Stem cell therapy and Platelet Rich Plasma therapy for Morton’s Neuroma
We are often asked:
What is Regenerative Therapy or Prolotherapy?
Why should I have Platelet Rich Plasma therapy and Stem cell therapy for Morton’s neuroma?
Are there any added benefits that would make one more superior to the other?
Are there any added benefits to using both together?
Regenerative Therapy (also known as Prolotherapy or proliferation therapy) include a wide variety of therapeutic procedures such as stem cell therapy, Platelet Rich Plasma and dextrose prolotherapy.
It is called regenerative due to its ability to induce growth factors which help regenerate damaged cells. When tissue gets injured, you feel extreme pain due to degeneration of connective tissue components. These components actually help break down damaged calls and stimulate the regeneration of new cells.
Platelet Rich Plasma and stem cell therapy both discharge small proteins called cytokines that can enhance the process of healing. Some cytokines are also released by the platelets that are required for the transformation of growth factors like transforming growth factor beta, platelet derived growth factors, vascular endothelial growth factors, fibroblast and epidermal growth factors.
Traditionally, stem cell therapy has been in use since 1995 to address long standing osteoarthritis and cartilaginous disorders. But the major concern has always been to identify the optimum strategies to repopulate the damaged tissue in shortest possible time-frame. It has been observed that stem cell therapy and Platelet Rich Plasma, when used together, are highly effective at improving the health of tissues in the setting of Morton’s neuroma.
Platelet Rich Plasma therapy (PRP) and Stem Cell Therapy Combination for Morton’s Neuroma:
Based on the clinical data, Platelet Rich Plasma therapy alone is quite helpful. The quality of results can however be significantly improved by combining stem cell therapy with Platelet Rich Plasma therapy to enhance the tissue regenerative processes.
Combining stems cells with Platelet Rich Plasma Therapy as a means to accelerate tissue regeneration in advanced degeneration has been the subject of numerous animal and human studies(1), (2), (3).
Platelet Rich Plasma (PRP) has the ability to both increase stem cells and guide them in healing. In initial findings, PRP assisted stem cells in “figuring out” what they needed to be – whether a cartilage cell, or a bone cell, or a collagen cell for ligaments and tendons.
So the platelets are already attuned to provide a healing environment or “scaffold” to build on. In the research cited, results confirmed that PRP enhances Mesenchymal stem cell proliferation and suggested that PRP causes chondrogenic differentiation of Mesenchymal stem cells in vitro – i.e. the platelets tell the stem cells what to do.
The platelets themselves secrete a variety of cytokines (messenger cells that regulate various inflammatory responses), including adhesive proteins and growth factors such as platelet-derived growth factor, transforming growth factor beta, vascular endothelial growth factor, basic fibroblast growth factor, Insulin-like growth factor-1 (IGF-1), and epidermal growth factor. All the healing elements in the body to travel through the blood, so using blood as a delivery vehicle makes sense.
This quality of enhanced regeneration is mainly attributed to the capacity of Platelet Rich Plasma to facilitate the release of growth factors (due to rupture of platelets).
Benefits of using PRP in conjunction with stem cell therapy are:
- PRP helps in treating co-existing acute and chronic musculoskeletal disorders.
- PRP helps the breakdown of connective tissue scar tissue
- PRP can facilitate tissue reengineering; thereby improving the process of stem cell regeneration.
- PRP plays role in enhancing MSC stem cell proliferation and chondrogenic differentiation in vitro (and that can explain rapid recovery and restoration of connective tissue health in the setting of Morton neuroma.)
Who are Ideal candidates for Stem cell therapy and Platelet Rich Plasma therapy?
As discussed previously, ideal candidates are:
- Individuals with a history of chronic Morton neuroma that is unresponsive to conventional therapeutic regimens.
- Those who have a history of an ongoing musculoskeletal conditions.
- Individuals who have had Morton’s neuroma surgery but still have persistent pain indicating a stump neuroma and scarring.
- Individuals who are reluctant to opt for surgical intervention for the management of Morton neuroma symptoms.
It is highly recommended to discuss various therapeutic options for Morton neuroma management with your healthcare professional in order to optimize healing and tissue regeneration.
- Simson J, Crist J, Strehin I, Lu Q, Elisseeff JH. An orthopedic tissue adhesive for targeted delivery of intraoperative biologics. J Orthop Res. 2012 Oct 23. doi: 10.1002/jor.22247. [Epub ahead of print]
- Xie X, Wang Y, Zhao C, Guo S, Liu S, Jia W, Tuan RS, Zhang C. Comparative evaluation of MSCs from bone marrow and adipose tissue seeded in PRP-derived scaffold for cartilage regenerationBiomaterials. 2012 Oct;33(29):7008-18. doi: 10.1016/j.biomaterials.2012.06.058. Epub 2012 Jul 19.
- Lin BN, Whu SW, Chen CH, Hsu FY, Chen JC, Liu HW, Chen CH, Liou HM. Bone marrow mesenchymal stem cells, platelet-rich plasma and nanohydroxyapatite-type I collagen beads were integral parts of biomimetic bone substitutes for bone regeneration. J Tissue Eng Regen Med. 2012 Jun 28. doi: 10.1002/term.1472. [Epub ahead of print]
- Busilacchi, A., Gigante, A., Mattioli-Belmonte, M., Manzotti, S., & Muzzarelli, R. A. (2013). Chitosan stabilizes platelet growth factors and modulates stem cell differentiation toward tissue regeneration. Carbohydrate polymers, 98(1), 665-676. hyaluronic acid. International wound journal, 10(4), 372-376.
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.