Evidence-Based Clinical Practice Guidelines on Regenerative Medicine Treatment for Chronic Pain: A Consensus Report from a Multispecialty Working Group

Ryan S. D'Souza, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Yeng F. Her, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Nasir Hussain, Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH, USA.
Jay Karri, Departments of Orthopedic Surgery and Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA.
Michael E. Schatman, Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA.
Aaron K. Calodney, Precision Spine Care, Tyler, TX, USA.
Christopher Lam, Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
Thomas Buchheit, Department of Anesthesiology, Duke University, Durham, NC, USA.
Brennan J. Boettcher, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
George C. Chang Chien, Department of Regenerative Medicine, GCC Institute, Torrance, CA, USA.
Scott G. Pritzlaff, Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA.
Christopher Centeno, Centeno-Schultz Clinic, Broomfield, CO, USA.
Shane A. Shapiro, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
Johana Klasova, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Jay S. Grider, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA.
Ryan Hubbard, Department of Sports Medicine, Anderson Orthopedic Clinic, Arlington, VA, USA.
Eliana Ege, Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
Shelby Johnson, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
Max H. Epstein, Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA.
Eva Kubrova, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
Mohamed Ehab Ramadan, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Alexandra Michelle Moreira, Department of Physical Medicine & Rehabilitation, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
Swarnima Vardhan, Department of Internal Medicine, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA.
Yashar Eshraghi, Department of Anesthesiology & Critical Care Medicine, Ochsner Health System, New Orleans, LA, USA.
Saba Javed, Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Newaj M. Abdullah, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
Paul J. Christo, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Sudhir Diwan, Department of Pain Medicine, Advanced Spine on Park Avenue, New York City, NY, USA.
Leslie C. Hassett, Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA.
Dawood Sayed, Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
Timothy R. Deer, Department of Anesthesiology and Pain Medicine, West Virginia University School of Medicine, Charleston, WV, USA.

Document Type

Article

Publication Title

Journal of pain research

Abstract

PURPOSE: Injectable biologics have not only been described and developed to treat dermal wounds, cardiovascular disease, and cancer, but have also been reported to treat chronic pain conditions. Despite emerging evidence supporting regenerative medicine therapy for pain, many aspects remain controversial. METHODS: The American Society of Pain and Neuroscience (ASPN) identified the educational need for an evidence-based guideline on regenerative medicine therapy for chronic pain. The executive board nominated experts spanning multiple specialties including anesthesiology, physical medicine and rehabilitation, and sports medicine based on expertise, publications, research, and clinical practice. A steering committee selected preliminary questions, which were reviewed and refined. Evidence was appraised using the United States Preventive Services Task Force (USPSTF) criteria for evidence level and degree of recommendation. Using a modified Delphi approach, consensus points were distributed to all collaborators and each collaborator voted on each point. If collaborators provided a decision of "disagree" or "abstain", they were invited to provide a rationale in a non-blinded fashion to the committee chair, who incorporated the respective comments and distributed revised versions to the committee until consensus was achieved. RESULTS: Sixteen questions were selected for guideline development. Questions that were addressed included type of injectable biologics and mechanism, evidence in treating chronic pain indications (eg, tendinopathy, muscular pathology, osteoarthritis, intervertebral disc disease, neuropathic pain), role in surgical augmentation, dosing, comparative efficacy between injectable biologics, peri-procedural practices to optimize therapeutic response and quality of injectate, federal regulations, and complications with mitigating strategies. CONCLUSION: In well-selected individuals with certain chronic pain indications, use of injectable biologics may provide superior analgesia, functionality, and/or quality of life compared to conventional medical management or placebo. Future high-quality randomized clinical trials are warranted with implementation of minimum reporting standards, standardization of preparation protocols, investigation of dose-response associations, and comparative analysis between different injectable biologics.

First Page

2951

Last Page

3001

DOI

10.2147/JPR.S480559

Publication Date

1-1-2024

Identifier

39282657 (pubmed); PMC11402349 (pmc); 10.2147/JPR.S480559 (doi); 480559 (pii)

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