Abstract
Purpose of Review
Chronic pain is a highly prevalent condition affecting millions of individuals.
Recent Findings
In recent years, newer treatments have emerged that are changing the way clinicians treat pain pathogenesis, including novel nonopioid strategies. In this regard, spinal cord stimulation, the MILD procedure, and regenerative medicine have shown promise. This review summarizes recent literature on these three emerging treatment strategies.
Summary
The results of this review suggest that under certain conditions, spinal cord stimulation, the MILD procedure, and regenerative medicine can be effective treatment modalities.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Kapural L. Spinal cord stimulation for intractable chronic pain. Curr Pain Headache Rep. 2014;18(4):406.
Xu J, Liu A, Cheng J. New advancements in spinal cord stimulation for chronic pain management. Curr Opin Anaesthesiol. 2017;30(6):710–7.
Zhang TC, Janik JJ, Grill WM. Modeling effects of spinal cord stimulation on wide-dynamic range dorsal horn neurons: influence of stimulation frequency and GABAergic inhibition. J Neurophysiol. 2014;112(3):552–67.
Kapural L, Peterson E, Provenzano DA, Staats P. Clinical evidence for spinal cord stimulation for failed back surgery syndrome (FBSS): systematic review. Spine (Phila Pa 1976). 2017 Jul 15;42(Suppl 14):S61–6.
Kumar K, Buchser E, Linderoth B, Meglio M, Van Buyten JP. Avoiding complications from spinal cord stimulation: practical recommendations from an international panel of experts. Neuromodulation. 2007;10(1):24–33.
Rudiger J, Thomson S. Infection rate of spinal cord stimulators after a screening trial period. A 53-month third party follow-up. Neuromodulation. 2011;14(2):136–41.
Smith CC, Lin JL, Shokat M, Dosanjh SS, Casthely D. A report of paraparesis following spinal cord stimulator trial, implantation and revision. Pain Physician. 2010;13(4):357–63.
Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. Spinal stenosis prevalence and association with symptoms: the Framingham study. Spine J. 2009;9(7):545–50.
•• Deer TR, Kapural L. New image-guided ultra-minimally invasive lumbar decompression method: the mild procedure. Pain Physician. 2010;13(1):35–41. excellent description of the mild procedure.
Schomer DF, Solsberg D, Wong W, Chopko BW. Mild® lumbar decompression for the treatment of lumbar spinal stenosis. Neuroradiol J. 2011;24:620–6.
Basu S. Mild procedure single-site prospective IRB study. Clin J Pain. 2012;28:254–8.
Mekhail N, Vallejo R, Coleman MH, Benyamin RM. Long-term results of percutaneous lumbar decompression mild for spinal stenosis. Pain Pract. 2012;12:184–93.
Chopko BW. Long-term results of percutaneous lumbar decompression for LSS: two-year outcomes. Clin J Pain. 2013;29(11):939–43.
Kreiner DS, MacVicar J, Duszynski B, Nampiaparampil DE. The mild procedure: a systematic review of the current literature. Pain Med. 2014;15:196–205.
Staats PS, Benyamin RM, MiDAS ENCORE Investigators. MiDAS ENCORE: randomized controlled clinical trial report of 6-month results. Pain Physician. 2016;19(2):25–38.
Benyamin RM, Staats PS, MiDAS Encore I. MILD is an effective treatment for lumbar spinal stenosis with neurogenic claudication: MiDAS ENCORE randomized controlled trial. Pain Physician. 2016;19:229–42.
Giannadakis C, Hammersbøen LE, Feyling C, Solheim O, Jakola AS, Nerland US, et al. Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study. Acta Neurochir. 2015 Jul;157(7):1165–71. https://doi.org/10.1007/s00701-015-2450-4.
Arai Y, Hirai T, Yoshii T, Sakai K, Kato T, Enomoto M, et al. A prospective comparative study of 2 minimally invasive decompression procedures for lumbar spinal canal stenosis: unilateral laminotomy for bilateral decompression (ULBD) versus muscle-preserving interlaminar decompression (MILD). Spine (Phila Pa 1976). 2014;39(4):332–40. https://doi.org/10.1097/BRS.0000000000000136.
Tonomura H, Hatta Y, Mikami Y, Ikeda T, Harada T, Nagae M, et al. Magnetic resonance imaging evaluation of the effects of surgical invasiveness on paravertebral muscles after muscle-preserving interlaminar decompression (MILD). Clin Spine Surg. 2017;30(2):E76–82. https://doi.org/10.1097/BSD.0b013e31829eb9de.
Udeh BL, Costandi S, Dalton JE, Ghosh R, Yousef H, Mekhail N. The 2-year cost-effectiveness of 3 options to treat lumbar spinal stenosis patients. Pain Pract. 2015;15(2):107–16. https://doi.org/10.1111/papr.12160.
•• Siniscalco D, Rossi F, Maione S. Stem cell therapy for neuropathic pain treatment. J Stem Cells Regen Med. 2007;3(1):2–11. excellent description of the stem cell therapy for neuropathic pain treatment.
Franchi S, et al. Adult stem cell as new advanced therapy for experimental neuropathic pain treatment. BioMed Res Int. 2014;2014:470983.
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington (DC): National Academies Press (US); 2011. 2, pain as a public health challenge
American Academy of Pain Medicine (AAPM). Significant blocking of opioid tolerance with mesenchymal stem cell transplant. ScienceDaily. ScienceDaily, 24 March 2015. www.sciencedaily.com/releases/2015/03/150324153349.htm.
Klass M, Gavrikov V, Drury D, Stewart B, Hunter S, Denson DD, et al. Intravenous mononuclear marrow cells reverse neuropathic pain from experimental mononeuropathy. Anesth Analg. 2007;104(4):944–8.
Schultz SS. Adult stem cell application in spinal cord injury. Curr Drug Targets. 2005;6:63–73.
Klein S, Svendsen CN. Stem cells in the injured spinal cord: reducing the pain and increasing the gain. Nat Neurosci. 2005;8:259–60.
Hains BC, Johnson KM, Eaton MJ, Willis WD, Hulsebosch CE. Serotonergic neural precursor cell grafts attenuate bilateral hyperexcitability of dorsal horn neurons after spinal hemisection in rat. Neuroscience. 2003;116:1097–110.
Bonfield TL, Caplan AI. Adult mesenchymal stem cells: an innovative therapeutic for lung diseases. Discov Med. 2010;9(47):337–45.
•• Hsu WK, Mishra A, Rodeo SR, et al. Platelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment. J Am Acad Orthop Surg. 2013;21:739–48. excellent evidence-based recommendations for platelet-rich plasma in orthopaedic applications.
Toumi H, Best TM. The inflammatory response: friend or enemy for muscle injury? Br J Sports Med. 2003;37:284–6.
Blair P, Flaumenhaft R. Platelet a-granules: basic biology and clinical correlates. Blood Rev. 2009;23:177–89.
Leslie M. Beyond clotting: the power of platelets. Science. 2010;328:562–4.
Arnoczky SP, Delos D, Rodeo SA. What is platelet-rich plasma? Oper Tech Sports Med. 2011;19:142–8.
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leukocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27:158–67.
Mazzocca AD, McCarthy MB, Chowaniec DM, et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg Am. 2012;94:308–16.
Marx RE. Platelet-rich plasma (PRP). What is PRP and what is not PRP? Implant Dent. 2001;10:225–8.
Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37:2259–72.
Jeong GK, Sandhu HS, Farmer J. Bone morphogenic proteins: applications in spinal surgery. HSS J. 2005;1:110–7.
Alsousou J, Thompson M, Hulley P, et al. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br. 2009;91:987–96.
Lee KS. Platelet-rich plasma injection. Semin Musculoskelet Radiol. 2013;17:91–8.
Cerza F, Carni S, Carcangiu A, et al. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40:2822–7.
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double- blind, randomized trial. Am J Sports Med. 2013;41:356–64.
Filardo G, Kon E, Di Martino A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 2012;13:229.
Kanchanatawan W, Arirachakaran A, Chaijenkij K, Prasathaporn N, Boonard M, Piyapittayanun P, et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc: Off J ESSKA. 2016;24(5):1665–77.
Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1- year follow-up. Am J Sports Med. 2010;38:255–62.
Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop. 2010;34:909–15.
Gosens T, Den Oudsten BL, Fievez E, ‘t v, Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments. Int Orthop. 2012;36:1941–6.
de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy a randomized controlled trial. JAMA. 2010;303(2):144–9.
Emel E, Ergun SS, Kotan D, et al. Effects of insulin-like growth factor-I and platelet-rich plasma on sciatic nerve crush injury in a rat model. J Neurosurg. 2011;114:522–8.
Elgazzar RF, Mutabagani MA, Abdelaal SE, Sadakah AA. Platelet-rich plasma may enhance peripheral nerve regeneration after cyanoacrylate reanasto- mosis: a controlled blind study on rats. Int J Oral Maxillofac Surg. 2008;37:748–55.
Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci. 2011;121:176–80.
Cho HH, Jang S, Lee SC, Jeong HS, Park JS, Han JY, et al. Effect of neural-induced mesenchymal stem cells and platelet-rich plasma on facial nerve regeneration in an acute nerve injury model. Laryngoscope. 2010;120:907–13.
Kuffler DP. Platelet-rich plasma and the elimination of neuropathic pain. Mol Neurobiol. 2013;48:315–32.
Li P, Zhang R, Zhou Q. Efficacy of platelet-rich plasma in retarding intervertebral disc degeneration: a meta-analysis of animal studies. BioMed Res Int. 2017;2017:7919201, 10 pages.
Chen WH, Lo WC, Lee JJ, Su CH, Lin CT, Liu HY, et al. Tissue-engineered intervertebral disc and chon- drogenesis using human nucleus pulposus regulated through TGF-beta1 in platelet-rich plasma. J Cell Physiol. 2006;209:744–54.
Akeda K, An HS, Pichika R, Attawia M, Thonar EJMA, Lenz ME, et al. Platelet-rich plasma (PRP) stimulates the extra- cellular matrix metabolism of porcine nucleus pulposus and annulus fibrosus cells cultured in alginate beads. Spine. 2006;31:959–66.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Ken P. Ehrhardt Jr., Susan M. Mothersele, Andrew J. Brunk, Jeremy B. Green, Mark R. Jones, Craig B. Billeaud, and Alan David Kaye declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Other Pain
Rights and permissions
About this article
Cite this article
Ehrhardt, K.P., Mothersele, S.M., Brunk, A.J. et al. Spinal Cord Stimulation, MILD Procedure, and Regenerative Medicine, Novel Interventional Nonopioid Therapies in Chronic Pain. Curr Pain Headache Rep 22, 26 (2018). https://doi.org/10.1007/s11916-018-0680-x
Published:
DOI: https://doi.org/10.1007/s11916-018-0680-x