Regenerative Medicine

Stem Cells or Platelet Rich Plasma (PRP)

Regenerative medicine, or the use of biologics such as stem cells or platelet rich plasma (PRP), is an exciting and new treatment option to treat a multitude of chronic pain complaints including:

• Disc degeneration
• Joint pain
• Tendon-related issues

Regenerative medicine therapies, in combination with diet optimization, and a focused post-treatment rehabilitation program give patients the best chance for long term pain reduction and improved function. While regenerative medicine is a newer branch of medicine as it relates to treating chronic pain conditions, there are numerous studies showing encouraging results with the use of stem cells and PRP for repairing tendons, osteoarthritis, and the intervertebral disc. The goal of regenerative medicine therapies is to postpone and, in some cases, eliminate the need for more invasive surgery.

Regenerative Medicine: Stem Cells

Stem cells are precursor cells that release growth factors and can differentiate into more specific cells. Mesenchymal stem cells (MSCs) have gotten the most attention in spine and orthopedics because of their ability to turn into cells that make up cartilage, tendons, intervertebral discs, and bone.

Where do stem cells come from?

Stem cells are classified as either autologous, meaning they are from your body, or allogeneic, meaning they are taken from another person, or donor. When stem cells are harvested from your own body, they are typically taken from bone marrow or adipose tissue (fat).

Harvesting stem cells this way has a few problems, including:

• The number of stem cells is reduced as we age
• Certain medical conditions can also reduce the number of stem cells you have
• Good information regarding how many stem cells can be harvested from a patient is still lacking
• The procedures for harvesting stem cells from bone marrow and fat can be invasive and painful

For this reason, we prefer to use an allograft, or donor stem cells, called Wharton’s Jelly as our source of stem cells of injections. Wharton’s Jelly is a gelatinous substance found in the umbilical cord. In utero, it functions to protect the umbilical vessels. Research suggests that Wharton’s Jelly is rich in mesenchymal stem cells (MSCs), growth factors, and even hyaluronic acid. The Wharton’s Jelly product we use is harvested and donated from full-term healthy babies and has undergone a rigorous screening process to assure quality and safety. This Wharton’s Jelly product is frozen and stored onsite at the Denver Spine and Pain Institute. Prior to injection, it is thawed, mixed with saline, and injected into the targeted tissue using either ultrasound or fluoroscopy (X-ray). While some of the cells are lost in the thawing process, data suggests there are still approximately 760,000 viable stem cells per cc of Wharton’s Jelly.

The Role of Diet with Regenerative Medicine Therapies

The adage “you are what you eat” is especially true with regards to wound healing and tissue repair. The goal of proper nutrition is to reduce breakdown and promote building of new healthy tissues. As the body heals, it has increased nutritional demands, and will therefore need more nutrients to complete the healing process. Important components of proper nutrition include:

• Protein, which is the most important aspect of your diet when healing from a wound. You should aim to get 3-4 servings of protein per day.
• Essential fatty acids, or EFAs, provide additional energy for the healing process as well as components of cell membranes that are vital for cell function and structure. Omega-3 fatty acids have powerful anti-inflammatory effects, and for this reason we suggest them as an important part of pain management diet. Healthy fats should make up 20-25 percent of your total caloric intake. Healthy sources of EFAs such as omega-3s include flax seeds, almonds, avocado, salmon, and almond butter.
• Carbohydrates are an important energy source, because they prevent the use of nutrients such as protein to be used for energy. They also play an important role in cell signaling and wound healing. Sources of healthy carbohydrate include whole grain cereals, bread, brown rice, and whole grain pasta, as well as vegetables. Avoiding processed grains or sugary foods is also important in reducing inflammation. Healthy carbohydrates should constitute 55-60 percent of your total caloric intake to assure adequate energy stores as well as to spare valuable proteins that are needed during the healing process.

Vitamin C, manganese, and zinc are all important in the production of collagen. Vitamin A has anti-inflammatory affects and Vitamins B6 and E have also been linked to tendon health. Vitamin D also has an inti-inflammatory effect.

What can I expect after my injection?

Typically, you will be put in an immobilization brace for two weeks post procedure. You will then start a physical therapy program that is specific to your condition. You will have routine follow up with our providers to make sure you are making progress, both in pain reduction and improved function.