Regenerative Interventions For Pain And Musculoskeletal Dysfunction

By Author: Dr.Tushar Munnoli
Total Articles: 10
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Dr.Tushar Munnoli
Spine and Pain Specialist
Associate Consultant, IPSC Bengaluru
Pain Management Specialist

What is Regenerative therapy?
Regenerative medicine may be defined as the process of replacing or "regenerating" human cells, tissues or organs to restore or establish normal function. This exciting field holds the promise of regenerating damaged tissues in the body by replacing it or by stimulating the body's own repair mechanisms to heal tissues or organs.

What are the types of regenerative therapy for musculoskeletal conditions (Arthritis/Sports injuries)?
There are various types of Regenerative therapy:
1) Stem cell therapy
2) Platelet rich plasma (PRP) therapy or Growth factor concentrate therapy.
3) Prolotherapy.
Although these are different cell-based therapies, basic concept remains same – Regenerating or repair of damaged tissue.

What is the best type of regenerative medicine?
Not all regenerative treatments may be effective in relieving pain and/or dysfunction, and the decision is influenced by several factors, including the ...
... nature of patient’s condition, the location of pain, the degree of injury/tear and other underlying medical conditions.
The Interventional Pain and Regenerative medicine specialist at IPSC India evaluate patient’s acute or chronic pain condition, and prior medical history to determine which regenerative treatment option is best for them.

Who Is a Good Candidate for regenerative medicine therapy?
Anyone who suffers from Chronic pains and dysfunction due to age or injury can be a candidate for regenerative therapy.
Patients with:
 Ligament or tendon injury (rotator cuff partial tears; ligament sprain and partial tear; plantar fasciitis; tendinopathies like Tennis elbow, Achilles tendinopathy)
 Osteoarthritis or other joint problems
 Suffer from torn or worn cartilage
 Resistant to other non-invasive treatments, like physical therapy or medication
 Want to explore options that might help avoid or delay joint surgery
 Want to potentially improve healing following a surgical repair or procedure.

How does the regenerative medicine therapies work?
In earlier days for chronic musculoskeletal pain the traditional treatment included NSAIDs - Pain killer medications, Steroids - which would primarily focus on symptom management and thus masking the pain, waiting for an eventual surgery. Whereas regenerative medicine works on treating the source of pain.
Regenerative medicine therapies contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing in the treated area. The PRP solution or stem cells or prolotherapy is injected into the target area, such as an injured knee or a tendon, these stimulate or speed up the healing process, shortening healing time for injuries, and thus decreasing pain.
How long does it take for regenerative medicine to work?
Most people start to experience initial improvements within a few weeks after their treatment. The complete repair process inside the joint takes a bit longer — typically a couple of months.

How many procedures/sessions are required to see the benefits?
The number of Regenerative sessions vary and is influenced by several factors, including, the degree of injury/tear and region of the body.
Although usually, 1 session of Stem cell therapy or 3 sessions of PRP/Prolotherapy are required for wear and tear conditions like Arthritis. Whereas, ligament or tendon issues single session may suffice.
What are the side effects of Regenerative medicine?
Side effects are very rare with these interventions if administered by a trained specialist with help of image guidance.
The most common side effects are the same effects anyone might have with any type of injection — swelling, bruising and tenderness around the injection site. All of these possible side effects resolve within a few days to a week or so.
How long does stem cell therapy last?
That depends in part on the treatment site, the extent of the underlying injury, patient’s health and activity level, and other factors. Generally, the benefits of regenerative medicine for joint repair can last for a year or longer. If regenerative medicine therapies are complemented with physical therapy/exercises and rehabilitation the patients might benefit for years. In some cases, patients may have additional injections to extend those effects.
How the pain specialist doctor administers the stem cells/PRP/prolotherapy at the target location?
All procedures at IPSC are performed by expert interventional physicians using ultrasound guidance, fluoroscopy (real-time X-rays), or both to guarantee that we’re delivering cells into the precise location of your injury. Image guidance means that the doctor can see where the needle is going. Using these image guided techniques not only improves the procedural results and patient comfort, but also prevents potential complications.

Does Regenerative therapies need hospitalisation or Anaesthesia?
No. Usually, it is a day care procedure and done under local anesthesia. At IPSC: Pain and Spine hospital, we use ultrasound to localize the damaged tissue. This adds to the accuracy of the procedure and higher success rate.

Is the Regenerative medicine treatment allowed to be practised in India?
The government of India has heavily promoted research and development in regenerative medicine. In September 2022, StemOne – a cell therapy product for Knee Osteoarthritis was also launched after receiving a regulatory approval from the Drugs Controller General of India (DCGI) for the product.
Platelet rich plasma (PRP) therapy or Growth factor concentrate therapy are derived from patients own blood and hence these are not considered as drugs. The DCGI and FDA agencies have not initiated any rules or regulations for PRP preparation or providing therapy. Research for the different applications of PRP is promising and rapidly growing. Although the equipment used to produce PRP and the injections themselves has to be cleared by the FDA.

What is the role of regenerative cell therapy in Sports injuries?
Sports injuries may entail the repairing or replacement of damaged tendon, cartilage, and ligament tissues. Regenerative medicine is of particular interest in the treatment of sports injuries, as historical and recent evidence increasingly refute the commonly used treatments of anti-inflammatory medications and corticosteroid injections. The use of regenerative treatments using a patient’s own stem cells and growth factors to heal damaged tissues, in conjunction with aggressive/ comprehensive rehabilitation, may maximize the nonsurgical treatment of these various sports injuries. Another advantage of these techniques is that they don’t require a prolonged post-procedural recovery period. A patient can return to their daily activities in a short time. That is why regenerative medicine is ideal for athletes who cannot afford to stay out of sports for longer than several weeks.

Are stem cells allowed in India for Knee arthritis?
Drug Controller General of India (DGCI) had seven products of stem cell medications. Recently, September 2022, DGCI approved StemOne for Knee Osteoarthrtis. It is the first allogeneic cell therapy product to be approved for commercial use in India for Knee OA. The treatment comprises of a single intra-articular injection of StemOne in an outpatient procedure with no anaesthesia requirement.

Is regenerative therapy covered by insurance?
Certain companies do cover PRP, though, the coverage depends on the condition or injury being treated. Most insurance providers do not cover it. Clinics/Hospitals that offer PRP consider it a “fee for service” type of treatment.