Regenerative medicine in the field of pain medicine: Prolotherapy, platelet-rich plasma therapy, and stem cell therapy—Theory and evidence

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The concept of “regenerative medicine” (RM) has been applied to musculoskeletal injuries dating back to the 1930s. Currently, RM is an umbrella term that has been used to encompass several therapies, namely prolotherapy, platelet-rich plasma therapy (PRP), and stem cell therapy, which are being used to treat musculoskeletal injuries. Although the specific treatments share similar concepts, the mechanism behind their reparative properties differs. Recently, treatments that possess a regenerative quality are resurfacing and expanding into the musculoskeletal field as potential therapeutic treatment modalities. RM, in the form of prolotherapy, was first used to treat tendon and ligament injuries. With the advancement of technology, RM has expanded to PRP and stem cell therapy. The expansion of different RM treatments has lead to its increase in the application for ligament and tendon injuries, muscle defects, as well as pain associated with osteoarthritis and degenerative disks. Recently, the use of ultrasound has been added to these therapies to guide the solution to the exact site of injury. We review 3 forms of RM injection: prolotherapy, PRP therapy, and stem cell therapy.

Section snippets

Prolotherapy

The term “prolotherapy” first appeared in the medical literature during the mid-1950s and was described as a form of treatment for “incompetent structures through the generation of new cellular tissue.”5, 6 Introducing an irritating substance to induce healing has been used since the time of Hippocrates7; however, the modern use of prolotherapy in musculoskeletal injuries can be traced back to the 1930s.8, 9

Proliferant solutions used in this form of treatment are hypothesized to induce collagen

Platelet-rich plasma therapy

In the search for better modalities in the nonsurgical treatment of musculoskeletal injuries, platelet-rich plasma therapy (PRP) has recently been thrust to the forefront of public attention.45, 46 Initially used clinically in the fields of cardiothoracic and maxillofacial surgery in the late 1980s and early 1990s, PRP has since been adopted into the field of musculoskeletal medicine.47, 48, 49 The concept behind its use as a nonsurgical treatment modality is to place it directly into areas of

Stem cell therapy

Adult tissues often have the ability to repair and regenerate following injury. To date, the exact mechanism of repair is poorly understood; however, it is hypothesized to occur through the proliferation and differentiation of cells that ultimately restore tissue functionality. One possible explanation is found within nonhemopoietic progenitor cells found in pathologic tissue, as well as cell reservoirs at other locations, which may help to provide this reparative capability.89 These

Conclusions

Regenerative medicine is a new intriguing concept on the horizon in the field of pain medicine. Although continued research is greatly needed to determine efficacy and safety profiles, early evidence may foreshadow its future use in clinical practice.

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