Stem Cell Therapy for Back Pain
Many effective treatments for back pain and spine conditions have been around for years or decades. But a new wave of therapies is providing more options for people to find relief from pain, physical limitations, and other symptoms caused by spine-related problems.
One of these cutting-edge treatments is stem cell therapy, a type of regenerative medicine. This involves repairing damaged, dysfunctional, or diseased tissue using stem cells, versatile cells that can turn into many other types.
Stem cell therapy is being tested for a number of conditions throughout the body, including those that affect the spine.
“There are reported uses of this for many conditions of the spine, but the most common condition is degenerative disc disease,” says Brian Adams, MD, an interventional spine physician at Spine Center Atlanta in Georgia.
Where do stem cells come from?
Scientists have discovered several sources of stem cells, including:
- Embryonic stem cells. Embryos that are three to five days old contain stem cells that can grow into more stem cells or turn into other types of cells in the body.
- Adult stem cells. Adults also have some stem cells in their body, such as in the bone marrow or abdominal fat. These can turn into other types of cells, but are not as versatile as embryonic stem cells.
- Adult specialized cells. Scientists can sometimes turn adult cells into stem cells by altering their genes.
- Perinatal stem cells. The fluid that surrounds and protects the fetus in the womb (amniotic fluid), and the blood in the fetus’ umbilical cord, both contain stem cells.
Stem cells used for treating back pain and spine conditions usually come from the patient’s own body, such as from the bone marrow or abdominal fat.
This is done because there is a lower risk that the body’s immune system will attack the cells as a “foreign” material.
Once the stem cells are isolated, they are injected into the area that is being treated.
Is stem cell therapy approved for spine conditions?
Stem cell therapy has not yet been approved by the Food and Drug Administration (FDA) for back pain and spine conditions. That means it is still an experimental therapy.
“The lack of FDA approval and the specific regulations placed by the FDA do limit access to certain aspects of regenerative medicine. This may make patients leery of treatment,” says Adams.
However, the lack of FDA approval “does not mean that [these therapies] are not useful or inappropriate,” says Kaliq Chang, MD, a spine and neck interventional pain management specialist with Atlantic Spine Center, which has locations in New York and New Jersey.
He says that in his practice patients have had “good lasting pain relief outcomes and minimal dangerous side effects” with stem cells injected into injured or damaged spinal discs.
Some aspects of stem cell therapy are approved by the FDA, such as the harvesting of bone marrow cells from patients. If these stem cells are not changed greatly during collection and processing, physicians can use them for unapproved therapies and still comply with the FDA’s rules.
However, before stem cell therapy can be approved by the FDA for spine conditions, clinical trials will need to be done in people showing that it works and is safe.
“This is an area that we, as clinicians, desperately need to advance in order to get these treatments available to more patients,” says Adams.
This type of research often involves a randomized clinical trial, or RCT. In this type of study, half of the patients would receive stem cell therapy. The other half would receive a currently-approved treatment.
Clinical trials, including longer ones, are needed to show that stem cell therapy is safe. One review paper in 2018 identified 35 cases of complications or death due to unproven stem cell treatments. This included loss of vision, infections, and cancer.
The researchers don’t know if these problems were due to the use of stem cells or a problem caused by how the procedure was done.
Another concern that some doctors have with stem cell therapy is that there are many causes of back pain. This includes conditions such as a herniated disc, degenerative disc disease, facet joint syndrome, osteoarthritis and muscle spasms.
Some of these may require more than one type of treatment.
“[Regenerative medicine] is by no means a panacea,” says Adams. “The spine is a complex mechanical structure and is best treated using a multi-specialty approach.”
What studies have been done with stem cells for back pain?
Although there is a lot of interest in stem cell therapy for back pain and spine conditions, more research is needed.
“While there are numerous case reports and small case studies that show impressive results in decreased pain and disability scoring, there is a lack of large-scale controlled trials,” says Adams.
Some studies have already been done. The most evidence comes from ones looking at the benefits of stem cell injections for spinal disc injury or degeneration.
”Only back pain that has been diagnosed as purely disc-related pain … will likely be helped with intradiscal stem cell therapy,” says Chang.
Recent clinical trials have looked at the use of stem cell therapy for several spine conditions:
- Chronic low back pain caused by degenerative disc disease. Scientists are studying to see if stem cell therapy can restore the damaged spinal discs that are causing the pain.
- Spinal fusion surgery. This procedure is used to add stability to the spine, such as for degenerative disc disease or severe scoliosis. Some studies have found that stem cells made from bone marrow may help the bone grow.
- Ankylosing spondylitis. This is a type of arthritis that mainly affects the spine. Scientists are testing to see if stem cells can be used to reduce inflammation in the body that causes damage to the spine, and help the damaged cells heal.
- Spinal cord injury. There is a lot of interest among scientists in using stem cells to help people who have had a spinal cord injury. This research is still in the very early stages. Many of the studies are being done in rats or other animals.
Talk to a doctor about your options
Because stem cell therapy is so new, it is important to find a reputable clinic to see if this treatment is right for you.
“I would encourage patients to seek a multi-specialty spine center for regenerative treatments,” says Chang. Also, “ask if they [keep track of their] outcomes or try to publish [their] results. These types of facilities are generally more cutting edge.”
You may need to have a physical exam and tests such as an MRI or CT scan to determine the cause of your pain and other symptoms.
Your doctor will then talk to you about your treatment options, including the benefits and risks of each. There are many treatments for back pain. Stem cell therapy may not be the correct option for you.
In fact, it may be best to find a physician who knows about both stem cell therapy and standard treatments.
“People should only pursue stem cell therapy for back problems from physicians that are well-versed in the standard treatments,” says Chang.
A physician may want to try these standard treatments first, he says, because they are “less invasive and usually covered by insurance.”
Adams recommends that you go in with your questions ready. And be wary if what the clinic promises seems too good to be true.
“Never feel pressured into making a snap decision about your care,” says Adams, “and don't hesitate to seek a second opinion.”