Your body has been healing itself since you were born. It’s how you’ve recovered from colds, closed up cuts and even built new muscles. Now, doctors are using the body’s own repair cells to treat chronic joint and back pain through a practice called regenerative medicine, a type of stem cell therapy.
How does it work?
According to Ryan Szepiela, MD, ProMedica Physicians, it all starts with the mesenchymal stem cells in your bone marrow. These natural healing cells have the ability to differentiate into various types of cells, including bone cells, cartilage cells and muscle cells. When relocated to an injured or degenerative spot in the body, they can adopt the work of area cells and spark the natural healing process.
“If you put these cells into the brain area they can become nerve cells. If you put them into the joint area they can become cartilaginous (cartilage) cells,” explained Dr. Szepiela. “They are cells that are ready to differentiate into whatever is needed to repair as damage occurs.”
You can find these helpful stem cells in various locations in the body, but the iliac crest, at the top of your hipbones, is where Dr. Szepiela and the other doctors with ProMedica Regenerative Medicine retrieve them for injections. In the studies they’ve done, they’ve found that this area leads to a higher amount of mesenchymal stem cells.
While fat cells are easier to retrieve than bone marrow cells, the stem cell counts tend to be lower. Plus, the fat cells aren’t as good at adopting the work of cartilage cells for repair.
“With what we’re trying to do at the musculoskeletal level, trying to promote healing inside of the joints and produce cartilage, we don’t see that same level of production and healing with fat cells compared to bone marrow stem cells,” said Dr. Szepiela.
Stem Cell Extraction and Injection
A local anesthetic is all that’s needed for the procedure. Dr. Szepiela said patients are usually surprised when they are done that the cell extraction is over.
After the cells are extracted, the mesenchymal stem cells are isolated in the lab just across the hall. And, it’s all done by hand to ensure that the no cells are damaged or lost during the process. The stem cells are also counted so that the physicians can record exactly how many are injected.
And when they are injected, fluoroscopic (e.g., ultrasound) guidance is used to get these healing cells exactly where they need to go. If injected in the wrong spot, the stem cells won’t be able to repair the damaged area. In fact, this precision is key to regenerative medicine.
“In order to differentiate, these cells need to be placed under guidance directly into the joint, nerve or disc that is breaking down,” said Dr. Szepiela. “Our goal is for these cells to go into repair and actually differentiate into the specific type of cells in the damaged area.”
A Healthy Balance of Breakdown and Growth
Regenerative medicine also helps create what Dr. Szepiela calls “homeostasis in the joint,” or a healthy balance of breakdown and growth.
“Every area of your body undergoes continual transformation,” said Dr. Szepiela. “Even your bone cells are continually turning over where you break down bone and form new bone.”
The problem is when you have more break down than growth.
“As you get further damage, you get more breakdown than you get formation. It’s hard for these areas to get those healing cells naturally to repair,” explained Dr. Szepiela. “That’s what we’re trying to turn around.”
Sometimes the damage is beyond what can be helped with regenerative medicine.
“We look at imaging to make sure you’re a good candidate,” said Dr. Szepiela. “If we don’t think stem cells will help, then we’ll tell you that right up front. Our desired outcome is the patient’s desired outcome.”
To date, ProMedica Regenerative Medicine has seen more than 1,000 patients for patients with chronic pain in the knee, shoulders, elbows, thumb joints and back. Unlike steroid injections, the benefits of regenerative medicine are not immediate and then “wear off”.
“When the stem cells are no longer active, the patient keeps the improvement they’ve gained. They just don’t gain anymore,” said Dr. Szepiela.
Typically, it takes about six weeks for the stem cells to generate healing and growth into the area and for patients to feel the difference.