What is regenerative medicine?
Regenerative or restorative medicine is an emerging medicine that is rising in popularity, most likely since well-known athletes such as Rafael Nadal and Tiger Woods have benefited from platelet injections. Erik Guay received prolotherapy and Jean-Luc Brassard received stem cells. Promising studies involving stem cells are also being talked about more and more. But, regenerative medicine has actually existed for a very long time…
Regenerative (restorative) medicine is a valuable tool in the treatment of tendon, ligament and joint problems.
The history of regenerative medicine began with prolotherapy (proliferative therapy). At the time, prolotherapy doctors used irritating substances that were sometimes dangerous (phenol, for example). Over time, doctors realized that the use of dextrose at a concentration of 12.5-15% was sufficient to trigger the inflammatory cascade, essential for tissue healing (see image). Dextrose is a form of sugar given to diabetic patients when they experience hypoglycemia. It is also used in various hospital fluids. Dextrose is a safe and affordable solution that is used regularly in medicine.
In medicine, many studies are funded by pharmaceutical companies. Needless to say, no companies have ever provided resources to research simple dextrose injections. However, even in the absence of funding from the pharmaceutical industry, my colleagues have recently conducted some fine studies internationally, including right here in Canada. Read the studies»
In Quebec, a report issued by INESSS in 2013 stated that prolotherapy was dangerous and that research should stop in this area. It’s important to note that this report is not based on current data and includes toxic substances that haven’t been used in a long time.
Prolotherapy has existed for more than 50 years. It is practiced without complications in all Canadian provinces and all over the world. To date, Quebec is the only one that does not fully recognize its benefits.
It should be noted that it is taught in a Canadian and American association. Harvard Medical School trains physiatrists in prolotherapy.
Prolotherapy is a pillar of regenerative medicine, it is safe, it costs virtually nothing in the public system, and finally, prolotherapy injections with hyperosmolar dextrose are no longer experimental, unlike stem cell injections.
Essentially, regenerative or restorative medicine (dextrose or platelet-rich plasma, and soon stem cells injections) is a great avenue for patients who suffer from chronic pain, osteoarthritis or have tendon or ligament problems.
Hyperosmolar dextrose (prolotherapy) or platelet injections are not a cure-all or a quick fix. They simply represent a very interesting alternative when the patient does not want cortisone, when the conventional approach has failed, or when the patient suffers from different allergies or intolerances to the proposed drugs. None of these therapies (prolotherapy, PRP, stem cells or viscosupplementation) regenerate the cartilage.
At the very least, these therapies slow the deterioration of cartilage and reduce pain, unlike cortisone, which reduces pain, but destroys cartilage.
In regenerative medicine, there are two groups of treatments: biological treatments (PRP and stem cells) and non-biological treatments (prolotherapy, percutaneous needle tenotomy).
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Tissue Repair Phases
Cell migration begins with the injection of dextrose or platelet-rich plasma. For 3 to 4 days, the inflammatory phase dominates. White blood cells and macrophages will clean the inflamed structure (neovascularization) and then send a signal to the construction team (fibroblastic activity) for collagen deposition and repair.
Types of injections available
In regenerative medicine
Viscosupplementation
Viscosupplementation (Synvisc One, Cingal, Durolane, Neovisc, Suplasyn, Ostenil, Monovisc, etc.) is hyaluronic acid that is similar to your synovial fluid. This lubricant nourishes your cartilage. Unlike cortisone, there is no maximum number of injections per year. Its cost is high but the effects of viscosupplementation on the joints are excellent. Viscosupplementation has short and long-term positive effects on cartilage protection, thus limiting the progression of severe osteoarthritis.
- Indications: treatment of osteoarthritis
- Contraindications: allergies to chicken or eggs (in the case of Synvisc only)
- Side effects: significant inflammatory reaction at the site of injection within the first three days. (6 injections out of about 100)
Download post-viscosupplementation injection tips here.