Evidence-Based Regenerative Medicine

The field of regenerative medicine has led to exponential advancements in the management of musculoskeletal and spinal pain. As this field is a relatively new area of medicine, it is imperative to review the available literature and establish evidence-based protocols for standardized therapies using biologics. This chapter covers two key topics in this area, platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs), which are the most commonly used biologics for chronic spinal pain, tendinopathy and osteoarthritis. Currently, there are level I to level IV studies to support the use of PRP and MSC injections for discogenic pain, PRP for facet joint and sacroiliac joint pain, patellar and rotator cuff tendinopathy and hip and knee osteoarthritis. These studies have unequivocally demonstrated reduction in pain and improvement in functional scores; however, some of them continue to remain limited by either small sample size or uniform procedures for preparation of biologics, as discussed in the chapter. Overall, this field requires active research focusing on long-term outcome studies for improving our understanding of the efficacy of regenerative treatment options.