Our last article was about evidence-based medicine, and how any physician practicing modern medicine should be abiding by it. This matters in the realm of regenerative medicine, because for any condition that comes through the door, our doctors are able to guide the patient toward the best procedure recommendation for their injury.
At Regenexx at New Regeneration Orthopedics, we only perform regenerative medicine procedures, so we see this all day, everyday. Our specialized clinical experience, paired with the data from the research, paired with our accounting for a patient’s goals and value system, guides the decision between prolotherapy, PRP, or bone marrow concentrate (BMC) for every procedure we perform.
So, let’s just dive into a high-level overview of what each injectate does, and then we will discuss the decision-making process on which type of treatment is best for your injury.
Prolotherapy is a solution not derived for the patient. It is a solution including dextrose, making it basically sugar water. This is way cooler than basic sugar water, though, because it is super-concentrated. It is more concentrated than what is found in the body, making it have an impact on healing.
When we sustain an injury, the body kick-starts its own healing cascade. Prolotherapy is an injectate that can help give a second round of the body’s intrinsic healing ability by instigating new inflammation, which signals the body to heal.
Platelet Rich Plasma (PRP) is a product that comes from the patient’s own blood. Their blood is drawn, and then processed in a specialized system in a lab. This processing concentrates the blood just down to the plasma containing a huge concentration of platelets. What the PRP has an effect on are: growth factors, the exosomes, and the mitochondria.
PRP gives the growth factors a boost to get them to work harder on the repair job, making them more effective and faster. The exosomes released from the platelets can provide materials that serve as supportive building blocks to the healing area. And finally, the platelets can give their cellular powerhouse, the mitochondria, to the cells undergoing the repair to support the process.
So, in short the PRP can lend some additional cellular “goodies” to the local healing area on top, reigniting that healing cascade.
Bone Marrow Concentrate (BMC)
BMC is the third injectate in this conversation. The BMC is acquired by extracting bone marrow from the patient’s body and processing the bone marrow in a lab, distilling it down to its most super-concentrated substrates. What sets the BMC apart from PRP and prolotherapy, though, is that it also helps to create a healing inflammatory cascade, and BMC also has growth factors, exosomes, and mitochondria to donate to the rebuilding process. The additional piece with BMC are the mesenchymal cells. These cells manage the repair process and can differentiate into the necessary cells to get the repair job done.
What Best Treats What?
Now, while we can take what we know about what makes Prolotherapy to PRP to BMC increasingly more potent, these aren’t one-size-fits-all substances. There are considerations which could make any of these your best choice, which might include: cost, best tissue response, and the power rating (as seen below).
When it comes to price-point, prolotherapy is pretty inexpensive. It is a simple process to constitute the solution to be injected, so the cost burden to the patient is minimal, in comparison to its counterparts.
PRP is the mid-range and a good option for someone who wants more than just the inflammatory cascade, but isn’t ready to spring for BMC. BMC is the most costly of the bunch, as you can imagine, because it has the most specialized extraction and processing involved.
Now, if your doctor recommends BMC and you want to save and go with PRP, the next sections will explain what else there is to consider in this choice. Or, on the other hand, your doctor might recommend PRP and you think, “is more, better? Should I do the BMC?” We’ll also discuss that.
Each injectate has tissues it does the best with. In the case of prolotherapy, ligament and tendon can respond great to this injectate.
The growth factors, exosomes, and mitochondria donated by PRP make the target tissues more expansive because it starts to include area that need more umphf to get the same impact, like more advanced ligament/tendon injuries, meniscus, disc, labriums, and joints.
Now BMC can treat the same list of tissues as PRP, but what might set it apart from PRP is the severity of the injury. For example, PRP can handle partial tears of ligament and tendon tissue, but severe joint arthritis or complete non-retracted ligament tears would call for BMC.
Since all three injection types have quite a bit of overlap in the types of tissues treated, the power rating can be put up against the cost, so you can do the math. The power rating is to denote the potency of a single injection. The power injections for prolotherapy, PRP and BMC are respectively: 1, 2, and 4.
These power ratings are best described by Chris Centeno, MD:
That means that if a patient would normally need 8 prolo treatments to get the maximum healing effect, in general, it would require about 4 PRP treatments to get the same effect…[In the case of BMC], if a patient would normally need 8 prolo treatments to get the maximum healing effect and 4 PRP treatments, they need about 2 BMC treatments to get the same effect. In fact, for many patients getting BMC injections, it’s a one-and-done therapy (2).
The takeaway? There are several options for anyone considering regenerative medicine that can meet your body’s needs, and hit the right price point. Your Regenexx at New Regeneration Orthopedics physician will ensure you are fully briefed on the various options that could get you the best result, as well as the risks and alternatives you can consider.