For decades now, pain doctors have been injecting steroids around the spine for pain relief from multiple conditions. These include relief of the pain from herniated discs, bulging discs, facet arthritis, and degenerative disc disease.
Do they work? Yes they do. Multiple studies show the benefits of steroid injections for alleviating pain, improving function, and avoiding surgery for multiple painful conditions. However, they are not without their downside.
For example, steroids are a huge anti-inflammatory substances. This is great for pain relief. But the method by which steroids provide pain relief is with cortisone, which knocks out inflammation high on the flowchart of how anti-inflammation works. At this high level on the chart, it also emulates the cortisone that is produced by the adrenal glands and may affect those glands.
If the adrenal glands receive feedback that the body is receiving cortisone from another source, the response may simply be to cut back its own production. When the body cuts back its production, and the steroid wears off, then it may take a while for the adrenal glands to realize it needs to ramp up production again. The body may suffer some deleterious effects while that process is occurring.
Steroid injections have very low side effects overall. However, they may transiently raise blood sugars and cause a small weight gain. This is because although the steroid material is injected into a defined area, that steroid may slowly get absorbed into the blood stream and have that effect. Usually it is mild and transient.
Physicians performing injections are cognizant of these effects and therefore limit the amount of steroid injections given. In the case of an older citizen trying to function and enjoy life, he or she may suffer from arthritis in the spine, knees, hips, and shoulders. If a limit is set at say 6 injections per year, there is no way to cover all these areas. If a steroid injection lasts for 3 months (typical), that one joint will receive 4 injections per year. A typical patient with facet arthritis of the spine will have pain at multiple levels - is that one or two levels going to get injected and suck up all the injections for the whole year?
Clearly there is room for improvement in this area, as limiting treatment based on the "weakest link" being simply too many injections from steroids leads us to the obvious question - Isn't there a better injection substance?
What if a material existed that could have the same (or better) pain relieving effects of steroid injections, however, be non-steroidal? What if that substance also showed promise for cell regeneration, of which steroid doesn't do?
That question is one of the most burning and appropriate questions for interventional pain management. There is a potential revolutionary option for pain management on the horizon and that is... stem cell injections.
Years ago stem cell therapies developed a questionable reputation based on the fetal harvesting. There are ways now to get stem cells without dealing with the fetus or any embryonic origin. For instance, there is a stem cell rich product that is obtained from live willing donors from amniotic fluid.
The stem cell rich injection product is non-steroidal based and anti-inflammatory. The anti-inflammatory qualities come from chemicals called cytokines, which act like a steroid in the sense they alleviate pain, but do not have the steroid side effects. In addition, the stem cell rich injection material is FDA regulated and processed at an ISO certified lab, so all major diseases are ruled out.
The stem cell rich injection material has been used for years in the US over 3000 times successfully so far for spine fusion enhancement, wound healing assistance, and scar barrier around the spinal cord. Pain management is the obvious next step.
So the hope is results for pain relief as good as steroid without the side effects. The real question is, will it help with cell regeneration?
There was a rabbit study looking at this (Im et al, JBJSB, 2001) and the results showed cartilage defects can be enhanced by the implantation of mesenchymal stem cells. Other studies have shown amniotic fluid to have a very safe risk profile for human injections once processed according to the FDA's Current Good Tissue Practices.
If a stem cell rich injection product from amniotic fluid that is FDA regulated actually allows for cell regeneration along with immediate pain relief, the potential is for patients to achieve a longer lasting pain relief effect. Some of the cartilage degradation and defects could be benefitted with the injections, and that would potentially allow for lengthier, lasting pain relief. Studies looking at this are underway, and we will know soon enough.
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