I often get asked about where things stand with stem cell therapy for back pain, which is the focus of today’s post.
Back pain is a complex condition with many potential causes. New treatments are needed as existing approaches often don’t work that well.
What about stem cells?
Stem cell therapy or other cell therapy approaches really only make sense even in theory for back pain caused by certain things.
It is in these areas where this is the best hope based on data and clinic trials. Where does the research stand today? Let’s get into it.
What is back pain?
Back pain can be caused by various injuries to different parts of the back. One of the most common injuries causing such pain is to the spine or more specifically the discs.
Disc injuries often include herniations or other damage, which can cause pain both in the back but also elsewhere. I once had a minor disc injury high up that made my arm hurt and tingle for a while.
Back problems and pain can also be due to muscle injuries or other muscle issues. Tendon issues can also be painful in the back.
How stem cell therapy for back pain could work
What we most often hear about in terms of stem cells for back pain are injections of mesenchymal cells like MSCs. However, these cellular products are mostly prepared in ways such that true stem cells only constitute a small minority of the cells in the products.
So this is often not technically a stem cell therapy but it’s still frequently called “stem cell therapy.”
The idea behind these MSC offerings is to reduce inflammation that causes pain. The data just aren’t there to support selling this kind of thing now for back pain, but research is ongoing.
I found 37 trial listings on Clinicaltrials.gov for a search for stem cells and back pain. Some of the sponsors are stem cell clinics but there is also solid research ongoing at universities. (See also: Fact-check of stem cell therapy for pain & neuropathy.)
Only two of these trial listings have results and only one of those is on topic. This relevant trial used Mesoblast’s Rexlemestrocel-L. The data as listed on Clinicaltrials.gov is very hard to interpret so I turned to the literature.
A PubMed search for Rexlemestrocel-L yielded only two papers and neither related to the back pain study.
However, this other Mesoblast-funded study paper appears to be the key trial even if it doesn’t use the exact drug name. In this randomized, blinded, placebo-controlled study, there were some indications of significant benefit of the mesenchymal precursor cells. The cell therapy was generally well tolerated too, but some patients getting the cells had side effects. I’d say this is moderately encouraging. Also, the FDA recently granted an RMAT for Mesoblast here so that’s something.
Unproven Clinics & risks
On the flip side, hundreds of stem cell clinics are selling the idea of cell therapies for back pain and other related conditions.
The same general issues mentioned as possible causes of back pain can lead to pain elsewhere too like if you have disc, muscle or tendon injuries in your neck. For that reason, we often see unproven stem cell clinics selling similar injections for back, neck, and other pain-related conditions. Pitching more conditions mentioned by businesses equals more customers but is not necessarily based on medical logic.
Unfortunately, the clinics generally have no good evidence that what they are selling actually works or is safe for back pain. The same gap exists for their supposed treatments for neck pain and other conditions.
Many times what they are selling is bogus. For example, clinics or chiropractors selling perinatal materials like from amnion or placenta may not even have living, actual stem cells in what they give customers.
Some clinics claim that the results of others like good citizen biotechs mean that what they themselves are selling at clinics works. And that it is safe. It’s not that simple.
Speaking of safety, what about risks?
You can imagine that injecting cells into the back including sometimes into the intervertebral space (the area between discs) has risks. One is infection. Clinics may also inject cells into the wrong place. The cells themselves could cause issues too such as leading to scar tissue or other unwanted growth. Yes, tumors. I wrote before about a guy who had a tumor growing on his spine after going to stem cell clinics.
Overall, there is some solid hope in the research space here of stem cells for back pain, but again it’s wrong in my view to be selling supposed therapies already.
Not that I’m not a physician but I personally would not get a stem cell therapy for back pain right now. As a stem cell biologist, the data just aren’t there yet to support this. The risks worry me too.