There were many exciting presentations and posters at the 29th Annual Meeting of the American Academy of Pain Medicine (AAPM) this month including one looking at using stem cell injections for low back pain. Results from patients two years after receiving autologous bone marrow grafts were promising and the researcher presenting the findings hoped to encourage others to carry out long-term studies of the therapy for low back pain, a notoriously difficult condition to treat and often the result of spinal stenosis from degenerative processes in the back.
Low Back Pain Patients
Dr D. Joseph Meyer, MD, PhD, is an anaesthesiology and pain medicine specialist in Columbia, Missouri, and he and his colleagues worked with 24 patients over the last few years to investigate the use of stem cell injections for low back pain. The majority (17) of these patients were men and they had an average age of 45 years, with a history of low back pain for 4 years on average. Patients had not found successful pain relief from other interventions and all had been diagnosed with disc degeneration in the lumbar spine, using magnetic resonance imaging (MRI) or computerised tomography (CT).
Causes of Low Back Pain
Disc degeneration can occur as a result of wear and tear as we age, after direct trauma to the spine or as a premature ageing condition courtesy of inflammatory processes, arthritis in the spine, smoking and other harmful lifestyle practices. Dehydrated, poorly nourished discs become brittle, more liable to rupture and herniate and result in a loss of intervertebral height and, potentially, pinched nerves and back pain. Disc fragments may also protrude into the foraminal spaces where nerve roots exit the spinal column, causing back pain and/or radicular pain such as sciatica.
Treating Low Back Pain
When there are numerous adverse changes in the spine, such as osteophyte growth, disc degeneration and ligament calcification it can be difficult to determine which treatment will be most likely to relieve pain. Regenerative medicine has the potential to benefit all of these sources of low back pain and the ability to use patients’ own stem cells means that treatments are less likely to cause adverse reactions and immune system rejection, as well as avoiding some of the risks of back surgery for spinal stenosis.
How Stem Cells May Help Back Pain
This latest research involved each patient having 60ml of bone aspirate taken from their hip bone marrow followed by the processing of this aspirate to separate out 8ml of concentrated bome marrow aspirate. Up to two intervertebral discs showing signs of degeneration were then injected with 1-1.5ml of the bone marrow aspirate concentrate (BMAC) directly into the discs’ fibrous outer shell (the annulus). The physicians used a fluoroscope to guide each stem cell injection and another 0.5-1ml of the BMAC was injected immediately outside of the discs’ annulus along with an injected steroid. Some patients had the whole procedure performed in just 20 minutes, others were done in under an hour, making the low back pain treatment an excellent choice for outpatient therapy for those with busy lives.
Significant Pain Relief from Stem Cell Injections
Results of the low back pain stem cell treatment look very encouraging as follow-up data available for 11 of the 12 who had the stem cell therapy alone showed no adverse reactions and significant pain relief (some 74%) for 8 patients at the one-year mark. The other three patients reported no pain relief at this stage, nor at the two-year follow-up. Of the 8 who felt better at 12 months, 5 reported significant pain relief (81%) at the two-year mark. These patients also noted that they were using less medication for their condition and had experienced improvements in terms of activity tolerance.
The Future of Back Pain Relief?
Three years after the treatment using bone marrow-derived stem cells for low back pain relief, the three patients Dr. Meyer and colleagues have been able to track are reported to still be doing great. Unfortunately, this kind of paper only provides retrospective data on the patients and so the researchers are hopeful that others will take on the challenge of conducting a full placebo-controlled, double blind clinical trial into the use of bone marrow aspirate injections for low back pain. Dr Meyer said “I hope that as we study this in a more controlled prospective fashion we can refine the technique, and learn what is actually happening.”
Stem Cells Without Steroids
Dr Meyer is especially careful not to use the word ‘regenerate’ in his presentation of the cases and there has been some criticism based on the fact that the treatment was combined with a steroid injection that also works to relieve pain in some patients but which may actually break down muscle tissue (a catabolic effect). Encouraging growth and healing with one treatment whilst simultaneously hindering such growth seems somewhat nonsensical. Epidural steroid injections remain a standard treatment for low back pain when the source is considered discogenic, perhaps stem cell injections on their own may offer an alternative, regenerative treatment in the future.
American Academy of Pain Medicine (AAPM) 29th Annual Meeting. Abstract 203. Presented April 11, 2013.