Caring Medical - Where the world comes for ProlotherapyDoes stem cell therapy work? Will it work for you?

How stem cells heal degenerative joint disease after years of cortisone and painkillers

Ross Hauser, MD

In our clinical experience we have seen bone marrow derived stem cells and lipoaspirate derived stem cells provide very satisfactory results for patient clients.

  • This article will provide our clinical insights of more than 25 years experience in regenerative medicine into the workings of stem cell therapy.
  • The findings from patients who had stem cell therapy at other clinics that did not respond to treatment as hoped for.
  • How to make stem cell therapy more successful and long-lasting.
  • What you need to know to explode and research the many myths surrounding stem cell therapy treatments.
  • In this article we will cover if you are a good candidate not only for stem cell therapy, but comprehensive stem cell Prolotherapy
  • How stem cell therapy works in conjunction with Prolotherapy to rebuild damaged joints

Stem cell therapy will likely not work if the doctor and the patient believe it is a “one magical shot treatment.”

  • One out of 10 new patients that we see here at Caring Medical Regenerative Medicine Clinics have already received stem cell treatment by another clinic.
  • The reason that these patients are here is that they believe stem cell therapy will work for them, if the treatment is more comprehensive.

A great myth of stem cell therapy is that it is a magical one time injection into the joint. Thus, patients believe that if they get a single injection into the knee or a single injection into the facet joint in the spine, that somehow all of their pain is going to disappear.

The single shot thinking debunked:

The damage that caused sufficient injury to your joint, enough so that you sought out stem cell therapy, possibly even as an alternative to joint replacement surgery, is accumulated damaged from degenerative joint disease. It is damage from advanced joint instability that caused the cartilage cells to break down and gave you a bone on bone situation.

Joint instability comes from loose, weakened, unsupportive ligaments that, when healthy and strong, prevent the abnormal motion of the joint that causes joint destruction.

To treat this joint, you must go beyond the simple one shot stem cell thinking. What is needed is a comprehensive treatment that treats all the stabilizing ligaments and structures of the joint to prevent the same destructive forces from continuing to breakdown the cartilage even after stem cell therapy was administered.


One injection “treatments” are not sustainable pain relief

People believe that one stem cell injection will make all their pains go away. For most this is not true. It is not true for the same reasons outlined above, a single injection will not be comprehensive enough to reverse the damage affecting the entire knee.

This one shot thinking leads to an unrealistic expectation of pain relief.

In the first treatment, indeed, many people will get pain relief. However, in our practice we are looking for sustained more permanent pain relief. One injection treatments are not sustainable pain relief.

Ligament tissue and other soft connective tissue as well as bone heal over time. The ligaments over a four to six-week period. A second treatment is often needed to build on this healing. Sometimes a third and sometimes a fourth treatment is necessary depending on your level of joint degeneration. This comprehensive approach stops the destructive joint forces that prevent stem cell therapy from working.


One stem cell injection will usually not fix the problem of chronic inflammation

Medical university researchers in Spain examined the role of systemic inflammation in older adults with osteoarthritis and the factors associated with osteoarthritis progression, pain and functional impairment.(1)

  • Excessive mechanical loading of the joint (wear and tear on an unstable hip, knee or ankle for example) may lead to systemic inflammation by way of stress-induced inability of healing factors to multiply and fix the problems of the joint. (Chronic inflammation being caused by more damage being done than can be healed – a broken “healing cycle”).
  • Therefore, where the cycle is broken, natural anti-inflammatory factors are not being produced, there is an increased production of pro-inflammatory mediators (chronic inflammation).
  • Premature deterioration would result in a lower ability of chondrocytes (cartilage building cells)  to counteract the cartilage deterioration and prevent the progression of osteoarthritis.

The researchers then explained that a wide range of evidence indicates that intra-articular injection of adipose-derived mesenchymal stem cells, alone or associated to growth factors and/or scaffolds, can improve cartilage quality in osteoarthritis and therefore fix the healing cycle.

However, cartilage repair may only be one factor.

Cell signaling or the paracrine effect may have therapeutic potential in the down-regulation of inflammatory and catabolic mediators and exert protective effects by countering inflammatory stress.1 Simply, the stem cells are turning off the systemic inflammation (inflammatory stress) that has not been effective, it is shutting down the disease environment so a new healing environment can be created. Please see The Paracrine Effect and Inflammation in our article on Stem cell therapy for bone repair in osteoarthritis.

In Caring Medical research we published in 2013 in the medical journal Clinical medicine insights. Arthritis and musculoskeletal disorders, (2) we were able to show that ProlotherapyPlatelet rich Plasma Therapy, and in this instance bone marrow aspirate (stem cells and healing factors)  supported chondrogenesis (Cartilage growth and repair) by enhancing the availability of pro-chondrogenic microenvironmental factors. In essence an environmental change from diseased to healing within the osteoarthritic joint by addressing supportive ligament and tendon damage.

This was achieved in our study by a combination of the above treatments.

While treatments based on either stem cells or the other mentioned treatments show effectiveness for osteoarthritis as a stand alone or single therapy, treatments that combine these modalities may be especially promising.


One stem cell injection will usually not get you back to competitive athletics 

People get very expensive one shot stem cell treatments. Then that person is left to basically do whatever activities they want. In our opinion this is money down the drain.

If the athlete/weekend warrior had sufficient cartilage damage that they sought out stem cell therapy, that damaged cartilage was the result of unnatural hypermobile  shearing/rotational forces being exerted on the joint. The one shot of stem cells is trying to patch the cartilage. It is not trying to stop the unnatural hypermobile  shearing/rotational forces.

In our practice we address these unnatural hypermobile forces with Comprehensive Prolotherapy. These are simple dextrose injections with decades of research behind them in the repair of damaged ligaments and tendons.


 

Stem Cell Therapy or Stem Cell Prolotherapy

Stem Cell Therapy or Stem Cell Prolotherapy (SCP) is the utilization of stem cells from bone marrow and fat tissue (adipose) to stimulate damaged tissues such as cartilage, (cartilage repair) ligaments, tendons, meniscus and labrum to repair.

Dextrose Prolotherapy stimulates the cells that are present in the damaged area to proliferate. However, sometimes there is a deficiency of cells or not enough building blocks to rebuild a joint, such as in osteoarthritis or tendinosis and one needs to provide additional cells for healing. Stem Cell Therapy injections provides the new material in the joint. It provides immune cells and stem cells (and other progenitor cells) that can change into healing cells and fibroblasts to make collagen for ligaments and tendons.

 Are you a candidate for stem cells?

In our practice the main reasons people give for exploring stem cell therapy are:

  1. Avoidance of joint replacement surgery because they are fearful of poor outcome or limitation on their lifestyle following the procedure.
  2. The person is more mature in years and fearful of surgery.
  3. The person is too young for joint replacement and he/she is in constant pain and being pain managed until they get older.
  4. Cannot afford the down time in being away from his/her work
  5. High insurance deductibles that will sometimes exceed the cost of stem cell treatments
  6. The person want to remains active in sports
  7. The person had years of cortisone, NSAIDs, and opioids treatments that made their condition worse and are skeptical of surgery.
  8. The are sold on the concept of stem cells

Frequently asked questions about stem cell therapy:

1 Platas J, Guillén MI, del Caz MD, Gomar F, Castejón MA, Mirabet V, Alcaraz MJ. Paracrine effects of human adipose-derived mesenchymal stem cells in inflammatory stress-induced senescence features of osteoarthritic chondrocytes. Aging (Albany NY). 2016 Aug;8(8):1703. Google Scholar

2. Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. Google Scholar

 

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