Regenerative Injection Therapy – An Interview with Shane Mangrum, MD & Thomas J Morrison III, MD

Interviewer: What is regenerative injection therapy?

Mangrum: It’s a spectrum of tools that we use to try to induce healing and repair. It historically has included things like prolotherapy, but now involves platelet-rich plasma and stem cells.

Morrison: The regenerative medicine space is ill-defined, but it has a lot of potential therapies. Here at Polaris, we’ve focused on administering injectable therapies in joints. We’ve tried a number of different therapies, but what we’ve found to be the most successful is the use of PRP and fat-based stem cell injections in the lumbar spine, cervical facets, shoulders, and knees.

Mangrum: The reason we’ve chosen to focus on PRP and stem cells is based on studies and the research that’s been done so far. There’s pretty good data out there for uses of PRP in joints and, to some degree, stem cells. So we’ve tried to build on that and use PRP and stem cells in joints, the spine, hips, knees — areas that have the most evidence basis for that decision making. Focusing on these areas allows us to have an informed discussion with patients about their options and what expectations are realistic.


Interviewer: What can regenerative therapies accomplish that standard medical interventions cannot?

Morrison: We all suffer injuries at different times in our life, and we recover from them. Whether you twist your ankle or break your ankle, your body does what it can to heal itself. Most of the time you don’t need to have surgery.What we’re doing with regenerative injection therapy is taking your own body’s power, concentrating it, activating it, and putting it into an area or a joint that’s causing you trouble. These injections then signal your body to heal.What’s interesting is that we don’t know all the details behind what specifically is happening. There’s a lot going on in this area of treatment. Much of it we don’t really understand. What we do know, though, is that by concentrating and activating these substances, we’re seeing very encouraging results for our patients.

Mangrum: For that reason, PRP and stem cells may fill a void that exists in current care options. When we treat people with joint issues or back pain of some form, it often means fusing a joint, burning the nerves, or using radio frequency to blight the nerves that go to a joint. We do this because we can’t necessarily make it better, so we’re stuck with trying to block pain perception or pain related to that. And while it’s still an evolving space, regenerative injection therapies may be able to encourage repair and recovery in those tissues without resorting to more extreme measures.Morrison: People who are benefiting from PRP and stem cell treatment are often people that don’t fit in our traditional treatment paths, and maybe have been unsuccessful with other treatments.


Interviewer: I know you, Dr. Mangrum, particularly, have been interested in PRP for treatment in post-traumatic facet syndrome. Would there be an analog in our traditional model for how to treat that?

Mangrum: No, the current treatments are often antithetical in a sense to that. And we may with steroids try to decrease inflammation in the joint to kind of block that process. Or with radio frequency ablation, you burn the nerves that go to that joint to block the perception of pain. There’s encouraging data that those things can be helpful, but PRP and stem cell therapies approach it from a totally different direction where you’re trying to encourage repair. So somebody has whiplash, for example, may not only have joint pain, but they may have stretched out the ligaments or the capsule that helps stabilize that joint. With PRP, the hope is that you can induce repair across that whole joint, so you get a better, more lasting solution.


Interviewer: What are the differences between stem cell and PRP? Are there certain criteria that allow you to determine if patients should be treated with PRP or stem cell?

Mangrum: They fit on a spectrum. There’s not a lot of head-to-head studies that say that stem cells are better than PRP. There’s more data on PRP and it has been used for a longer period of time, so it’s more accessible in that way. But they’re similar and we don’t know necessarily how they’re different. They probably involve different sub-signaling pathways and parts of that regenerative process that they’re trying to encourage.

Morrison: Yeah, I think if you look the data from PRP, a lot of it has some shortcomings in durability. That is its big weakness. So the thought behind injecting stem cells is that they are going to stay there and help send out these signals for longer periods of time. That’s the theoretical process of it. And so the hope is, when you stick in the cells with a lot of the healing factors of PRP, that you’re going to get a longer or a more durable result. We don’t have the proof because stem cell therapy is so new, but the hope is it has more horsepower than PRP. So if your joint is severely damaged and PRP doesn’t quite help, then stem cells will have enough power to overcome the damage and help you heal more effectively. But for less serious injuries, you don’t necessarily need the horsepower of stem cells. It just depends on where you are in that spectrum of the injury and finding out which is going to work best for you or what you need.


Interviewer: What should a patient expect during and after one of these treatments?

Morrison: Well, it depends on what they have done. If patients have stem cells injected in joints other than your spine — like your knee or shoulder — I think the recovery is really easy for them. They don’t have a whole lot of pain; they recover very quickly. Before long, they’re back doing everything they were doing before the procedure. The thing is, people don’t improve right away. People improve three to six months out. So it’s not an instantaneous “get it done” and then- boom you’re better the next day. It takes time for the stuff to work.

Mangrum: PRP is similar in that it takes some time to take effect. People may be sore after an injection for a few days and that’s part of the regenerative process. But usually on the order of weeks, people start to notice improvement.


Interviewer: Polaris is currently overseeing a lumbar stem cell study. Have you seen any significant data or trends?

Morrison: Yeah, we have basically about a 70% success rate with roughly a 60% reduction in pain and 60% reduction in their functional disability. So that’s pretty good, but we try to be realistic. It’s not the perfect answer for everyone, but it’s promising and could help a lot of people.


Interviewer: Do you think that we’re using PRP or stem cells in a way that’s different than other people in our area?

Morrison: We use more spine-related injections than most practices. I think we’re very straightforward and honest with the people about what they can expect. We really want our patients to understand that this treatment may be very helpful and worthwhile but it’s also not a magic bullet or a cure-all or something like that. I don’t know that it’s always “sold” or presented to the market in that fashion, though. I think that’s important to be able to be critical of what you do, so you can say, well, it doesn’t work for everybody. A lot of people that are in this business, they tell everybody it works all the time.

Mangrum: And that it cures everything.

Morrison: That it cures everything — right. That’s one of the things that we’re very different about when we talk to people about it, and that’s kind of good and bad, but it’s important to be honest.

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