenexx?) but after listening to this I’d be hard pressed to recommend stem cells for any of my patients. For you guys that offer this, would be interested in hearing your thoughts after listening to the podcast
Click to expand...

Bad Batch: Chiropractor injects bacterial-contaminated non-viable umbilical "stem cell" product from a dubious company with poor quality control founded by a serial scam artist.

This has almost nothing to do with autologous PRP/BMAC injected by a fellowship-trained interventional pain doc.
 
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Ferrismonk said:
Bad Batch: Chiropractor injects bacterial-contaminated non-viable umbilical "stem cell" product from a dubious company with poor quality control founded by a serial scam artist.

This has almost nothing to do with autologous PRP/BMAC injected by a fellowship-trained interventional pain doc.
Click to expand...

Except that patients don't know the difference and don't know HOW to know the difference between an evidence-based practitioner and a quack. And, being "pain-trained" is not enough. There's a knowledge base to selecting and using orthobiologics appropriately that goes beyond, "Your surgeon sent you here for a right L5..."

Bad Batch is an example of what's happened in this field over and over again for the last 30 years: Treatments get embraced with irrational exuberance, then they get overused, then outcomes suffer, then meta-analysis practitioners wanting to make splash and get tenure go publish GIGO systematic reviews "proving" nothing works for pain, and then the whole thing collapses.

It happened to IDET, vert/kypho, ESI's, and soon stim...
 
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I think intradiscal CBD injections by chiropractors will take this whole regenerative "medicine" field down...
 
Jcm800 said:
I think intradiscal CBD injections by chiropractors will take this whole regenerative "medicine" field down...
Click to expand...

regenexx.com

google and the stem cell wild west

Advanced regenerative orthobiologic injection treatments for injuries, arthritis, athletes & more. Regenexx is the trusted alternative to surgery.
regenexx.com regenexx.com
 
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Anyone get a cult-like feeling when it comes to regenerative medicine folks? If someone told me corticosteroids don't work I'd shrug and move on with my day. When I say that some of these "regenerative" products don't work, people suddenly get very, very upset about it.
 
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20190717_181725.jpeg
 
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Ferrismonk said:
Its amazing how the angle of the XRay makes the joint look bigger!

regenexx.com

knee stem cell x ray results watch grow new cartilage minutes

Advanced regenerative orthobiologic injection treatments for injuries, arthritis, athletes & more. Regenexx is the trusted alternative to surgery.
regenexx.com regenexx.com
Click to expand...

Definitely an interesting video. I was disappointed to see that he advocates for MiMedX products, though, and even calls them a "good guy company" on his website.

Hard to argue they are a good guy company when they are actively bribing providers, not adhering to Sunshine Act Laws, failing FDA inspections, getting kicked out of government facilities for overreaching, and their former CEO and COO were just indicted for fraud.

When they bombed their 2016 inspection for major problems like sterility and preventing the spread of transmissible diseases, their CEO's kneejerk response was literally, "but what about our stock values and shareholders?" with no regard to patient safety.
 

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as a side note, if you are a Centeno minion, do you have to stop doing treatments that he states are unsafe and ineffective, such as lumbar radiofrequency ablation, multidisciplinary pain programs, and of course epidurals/sacroiliac injections, etc.?
 
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Ducttape said:
as a side note, if you are a Centeno minion, do you have to stop doing treatments that he states are unsafe and ineffective, such as lumbar radiofrequency ablation, multidisciplinary pain programs, and of course epidurals/sacroiliac injections, etc.?
Click to expand...
Well, I'm not a "Centeno minion", but yes, in the regenerative medicine field steroids are bad. They inhibit healing.

Multidisciplinary pain treatment including PT, appropriate bracing, etc is an integral part of regenerative medicine. Not to be confused with chiropractors injecting purchased non-viable cord products.
 
not per Centeno...

regenexx.com

pne review 2 pain neuroscience

Advanced regenerative orthobiologic injection treatments for injuries, arthritis, athletes & more. Regenexx is the trusted alternative to surgery.
regenexx.com regenexx.com

Back in the ’80s and ’90s, it was called a comprehensive, multidisciplinary chronic pain program. Back then, the concepts were the same, save for the recognition that chronic pain patients had abnormal nerve activity (central sensitization). Patients would enter these obnoxiously expensive and resource-intensive 2–3 week programs where they would be mentally “buffed.” Most would figure out, pretty quick, that this personal hell would all be over once they reported that their perception of their pain wasn’t real and that the coping strategies they learned were helping their pain and improving their function. Hence, the chronic pain programs all reported amazing results. However, they became a bit of a joke in the medical community because after spending tens of thousands of dollars on these programs, these patients all still had pain, and all were still disabled.
Click to expand...
and RFA bad

regenexx.com

treatment for low back pain

New research suggests that radiofrequency (burn nerves in low back) treatment for low back pain is no better than physical therapy!
regenexx.com regenexx.com

The upshot? RIP low back RFA. Good-bye to the Burn Nerves in Low Back procedure. Not sure how we ever thought that killing the nerve that goes to the muscle that stabilizes the spine was a good idea as a treatment for low back pain? With newer regenerative medicine techniques, it’s time to hold a big wake and get those RFA probes six feet under, where they belong!
Click to expand...
 
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Ducttape said:
not per Centeno...

regenexx.com

pne review 2 pain neuroscience

Advanced regenerative orthobiologic injection treatments for injuries, arthritis, athletes & more. Regenexx is the trusted alternative to surgery.
regenexx.com regenexx.com


and RFA bad

regenexx.com

treatment for low back pain

New research suggests that radiofrequency (burn nerves in low back) treatment for low back pain is no better than physical therapy!
regenexx.com regenexx.com
Click to expand...

PNE is Maoist indoctrination for the somatically focused.
 
Ferrismonk said:
Well, I'm not a "Centeno minion", but yes, in the regenerative medicine field steroids are bad. They inhibit healing.

Multidisciplinary pain treatment including PT, appropriate bracing, etc is an integral part of regenerative medicine. Not to be confused with chiropractors injecting purchased non-viable cord products.
Click to expand...
So do you steroid injections?
 
lonelobo said:
So do you steroid injections?
Click to expand...
Of course. Regenerative medicine is a cash-only pipe dream for most people. Even if its done at cost, most people I see cannot afford it.

I give them the option of traditional covered treatments as well as not-covered treatments I think may help. Patient choice.
 
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