Conway McLean, DPM, Journal columnist

Times are hard for many Americans, many of whom are struggling to pay their bills and put food on the table. And things don’t appear to be returning to the glory days any time soon. The challenge of paying for health insurance and medicine plagues many Americans. A single medical emergency has driven too many into bankruptcy, homelessness, and worse.

A common topic on the subject of U.S. medicine is what our care consists of. Generally speaking, the most frequent result of a visit to a healthcare office is a prescription for some drug. But how often do our medications resolve a problem versus treating the symptoms? Too often, we are treating some type of pain, as opposed to the root cause of the discomfort.

Obviously, this is a complex question demanding a multi-faceted answer. But, too often, it is symptomatic relief only. Part of the problem has been our lack of options for pain relief, especially of musculoskeletal problems. Chronic pain of some joint or muscle is treated with either an opioid, an inappropriate practice, an anti-inflammatory, or acetaminophen (aka Tylenol). All three are capable of providing some temporary reduction of discomfort, but in no way stimulate a process of healing or repair.

The human body has tremendous potential for healing. But do our drugs, the opioids or anti-inflammatories, assist in this essential process, the removal of damaged tissue and production of new, healthy structures? The latest research indicates ibuprofen and the like actually impair healing by altering acute inflammation, which apparently is a necessary component of tissue repair.

Regenerative medicine takes a different tack, and involves no use of pharmacologic therapies, i.e. drugs. It is a novel concept, and an intriguing new direction in medicine, stimulating the process of healing. A number of different approaches have been investigated over the last two decades with some favorites emerging. Most of them revolve around the benefits of stem cells.

Stem cells are unique in that they are able to differentiate into various types of specialized cells. Once thought to be absent in the body by the time one reaches adulthood, they can be obtained from various sources including, fortunately, adult tissues. This fact is critically important in many regenerative techniques.

But regenerative medicine is no gimmick, no flash in the pan. These are effective, often shockingly beneficial. Healing is usually the result, and healed tissue is stronger for longer, unlike the typical drug regimen. This potential of stem cells to enhance tissue regeneration has numerous applications in medicine, from cartilage regeneration to bone production, even the engineering of heart tissue.

Prolotherapy was the first form of regenerative medicine, practiced for nearly 90 years. Not as expensive as many of these methods, it involves the injection of a naturally occurring substance (again, not a drug) into the area of discomfort. This has the effect of jump-starting healing.

The exact mechanism of action of prolotherapy is uncertain, but that can be said for many of our therapies. It works to harness the healing power of acute inflammation, quite different from the chronic variety. A series of three are performed, although occasionally additional are needed. This method entails no significant complications that aren’t associated with getting stuck with a needle.

Amniotic tissue has been used to great effect for wound healing. But another product in this category is injectable, used for joint and soft tissue problems, even those of cartilage. The material injected is obtained from a planned C-section and is loaded with growth factors. These are powerful signaling molecules which recruit stem cells to the region.

Typically, a single injection of this substance into an arthritic joint acts to reduce pain and stiffness, consequently improving function. Amazingly, there is evidence this technology may act to stimulate the growth of actual joint cartilage, an ability heretofore unknown. And this leads to a key component of this discussion of healed tissue. It is not asymptomatic because of the presence of a medication but because the tissues are healthier.

One benefit would be to reduce the need for invasive surgical procedures. These are costly and all carry some risk of complications and untoward results. But the consequences of age, the occurrence of disease, the damage caused by trauma, all may eventually be resolved or minimized with these advanced techniques.

The search continues for safe and effective treatments of chronic pain. Many people receive conventional treatment and continue to have significant discomfort as part of their daily life. But therapies harnessing the power of stem cells have the potential to change that paradigm, making resolution, a cure of sorts, a real possibility. Some of the uses discussed are the stuff of science fiction, like tissue and organ regeneration. Further research is clearly necessary, and it’s on-going.

The data to support the use of these newer approaches is there. The possibility of treating both chronic disease and acute insult, of resolving maladies originating in various organs, makes regenerative medicine the frontier, the future, of healthcare. These treatments are available and being used daily in clinics throughout the country. Is this the face of the future healthcare?

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.