Consistent chronic pain can impact every moment of your day, from interrupting your sleep to affecting your day-to-day function and mobility. Are you struggling to manage pain from a persisting condition like arthritis or an overuse sports injury, with no progress? Orthobiologic procedures are new treatment options that could help you reduce or manage chronic pain. Dr. Trevor Kitchin provides more details on what these procedures are and who these treatments can help.
What are orthobiologics?
Orthobiologic procedures, also known as regenerative medicine, are developed from biologic (natural) substances used to help relieve pain and other symptoms from arthritis and enhance the body’s ability to heal from repetitive soft tissue injuries (ligament and tendon issues such as tennis elbow, Achilles tendinitis, and partial rotator cuff tears). Arthritis is a chronic disease that causes the cartilage in joints to break down from chronic wear and tear, leading to pain, stiffness, and swelling. Orthobiologics use your body’s own cells to help treat conditions that have not healed well on their own. Examples of orthobiologic regenerative therapies include blood or bone marrow products.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is the most studied and most commonly used orthobiologic treatment. Platelets are a part of the blood that helps your body form clots to stop bleeding. Platelets also contain growth factors that can trigger cell reproduction and stimulate tissue regeneration or healing. PRP is simply plasma (the liquid portion of blood) with very high concentrations of platelets. PRP is created by drawing your blood and placing it in a device called a centrifuge that spins the blood to separate the different components (red blood cells, plasma, etc.). We then combine the highly concentrated platelets, growth factors, cytokines and plasma and inject it directly into the area of the body that is causing pain. Although it is not exactly clear how PRP works, studies have shown that the increased concentration of growth factors that is found in PRP may speed up and enhance the body’s natural healing process and decrease inflammation found in joints with arthritis.
Platelet-rich plasma injections have been shown to be effective in treating pain associated with knee arthritis as well as chronic tendon injuries such as tennis elbow, patellar tendinitis (jumper’s knee), partial rotator cuff tears, chronic Achilles tendinitis and chronic back pain related to arthritis. PRP injections are most effective in relieving knee pain from mild to moderate knee arthritis and have been shown to be effective for up to 2 years. Like all of the treatments for knee arthritis including steroid (cortisone) injections and viscosupplement (gel) injections, the effectiveness of the treatment decreases as the arthritis progresses. This means these injections tend to provide less relief as your arthritis progresses to severe, ’bone on bone’ arthritis. When treating arthritis, PRP injections provide temporary relief and would need to be repeated when the effects begin to wear off. When treating soft tissue injuries, one injection is usually sufficient to treat the symptoms, although a repeat injection is sometimes necessary.
Bone Marrow Aspirate Concentrate (BMAC)
Bone marrow aspirate concentrate (BMAC) is a procedure where bone marrow, the soft, fatty tissue inside the bones of your body, is removed and used to help relieve pain and enhance healing. Bone marrow contains growth factors, platelets, blood cells and stem cells. The procedure typically involves removing the bone marrow from the back of your pelvis (hip) under ultrasound or fluoroscopy guidance. The removed bone marrow is processed in the lab to concentrate the platelets, growth factors, and stem cells. This concentrated mixture is injected into the area of the body that is causing pain to try and stimulate healing.
BMAC injections have been shown to provide relief in similar conditions to platelet-rich plasma and may be more effective when treating moderate to severe arthritis compared to PRP. BMAC treatment will not reverse osteoarthritis or grow new cartilage in advanced, ‘bone on bone’ arthritis. However, it has been shown to help with the pain and swelling caused by this condition, especially swelling of the knees. It can also help enhance the body’s natural healing process similar to, and often to a larger degree than PRP injections.
Who could orthobiologic treatments help?
Patients with chronic pain related to arthritis and chronic tendon injuries that have failed traditional conservative treatment would be good candidates for orthobiologics. Traditional conservative treatment includes physical therapy, over-the-counter medications such as Tylenol and ibuprofen, and steroid (cortisone) injections. Benefits of orthobiologic injections include avoiding or delaying significant surgeries such as joint replacements and allowing patients to continue enjoying a healthy, active lifestyle without depending on medications. Since these injections are natural and use your body’s own cells, they tend to have less risks associated with them compared to steroid (cortisone) or viscosupplement (gel) injections. There are, however, still some risks associated with these procedures. These risks include bleeding, infection, and damage to surrounding tissue like nerves and tendons. These procedures should always be done under imaging guidance (ultrasound or fluoroscopy) to decrease the chances of damaging surrounding tissues.
What else should you know?
Other things to consider when looking into orthobiologic procedures include cost of the procedure, the type of procedure, and the transparency of the provider performing these procedures.
COST
These procedures are typically NOT covered by insurance, including Medicare. Some employers are partnering with Regenexx to cover these procedures, but for the vast majority of patients, these will be an out-of-pocket expense.
TYPE OF PROCEDURE
When it comes to the type of procedure, even PRP has many different types including leukocyte-rich vs leukocyte-poor. Discussing this with your provider is important to make sure you are choosing the right procedure for your issues.
FIND A TRUSTWORTHY EXPERT
When choosing a provider, you want someone who is experienced in these procedures and always uses imaging guidance (ultrasound or fluoroscopy) when performing these procedures. An expert who speaks honestly about expected outcomes, treatment frequency, and alternative treatment options, is someone who has your best interests in mind and wants you to be prepared to make the best decision for your lifestyle. These procedures are not for everyone, and you should never feel pressured into choosing something that you aren’t comfortable with.
Find Local Experts in Orthobiologic Procedures
Central Ohio Primary Care- COPC Sport Spine, & Joint practice has skilled providers serving patients from their Westerville and Reynoldsburg locations. These providers use Regenexx orthobiolgic products to help reduce pain for qualifying conditions and injuries.
Call their office today at (614) 895-3344 to schedule a consultation.
Sources:
https://my.clevelandclinic.org/health/treatments/21102-platelet-rich-plasma
https://orthoinfo.aaos.org/en/treatment/platelet-rich-plasma-prp/
https://mcpress.mayoclinic.org/healthy-aging/platelet-rich-plasma/
https://www.hss.edu/condition-list_prp-injections.asp
https://orthoinfo.aaos.org/en/treatment/orthobiologics-faq/
https://regenexx.com/blog/stem-cell-knee/
https://regenexx.com/blog/prp-injection/
https://regenexx.com/blog/is-bone-marrow-concentrate-a-stem-cell-therapy/