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.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
In several indications, injectable biologics were suggested to provide superior analgesia, functionality, and/or quality - often compared with corticosteroid injection. However, this may be due to negative effects of corticosteroids and not an effect of the PRP-injection.
Physician rater
There is still a huge medical need for further improvements in handling of patients with chronic pain. The therapeutic options need to be further developed. Individual patient care plans should be used to find optimal effect. Regenerative options should be kept in mind when other treatments fail.
Physician rater
The guidelines provide an excellent review. The information is more useful for those who practice pain medicine. The evidence-based approach for the development of guidelines makes this article an interesting read.
Physician rater
From a rehabilitative perspective, the guideline emphasises the potential of regenerative medicine treatments to reduce pain and improve function. Many recommendations are based on low-quality evidence or expert opinion, limiting their generalizability across diverse clinical settings. In addition, the absence of universally accepted standards could lead to inconsistent application by practitioners, potentially compromising patient care. Overall, the guideline provides valuable insights, but further high-quality research is needed to support its recommendations in clinical practice.
Physician rater
This consensus guideline fills a gap in the correct prescribing of regenerative medicine treatments (e.g., injectable biologics) for chronic pain. However, many recommendations are based on lower-quality evidence or expert opinion, which may limit their applicability, and the lack of widely accepted standards may lead to variability in implementation in different clinical settings. Any author conflicts of interest are properly disclosed.
, McMaster University