The latest treatment he’s found to be very effective is a regenerative therapy using stem cells from amniotic fluid.
Amniotic stem cell injections are successful in treating hard-to-treat chronic pain conditions, such as arthritis, old injuries that won’t heal, and joint, tendon, and ligament issues.
Stem cells are cells that have the potential to replicate themselves and regenerate tissues. When they are injected into a painful area, they repress inflammation—the root cause of pain—and grow into new tissue that replaces the damaged tissue.
While treatment with amniotic stem cells is not always permanent, it can give people years of pain-free, functional movement, Dr. Elbaz says. The risk of complications from stem cell treatment is also very low because infections rarely develop from a small injection area. Also, unlike with blood transfusions or organ transplants, there is no need to screen for compatibility of stem cells before treatment. Stem cell donors are always screened for health, however.
How It Works
For the amniotic stem cell treatment, amniotic fluid is collected at the time of birth from pre-screened women who have agreed to donate. The stem cells are then sterilized, freeze-dried, and shipped to the doctor’s office, where they are reconstituted for injection.
Given the extent of the process needed to obtain and preserve the stem cells, the treatment is relatively expensive. Because of this, and the fact that the treatment is potent, Dr. Elbaz reserves it for patients who have more advanced pain conditions.
Alternatively, for patients (especially younger ones) with more moderate conditions, treatments with platelet-rich plasma (PRP) are very successful, he said.
Platelets, the smallest type of blood cell, are the body’s first responders to any injury. Platelets cause the blood to clot and signal to the body to start a cascade of healing responses in an injured area, including attracting the body’s own stem cells.
With a PRP treatment, the doctor draws a small amount of the patient’s own blood (as one would for a blood test). This blood is then placed in a centrifuge, where it is spun to separate the platelets from the rest of the blood. The doctor then injects the concentrated platelets into the injured area, and the patient’s body responds by mounting a stronger healing response.
Like amniotic stem cell injections, the risk of complication from infection after PRP is very low, and there is no risk of rejection because the patient’s own blood is being used.
Both amniotic stem cells and PRP treatments have big advantages over conventional pain treatments like steroid (cortisone) injections and lubricating injections, because they can restore health to a diseased or injured area instead of only reducing pain.
These regenerative treatments do take more time to work, however. With cortisone, the pain relief is immediate, whereas it can take one to two weeks for patients to feel better after treatment with amniotic stem cells or PRP.
Regenerating Injured Knees
The method Dr. Elbaz uses to treat knee pain today is not something he could have imagined during his residency, when the main tool he was given to treat knee pain was cortisone.
Back then, regenerative treatments were not even “on the horizon” for chronic pain, let alone for knees, he said.
Regenerative therapies are especially advantageous for people in their 30s and 40s with severe knee pain, because people at these ages are not candidates for a knee replacement, Dr. Elbaz explained. This is because the hardware used for knee replacements has a limited lifespan, and it’s difficult to redo a knee surgery if the replacement gives out. So doctors prefer to wait to do the surgery until patients are in their 50s or 60s.
Another good option for helping the knee to heal is the nonsurgical treatment Iovera, which uses extreme cold to shut down nerves so that they stop sending pain signals to the brain. The nerves grow back, but living pain-free in the interim allows people to resume activities that can ultimately heal their knee condition, Dr. Elbaz said.
And while there are certainly advancements coming, Dr. Elbaz is optimistic that with the current state of pain medicine, there are now treatments for lessening any kind of pain.
“We definitely have something for everyone,” he said.
Pain Physicians NY Dr. Tamer Elbaz 212-757-0222 780 Eighth Ave., Suite 201 New York, NY 10036 PPNYC.com
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