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Stem Cell Therapy for Trigeminal Neuralgia

There has been some interaction on our Facebook page referencing Stem Cell Therapy for trigeminal neuralgia.  Over the years there has been some controversial claims on the subject, with medical professionals choosing which side they stood on the issue.

In this article we provide educational content to help you understand the science and potential applications.

Current research is very much focused on the auto immune system and activating the bodies own healing capacities to cure invasive conditions like cancer.

So what are stem cells?

Stem cells are immature cells that have the ability to renew and differentiate to form different types of cells; in other words, they are cells that have the ability to develop into various kinds of other types of cells. For example, blood cells, nerve cells, immune cells etc. Human stem cells can be found in adult bone marrow or human embryos.

Australia is currently watching with amazement, one of our own prominent melanoma specialist treating himself with ground breaking novel treatments to try and beat a life ending brain tumour.

Stem cell therapy is not a new concept and has been researched for more than 15 years and below are highlighted two studies covering the subject.

A preliminary report on stem cell therapy for neuropathic pain in humans

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.

Stem Cell Therapy and Its Significance in Pain Management 

Stem Cell Therapy in Trigeminal Neuralgia

Trigeminal NP encompasses variable states of diagnosis, this includes trauma resulting in maxillofacial NP, odontalgia which is atypical, and burning mouth syndrome. Trigeminal NP is considered to be a localized pain. Thereby, its patient population forms an ideal group to investigate the innovative novel therapy.

Stem cell therapy

The below article link has been published via  Stem Cell Care India

Pros and Cons of Using Various Stem Cells

DISCLAIMER INFO: In 2010, for example, Regenexx sued the FDA, claiming the agency lacked the authority to regulate its procedures, which involved culturing stem cells before reinjecting them into patients. Regenexx lost its case and was countersued by the FDA, which charged that Regenexx was marketing an unapproved drug.20 June 2019

Another Trigeminal Neuralgia Patient Helped

Credit: Shutterstock

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):

Credit: Shutterstock

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

If you have questions or comments about this blog post, please email us at info@regenexx.com

NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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Contributing to risk-based Chinese medicine regulation in Australia

Many of our people living with trigeminal neuralgia who are unsuccessful in achieving pain relief from a surgical procedure, have turned to Chinese Medicine practises to manage their pain.  However it is important to understand how Chinese medicine regulation occurs.

Chinese medicine covers the following treatments

  • Acupuncture
  • Cupping
  • Herbal medicine

 

In Australia we are fortunate to have a well regulated market and are overseen by the Australian Health Practitioner Regulation Agency (AHPRA)

The following is the 2018 covering letter describing a report reviewing Chinese medicine and the full report can be downloaded below

Foreword
National Boards work in partnership with the Australian Health Practitioner Regulation Agency (AHPRA) to implement the National Regulation and Accreditation Scheme (NRAS) for regulating health practitioners in
Australia.

The Research Unit (RU) of AHPRA, on behalf of the Chinese Medicine Board of Australia (CMBA), conducted a research project to develop an evidence base from which to establish a risk profile for the profession of Chinese medicine.

The project involved a combination of:
• a literature review (analysing international evidence in particular); and,
• a critical analysis of AHPRA’s notifications and complaints data (for current national regulatory evidence).

The report that follows outlines the findings from this project, including that the practice of Chinese medicine is generally safe in contemporary regulatory environments, such as Australia. However, there are a number of limitations in the applicability of these findings, including:
• while the size of the profession has been doubled over the last two decades, both the numbers of Chinese medicine practitioners in Australia (<1% of the regulated health workforce under NRAS) and the incidence rate of notifications are low;, and
• the comparatively limited literature associated with quality of care and patient safety concerning Chinese Medicine practice.

It is also important to note that the report includes evidence of both Australian and international risks and issues, some of which have minimal relevance in the Australian practice setting. This is due to practice
controls (e.g. the regulation of health professions, the restriction of drugs and poisons, etc.), different training and education, a different dominant model of health care in Australia, and quite specific public understanding and expectations around healthcare.

Despite the above limitations, the CMBA sees this report as valuable initial work to educate the profession and to highlight potential areas for the development of future regulatory responses including Continuing
Professional Development (CPD) and clinical guidance.

This preliminary analysis of notifications also sets the scene for further research including a more in-depth review at the available data, perhaps per examination of:
• comparative data from other health professions, and
• links with sub-factors such as education level, experience of practitioners, location, age, gender and English proficiency.
The CMBA is committed to improving its effectiveness as a risk-based regulator and welcomes feedback.

Please provide your comments by contacting Ms Debra Gillick, Executive Officer CMBA,
debra.gillick@ahpra.gov.au
I also would like to take this opportunity to thank Paul Shinkfield and the Research Unit for the excellent work they did for this project.
Professor Charlie Xue
Chair
Chinese Medicine Board of Australia

Chinese Medicine Board Report 2018

 

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Diagnosis and treatment of trigeminal neuralgia: Consensus statement from the Spanish Society of Neurology’s Headache Study Group

Diagnosis and treatment of trigeminal neuralgia criteria see below statement.

Abstract
Introduction: Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder affecting one or more branches of the trigeminal nerve. Despite its relatively low global prevalence, TN is an important healthcare problem both in neurology departments and in emergency departments due to the difficulty of diagnosing and treating the condition and its significant impact on patients’ quality of life. For all these reasons, the Spanish Society of Neurology’s Headache Study Group has developed a consensus statement on the management of TN.
Development: This document was drafted by a panel of neurologists specialising in headache, who used the terminology of the International Headache Society. We analysed the published scientific evidence on the diagnosis and treatment of TN and establish practical recommendations with levels of evidence.

Conclusions

TN is diagnosed clinically. Patients consulting due to facial pain (whether paroxysmal or continuous) should be assessed thoroughly (history-taking and physical examination). In the ICHD-3, pain attributed to a lesion or disease of the trigeminal nerve is categorised into TN and painful trigeminal neuropathy. In turn, TN is divided into 3 main types according to pain aetiology: classical, idiopathic, or secondary. The most relevant conclusions of this review are that:

1 In patients with TN (and in the absence of contraindications), an MRI study is essential in the proper assessment of the brainstem and posterior fossa and to rule out secondary causes. To establish the presence of neurovascular compression, FIESTA, DRIVE, and CISS protocols are recommended.

2 After diagnosis of TN, the pharmacological treatment of choice should be carbamazepine, unless contraindicated. Other sodium channel blockers, such as oxcarbazepine, may be better tolerated.

3 In patients unresponsive/intolerant to a first-line drug, second-line treatment with other neuromodulators or polytherapy should be considered. In patients presenting concomitant continuous pain, such antidepressants as amitriptyline or duloxetine may be indicated. Local infiltration of botulinum toxin may be an effective alternative in non-responders or in polytherapy.

4 Surgical treatment should be considered in refractory cases.  The specific procedure should be selected based on the presence or absence of neurovascular compression, patient age, and other factors. The technique of first choice is MVD, especially in patients in whom neurovascular compression is identified.

Diagnosis and treatment of trigeminal neuralgia: Consensus statement from the Spanish Society of Neurology’s Headache Study Group