Thursday, October 2, 2014

Catching or Crashing on the Wave of New Sports Medicine Technology: PRP and other Cell Therapy

Platelet Rich Plasma (PRP) has its advocates as a viable treatment option, but it lacks evidence shown in clinical studies substantiating these claims. There is very little difference between placebo and treatment groups. The PRP disposable kit costs approximately 250 dollars per kit. Skeletal muscle has a greater regenerative capacity than tendon and ligament. There is also the cost of the centrifuge (approximately 10,000 dollars) needed to spin the blood down. One small level 3 evidence study showed comparable results to cortisone injections for plantar fasciitis after three months using VAS scores. As with lasers, PRP has not yet established strong efficacy for musculoskeletal use. One disadvantage of PRP is that the potency of the cells is dependent on the age of the patient. Stem cell harvesting from adipose tissue and bone marrow may be the next progression in regenerative technologies but there are no large trials to support the theory at this time. Finally, amniotic tissue is being investigated and used for musculoskeletal injuries. Amniotic tissue has the advantage of possessing very young cells, which are pluripotent (able to differentiate into all three germ layers). The price of ¼ cc of tissue ranges from $500-$750. One plantar fascial injection uses ¼ cc. One small study, that had Charles Zelen, DPM as the lead investigator, showed some promise versus control for an eight week follow-up for plantar fasciitis.

Monday, September 29, 2014

Catching or Crashing on the Wave of New Sports Medicine Technology

There are a number of new technologies in the sports medicine space that promise to get you back in the game more quickly. How do you as the patient know what to believe? One important question is “Does the technology provide long term relief”." If the patient has shown noticeable improvement immediately after prescribed treatment but returns to symptoms after activity, they will be left unsatisfied with the treatment. David Armstrong, DPM, MD (University of Arizona) adds that it is difficult to cut through the noise around many technologies. It is expensive to run good quality studies and smaller companies rely on 510k status to cover like technologies. On the other hand, he believes some potential good technologies never see the light of day. The other question to ask is how the natural progression of the acute or chronic injury compares with the improvement noted after intervention. One example is heel pain. Studies have stated that there may be as high as 90% conservative improvement with heel pain. Specialists obviously will get the recalcitrant cases. The argument can be made that continuing a trajectory of failed treatments will cost more money than an intervention that will cure the problem earlier. For example, there are about 1 million patient visits for plantar fasciitis alone in the United States with an estimated cost of $192 million to $376 million dollars. The average time for resolution for plantar fasciitis is about 18 months. Look for part 2 on this topic Thursday.

Monday, September 8, 2014

Brave New World Of Regenerative Medicine

It's a brave new world of regenerative medicine. David Armstrong DPM, MD has a lecture devoted to replacement parts. Another type of regenerative medicine is using cells to repair injuries. With appropriate cell signaling organs can be created from cells. Amnion cells are being used to help heal injuries. They are more potent than stem cells derived from our own bodies because they are not worn down with age. Industry studies, including one with Dr. James Andrews as a secondary author, that are double blinded have shown some promise injecting these substances into injured area like the ankle and plantar fascia as well as arthritic joints. Dr. Andrews is the consultant orthopedic surgeon to NFl teams with tricky knee injuries like RGIII's. Stay tuned!

Wednesday, August 27, 2014

On Breathing & becoming a Lifetime Learner

While in upstate New York, I took a class on healing Thai Chi. The instructor mentioned that we should be breathing in through the nose and not the mouth in practice because it restores more oxygen to the brain than mouth breathing which is more of a fight & flight mechanism.I thought , wow I never new that and I have been doing yoga a while now. it reminded me that you can never stop learning if you want to optimize your well being and your ability to help others. I watched a sales presentation on lasers once and the video had the standard doc in the white coat behind a bunch of books stating that 100% of his patients improved with the laser. I started getting this "Amway brain wash"Danger Will Robinson" feeling wash over me and had an impulse to take my own flight from the program. When the sales rep spoke to me regarding my hesitation with the studies he said a bit exasperated "Well, Dr. Pearl, you're a unique individual - you're a Lifetime Learner and sometimes you just have to pull the trigger. I suppose being called a Lifetime Learner isn't such a bad thing.