Regenerative Medicine as an Alternative to Surgery for Back and Joint Pain

At Biltmore Restorative Medicine, we thrive at bringing state-of-the-art and regenerative options to our patients. Regenerative therapy encompasses a variety of treatments. It strives to heal damaged tissues and restore function due to disease, injury, or age. This includes options for those struggling with joint pain, back pain, and degenerative conditions such as osteoarthritis. With age, the spine's bones can become arthritic, and intravertebral discs dry out, which leads to more pressure upon bony structures, nerve roots, and sometimes the spinal cord. This leads to pain and decreased mobility.

Additionally, the body's major joints, including the shoulders, hips, and knees, are impacted with age. This occurs when cartilage breaks down over time, exposing the bone, and then pain and inflammation occur. For some, autoimmune disorders such as rheumatoid arthritis contribute to pain. Often, this is when people find themselves in an orthopedist's office. Sometimes, an injury leads to soft tissue damage, such as a meniscus tear in the knee or a rotator cuff tear in the shoulder. Luckily, with regenerative medicine, all of these conditions can be treated, and ideally, people can be kept out of the surgical suite and fully recover.

My background as a nurse practitioner includes orthopedic surgery, and I was mentored by two wonderful orthopedic surgeons. I specialized in the spine, hip, and knee. I have treated patients with all types of orthopedic complaints and have given thousands of injections. In practice, I felt the limitations of conventional practice, where surgery, physical therapy, and steroid injections were the only options available to patients. This propelled my interest in regenerative solutions, which included plasma-rich protein (PRP) injections for knees. This yielded phenomenal results and offered something unique: the ability to regain mobility, decrease pain, and regenerate cartilage. Seeing such results furthered my desire to harness the power of regenerative medicine, which eventually led me to Biltmore Restorative.

At Biltmore Restorative Medicine, we utilize several therapies, including Plasma-Rich Protein (PRP), Plasma-Rich Fibrin (PRF), Human Cells, Tissues, Cellular Tissue-Based Products (HCTP), and peptides. These are used in combination and independently, pending your individualized plan and the provider's recommendations.

PRP, PRF, and HCTP are used to promote healing in various conditions.

Platelet-Rich Plasma (PRP) versus Platelet-Rich Fibrin (PRF)

Both PRP and PRF are obtained by collecting your blood and utilizing specialized centrifuges and kits to isolate the desired product. Both contain growth factors and an extracellular matrix that works as a lattice for tissue regeneration. PRF is considered superior to PRP as it has a larger number of growth factors that are released over a longer period of time. These can be used independently, or you can choose to add human cellular tissue products (HCTP) for accelerated results. 

• The reasons to consider adding HCTP vary. As we age, our platelets do not contain as many growth factors. A good rule of thumb is that anyone 50 years of age or older should consider adding HCTP. Other factors are the location, severity of injury, and therapy goals. The provider will make specific recommendations at the time of your consultation.

Human Cellular Tissue Products (HCTP)

HCTP is from donated tissues from the umbilical cord and/or placenta from full-term infants delivered via cesarean section. There is rigorous screening and sample testing to ensure the quality of these products. Considering that as we age, our cells age and platelets are not as robust as they were when we were younger, this is a wonderful alternative or addition to PRP or PRF. 

Depending on which formulation is selected, HCTP may contain mesenchymal cells, exosomes, or growth factors. They work concertedly to direct the repair of structural tissues and boost regenerative potential.

Types of HCTP we utilize

• WJ Pure is a filtered mesenchymal cell preparation derived from the Wharton jelly of the umbilical cord tissue. This does not contain extracellular matrix components. This can be used for any application.

• HylaPure is similar to WJ-Pure but with hyaluronic acid and less volume. Hyaluronic acid is best used in joints to help provide cushion and glide when the joint moves. This is best for joints.

.

• HylaJel is a mesenchymal cell preparation derived from umbilical cord tissue. These formulations contain mesenchymal cells, exosomes, and growth factors, including extracellular matrix components (elastin, hyaluronan, collagen fibers, and fibronectin). These are infused into hyaluronic acid and are best used in the joints.

• EV Pure is a formulation that contains 75 billion exosomes per milliliter. Exosomes are small vesicles released from mesenchymal cells that contain growth factors, mRNA particles, lipids, and proteins to direct cellular repair processes. There are no live cells. These are ‘messengers’ that induce our existing mesenchymal cells to organize repairs and regenerate needed tissues. This can be used for any application.

• Vitti Pure is an excellent source of glycosaminoglycans, hyaluronic acid, chondroitin, glucosamine, proteins, and lipids. This formulation contains 28 types of collagen for outstanding support. There are no live cells. Think of this as a more ‘super-charged’ version of PRP (Platelet Rich Plasma). Remember, the platelets of a 50-year-old have lost half of their growth factors that were present at the age of 20. This product can add these missing growth factors. 

Peptide Therapy

Peptides are chains of amino acids, the building blocks of proteins. They occur naturally in the body and are used in regenerative medicine to target specific functions of the body. They signal a desired process, similar to how hormones work in the body. These can be in the form of injectables, nasal sprays, and oral capsules. Peptides can be used to treat many concerns. Some are used for longevity or anti-aging, while others are targeted. Two targeted peptides used for the musculoskeletal system in combination or separately are BPC-157 and TB-500, which target soft tissues for regeneration. Meanwhile, GHK-Cu addresses chronic pain by rebuilding collagen and decreasing the inflammatory process. Peptides can be “stacked,” meaning that they can be used together or added to other treatments as they work synergistically.

• BPC-157- This peptide is a partial sequence of body protection compound (BPC) found in human gastric juice. It addresses soft tissue injury, wound healing, and bone healing. It can be used after injury or surgery to decrease healing time and inflammation. It stimulates collagen synthesis. It enhances growth hormone receptors in tendons, and its healing is enhanced with CJC/Ipamorelin, a peptide that increases the endogenous production of growth hormone. This is best used as a daily injection near the site of injury or can be used for a general systemic treatment.

• TB-500- This peptide is vital in repairing and regenerating injured tissues and cells. Improving cell migration to the site of injury promotes the repair of soft tissues and skeletal tissues. It has an affinity for the central nervous system and the heart. For example, traumatic brain injuries, spinal cord injuries, stroke, multiple sclerosis, and recovery after a heart attack are conditions that are targeted by this peptide. This is best used as a weekly injection. 

• GHK-CU- This peptide promotes wound healing and tissue regeneration. Increases angiogenesis (new blood vessel formation) and nerve outgrowth. Possesses antioxidant and anti-inflammatory effects. Activation of DNA repair genes, antioxidant genes, and cancer-controlling genes. Attraction of immune cells, collagen stimulation, and glycosaminoglycan synthesis of fibroblasts. Activation of the Ubiquitin/Proteasome System (UPS) which decreases inflammatory and chronic pain, such as in arthritis. Tissue repair by the TGF Superfamily targets nerve regeneration.

Treatments that can be applied to specific injuries or conditions

Back pain 

Back pain can be multifactorial. For some, it may come in the form of an acute injury, where a disc bulges and applies pressure on a nerve, causing localized pain to radicular pain, which may radiate to the hip, leg, and occasionally into the foot. Numbness and tingling can sometimes occur. Chronic back pain is a common complaint and can range from mild to severe. Regenerative therapy is a wonderful noninvasive treatment for both acute and chronic back pain that can be performed alongside other treatments. 

• HCTP can be injected into the paraspinal muscles (the muscles that run along the right and left sides of the spine) at precise locations. These cellular products have an “intelligence” and travel to the site of injury to begin reparative work. 

Hip pain

Hip pain can come from multiple sources, including osteoarthritis, bursitis (greater trochanteric pain syndrome), Iliotibial (IT) band tendonitis, and labral tears. Sometimes, this pain is referred from the lumbar spine. Regardless of the source of the pain, injections with HCTP can address the root cause.

• HCTP can be injected into the area identified as the source of the discomfort. Your health history, physical exam, and any imaging performed will determine this.

Knee pain

Knee pain can result from osteoarthritis, meniscus injury, pes anserine bursitis, stress fractures, and other conditions. Often, when a person has a painful knee, they compensate by placing additional strain on the other knee. With this in mind, it may be advisable to treat both knees simultaneously, especially with osteoarthritis.

• PRP or PRF is used for joint injections alone or in combination with HCTP. If you are 50 years or older or want to amplify your results, adding HCTP is recommended. The injection itself is 

Shoulder pain

Shoulder pain can result from osteoarthritis, ligament, tendon, or muscle tears (rotator cuff tear or SLAP tear), bursitis, shoulder impingement syndrome, or frozen shoulder, all of which can benefit from regenerative therapy.

• PRP or PRF is used for joint injections alone or in combination with HCTP. Adding HCTP is recommended if you are 50 years or older or want to amplify your results.

For all of these treatments, the addition of peptide therapy with BPC-157, TB-500, and GHK-Cu can relieve pain, decrease inflammation, and promote tissue regeneration.

How to prepare for your injection

• Before your injection, avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or aspirin for at least two weeks unless you have been prescribed a daily aspirin by a healthcare provider for cardiovascular disease. This will allow for the best response to treatment.

• Avoid alcohol for 72 hours before treatment.

• Avoid oral steroids or steroid injections, not including testosterone injections or creams, for at least two weeks and ideally up to one month.

What to expect the day of your injection

• If you will receive a PRP or PRF injection, arrive well-hydrated for a blood draw at the appointment.
• Eat something before your appointment to avoid feeling queasy during the procedure.
• Wear loose-fitting clothing to access the area of concern and for comfort afterward.
• The provider will review the procedure with you and answer any questions you may have.
• Sign any needed consents and have pictures taken if applicable
• A topical anesthetic will be applied, and the area prepared for the procedure
• After your procedure, post-care instructions will be provided to you

Unlike pain relief medications or temporary solutions like corticosteroids, regenerative injections may provide longer-lasting benefits by addressing the underlying damage rather than just masking symptoms.

Our patients have seen phenomenal results, and as a provider, I am never less than amazed at how transformative these therapies are. Please reach out to schedule your consultation, and we will create an individualized treatment plan for you!