Specialist chronic pain solicitor, Andrew Atkinson, considers progress in the use of stem cell therapy for CRPS.
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At times, stem cell therapy – also known as ‘regenerative therapy’ – appears to be the panacea for all ills. But could stem cell therapy for CRPS soon become commonplace?
As we shall see below, it’s already available in private clinics if you have the hard cash. And in the US, the National Institutes of Health (NIH) recently awarded a $5.5 million grant to researchers at the Cleveland Clinic to develop a stem cell therapy for CRPS. Unsurprisingly, this federal funding flows indirectly from America’s anti-opioid war chest.
So, what is stem cell therapy for CRPS?
We have previously considered the work undertaken at the University of California, San Francisco, to use stem cells to overcome the neurological effects of peripheral nerve damage, including pain. Their method involves transplanting Cortical GABAergic Precursor Cells derived from stem cells into the spinal cord.
In the words of their research lead, Professor Allan Basbaum, the study revealed “an entirely new perspective on the circuits that process the injury messages that generate acute and persistent pain and on novel approaches to therapy.”
Professor Basbaum describes neuropathic pain as “a disease” of the central nervous system. Nerve damage causes pain, and to alleviate that pain, you must treat the nerve damage. However, he says that traditional drug therapies often provide only a temporary benefit and usually go hand-in-hand with side effects, impacting a person’s quality of life. The San Francisco team’s approach is entirely different in repairing nerve damage through stem cell therapy. And their research suggests that neuropathic pain decreases without side effects following stem cell transplantation.
The technique may also benefit other conditions, including Trigeminal Neuralgia and Multiple Sclerosis.
Human case study
Although very encouraging, the results in San Francisco were at the pre-human trial stage. However, in 2014, the American Journal of Thermology published the results of a human case study from Pennsylvania:
“A female Registered Nurse presented to our clinic with a chief complaint of left lower extremity pain after suffering from a complex, medial malleolar fracture that required operative repair and internal fixation. Post-operatively she experienced allodynia and was diagnosed with CRPS/RSD. Despite many months of aggressive therapy she was still unable to ambulate with any weight bearing on the left leg. In addition to using a knee scooter for mobility she had clear trophic skin changes. Both vaso and sudomotor findings were present.
“As a result of the findings local injection including posterior tibial nerve block, sciatic nerve block, lumbar epidural steroids, and L5S1 facet region injections were tried. Blocks were followed with proliferative injection into the medial deltoid and tibial-calcaneal ligaments. Medication changes including the addition of clonidine to aid in vasodilatation, non-narcotic analgesics, and muscle relaxers. Nutritional recommendations were made and restorative therapy was prescribed. Variable success was achieved.”
Consequently, they proceeded with stem cell therapy. Cells were harvested from the subject’s hip and transplanted into her calf, with a platelet-rich plasma (PRP) booster given 30 days later, with the following results:
“At two week follow up trophic skin changes already showed signs of lessening. The patient had also begun to weight bear on the left leg and reported less allodynia. By the time the 30 day PRP booster was performed she was no longer using adaptive aids to walk however compensatory gait persisted. Six weeks after the stem cell procedure trophic skin changes, sudo and vasomotor instability, and allodynia had dramatically improved.”
While these results are encouraging, to say the least, significant questions remain. For example, the facts available indicate localised CRPS in the lower part of the Pennsylvania subject’s left leg. But what about those with established disease whose CRPS has spread elsewhere in the body?
Private stem cell therapy
Of course, some private clinics wasted no time offering stem cell therapy for CRPS, despite the major knowledge gaps and lack of recognised treatment protocols. And that’s not surprising given the ready market of desperate people living with the torment of the condition. Indeed, expectation management is a key consideration in marketing literature, with statements like this one typical:
“Regenerative Medicine is still considered an experimental procedure and not approved by the FDA. Patients must consider realistic expectations in their research and possible therapy options.”
Understandably, there is considerable and well-placed optimism for stem cell therapy for CRPS. But the outcome of more wide-ranging human clinical trials is needed before it can be considered a mainstream ‘fix’.