Roshni N. Patel, MD, is an interventional pain management physician who is quadruple-board-certified in the areas of pain, headache, neurology and brain injury. Currently the medical director of the Center of Excellence in Pain & Regenerative Medicine in Farmington, she has been treating patients for 15 years and offers regenerative medicine procedures to patients seeking pain relief and improved quality of life. We asked her to share her thoughts on the regenerative medicine questions that are top of mind for our readers.
What are the most exciting developments in the regenerative medicine field right now?
The most exciting recent developments in the field certainly include the advances in research both conducted and published. Also, while still slow-moving, we’re seeing a bit of momentum gained in the increase in insurance companies willingness to pay for these procedures; they’ve begun to realize that the patients and their own coffers stand to benefit in the long run by avoiding expensive medical procedures down the line. For example, Alabama is now paying for its state employees to undergo these therapies.
I am hoping primary care providers become more aware of therapies, so they can accurately guide their patients in seeking out the right medical professional for these treatments. Patients should be well-informed on the possibilities and limitations of regenerative medicine.
The other exciting recent development has been the momentum and gains we’re seeing in the field of iPSC, or induced pluripotent stem cells, which can be engineered to treat a myriad of conditions affecting degeneration. The National Institutes of Health (NIH) is taking a lead in researching and conducting the trials on it. The therapy involves taking a patient’s blood cells and, in a lab, converting them into iPS cells, which have the potential to form any type of cell in the body. This study goes back to the basics of using the patient’s own blood cells to treat degeneration without the use of external biologics. iPSC, once perfected, will be able to change how we treat patients.
I’m also following the use of regenerative medicine for neurological conditions, as researchers are still in the early stages of developing therapies for Multiple Sclerosis, ALS, Parkinson’s, traumatic brain injury, dementia and Alzheimer’s. The therapeutic potential of cell-based treatment for several neurological disorders cannot be understated, as many of them currently result in either permanent neurological damage or are incurable. Regenerative medicine may offer an alternative approach to supportive care.
How do you address the common misconceptions patients and the public have about regenerative medicine?
When it comes to misconceptions by the public at large, primarily they think all regenerative medicine is a stem cell procedure, which just isn’t true. Most of them don’t know about other options, like PRP, and that these procedures are available in reputable facilities within the United States. They also think the therapies will cost tens of thousands of dollars.
One of the most common misconceptions about regenerative medicine by patients is that they see it as a cure. Rather, it is a therapy that can improve their quality of life, and that is what practitioners should aim for with every patient that walks into their practice. There are still other factors to consider. For example, patients with healthy lifestyles have better outcomes compared to patients with unhealthy lifestyles.
Patients often think that stem cells or other biological products provide better outcomes versus their own blood cells because such treatment is more expensive compared to a PRP procedure, and that’s just not the case. We only approach second-level use of bone marrow if PRP has failed.
Also, patients wonder why they would choose regenerative medicine over surgery since the latter is covered by insurance and regenerative procedures most likely are not. They need to consider the downside of surgery and total joint replacements, including recovery time, pain and the risks of surgery.
The most dangerous misconception, however, is that it is a miracle cure for everything that ails them. This thinking has led to unscrupulous practitioners taking advantage of desperate patients seeking a miracle. The best thing to do is seek proper medical advice from a trusted professional.
What criteria should a patient use in choosing a health care professional in the regenerative medicine field?
When it comes to regenerative medicine, a practitioner’s technique, education, equipment and skill set all matter. Most importantly, practitioners should follow clinical studies on PRP, non-autologous biologics, bone marrow, adipose and many others, and monitor ASIPP and FDA guidelines to ensure they are offering safe regenerative medicine treatment options when it comes to regenerative medicine.
When searching for a regenerative medicine practitioner, be sure the therapies they offer are in line with their area of specialty. What is the physician’s background and training? For example, I largely focus on pain- and neurology-related conditions so I can offer optimal outcomes.
Is a proper work-up being done to identify the root cause of the symptom?And if they suggest a regenerative medicine-based treatment, ask for clinical studies that back up their reason for suggesting it.
Ask what kind of biologics will be used.PRP and BMAC are allowed for autologous use. Adipose is not allowed. If non-autologous biologics are suggested, find out how they are sourced and, if it is donor-derived has the provider performed due diligence? Patients should understand that non-autologous biologics marketed as “stem cells” actually contain zero stem cells. They do, however, contain growth factors and cytokines, which are used to signal patients own stem cells to repair and regenerate.
Find out what kind of equipment is being used to process PRP or BMAC.Not all centrifuges are created equal: A lab centrifuge is not ideal for achieving the correct concentration of platelets needed in PRP to ensure efficacy.
Will the injection be done under image guidance?Look for a practitioner who uses fluoroscopy or ultrasound to inject PRP. When it is done blindly, it is not as effective as when it’s done under image guidance, which ensures accurate needle placement.
If the clinic charges an exorbitant amount, seek additional medical advice.The average cost of a single PRP injection is around $1,500 at a reputable practice; BMAC and other biologics are between $3,000 and $5,000. On the other hand, be wary if the cost is far less, as it’s possible they do not use the right equipment, which could compromise the patient’s safety.
One final thought: One of the major concerns in the field of regenerative medicine is that it has become the wild, wild west, which has put a damper on what regenerative medicine can do for patients. There are practitioners packing seminars at hotels and marketing directly to customers. They are often run by out-of-state entities, and, in many cases, the treatments are not performed by physicians. Instead, they hire a nurse practitioner who lacks the training and skills to perform the diagnosis.
For the best experience with regenerative medicine, the patient must be as responsible as the physician in terms of being educated and informed.