Stem Cell Therapy for Low Back Pain

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inflamesdjk02

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Does anyone have an opinion on the injection of stem cells for the treatment of low back pain? I recently had an interested party approach me and ask if I was interested in performing this procedure for cash payments from patients ... it sounded good in theory, but I don't know ...
 
In the spine this is human experimentation without an experiment. Some docs (especially orthopedic surgeons) offer "stem cells" for knees and shoulders- this is derived from amnionic fluid and has exactly zero live stem cells in it, but the orthopedic surgeons do not mind scamming people by charging $2000-3000 to do these injections. Autologous stem cells may be obtained via bone marrow aspiration or adipose, but the cellular mix has less than 2% stem cells in it since our illustrious FDA will not permit anything except centrifugation and filtration of the cells. There is also a lot of junk in the cellular mix, including fibroblasts. It is also impossible to sterilize the stem cell matrix since filtration will also filter out the stem cells, and it is not legal via the FDA to use any other method of sterilization for these cells (manipulation). Given the paucity of research and the relegation of using garbage injections instead of purified stem cells, this is at best wishful thinking, and at worst a hoax perpetuated by charlatans.
 
On a practical level how is this supposed to even work? You can't just throw stem cells into an area and expect them to replicate damaged tissue perfectly. And that assumes that it's a mechanical issue and not a somatosensory one secondary to things like nerve sensitization or cortical reorganization.

Pain is a multifactorial issue that requires a multifactorial approach. You're not just going to be able to bulldoze away pain with some panacea treatment. The last time we tried that we got the prescription drug epidemic. You need specific indications for specific therapies with specific research. This idea doesn't even seem plausible.
 
I have not seen any stem cell therapy ever work.

Unless you like scamming people I would say stay away.
 
trainofe4 said:
On a practical level how is this supposed to even work? You can't just throw stem cells into an area and expect them to replicate damaged tissue perfectly. And that assumes that it's a mechanical issue and not a somatosensory one secondary to things like nerve sensitization or cortical reorganization.
Click to expand...

Well sure but assume it is mechanical compression of a nerve, WTF are some stem cells going to do? Are they going to destroy whatever bone or disc is compressing the nerve in the first place?

You'd be just as well offering them an injection of a new med called placebo.
 
There is some evidence stem cells work injected into knees and to a much lesser degree in the shoulders. For the spine, there is very little evidence. There was one Spanish study of 10 patients with intradiscal injections and a pilot study of 15 patients (https://www.ncbi.nlm.nih.gov/pubmed/28086781) using autologous fat stromal fraction with improvement in pain. Another study of 26 patients using autologous bone marrow showed some improvement over a year with 8/20 demonstrating MRI improvement. (https://www.ncbi.nlm.nih.gov/pubmed/26156727). However there is another series of 10 patients that received zero improvement from intradiscal stem cells (https://www.ncbi.nlm.nih.gov/pubmed/16522171) There are no controlled studies of intradiscal stem cell therapy, yet this is frequently offered much in the way DC electricity was offered as a treatment in the late 19th and early 20th century. There are also cowboys injecting intrathecally stromal fractions from fat or bone marrow, sometimes with disastrous results. Some inject both into the disc or both plus PRP and there have been severe discitis cases due to the fact you cannot sterilize the cells obtained by penetrating the skin with needles to obtain them. There is also a case report of epidural abscess with cauda equina syndrome after intradiscal stem cells (https://www.ncbi.nlm.nih.gov/pubmed/23131581) Perhaps in the future we will have better capabilities to understand why stem cells (or the other 98% of stromal fractions) may work, but it would be prudent in intradiscal injections to wait for controlled studies, while completely avoiding injection of cellular debris and other undesirable cells into the intrathecal or epidural areas until we can purify and sterilize the injectates.
 
Last edited:
This is interesting.

They give neupogen and 3-4 days later take a biopsy from bone marrow and separate the stem cells and culture them.
They freeze that culture.

In auto immune arthritis autologous stem cell transplant may reset your immune system and give you benifit. The question is for how long will the benifit last? Do they inject umbilical mesenchymal cells with it for better results?

In India, i met a surgeon who is autologous doing stem cell translant. They had a kid in his clinic who had cerebral palsy and they injected stem cells into the csf. He claims that the kid is doing much better.

He is collecting all the data, make the patients pay for all the lab work and experimental surgery. Then sell the data to a us pharma company
 
algosdoc said:
There is some evidence stem cells work injected into knees and to a much lesser degree in the shoulders. For the spine, there is very little evidence. There was one Spanish study of 10 patients with intradiscal injections and a pilot study of 15 patients (https://www.ncbi.nlm.nih.gov/pubmed/28086781) using autologous fat stromal fraction with improvement in pain. Another study of 26 patients using autologous bone marrow showed some improvement over a year with 8/20 demonstrating MRI improvement. (https://www.ncbi.nlm.nih.gov/pubmed/26156727). However there is another series of 10 patients that received zero improvement from intradiscal stem cells (https://www.ncbi.nlm.nih.gov/pubmed/16522171) There are no controlled studies of intradiscal stem cell therapy, yet this is frequently offered much in the way DC electricity was offered as a treatment in the late 19th and early 20th century. There are also cowboys injecting intrathecally stromal fractions from fat or bone marrow, sometimes with disastrous results. Some inject both into the disc or both plus PRP and there have been severe discitis cases due to the fact you cannot sterilize the cells obtained by penetrating the skin with needles to obtain them. There is also a case report of epidural abscess with cauda equina syndrome after intradiscal stem cells (https://www.ncbi.nlm.nih.gov/pubmed/23131581) Perhaps in the future we will have better capabilities to understand why stem cells (or the other 98% of stromal fractions) may work, but it would be prudent in intradiscal injections to wait for controlled studies, while completely avoiding injection of cellular debris and other undesirable cells into the intrathecal or epidural areas until we can purify and sterilize the injectates.
Click to expand...

This stem cell and PRP business is well known to plastic surgeons. They have been injecting autologous fat stem cells into the face to make you look younger.
There is a podiatrist Dr Gusenoff, who is doing research to see if fat pad transplants help in plantar fascitis
https://clinicaltrials.gov/ct2/show/NCT02465333. The results are awaited
Of course injecting into the epidural or intrathecal space one has to be meticulous about sterilty
 
Stem cells would be great, but that is not what is being injected. 98% garbage, 2% stem cells. If stem cells are so great, why haven't there been any controlled trials in spinal use of stem cells?
 
inflamesdjk02 said:
Does anyone have an opinion on the injection of stem cells for the treatment of low back pain? I recently had an interested party approach me and ask if I was interested in performing this procedure for cash payments from patients ... it sounded good in theory, but I don't know ...
Click to expand...

The question is why are patients wanting it and for what conditions?
What is the motivating factor for this patients? Is the condition a rapidly debilitating condition that we dont have answers and the patients are desperate for a quick fix? Or at least a try before they give up all hope
 
They want it because they hear buzz words flippantly bandied about by their doctors who know nothing of stem cell therapies or by unwitting victims of dead stem cell scams perpetuated by orthopedic surgeons injecting these into their joints. They hear of miraculous cures from stem cells on TV not realizing that the stem cell cultures being used in these clinical experiments have little to do with the garbage that is being injected due to restrictions on advancement of the field by the FDA.
 
inquisitiveanes said:
The question is why are patients wanting it and for what conditions?
What is the motivating factor for this patients? Is the condition a rapidly debilitating condition that we dont have answers and the patients are desperate for a quick fix? Or at least a try before they give up all hope
Click to expand...


Many patients are basically clueless. Yesterday I had a patient ask me if the surgeon would be using a laser to fix his hernia. Stem cells could be an easy sell for the unscrupulous. It's a buzzword. No science necessary. Then they can tell their friends about it.
 
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nimbus said:
Many patients are basically clueless. Yesterday I had a patient ask me if the surgeon would be using a laser to fix his hernia. Stem cells could be an easy sell for the unscrupulous. It's a buzzword. No science necessary. Then they can tell their friends about it.
Click to expand...

I have a clinic where I use a laser guided robot to inject stem cells, then initiate photon therapy for 15 visits. This all fails if you are eating a non ketogenic diet or are deficient in B vitamins. By the way, my wife has an all natural vitamin shop with products made organically where you can get the necessary probiotics to active your macrophages.


Sent from my iPad using SDN mobile app
 
pjl said:
I have a clinic where I use a laser guided robot to inject stem cells, then initiate photon therapy for 15 visits. This all fails if you are eating a non ketogenic diet or are deficient in B vitamins. By the way, my wife has an all natural vitamin shop with products made organically where you can get the necessary probiotics to active your macrophages.


Sent from my iPad using SDN mobile app
Click to expand...

 
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