Doctors who undergo stem cell and PRP training at the Advanced Regenerative Medicine Institute (ARMI) are told, in no uncertain terms, that not everyone they eventually treat will respond well. Both PRP and stem cell injections work very well for a lot of orthopedic patients, but they do not work for everyone.
Efficacy is of great concern to both the FDA and critics of stem cell therapy. Though criticisms can sometimes be a bit harsh, the underlying concern is legitimate. It is not appropriate for any doctor or clinic to promise that stem cell therapy is guaranteed. There are no guarantees in medicine – ever.
Every cancer patient will not go into remission after chemotherapy. Every diabetic is not going to be able to manage with just medication alone. Likewise, every patient who receives stem cell injections for osteoarthritis is not going to experience pain relief.
Knowing this leads to the question of why some patients respond better than others. There is a lot to consider, beginning with the biology of the healing process. Understanding how complex this process is makes it easier to understand how a treatment can fail to deliver.
A Four-Step Process
Human biology is amazing in its ability to heal. A typical orthopedic injury offers a good example. Let’s say a football player tears a ligament during practice. As long as everything is operating as it should, his body will undergo a four-step process of healing:
- Initial Response – The initial response to injury occurs within the first 72 hours. In most cases, the response starts immediately. Blood platelets quickly respond to stop internal bleeding. Along with those platelets are growth factors that both initiate inflammation and signal the body that something needs repair.
- Inflammation – Inflammation follows the body’s initial response. Believe it or not, inflammation is a good thing. It defends against infection and further damage; inflammation also floods the site of injury with white blood cells. Those cells destroy any present bacteria and consume dead cells. They are like the demolition crew preparing for new construction.
- Proliferation – The third step is known as proliferation. This is the step in which the body begins rapidly multiplying stem cells to create the tissue necessary to make the repair. Tissue development at this stage is often chaotic rather than organized, because the body is working just to get things patched up.
- Maturity – Finally, the fourth step of maturity takes place. This final stage typically lasts for months. The body continues to produce new tissue until what started as chaos becomes very orderly. Maturation adds strength, elasticity, and durability to the repaired tissue.
The above four-step process has been simplified for the purposes of general understanding. Still, you should have a pretty good idea of how complicated the healing process is. All it takes to inhibit healing is for one little component of one of the four stages to be out of kilter.
For example, a patient’s overall health might be such that the proliferation phase doesn’t move quickly enough, thus exposing the site of injury to even further injury down the road. Another patient may be lacking in the volume of growth factors in his or her blood platelets. Such a lack would inhibit the very first stage of healing which, over time, would impact the other three stages as well.
Everything from patient health to the quality of the stem cell or PRP material used to prepare injections can affect outcome. And because every patient is different, every response to stem cell therapy is somewhat unique.