“Anatomy is to physiology as geography is to history; it describes the theatre of events.”
– Jean Francois Fernel, De Naturali Parte Medicinae Libri Septem, 1592
At the 2013 Annual Meeting of the AAOM, there were some compelling lectures on what may possibly become treatments of choice for difficult conditions such as discogenic back pain (back pain originating from a “pinched nerve” or “slipped disk” in the lower back region), and knee arthritis.
Back pain with associated leg pain is a condition that, first of all, can be very difficult to diagnose because there may be overlapping pain patterns, or pain going down the leg from different sources such as muscle, tendon, ligament, facet joint, or what many people are familiar with as a “slipped disk”. This is otherwise known as the intervertebral disk which acts like a shock absorber between the vertebra of the spine. It is located close to the nerve roots as they come out of the spinal cord which can become “impinged” or inflamed by the disk or its material as it degenerates over time, or from injury.
Common treatments for this condition include epidural steroid injections aimed at decreasing the inflammation on the nerve root, or even more aggressively, surgery is performed to decompress the nerve. Both of these treatments have mixed results, therefore, more recent research has focused on restoring a more normal size and functioning of the disk.
Furthermore, in a study on intradiscal injections to essentially prop up or restore the disk back to its normal functioning anatomy (kind of like re-inflating a tire), Yin and Pauza (Pain Med 2009; 10(5):955.abstract) show a greater than 50% reduction in both back and leg pain at 12 weeks in preliminary studies of this type of treatment. A multi-center, randomized controlled phase III trial is currently underway in the United States, which supports these preliminary findings.
Another speaker, Chris Centeno, MD of Regenexx, presented some “registry data” (a registry is a group of patients followed in time to monitor the effects of a treatment) on stem cell treatment for knee arthritis. While this type of scientific data is limited in its strength in terms of scientific design, patients in the registry reported an almost 60% relief in their knee pain symptoms (www.regenexx.com). An update of this information from the registry is forthcoming this summer according to Dr Centeno. We have better science for platelet rich plasma (PRP) injections for knee arthritis in terms of “controlled trials” as published in: http://www.arthroscopyjournal.org/article/S0749-8063(11)00523-8/abstract
So, what does this mean for patients? Regenerative Medicine as a field is coming up with ways to restore more normal structure and function of the anatomy, as opposed to a surgical option such as “cutting it out or fusing it”. If stem cells go the way of PRP in terms of their scientific study, we will be seeing a paradigm shift in our treatment of degenerative conditions.