Tag: research

Pros and Cons of Using Various Stem Cells

At Regenexx, we’re constantly expanding the number and type of patients we can help with precision orthobiologic procedures. While that occurs at all of our sites, our primary new treatment research site is our Colorado HQ. There we’ve been developing a new procedure to help patients with Trigeminal Neuralgia. This is very different than the Trigeminal Neuralgia stem cell treatment scams popping up at local integrative medicine practices. Let’s dig in.

What Is Trigeminal Neuralgia? How Is It Usually Treated?

Imagine that you wake up one day with severe facial pain. The pain is just like a severe toothache but in your eye, cheek, or jaw and nothing makes it go away. In fact, after a few months like this, with most doctors not knowing how to help, you’re considering the possibility that suicide could be the answer. That’s Trigeminal Neuralgia in a nutshell.

There are specialized nerves that exit the skull at various places called “Cranial nerves”. They come directly off of the brain or brainstem, unlike all other nerves that come off the spinal cord. They’re numbered 1-12 and the fifth nerve is called “Trigeminal”. It’s responsible for taking sensations from the face to the brain.

The Trigeminal nerve has three branches, the Mandibular (jaw), Ophthalmic (eye), and Maxillary (cheek):

These branches from top to bottom are also known as V1, V2, and V3.

When one or more of these nerves chronically misfires, this can cause chronic severe pain in the face, teeth, or nose. This pain is usually more intense than when other nerves in the body misfire because there’s less pain control circuitry for Cranial nerves.

The treatments are very invasive and involve either focused radiation to destroy the nerve (gamma knife or radiosurgery) or microsurgery to move an artery that may be aggravating the nerve (microvascular decompression). Both have high complication rates and aren’t always successful.

The New Orthobiologic Trigeminal Neuralgia Treatment

We’ve known for some time that platelet growth factors can help nerve function. In fact, we’ve published a paper suggesting that Platelet Lysate (the growth factors stripped from platelets in plasma) may help chronically irritated low back nerves. Others have published research showing that PRP can help the Median nerve in Carpal Tunnel Syndrome patients (4-9).

Hence, it wasn’t too far a stretch to think that if we developed a precise way to inject the Trigeminal nerve with Platelet Lysate (or PRP) that these patients may be helped as well without these invasive and destructive procedures. While I’ve treated some of these patients as well who also have Craniocervical Instability, Jason Markle, M.D. at our Colorado HQ really took the lead on this advancement. I’m proud to say that Jason has now begun to dial in this new promising therapy.

Perc-TGN Procedure

The new treatment, known as the Perc-TGN procedure is percutaneous hydrodissection of the Trigeminal nerve using Platelet Lysate. This involves first isolating platelets from the patient’s blood and creating a growth factor rich plasma in our lab. Then the doctor precisely places this mix using x-ray and ultrasound guidance around the problematic branches of the nerve. This both breaks up local scar tissue and provides growth factors for the nerve to help it heal.

Does Perc-TGN Work?

Let one of the first patients to receive this new procedure tell you about their journey:

“After a year of misdiagnosis, I was correctly diagnosed with Trigeminal Neuralgia (TN) in 2015. TN is often called the “Suicide Disease”, because of the level of pain and no cure. The TN nerve on the left side of my face was damaged, because a blood vessel was in constant contact and had worn away the Myelin Sheath, which protects the nerve. With every pulse I experienced excruciating pain. After seeing multiple neurologists and neurosurgeons in December 2018, I had Radiosurgery on the damaged nerve. This doesn’t heal the nerve, but blocks the pain signal from the nerve to the brain. The hope was that I would be pain-free for up to three years. After 13 months in February 2020, the pain returned like a freight train.

The next step would have been Microvascular Decompression Surgery. The possible complications from this surgery include a stroke or loss of hearing or sight on the side where the damaged TN nerve is located. While they have success, it’s not known how long one might be pain free. Not excited about this option, God another door opened for me.

Today there are lots of stem cell clinics. Although Centeno-Schultz in Broomfield, Colorado pioneered stem cell and PRP. Dr. Jason Markle, one of the doctors at the clinic, decided to do a small trial with me. I have had three Plasma Rich Platelets (PRP) injections over and around the damaged Trigeminal nerve. Because I was patient number one with PRP for TN at the clinic, each procedure was slightly modified. Initially, I had about three months free from pain after each procedure. It was explained, the PRP, if correctly placed, pushes the nerve and blood vessel apart and then initiates healing. It was expected after a period of time, the nerve and blood vessel would come in contact once again causing pain. When this occurred, I would have another PRP treatment.

I’m ecstatic to say, PRP is the answer to my prayers. It’s been 10½ months since my last PRP. NO PAIN for 10½ months and counting! When there’s no pain, you can easily forget that TN was ever an issue! NO PAIN whatsoever. I’m praying the nerve and blood vessel will stay in place where they belong… apart from each other. If the pain reoccurs, you can be sure I’ll schedule another treatment with Dr. Markle.”

Beware of Trigeminal Neuralgia Stem Cell Treatment Scams

This treatment approach will only work if the doctor has the skill set to use ultrasound and x-ray imaging to target these very difficult to reach areas where the Trigeminal nerve is being irritated. That takes years of specialized training that just isn’t available at your local chiropractic or integrative medicine clinic where there’s usually a nurse or poorly trained physician performing the procedures. Precision placement using advanced imaging guidance is everything in this procedure.

While you, like this patient above, may have heard about a local office offering to treat Trigeminal Neuralgia with stem cells, that’s almost always a scam. First, the birth tissues they’re using have no living and functional stem cells. Our research lab proved that in our recent publication in the American Journal of Sports Medicine (10). Second, this treatment won’t work if an alternative medicine clinic gives you an IV treatment (in the vein in your arm).

The upshot? It’s great to see that the physicians at Regenexx HQ in Colorado continue to push the envelope of what’s possible with precision ortho-biologic procedures. The new Perc-TGN procedure is a big deal as these patients in severe pain have few good options.

References:

(1) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. doi:10.1186/s40634-017-0113-5

(2) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi:10.1097/PRS.0000000000006266

(3) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi:10.1080/14712598.2017.1259409

(4) Senna MK, Shaat RM, Ali AAA. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol. 2019 Aug 16. doi: 10.1007/s10067-019-04719-7.

(5) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi: 10.1097/PRS.0000000000006266.

(6) Shen YP, Li TY, Chou YC, Ho TY, Ke MJ, Chen LC, Wu YT1. Comparison of perineural platelet-rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized, single-blind, head-to-head comparative trial. J Tissue Eng Regen Med. 2019 Jul 31. doi: 10.1002/term.2950.

(7) Güven SC, Özçakar L, Kaymak B, Kara M, Akıncı A. Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study. J Tissue Eng Regen Med. 2019 May;13(5):709-714. doi: 10.1002/term.2815.

(8) Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg. 2017 Oct;51(5):301-305. doi: 10.1080/2000656X.2016.1260025.

(9) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi: 10.1080/14712598.2017.1259409.

(10) Berger DR, Centeno CJ, Kisiday JD, McIlwraith CW, Steinmetz NJ. Colony Forming Potential and Protein Composition of Commercial Umbilical Cord Allograft Products in Comparison With Autologous Orthobiologics. Am J Sports Med. 2021 Aug 16:3635465211031275. doi: 10.1177/03635465211031275. Epub ahead of print. PMID: 34398643.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile