Ethical and Policy Issues in Practices of Regenerative Medicine for the Treatment of Chronic Pain

There is growing evidence for application of various biologicals in the form of regenerative medicine for numerous musculoskeletal and spine disorders. While the debate continues on the appropriateness of use of these modalities in managing chronic pain of musculoskeletal and spinal disorders, scientific evidence continues to grow. Among the multiple modalities available, platelet-rich plasma (PRP), bone marrow concentrate (BMC), and application of fat cells in managing these disorders have continuously been debated. PRP is the non-controversial modality of treatment, whereas growth factors derived from adipose-derived stem cells with application of enzymes has been a controversial issue opposed by the Food and Drug Administration (FDA). In application of biologics for musculoskeletal and spine disorders, there are multiple issues related to scientific/technical aspects and generated by social factors, circumstances, and concerns, and are not mutually exclusive, but rather are interactive. Issues inherent to science and technology are focal to safety, efficacy, clinical effectiveness, and cost. Costs and value contribute to and reflect need, demand, and provision (i.e., which patients will receive these state-of-the-art technologies, and the methods with which such questions about the allocation of resources can/should be addressed and resolved). In this chapter, ethical and policy issues in practices of regenerative medicine for the treatment of chronic pain are addressed.