Wednesday, 06 Octobre 2021 | ANOVA IRM

Alternatives to Back Surgery

If you suffer from chronic back pain, your doctor might have told you that back surgery is your final option at hand. But is this really the case? In this article, we will discuss potential alternatives with focus on stem cell therapies and share with you the latest research insights in that interesting field.

What is Back Pain and What are Potential Causes?

Back pain is very common and is becoming a major public health issue, especially in industrialised nations (NHS, 2020). In most cases, the reason for back pain is nothing serious and you can even do something to help to relieve it, e.g. exercises, stretches. But sometimes the pain is caused by reasons that cannot be fought by a change in lifestyle alone, leading to long-lasting and reoccurring pain. Examples include a herniated disc or arthritis, including muscle spasms which can be caused by these diseases.

What are the Current Options to Overcome Back Pain?

As of today, it is obvious that the lifestyle of industrialised nations favours the onset of back pain as we do not exercise enough to train our muscles and sit at our desks too many hours per day. If you suffer from reoccurring back pain it should therefore be important for you to do as much sport as possible to improve your situation (NHS, 2020).

Additionally, many other non-invasive options can be applied to treat back pain (NHS, 2020). The most common one is the usage of hot or cold compression packs for short-term relief. If the back pain is connected with muscle issues, the heat can help to relax the muscles, thereby leading to reduced pain. If nerves are causing the pain, cold compression packs are more suitable. In both cases, immediate pain can be reduced by so-called non-steroidal anti-inflammatory (NSAID) painkillers like ibuprofen, administered either systemically (as a tablet) or locally/topical (via salves or patches). If the pain is rather strong, other painkillers can be used for a short period in combination with muscle relaxants such as diazepam or injection of cortisone to reduce pain caused by inflammation (NHS, 2020).

Finally, another option to overcome permanent back pain is back surgery which is for obvious reasons a decision of last resort (NHS, 2020; M. W. van Tulder, Koes, Seitsalo, & Malmivaara, 2006). If you suffer from pain caused by a herniated disc, the protruding parts, which are applying the pressure on the nerves, are removed. Including the time in the hospital, it is realistic to be back at work 8-10 weeks after the surgery. If you suffer from sciatica it is an option to use nerve treatments. Needles are inserted into the nerves and radio waves are sent through the needles to heat them, thereby stopping the nerves from sending pain signals any further. This is an ambulant treatment, allowing you to recover rather fast. If arthritis damaged the spinal bones to a significant degree it might be an option to fuse some bones, thereby increasing their stability and (optimally) reducing the caused pain.

What are the Problems with Current Treatment Options and What Needs to be Changed?

If you suffer from mild back pain, combination of exercises, cold/heat compression packs and treatment with anti-inflammatory painkillers will most likely help you to overcome the issues without any problems. For those patients that have long-lasting or severe pain, the current treatments with NSAIDs or stronger painkillers like opiates can help to overcome issues that are caused by pain (e.g. malposition that lead to pain again) but will in any other case not address the underlying reasons. Additionally, some patients might suffer from side effects due to the treatment with NSAIDs and opiate-based painkillers (e.g. Codeine or Fentanyl) are extremely critical, as they can lead to addiction rather quickly and should only be used in situations of severe pain (NHS, 2020; M. van Tulder & Koes, 2002b).

Back surgeries can be very helpful as they will ideally eliminate the reason for back pain. Nevertheless, the surgery itself can cause several other side effects like bleeding, infections or even nerve damage that leads to permanent crippling of certain areas of the body (M. W. van Tulder et al., 2006). So, it is worthwhile to think about alternatives to treat long-lasting pain.

Which Trustworthy Alternative Treatments are Available to Treat Back Pain?

As the number of patients with back pain is constantly rising, there has been intensive research in the field of alternative medicine as well (Mounce, 2002), with focus on psychological support, herbal medicine and innovative new methods using stem cells.

It has been shown that just by encouraging activity and giving reassurance, patients realised a benefit on their specific situation but of course, this was combined with the treatment of short-term symptoms with NSAIDs as well (M. van Tulder & Koes, 2002a, 2002b).

Many clinical studies with herbal medicines have been conducted but only a few showed superiorities over the basic placebo effect. Examples include treatment with Harpagophytum procumbens (devils claw), Salix alba (white widow) and Capsicum frutescens (Chili pepper) (Gagnier et al., 2016). Such an approach could help patients that suffer from side effects when using NSAIDs or those that simply do not trust “Western Medicine”.

Unfortunately, there are many other so-called treatments which have never been analysed within clinical studies and are defined as “not recommended” by the National Institute of Health (UK) and other health institutes.

These not recommended treatments include (NHS, 2020):

  • belts, corsets, foot orthotics and shoes with "rocker" soles
  • traction – the use of weights, ropes and pulleys to apply force to tissues around the spine
  • acupuncture – a treatment where fine needles are inserted at different points in the body
  • therapeutic ultrasound – where sound waves are directed at your back to accelerate healing and encourage tissue repair
  • transcutaneous electrical nerve stimulation (TENS) – where a machine is used to deliver small electrical pulses to your back through electrodes attached to your skin
  • percutaneous electrical nerve stimulation (PENS) – where electrical pulses are passed along needles inserted near the nerves in the back
  • interferential therapy (IFT) – where a device is used to pass an electrical current through your back to try to accelerate healing

In contrast to these not recommended treatments, the use of stem cells and the use of stem cell-derived supernatants as alternative pain treatment was investigated in clinical studies and showed convincing results.

How can Stem Cells be Used as Alternative Pain Therapy?

Stem cells are well-known for their potential to differentiate and grow during our whole life, constantly replenishing various cell types. Those cells are mainly localized in our bone marrow but also in some other niches within our body. Since scientist revealed the potential of these immortal cells, they have been within focus for the development of certain technologies.

Applications include diseases like diabetes, arthritis and Alzheimer but are also investigated in the context of healing or restoring certain tissues (wound healing, repair hearing or vision) (Vizoso et al., 2019). Clinical trials for many of these applications are still ongoing but due to ethical restrictions, this is not possible in many countries worldwide, especially when experiments are performed with embryonic stem cells.

In recent years it became apparent that stem cells not necessarily have to be in direct cell-cell contact to promote an effect but rather secrete compounds (cytokines or other biologically active proteins) into their so-called “microenvironment”. The entirety of these secreted compounds is called “secretome”.

The idea to treat the reason for back pain (nerve and/or bone damage) with such a secretome is still experimental but a highly promising approach as an alternative to avoid back surgery. Tissue damage and constant nerve pressure lead to inflammation and subsequent additional pain and damage. The addition of stem cells into the inflamed tissue can mitigate primary pain, slow or reverse the catabolic metabolism and restore the surrounding tissue. In a review from July 2019 such approaches are summarised pointing out that more studies have to be conducted to proof an impact on tissue regeneration but claim that pain reduction is certainly possible (Urits et al., 2019). A respective body of evidence for the injection of stem cell-derived secretome is still being compiled but different clinical trials are ongoing, using the medium in which stem cells have been cultivated as a treatment for many different diseases. As of today (Oct. 2021), there are four active trials, using such a secretome for treatment of osteoarthritis or Colitis ulcerosa but many other trials have been conducted already (NIH, 2020).

Whether Stem Cell Secretome is a treatment option for you depends on your current health status and the underlying problem in your specific case. If you would like to know more about your treatment options with Stem Cell Secretome, schedule an appointment today. Our doctors will assess your medical files to see if you can benefit from stem cell treatment.

References and Literature

  1. Gagnier, J. J., Oltean, H., van Tulder, M. W., Berman, B. M., Bombardier, C., & Robbins, C. B. (2016). Herbal Medicine for Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976), 41(2), 116-133. doi:10.1097/BRS.0000000000001310
  2. Mounce, K. (2002). Back pain. Rheumatology (Oxford), 41(1), 1-5. doi:10.1093/rheumatology/41.1.1 NHS. (2020). National Health Service, Back Pain - Treatment. Retrieved from https://www.nhs.uk/conditions/back-pain/treatment/
  3. NIH. (2020). National Institute of Health, Clincial Trials. Retrieved from https://clinicaltrials.gov/ct2/results?cond=&term=stem%20cell%20secretome
  4. Urits, I., Capuco, A., Sharma, M., Kaye, A. D., Viswanath, O., Cornett, E. M., & Orhurhu, V. (2019). Stem Cell Therapies for Treatment of Discogenic Low Back Pain: a Comprehensive Review. Curr Pain Headache Rep, 23(9), 65. doi:10.1007/s11916-019-0804-y
  5. van Tulder, M., & Koes, B. (2002a). Low back pain and sciatica: acute. Clin Evid(7), 1018-1031.
  6. van Tulder, M., & Koes, B. (2002b). Low back pain and sciatica: chronic. Clin Evid(7), 1032-1048.
  7. van Tulder, M. W., Koes, B., Seitsalo, S., & Malmivaara, A. (2006). Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. Eur Spine J, 15 Suppl 1, S82-92. doi:10.1007/s00586-005-1049-5
  8. Vizoso, F. J., Eiro, N., Costa, L., Esparza, P., Landin, M., Diaz-Rodriguez, P., . . . Perez-Fernandez, R. (2019). Mesenchymal Stem Cells in Homeostasis and Systemic Diseases: Hypothesis, Evidences, and Therapeutic Opportunities. Int J Mol Sci, 20(15). doi:10.3390/ijms20153738
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Contraindications

Our stem cell treatments are experimental, but we only treat patients for whom we believe the risk/benefit ratio indicates treatment based on the state of the art, i.e., medical, scientific evidence.

Please understand that we therefore do not treat patients for whom the following points apply:

  • Active cancer in the last two years
  • Not yet of legal age
  • Existing pregnancy or lactation period
  • Unable to breathe on own, ventilator
  • Difficulty breathing in supine position
  • Dysphagia (extreme difficulty swallowing)
  • Psychiatric disorder
  • Infectious disease (hepatitis A, B, C, HIV, syphilis, or other)