06 Dec Back Pain: What is in the pipeline for new treatments?
Back Pain: What is in the pipeline for new treatments?
One common structural reason for having back pain is that the cushions between the bones of your spine (disc) has worn away. This may be from an injury or just wear and tear. This condition is sometimes called degenerative disc disease (DDD). It can be painful because it is like riding around in a car without functioning shock absorbers.
Most people who have back pain from DDD are successfully treated with a combination of over the counter medicines (such as ibuprofen), physical therapy and exercise programs.
But some patients have debilitating back pain despite conservative care and come to my office for surgical consultation.
Many patients ask me about the latest advances in treatment options.
A multinational group of physicians recently reported, “Many modalities for treatment of DDD have been developed including therapeutic protein injections, stem cell injections, gene therapy, and tissue engineering. These interventions have had promising outcomes in animal models. Several of these modalities have been attempted in human trials, with early outcomes having promising results.”
Injection of platelet-rich plasma (PRP) and stem cells may help back pain:
In 2019, a multi institutional group of pain management physicians reported on the available evidence regarding the use of platelet-rich plasma (PRP) and stem cells for spinal pain. The researchers reviewed multiple human studies. Based on the available evidence, they reported that there was reasonable evidence that injections of stem cells or PRP directly into a degenerated lumbar disc could benefit properly selected patients suffering from spinal pain. There was weaker evidence that Lumbar Epidural Injections, Lumbar Facet Joint Injections or Sacroiliac Joint Injection with stem cells or PRP would alleviate spinal pain.
Tissue engineering may provide for replacement or repair of damaged discs:
Researchers at University of Pennsylvania have reported on experiments conducted using specially engineered biomaterials and small animal models. In 2019 the scientists reported promising results, repairing the damaged scaffolding of degenerated discs with nanomaterials. They injected small molecules into injured discs before cell death led to scarring of the connective tissues and disruption of the ability of the disc to sense mechanical changes.
Injection of genetic material may prevent or reverse disc degeneration:
A multinational 2018 study investigated whether injection of genetic material (RNA) could alter disc degeneration. The scientists injected the RNA into the discs of experimental animals. They reported a decrease in inflammation in the disc space and a lower rate of cell death. This resulted in an improvement in the size and of the cushioning effect of the material that made up the disc.
Injection of proteins into discs have not produced much success:
In a 2017 review of available evidence, scientists reported mixed results. Multiple researchers have injected proteins into the discs of experimental animals. Some of the studies showed benefit, while others did not.