Regenerative Pain Management is an umbrella term which includes Dextrose Prolotherapy, Platelet Rich Plasma (PRP) Prolotherapy and Stem Cell Prolotherapy. These three therapies seek to cure the cause of chronic musculoskeletal pain by reversing damage to and degeneration of connective tissue caused by overuse injury, traumatic injury, or the natural aging process.
Their application includes but is not limited to the treatment of ligament and tendon injuries, joint osteoarthritis, degenerative discs, and muscle defects. They promote repair or replacement of pathologic tissues through the augmentation of natural processes. Although dextrose prolotherapy, PRP and stem cell prolotherapy share similar concepts, the mechanism behind their healable properties differs.
Healthy organisms can heal themselves after injury. Injury to the musculoskeletal system triggers an inflammatory pathway followed by a healing cascade. The majority of healing occurs in the first two months during which the body produces growth factors to stimulate the growth of new tissue. If healing is not complete after this period, there is decreased blood flow locally, compression of nerve endings, and accumulation of metabolic waste. Normal connective tissue develops into scar tissue. Nerve receptors compressed by scar tissue begin to repeatedly fire pain signals which can cause chronic pain syndrome.
This poor healing leads to lax ligaments or joint capsules because of insufficient tensile strength. Stretched ligaments cause corresponding joints to become unstable. The result is compensatory muscle spasm to stabilize weak joints. Arthritis is degeneration of joint surface tissue secondary to macro or microtrauma. Damaged and degenerated ligaments, tendons, muscles, and joint surfaces cause pain, dysfunction and instability of the spine and/or joints.
Regenerative Pain Management tries to restore health to these compromised tissues to decrease pain and improve function.
Syndromes Considered for Treatment with Regenerative Pain Management
- sprains and strains;
- tennis and golfer’s elbow;
- back pain;
- neck pain;
- headaches (except true hormonal headaches);
- sports injuries (tendonitis, rotator cuff tear, torn meniscus, iliotibial band syndrome etc.);
- repetitive and overuse injuries (carpal tunnel syndrome, TMJ syndrome, etc.);
- plantar fasciitis; and
- joint arthritis (shoulder, hip, knee, etc.).
To summarize, regenerative pain management’s principle interventions are Dextrose Prolotherapy, Platelet Rich Plasma (PRP) Prolotherapy and Stem Cell Prolotherapy. Regenerative pain management seeks to incite the body’s healing abilities to cure the cause of pain. It attempts to regenerate normal tissue, decrease pain, and improve function. It has the goal of inciting repair or replacement of diseased tissues through the amplification of natural processes.
Tania Faruque MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).
- DeChellis D, Cortazzo, M. Regenerative medicine in the field of pain medicine: Prolotherapy, platelet-rich plasma therapy, and stem cell therapy – Theory and evidence. Techniques in Regional Anesthesia and Pain Management. (April 2011), Vol 15, No 2, Pages 74-80.
- Alderman D, Alexander R. Advances in Regenerative Medicine: High Density Platelet-rich Plasma and Stem Cell Prolotherapy For Musculoskeletal Pain. Practical Pain Management. October 2011, Pages 49-63 and Page 90.
- Caplan AI. Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Physiol 2007, 213:341-347.
- McJunkin T, Lynch P, Deer T, Anderson J, Desai R. Regenerative Medicine in Pain Management. Pain Medicine News Special Edition. December 2012, Pages 35-38.
- Crevensten G, Walsh AJ, Ananthakrishnan D, et al. Intervertebral disc cell therapy for regeneration: mesenchymal stem cell implantation in rat intervertebral discs. Ann Biomed Eng. 2004;32(3):430-434.