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Potential role of stem cells for neuropathic pain disorders
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hronic neuropathic pain is estimated to be on the rise, particularly with the expected increase in patients with diabetes within the US. Diabetic and nondiabetic patients were surveyed for sick days from
work due to neuropathic pain; approximately two-thirds of these patients were found to consistently be taking days from work, and only one-fifth of those were satisfied with their current therapy.8,24 Unlike nociceptive pain (tissueinjury induced), neuropathic pain is specific to injury of either the central or peripheral nervous system and can be a combination of both. For this reason, several diseases manifest with neuropathy including SCI, stroke, multiple sclerosis, diabetes, infectious related, nutrient deficient,
immune related, and oncological. Interestingly, adjuvant therapies for these disorders including chemotherapy and radiation therapy can also lead to chronic neuropathy. Treatments have largely depended on anticonvulsants and antidepressants because of their analgesic effects; however, the nature of neuropathic pain is its chronicity and as such often becomes recalcitrant to these pharmacological strategies. Intractable neuropathic pain has gained increasing awareness due to its prevalence and the technological advancements in surgical neuromodulation. Electrical stimulation via spinal cord, peripheral nerve, and deep brain targeting has begun to show some early efficacy.18 To date, chronic neuropathic pain is largely considered a heterogeneous pain syndrome that remains with limited efficacious treatment modalities. Also, there is no treatment strategy that is effective for pain management while promoting nervous system repair.
Paralyzed man who can walk again shows potential benefit of stem cell therapy
A man who was paralyzed from the neck down after a surfing accident seven years ago is now able to stand and walk ok his own, thanks in part to a potentially groundbreaking stem cell treatment
Anti-Inflammatory Mesenchymal Stem Cells (MSC2)Attenuate Symptoms of Painful Diabetic PeripheralNeuropathy
ABSTRACT
Mesenchymal stem cells (MSCs) are very attractive candidates in cell-based strategies that target
inflammatory diseases. Preclinical animal studies and many clinical trials have demonstrated that
human MSCs can be safely administered and that they modify the inflammatory process in the
targeted injured tissue. Our laboratory developed a novel method that optimizes the anti-inflammatory effects of MSCs. We termed the cells prepared by this method MSC2. In this study, we
determined the effects of MSC2-based therapies on an inflammation-linked painful diabetic peripheral neuropathy (pDPN) mouse model. Streptozotocin-induced diabetic mice were treated with
conventionally prepared MSCs, MSC2, or vehicle at three specific time points. Prior to each treatment, responses to radiant heat (Hargreaves) and mechanical stimuli (von Frey) were measured.
Blood serum from each animal was collected at the end of the study to compare levels of inflammatory markers between the treatment groups. We observed that MSC2-treated mice had significant
improvement in behavioral assays compared with the vehicle and MSC groups, and moreover these
responses did not differ from the observations seen in the healthy wild-type control group. Mice
treated with conventional MSCs showed significant improvement in the radiant heat assay, but not
in the von Frey test. Additionally, mice treated with MSC2 had decreased serum levels in many
proinflammatory cytokines compared with the values measured in the MSC- or vehicle-treated
groups. These findings indicate that MSC2-based therapy is a new anti-inflammatory treatment to
consider in the management of pDPN. STEM CELLS TRANSLATIONAL MEDICINE 2012;1:
557–565
A preliminary report on stem cell therapy for neuropathic pain in humans
Objective:
Mesenchymal stem cells (MSCs) have been shown in animal models to attenuate
chronic neuropathic pain. This preliminary study investigated if: i) injections of autologous
MSCs can reduce human neuropathic pain and ii) evaluate the safety of the procedure.
Methods:
Ten subjects with symptoms of neuropathic trigeminal pain underwent liposuction.
The lipoaspirate was digested with collagenase and washed with saline three times. Following
centrifugation, the stromal vascular fraction was resuspended in saline, and then transferred to
syringes for local injections into the pain fields. Outcome measures at 6 months assessed reduction in: i) pain intensity measured by standard numerical rating scale from 0–10 and ii) daily
dosage requirements of antineuropathic pain medication.
Results:
Subjects were all female (mean age 55.3 years ± standard deviation [SD] 14.67; range
27–80 years) with pain symptoms lasting from 4 months to 6 years and 5 months. Lipoaspirate
collection ranged from 102–214 g with total cell numbers injected from 33 million to 162 million
cells. Cell viability was 62%–91%. There were no systemic or local tissue side effects from the
stem cell therapy (n=41 oral and facial injection sites). Clinical pain outcomes showed that at 6
months, 5/9 subjects had reduced both pain intensity scores and use of antineuropathic medication. The mean pain score pre-treatment was 7.5 (SD 1.58) and at 6 months had decreased to 4.3
(SD 3.28), P=0.018, Wilcoxon signed-rank test. Antineuropathic pain medication use showed
5/9 subjects reduced their need for medication (gabapentin, P=0.053, Student’s t-test).
Conclusion: This preliminary open-labeled study showed autologous administration of stem
cells for neuropathic trigeminal pain significantly reduced pain intensity at 6 months and is a
safe and well tolerated intervention.
Keywords: adipose, stem cells, neuropathic, orofacial, trigeminal
Intravenous neural stem cells abolish nociceptive hypersensitivity and trigger nerve regeneration in experimental neuropathy
A nonphysiological repair of the lesioned nerve leading to the formation of neurinomas, altered nerve
conduction, and spontaneous firing is considered the main cause of the events underlying neuropathic
pain. It was investigated whether neural stem cell (NSCs) administration could lead to a physiological
nerve repair, thus to a reduction of neuropathic pain symptoms such as hyperalgesia and allodynia in
a well-established model of this pain (sciatic nerve chronic constriction injury [CCI]). Moreover, since
we and others showed that the peripheral nerve lesion starts a cascade of neuroinflammation-related
events that may maintain and worsen the original lesion, the effect of NSCs on sciatic nerve pro- and antiinflammatory cytokines in CCI mice was investigated. NSCs injected intravenously, when the pathology
was already established, induced a significant reduction in allodynia and hyperalgesia already 3 days
after administration, demonstrating a therapeutic effect that lasted for at least 28 days. Responses changed with the number of administered NSCs, and the effect on hyperalgesia could be boosted by a new NSC
administration. Treatment significantly decreased proinflammatory, activated antiinflammatory cytokines in the sciatic nerve, and reduced spinal cord Fos expression in laminae I-VI. Moreover, in NSC-treated animals, a reparative process and an improvement of nerve morphology is present at a later time.
Since NSC effect on pain symptoms preceded nerve repair and was maintained after cells had disappeared
from the lesion site, we suggest that regenerative, behavioral, and immune NSC effects are largely due to microenvironmental changes they might induce at the lesion site
Acoustic Compression
Also known as Shockwave Therapy (ESWT)
The Non-Invasive Solution for an Active Lifestyle™
Acoustic Compression, also known as Extracorporeal Shockwave Therapy, is now available at Relief Medical Group!
Many patients have reported excellent results with only seven in-office sessions. Anesthesia is not required! ESWT is the healing technology that ends incurable foot, shoulder, elbow, and other areas of pain without surgery!
ESWT is also an effective, non-invasive treatment for Erectile Dysfunction and Cellulite Reduction!
The full price for consultation, examination, any necessary x-ray, and the seven weekly sessions of ESWT is only $1175 (when paid in advance—regularly $1275)
Only Seven Sessions Required! Please contact us for more information or any questions you may have!
Download information about Therapeutic Advances in Urology
ESWT has been used effectively worldwide to treat "insertional tendinopathies," such as:
- Heel Pain (Plantar Fasciitis)
- Tennis Elbow (Lateral Epicondylitis)
- Shoulder Calcifications (Calcific Tendonitis)
- Achilles Tendonitis
- Knees (Patellar Tendonitis)
- See our cosmetic pages to learn how this same technology is used to remove CELLULITE
Millions of people suffer from pain caused by inflammation of tendons and other soft tissues attached to bones, commonly referred to as "insertional tendinopathies” or enthesopathies".
How Does Extracorporeal Shockwave Treatment Work?
The widely accepted theory is that Extracorporeal Shockwave Treatment (ESWT) causes micro-trauma and controlled injury at the affected area, thereby leading to the formation of blood vessels (revascularization) which triggers the body's natural healing process and repair mechanisms. The sound waves are also thought to release adhesions and scarring to help increase mobility and optimize healing. Studies have shown a 60-80% success rate in significantly reducing or eliminating pain.
What Happens Before, During and After ESWT Treatment?
BEFORE: Patients will be instructed to discontinue medication containing aspirin or non-steroidal anti-inflammatory medications (e.g. Motrin) for several days before treatment (and most likely for up to 10 days following treatment) unless otherwise instructed by the treating doctor.
DURING: Treatment typically lasts 10 to 30 minutes and is performed in the office without the need for anesthetic. We use a high quality, low-medium energy ESWT unit.
AFTER: Patients may experience discomfort in the treated area after the effects of anesthesia have subsided. Some bruising, swelling, and temporary numbness is normal and expected. In the days immediately following treatment, many doctors will recommend stretching exercises to maintain mobility.
Patients can then typically resume normal activity. Heel pain patients are recommended to use custom orthotics when they have hyperpronation (flat feet) to optimize healing of the planter fascia and prevent recurrences.
Healing is generally near complete at about twelve weeks after the completion of the treatment visits, although patients may continue to experience additional reduction in pain and increased capacities thereafter.
What are Alternative Treatments?
Most doctors will first pursue conservative treatment options to reduce or eliminate pain. Conservative treatment may include such measures as rest, non-steroidal anti-inflammatory medications (NSAIDs), over-the-counter pain relievers, physical therapy, and orthotics (for heel pain). ESWT should be tried before cortisone injections, since injections increase the chances of tendon ruptures. Doctors will usually recommend ice, physiotherapy, exercises, and orthotics (heel lifts) prior to considering more aggressive approaches. However, when conservative treatments have failed, ESWT is increasingly being used to avoid traditional invasive surgery. Acoustic Compression is a more aggressive, more effective, and yet still conservative management for the conditions shown above.
Is This Treatment Right for Everyone?
You should speak to Dr. Cremata DC about your specific needs to see if Extracorporeal Shockwave Treatment is right for you. ESWT is not recommended for use on pregnant women, children, anyone with a pacemaker, or anyone on anti-coagulant therapy, or who has a history of bleeding problems.
How Do You Get Treatment?
Call Dr. Cremata, DC about your specific medical condition to see if Extracorporeal Shockwave Treatment (ESWT) is right for you.
The full price for consultation, examination, any necessary x-ray, and the weekly sessions of Acoustic Compression (Shockwave) is $995.00 (reg. $1195.00) when paid in advance. ONLY SEVEN VISITS REQUIRED!
Dr. Cremata, DC can provide additional complementary medical treatments as needed.
Pain Relief and Pain Management
Control of your pain is very important for your comfort, ability to sleep well, take care of yourself and your family, perform your job duties, etc.
At Relief Medical Group, we can provide you with prescription and non-prescription options to relieve your pain while you are undergoing treatment to improve the cause of your pain. We can dispense or prescribe various topical creams, anti-inflammatory agents, muscle relaxants, and other appropriate medications. When necessary for acute and severe pain, we can deliver these medications to you by injection for a rapid effect.
The ultimate goal is to improve your underlying condition enough so that you don’t need prescription medication for very long. The more conservative options of a topical medication cream, as opposed to oral medication, helps to prevent the dangerous and sometimes avoidable adverse effects from medications, such as stomach problems like ulcers, liver problems, or kidney toxicity.
A New Way of Thinking About Back Pain
The majority of back pain is preventable
This statement is at odds with the standard medical narrative for back pain. So much of western medicine focuses on treating injury and illness reactively- that is treating a problem symptomatically. But this relies on the logic that a problem need occur in the first place- why have we accepted this hook, line and sinker? A more logical way of treating pain is to prevent it in the first place. And while many types of back pain, the kinds that result from traumatic injury, genetic predisposition, or tumors, are unavoidable, the vast majority of back pain is preventable.
Envisioning a New Year with Less Headaches
Chronic headache sufferers have little cause for cheer during the holidays
If you suffer from regular headaches, it can be hard to know when one will strike. This can be particularly prominent during the holiday season when you are surrounded by holiday cheer one minute, then stricken by a headache the next. Headaches menace people of all ages and health profiles, and our medical community is still at an early level of understanding the causes which contribute to this menace of society. If you suffer from headaches we are willing to wager that you are interested in prevention. At our office in Fremont, we realize that banishing headaches forever may not be realistic. However, we can strive to reduce the intensity, duration and frequency of your headaches to help you live a better life despite your condition
Common Sense Saves You a lot of Back Pain
Listening to your body goes a long way
Too many people live their life at a pace too busy to consider their body’s internal signals. Technology is making it easier than ever to delegate the responsibility of listening to your body to your phone. There are apps that will ping reminding you to drink water, stretch, or take a break from the computer screeen. And while smart apps are designed to optimize our lives, we often find that all the optimization distracts us from what really matters: being in touch with our bodies. Besides, if you are too busy to remind yourself to stretch, you can just as easily ignore an app that tries to perform the same function. Now consider that instead of ignoring signals of muscle tension, you constantly ignore signals of pain. Human bodies are infinitely more powerful than we give them credit for: our capacity to perform everyday functions despite serious pain signals has the potential to cause a lot of problems in our lives.