Medical researchers are trying a new treatment for low back pain. Their hope
is that harvesting and then re-injecting the body's own bone marrow - which is
rich in stem cells - may repair worn-out discs in the spine.
In a small new study, the approach appeared to be safe - and none of the
patients reported that their pain got worse after the procedure.
But both the doctors who are testing the technique and outside experts say
much more research is needed before they can say whether the treatment offers
"I tell everybody that this is experimental, with a capital E," said Dr
Joseph Meyer Jr, an anaesthesiologist and pain medicine specialist at the
Columbia Interventional Pain Center, in St Louis. "We don't know if it works. I
do believe that it's safe, but it might not do anything for you."
How the study was done
For the study, Meyer and his colleagues reviewed the case histories of 24
patients who were injected with their own bone marrow aspirate cellular
concentrate (BMAC). Bone marrow concentrate contains adult stem cells, which
have been called the body's own repair kit because they can change into - and
potentially heal - different kinds of tissues.
Meyer's patients reported suffering from chronic low back pain for anywhere
from three months to 12 years. Imaging tests showed that all the patients had
some evidence of degeneration, or damage, to the discs that cushion the bones of
the spine. Disc degeneration is common with age, and it is thought to be a major
cause of low back pain.
Many times, exercise and weight loss can help people with persistent low back
pain. But if conservative approaches fail and the pain becomes debilitating,
Meyer said, the next option is invasive spinal fusion surgery.
"Fusion is a big, big step with questionable effectiveness," he said. "Often,
you're back in the same boat a year later."
Meyer said he offered patients the bone marrow treatment as something to try
before resorting to surgery.
Don't get 'too excited'
For the procedure, he used a long needle to extract bone marrow from the back
of the hip. The bone marrow was spun in a centrifuge to concentrate the cells
and then injected into the space around a damaged disc. Meyer said the treatment
costs a few thousand dollars and is not covered by insurance.
Of the 24 patients who initially received the bone marrow injections, half
went on to have other procedures over the next 30 months, making it impossible
to know what might have affected their back pain.
Of the 12 who had no other kinds of treatment, 10 reported that their pain
lessened in the two to four months after their injections. After a year, eight
patients were still reporting significant pain relief, while three said their
back pain had not improved. One patient had not yet reached the 12-month mark.
After two years, five said their back pain was better, and three had no
improvement. For the other four, it was still too early to tell.
Meyer said none of the 24 patients who tried the technique had complications
from their procedures, but injections always carry the risk of infection.
The study was scheduled for presentation at the annual meeting of the
American Academy of Pain Medicine in Fort Lauderdale, Fla. Studies presented at
scientific conferences usually haven't been scrutinised by independent experts,
and their results are considered preliminary.
An expert who was not involved in the study said people with back pain
shouldn't get too excited about these results, particularly since there was no
control group used for comparison.
"Low back pain often gets better over time," said Dr Richard Deyo, a
professor of evidence-based medicine and a back pain expert at Oregon Health and
Sciences University, in Portland. "Even patients who have chronic pain, their
symptoms tend to wax and wane and fluctuate. They seek care when their symptoms
are worst, and very often they drift back to their average level of pain, which
looks like improvement."
"People grasp at straws, and they shouldn't. We have a long history of
treatments that look promising when they start and turn out to be no more
effective than placebo interventions," said Deyo, who also is deputy editor of
the journal Spine. "We also have a history of treatments that, in some
cases, turned out to be harmful. It's really too early to know if this is going
to be effective or safe."
The study's authors agreed. They said they hope this pilot project will
encourage more research.
"We hope it will get people thinking and hopefully promote a future
controlled study," Meyer said.
There's more on low back pain at the US
National Institute of Neurological Disorders and Stroke.
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