Proposal: A 5-Year Study of Best Methods to Treat Intractable Pain


.

.

.

PROPOSAL

.

A controlled trial to improve care for chronic pain:

The study to understand prognoses and preferences for

outcomes and risks of treatments

.

..

 

..

Model after Joanne Lynn’s 1995 SUPPORT Study

.

A controlled trial to improve care for seriously ill hospitalized patients:

The study to understand prognoses and preferences for

outcomes and risks of treatments (SUPPORT)

.

.

Proposal

 .

A controlled five-year trial to improve care for outpatients with chronic pain. The study will be designed to understand prognoses and preferences related to the outcomes and risks of various treatments.

.

The focus:

.

Intractable pain, those who have failed pain medications and procedures or those with moderate to severe pain who only partially respond.

.

Study polypharmacy, compare medications that may show synergy or that additively improve relief.

.

Study and search for glial modulators – medications that reduce proinflammatory cytokines.

.

.

Problem

.

Research is needed to give persons with intractable pain the data and the confidence that they can affordably use to choose the best treatment needed to get their lives back again. They have already spent tens of thousands. They may be unable to work. We all need these options.

.

There are a few small islands in this country doing a radical experiment in managing pain without opioids [narcotics, the police term] as discussed in the New York Times in May 2014, and the 2008 Mayo Clinic study. Efforts such as these need to be supported with data as soon as possible in order to reduce the burden of disability and pain in our society, especially our youth, our children, our veterans, our aging seniors, well everyone. We can be productive and we want to be.

.

I have seen remarkable outcomes, pain that failed to respond to all known pain medications, going into partial and even total remission, lives restored after weaning off opioids and appropriate treatment given.

.

We cannot expect any medication to work every time. How often can we achieve better results after opioids are tapered off? Opioids may prolong pain in Complex Regional Pain Syndrome where remission seems possible only after they are stopped, yet opioids may be essential in many forms of chronic pain. We need data on the radical experiment to manage pain without opioids, and determine how best to manage chronic pain with them.

.

Opioids have a long history of being the drug of choice to treat chronic intractable pain by doctors who lack information and training about other exciting options now coming to the fore. Compounding the problem is the fact that physicians do not know how to diagnose musculoskeletal pain and do not know how that good physical therapy is actually effective.

.

Healthcare providers need data about all the options to begin to address the toll that chronic intractable pain exacts and government worldwide need to know what is cost effective and possible. Many countries cannot obtain opioids.

.

We must not be insensitive to the financial burden that frustrates patients when they spend tens of thousands of dollars for drugs that provide little if any benefit.

.

Investment in developing nonopioid treatments for pain does not even begin to compare to the investment in opioids for pain. The few medication choices we have are not enough. Often they fail to help. Expensive drugs are not the best choice if they are not affordable or they are limited to diabetic neuropathy when more than 100 types of peripheral neuropathy have been identified, plus many more types of even more severe neuropathic pain not classified as neuropathy. Shall we continue to ignore all those because FDA has classed these few new drugs for diabetic neuropathy exclusively?

.

Let me be clear, prescription of opioids is justified and they are valuable. Opioids are on the World Health Organization list of ten essential drugs. BUT there is little or no research on treatment of intractable pain without opioids.

.

Neuropathic pain, nerve pain, is the most difficult to treat. Neuropathy, radiculopathy, transverse myelitis, adhesive arachnoiditis, central pain, RSD, Guillain-Barre, trigeminal neuralgia, Tic Douloureaux, post herpetic neuralgia, to name a few. It is not enough to limit research of neuropathic pain to diabetic neuropathy when it fails to address all other causes. When FDA approves a drug only for diabetic neuropathy, insurers deny the drug for the other 95% of you without diabetes. Insurers may choose to read guidelines as mandates, fiats,  marching orders.

.

Neuropathic pain is not the only concern. Physicians do not know how to diagnose musculoskeletal pain. How can they if only 3% of medical schools teach pain management and when doctors do not know how to assess ineffective physical therapy when they have never seen better.

A patient dislocated her hip 7 times, manually repositioned each time in ER. The 6th surgeon impinged a wide band of muscle in the joint causing muscle all down the thigh to bulge 5 to 7 mm high, of rock hard spasm with intense relentless pain. The 7th surgeon had the gentle ability to restore position and release the entrapment. A light touch across the thigh even through clothing can detect the cause. Would a surgeon have discovered to release the entrapment unless she had dislocated a 7th time? Simple muscle strain, undiagnosed by a surgeon who deals with muscle all the time, was not even noticed and he ignored the acute pain it caused. She has now learned how to avoid dislocating that new hip. Had the muscle not been appropriately identified as cause, she would not be able to move by now. But the surgeon should have had the skills to notice instantly before those muscles became chronically strangled. She was referred for manual physical therapy and thankfully, before all else could occur, she dislocated and was repositioned by the 7th surgeon. A wonderful teaching case for a teaching hospital that should be every hospital. Grand Rounds for pain cases.

.

.

MAJOR FUNDING DECLINE IN PAIN RESEARCH

.

 BEFORE 2008

.

 BEFORE CONGRESS CUT NIH BUDGET BY UNTHINKABLE 30% IN 2010

.

Perhaps the biggest impediment to gathering data about pain management is the lack of government funding for pain research and lack of a Pain Institute at NIH. If not, funding will continue to be fragmented and split elsewhere, not to learn about one of the most costly problems in every society.

.

In 2008, before the worldwide depression, pain research was in major decline. The AAAS, the American Association for Advancement of Science told us then:

.

“Federal funding for pain research is declining sharply, more than 9 percent a year since 2003, according to a new study published in The Journal of Pain. Pain research, as a result, now accounts for only 0.6 percent of all grants awarded by the National Institutes of Health (NIH), despite the high prevalence of chronic pain in the U.S.

.

“This startling finding shows the government’s meager investment in pain research is seriously out of proportion with the widespread chronic pain incidence in our society, which is estimated at one in four Americans and accounts for more than 20 percent of all physician office visits,” said Charles E. Inturrisi, president of the American Pain Society and professor of pharmacology at Weill Cornell Medical College, New York. “And this disparity is not attributable to years of budget cuts at NIH because the Journal of Pain study clearly shows pain research has a higher percentage decline than the overall NIH budget. So the drop in agency funding has not affected all research areas equally.”

.

[emphasis mine.]

.

Research in pain was sharply declining prior to 2008. Then a 30% cut across the board in 2010. Thank the American Pain Society for those ancient 2008 figures. No one had ever asked – which is why we need a Pain Institute at NIH.

.

Frustration is compounded the last few years by insurers no longer willing to authorize many opioids and non-opioid medications, even generics.

.

As for the cost of opioids,  a single opioid for one patient may exceed $80,000 per month when the patient is required to use with another long acting opioid, and often several nonopioid adjuncts just to bring pain down from 9 on scale of 10, to a slightly more bearable 7 or 8 which is severe, relentless and prevents sleep and ability to concentrate. One drug that costs pennies to make, sells for $80,000 a month to allow 4 a day when at least 6 a day are needed and it is only one of many for pain every day.

.

Prescription of opioids is justified and may be invaluable.

but there is little or no research on

 treatment of intractable pain without opioids.

.

 

.

We need national consensus guidelines based on data

.

We must do a better job treating intractable pain. We need guidelines that have more to offer than the few opioids and few adjuvants we now have, so few in number, so great the need. Can we know when is it true that opioids are indicated? Our use is many times more than all the other First World countries?

 

.

Treatment must be individualized

.

Data is needed to guide choice

.

.

Compounded Medications are among the

most useful drugs we have for treatment of intractable pain

.

Compounded medications may be the only ones that help, and can reduce pain to zero. We can re-purpose the delivery of any medication, as long as it has been FDA approved. But the last few years insurers have been discontinuing coverage for compounded medications and Medicare has never covered them.

.

This must change. Who is funding that political blockade that denies coverage for compounded medicine? The cost may be $120 for one compounded medication vs $80,000 for one opioid. Either way, the person with intractable pain likely needs 3 or 4 or 5 or 6 medications, compounded or not. Who can afford $400 per month out of pocket for compounded medications that work, when insurance will not cover the affordable drugs. Who can afford that out-of-pocket expense if insurers cover nothing for your pain, neither the bright shiny opioid or the compounded sprays, capsules, suspensions, creams, troches, as well as the essential solutions instilled into the bladder for interstitial cystitis?

.

This must change. Lawmakers must be called to account for allowing and perpetuating the inhumane taking advantage of those who suffer intractable pain.

.

A first step in getting lawmakers to pay attention is to amass a body of compelling data.

.
.
BALANCE IS NEEDED

..

The United States as a society cannot afford for pain research to die and go bankrupt and leave only opioids as the standard treatment for hundreds of types of pain. Someone has to begin the needed studies. It does not just bankrupt the patient, it leaves us all bankrupt, the country most importantly. It ends marriages, tears apart families. To be struck down as a child with intractable nerve pain the rest of your life, or be struck in your prime, is devastating. And disability gets routinely denied for pain. Why? Perhaps because pain is taught in only 3% of university medical schools. How are doctors to imagine that pain can end lives when they have no experience seeing how disabling it can be?

.

.

 If doctors cannot see the devastating toll that pain takes,

how can we expect accountants to see it?

.

.

.

The Study We Need

.

Solution

.

 To gain a comprehensive and compelling picture of how pain impacts the population and how to effectively treat it we need a large-scale study:

 .

  • Five years in duration

  • 10,000 outpatients – statistically this must be adjusted to obtain multiple outcomes

  • At five major university teaching hospitals for regional differences

.

 Outcomes

.

The study will yield important information about the following:

..

  • Efficacy

  • Pain Numeric Rating Scores, Percent Improvement

  • Functional Improvement, etc

  • Compounded medications

  • Racial and Gender Disparities

  • Addicts who have chronic pain

  • Top notch manual physical therapy* [see below], not for what passes in most places. This must change ASAP. United States is far behind other countries. Even if the condition is neuropathic, it often becomes musculoskeletal after splinting for months, years

  • Interventional procedures

  • Meditation

    How you brain can heal your body and your body heal your brain.

  • Pain changes DNA, neurotransmitters. Have we permanently changed them with opioids?

  • Polypharmacy. When employing one drug alone is unlikely to lead to a successful outcome.

  • Stem cells for joint pain – autologous lipid derived mesenchymal stem cells

  • rTMS, experimental after 20 years, is it still better for acute than for chronic pain?
    Who will benefit, for how long? How many weeks of relief for that $15,000 investment?

  • Glia, the Innate Immune System

Opioids create pro-inflammatory cytokines that create pain and opioid tolerance.

Restore cytokine balance, reduce inflammation and pain.

Which of our existing medications either trigger or reduce inflammatory cytokines in the CNS?

  • Pain in the person with Alzheimers dementia

  • Danger of combining opioids with benzodiazepines

  • Danger of long term use of opioids (regardless if short or long acting)

  • Appropriateness of using opioids as a first choice in acute pain (loss of a milk tooth, sore throat in a teenager, acute back pain, ankle strain, etc.)

  • Appropriateness of opioid holidays.

  • Post op pain can be avoided completely with combined use of oral low dose naltrexone and ketamine IV anesthesia. Patients discharged directly from recovery room with no need for pain medication for months or years

  • Cost Benefit Analysis

 

.

Five Conditions Will Be Studied

.

Strong emphasis must be placed on neuropathic pain that so often fails to respond to any intervention

.

1. Complex Regional Pain Syndrome

The Netherlands invested €25 million over 5 years to study this one devastating pain condition, far out of proportion to the incidence in that small country. There are pain specialists who cannot recognize it and/or doctors who routinely deny disability for this devastating pain, like death in life.

.

2. Low Back Pain

Define criteria for surgery.

If we wait too long before surgery is done, will we ever reverse the chronic pain that has set in?

Have we condemned that patient to monthly visits for opioid the remaining 50 years of their life?

.

3. Other neuropathic pain conditions such as adhesive arachnoiditis, trigeminal neuralgia, transverse myelitis, Tic Douloureaux, Post Herpetic Neuralgia, Interstitial Cystitis, Vulvodynia, Proctalgia, Pudendal Neuropathy


4. Painful peripheral neuropathy nondiabetic and Painful Small Fiber Neuropathy  all forms of painful neuropathy

.
5. You choose – central pain?

.

.

.

What We Must Do Now

 

.

  • Find a pain advocate like the cancer advocate of the 1950’s that changed attitudes for research

  • Fund the pain SUPPORT study

  • This will spin off enormous research ideas that we must begin separately to implement with research as each develops, the need is beyond urgent. How many more years can we make everyone wait?

  • Write letters, to congress, the White House. Real letters, not email, not signature lists. Congress will not hear us unless we speak in very, very large numbers.

  • Help the topic of intractable pain become a part of the 2016 presidential conversation.

  • Incentivize teaching hospitals to teach pain management and to develop options for nonopioid treatment of chronic intractable pain. Pain is a multidisciplinary field, not limited to Anesthesiology procedures.

  • Create an Institute for Pain Management in addition to the 28 institutes at NIH, three of which are for addiction, none for pain. Pain is the number one reason people seek medical help.

  • Require that pain specialists sit on the FDA advisory committees for pain medication – none recently.

  • Require insurance coverage for compounded medications.

  • Prevent FDA from limiting medication to cancer pain.
    Cancer pain does not exist.

    There are basic types of pain that occur in persons who have cancer, neuropathic pain being worse than other forms of “cancer pain.” It has the same medication response or failure to respond as persons whose pain is not due to cancer.

  • How do we restrict the use of opioids to severe pain when there is nothing else to offer and after everyone is started on opioids by their family doctor years before they see a pain specialist?

  • Novel and ancient methods for treatment of pain should be explored including cannabis and possibly hallucinogens

  • Isolation of pharmacologically important medicine from rainforest and deep seas must be done before they disappear.

.

.

Physical Therapy is the #1 Key to Chronic Pain

.

Manual Physical Therapy was introduced to the United States in the late 1970’s but is rarely practiced or not done well. It does not mean “hands on.” It derives from techniques brought to us by British Commonwealth and Scandinavian countries. Our healthcare providers do not know how to differentiate between good and useless practices. Fortunes and lives are wasted hinging on that distinction. Pills never can undo the harm brought about by common musculoskeletal issues – and our providers have no training in recognizing simple muscle trigger points, let alone intractable connective tissue contractures. My patients have been misdiagnosed as histrionic, drug seeking, personality disorders, and worse. It boils down to ignorance and lack of basic training, let alone believing what the patient says and not having the tools to help.

.

The trend is for year long residency programs following the 3 year Doctorate of Physical Therapy (DPT).  The year long residency program is a very positive step.  The limitations are that it is a year with a clinical staff that may have a specific perspective.  The push towards evidence based practice is a reasonable step but should not exclude considerations of outside the box treatment options.

.

The osteopathic manipulative technique has been a cornerstone of best education for physical therapists.  The craniosacral approach is an offshoot from that tradition.  When we get to visceral mobilization, the evidence is much harder to produce but that does not have me shy away from its application.

.

Movement is critical for the hormonal regulation of the body.  Chronic stasis leads to numerous changes that compound an underlying medical diagnosis.  We see that with a 16 y/o female, Lyme’s disease, CRPS diagnosis, bedridden for years.  She is significantly benefiting from stretching dysfunction and improving axial extension.  Another who quit walking had global lower limb connective tissue contracture.  Walking is currently limited by soft tissue contracture through the tarsal tunnel, affecting the plantar nerves and the burning and tingling with walking greater than 5 minutes at a time.  Mobilizing the soft tissues will ultimately restore function. This 20 year old quit college due to pain and one first visit requested motorized wheelchair and Social Security Disability. This young person will walk again.

.

There is no end point to this educational process except when we think we know it all.  No certification, no degree, no one course signifies competency.  Ongoing intellectual curiosity is the most important element in preparation.

.

Prescription painkiller overdose epidemic in the U.S.

Not in other countries

.

Pain Management centers at major universities closed in 1991. They lose money, are time consuming, require team conferences that are not reimbursable. Thus began the era when prescription opioids took off for noncancer pain, and no one was generating nonopioid approaches to chronic pain. Anesthesiologists shifted to procedures – that is their focus after all. Procedures are not applicable to many types of pain.

.

“Since 1999, the amount of prescription painkillers prescribed and sold in the U.S. has nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report.”

from the CDC report of prescription painkiller overdose epidemic

.

 

I feel I have failed when I have to point out to my own patient whose pain is severe, that the high dose opioid I have prescribed is not helping, or is creating pain; when I know there are other options which are not available because the FDA has not approved them or because they are prohibitively expensive. I have failed when so many medications I prescribe are not on the formulary.

 

We need a mandatory formulary available for those with intractable pain.

.

There were 16,651 deaths from prescription opioids in the U.S.in 2010, “Starting with 4,030 deaths in 1999….” “…nearly 60 percent of the drug overdose deaths (22,134) involved pharmaceutical drugs. Opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths (16,651).” It’s far higher now. A CDC report stated that one in every 20 U.S. adults has a history of [opioid] use – not abuse, but use.

.

Monitor risk, yes, but that should not get all the investment. Many addicts would not be there if there were better treatments for pain, if they had not been given opioids after a minor procedure or injury that is better treated with real therapy, not drugs.

.

People with pain do not mention the pain has taken their lives. We may see them as weak. That young child with fractures on the ball field is going to need the best care so pain does not become chronic. Give him or her opioids and opioids cause pain, pain becomes worse, intractable before the 6th grade. That is not an addict, but that child and his or her parents are often treated like addicts, at least with suspicion, drug seeking. What is best for that child with chronic pain when she becomes pregnant? When nursing? Think of our young veterans, some with 3 or 4 different pains, and each type addressed differently. What if either of them was an addict before the pain? If we don’t treat them, they will turn to drugs. What are the best, most efficient, options for treatment of intractable pain? When will we learn? We need to identify and treat before it becomes chronic.

.

Chronic pain can be reduced or eliminated in many situations now even possibly without drugs, provided the issue is properly identified – and that will never happen until providers are educated in how to identify first class physical therapy. Further research will help to release persons with intractable pain from the prison that too often makes them feel that life is unbearable and that they can more easily face death. We all need to wake up to this situation.

.

If we continue to passively allow nothing to be done, then there may be nothing to help us when we fall into the sudden bind of intractable pain when we wake up one day with shingles or a pinched nerve or when pain of the face prevents us from eating or sleeping or speaking or even wanting to live. It will be too late.

.

Sharp like a razor’s edge is the path,
The sages say, difficult to traverse.

.

Shall we let those we love hang on the edge while we fail to move this multi-tentacled monster forward? How do we light the fire that enables us to solve this fearful fragmentation of choices?

.

 

 

See how beautifully it works when the right combinations are brought together?

.

Yellow rose blue hibiscus

 

 

.

.

.

.

.

.

.

.

The material on this site is for informational purposes only.
.
It is not legal for me to provide medical advice without an examination.

.
It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~
This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

Please ignore the ads below. They are not from me.

.

.

.

.

.

.

.

Stem Cells from Your Own Fat Tissue for Osteoarthritis of Knee and Hip


.

Human Adipose Tissue Is a Source of

Multipotent Stem Cells

.

Molecular Biology of the Cell
Vol. 13, 4279–4295, December 2002

.

Although “… its application in vivo is necessary, the results presented in this study suggest that adipose tissue may be another source of pluripotent stem cells with multi-germline potential.”

.

The abstract below, from a 2002 publication out of UCLA, appears to be the start of the research into stem cell injections of joints that I came to receive four months ago.

.

My fat was taken behind my back via quick liposuction by a highly qualified plastic surgeon and the aspirate was handed over to the orthopedic team. It remained in a fully enclosed system that isolated my own stem cells with their growth factors and PRP (platelet rich plasma) and then, under strict ultrasound guidance, injected into both knees and right hip. I am speaking of stem cells for osteoarthritis of joints, not for autoimmune disease.

 .

This is not covered by insurance; it is not an approved procedure. The injections were my own self-funded research in medicine and the trust of my orthopedic surgeon. Of course I interviewed others who had had the injections. There was so much potential to gain and I have benefited greatly.

.

In my decision to receive injections, I decided I’d rather invest in my own self-funded research than to take time from work for total hip replacement, and someday total knee replacements. Then revisions of those surgeries in another 15 years. I chose instead to receive injections of my own stem cells into these joints. The work was done by The San Diego Stem Cell Treatment Center that is an affiliate of Cell Surgical Network. The group consists of some of the country’s finest orthopedic surgeons in a few private clinics across the country who are working to do this clinical research. The San Diego Center is headed by Peter B. Hansen, MD. who has one of those rare CV’s, an ideal CV. Local boy, first in his class, chief of service, chief of staff, voted best in San Diego by peers. Similarly, the CV’s of the orthopedists who head the other centers across the country, anyone can easily see they are among the best.

.

Some of us are conservative with our patient’s care, but we will risk for our own lives for a reasonable cause. In the interest of medicine, and, in my case because all surgery has risks, I decided the unknown risk of stem cells. The other option, since I may live another 30 years, was total joint replacement in hip and knees, followed by how many revisions that will have to be made in 15 or 20 years, at what risk again and again?

.

Authors

.

Patricia A. Zuk,*† Min Zhu,* Peter Ashjian,* Daniel A. De Ugarte,* Jerry I. Huang,* Hiroshi Mizuno,* Zeni C. Alfonso,‡ John K. Fraser,‡
Prosper Benhaim,* and Marc H. Hedrick*

.
*Departments of Surgery and Orthopedics, Regenerative Bioengineering and Repair Laboratory,
UCLA School of Medicine, Los Angeles, California 90095; and ‡Department of Medicine and the
Jonsson Comprehensive Cancer Center, Division of Hematology and Oncology, UCLA School of
Medicine, Los Angeles, California 90095

.
Submitted February 25, 2002; Revised June 21, 2002; Accepted August 23, 2002
Monitoring Editor: Martin Raff

.

ABSTRACT

.
Much of the work conducted on adult stem cells has focused on mesenchymal stem cells (MSCs)
found within the bone marrow stroma. Adipose tissue, like bone marrow, is derived from the
embryonic mesenchyme and contains a stroma that is easily isolated. Preliminary studies have
recently identified a putative stem cell population within the adipose stromal compartment. This
cell population, termed processed lipoaspirate (PLA) cells, can be isolated from human lipoaspirates
and, like MSCs, differentiate toward the osteogenic, adipogenic, myogenic, and chondrogenic
lineages. To confirm whether adipose tissue contains stem cells, the PLA population and
multiple clonal isolates were analyzed using several molecular and biochemical approaches. PLA
cells expressed multiple CD marker antigens similar to those observed on MSCs. Mesodermal
lineage induction of PLA cells and clones resulted in the expression of multiple lineage-specific
genes and proteins. Furthermore, biochemical analysis also confirmed lineage-specific activity. In
addition to mesodermal capacity, PLA cells and clones differentiated into putative neurogenic
cells, exhibiting a neuronal-like morphology and expressing several proteins consistent with the
neuronal phenotype. Finally, PLA cells exhibited unique characteristics distinct from those seen in
MSCs, including differences in CD marker profile and gene expression.

.

.

.

So, adipose tissue has stem cells that are multi-potent, and perhaps even pluri-potent.

.

There is a stem cell researcher at UC Davis who, in his blog, waxes rather shrill in absolute opposition to any self-funded clinical research projects with stem cells until more is known. I presume that is his main attack and I apologize if that is incorrect. How many years do we wait until we can know it is safe 100%? Nothing is 100% predictable. Surgery isn’t safe either. Falling and hip fracture alone with surgical repair has a mortality of 18 to 48% in the six months after fracture. We don’t know why.

.

Well, they cannot do all the work in work academia. Researchers can’t get the funding for one thing. This alternate clinical approach is self funding, not covered by insurance. And if you think that is enriching the orthopedists, you have no idea what it costs to do any decent research, build specialized clinics, technology, equipment. If it’s medical, the ultra sound equipment alone will be $50,000 not $500. And are these centers in low cost neighborhoods where no one can afford the choice? Then overhead is deserving of every bit of the cost of what I see. Who will pay these pioneers for the time invested to design these studies and put it together with data, nurses, technicians, physicians, surgery center overhead? Surgeons cannot makes millions on this because it cannot be patented, like pharmaceutical companies. Doctors do not make the fortunes that business men do by patenting albuterol, the old asthma inhaler for example, so they can charge $100 instead of $15 a few years ago. Or the nasal spray selling for more than $250 a month by prescription, is over the counter in Europe for less than $7. Greed can destroy medicine. But these stem cell injections are minor procedures like the injections done all the time, but now injecting a small fraction of your own fat’s stem cells.

.

Medicine is always built on clinical trials. And off label medications or procedures. That’s how it evolves. We all know that what they see in mice does not always correlate in humans. If we wish to take the risk in our own joint space with our own cells, it is not the same as thinking that something injected into a vein or into spinal fluid will do a specific job to cure some degenerative disease in the brain. Is that magical thinking? This is a joint space for Pete’s sake. We can watch it, to some extent, with ultrasound. We can take a history. Can I now take a step without fear of the hip giving out? absolutely liberated! Every step I took for months was an absolute focus to avoid falling. And for 18 months, I was not able to stand on one leg to dress. All that resolved two weeks after stem cell injections, those were no longer problems. Every day since then has been better, now at four months I can sit in semi lotus almost comfortably. I can feel that improve. 

.

He wonders how many NFL players in the Super Bowl have had stem cell injections.

.

According to a recent, very important article by Kirstin R.W. Matthews and Maude L. Cuchiara stem cell therapies are quite common amongst NFL players. See Table 1 from their paper above that just shows the players who have publicly acknowledged getting stem cells treatments. Last year’s Seahawks player Sidney Rice apparently had a stem cell therapy.

.

Given how common stem cells are in the NFL, it’s interesting again to consider how many players in the Super Bowl might have had them.

.

We also do not know of course whether such stem cell interventions are safe or effective yet because to my knowledge there is no data on how much players have done after their “treatments”. Many so-called “stem cell treatments” may in addition not even involve actual stem cells.

.

Of course another issue with the NFL and stem cells is one looking to the future when there is hope that evidence-based stem cell treatments may be proven safe and effective for traumatic brain injury, a condition so common amongst ex-NFL players.

.

Harvard had to retract their stem cell spaper published one year ago. Their stem cells do not produce the slightest amount of insulin, despite all the headlines they received and no doubt all the funding that was thrown at them by private and agency sources to do more of this miracle research. We are all familiar with the claims to fame of academics who had their papers retracted and those who committed suicide. The field is rife with hope and greed.

.

Using my own cells, to spin down to the stem cell fraction and inject into my own joints, in a closed system with nothing added to it, that is very exciting and, in a sense, very basic clinical research indeed. I can hardly wait to see the combined results from the affiliates of Cell Surgical Network. But regardless of the results, even if a tiny percentage improved, for myself, I’d do it again if I had to choose.

.

My results so far are worth everything to feel the confidence that I will not fall with every step I take; to be able to walk up and down stairs, usually without hesitation, when I could not do that for months and months. These orthopedists have my full support. I am not willing to say we need to wait for more proof on this one, let’s just begin the work. No matter what, it will take years to learn. Let’s begin now, twelve years after that seminal paper from UCLA with the revolution in stem cell research that has already shown results in dogs.

.

While you all wait to do more sophisticated dazzling stem cell work in academia, the population is living longer than ever, with less than dazzling aging of major joints. Runners, you have it really bad before you are 60.

.

There are more joint replacements and revisions than ever before imaginable, and high mortality from hip fractures. It’s time to be realistic and a bit more open minded in this conservative field.

.

Someone else will do this work clinically unless the best take it on themselves?

.

Will we let the “flashers” start doing these? The flashy surgeons who are the worst, the most untrustworthy? Or will the work be done by this outstanding group of the best orthopedic surgeons joining together on a very smart question that afflicts millions of us every day for years of disability and pain?

.

.

.

.

.

 

The material on this site is for informational purposes only.
.
It is not legal for me to provide medical advice without an examination.

.
It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

~~

This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.

 

~~~~~

For My Home Page, click here:  Welcome to my Weblog on Pain Management!

.

Please ignore the ads below. They are not from me.

.

%d bloggers like this: