Regenerative Therapies for Chronic Intradiscal Pain

Abstract

Intervertebral disc degeneration involves a complex interaction of various processes including cell loss, inflammation, and matrix degradation. Many patients suffer relapsing and chronic back pain despite conservative and interventional treatment. Procedures including steroid injection, electrothermal therapy, and surgery have been met with challenges including lack of robust or long-term efficacy. The immunomodulatory and trophic effects of regenerative therapies have shown significant promise and attracted considerable interest from researchers, clinicians, and patients. Intradiscal injection of mesenchymal stem cell products and platelet-rich plasma is being studied increasingly by pain physicians as a novel therapy for the treatment of discogenic pain. Published studies in preclinical and human models demonstrate encouraging results, but well-powered, high-quality studies are needed to properly evaluate the safety and efficacy of such treatments. Regenerative therapies with bone marrow aspirate concentrate and platelet-rich plasma are offered in point-of-care settings. Treatments involving more sophisticated mesenchymal stem cells prepared with culture expansion or genetic modification are currently offered only in clinical trial settings with FDA approval.