Cartilage is a cushion for a joint that lives on both ends of the bone. When you lose cartilage from a joint, this means you’re getting arthritis. Almost every physician and patient I’ve met believes that cartilage loss is directly related to pain–meaning if you lose more cartilage you get more pain.
However, very large population-based studies of knee osteoarthritis, including one called the Framingham Osteoarthritis Study, have shown that the relationship between findings on radiographs and MRI’s in no way predicts pain. Still, often times the medical justification for performing invasive surgery or joint replacement is based predominantly upon the severity of radiographic findings.
So, if cartilage loss doesn’t cause arthritis pain, what does? That’s where the simple explanation gets more complex. We also know that bad inflammatory chemicals in the joint are better predictors of pain. We know that patients with arthritis often have problems in the nerves from the spinal cord to their joints. Finally, we know that certain cells inside the arthritic knee get activated and begin wrecking havoc resulting in changes of the chemical environment inside the knee. These chemical changes can result in tissue breakdown (catabolism).
Most people seeking stem cell therapy for arthritis already have obvious structural changes in their joints. Some believe that surgery can correct the structural problem and remove the pain. Or, they want a stem cell procedure to reverse a structural problem that they believe is the cause of their pain. In both cases, they believe that the structural problem is the source of the pain.
While stem cell therapies for orthopedic conditions do have modest tissue regenerating effects, increasingly it is believed that regeneration is not the mechanism of action that reduces painful symptoms. Instead, it appear that at least five other disease processes are affected with stem cell therapy for osteoarthritis pain:
1) Stem cells can block the cells that are literally eating away at the joint (activated marcrophages).
2) Stem cells release many helpful growth factors for the joint, essentially becoming tiny little medicine factories.
3) Stem cells can hijack the helpful protein making ability of other cells, getting them to become tiny little medicine factories.
4) Stem cells can revive the batteries (mitochondria) of dying cells by transferring some of their good batteries to the troubled cell.
5) Lastly, stem cells can morph into cell types that are needed in the arthritic joint, a process called differentiation.
What does this mean for patients? It means that if you’re focused on a single structural finding or “smoking gun” for the cause of your pain, then you may be missing the forest for the trees. The specialists at Columbia Pain Management, PC are experts at evaluating the whole picture and determining how all factors (biomechanical, neurological, and lifestyle) are affecting your pain and function. We are the only Center in the Pacific Northwest performing Regenexx-licensed procedures including same-day stem cell therapies and platelet rich plasma for orthopedic conditions. If you’re feeling stuck, stymied, or frustrated by lack of healing and persistent pain, we might be able to help.