Stem Cells and Chiropractic

My local newspaper is a constant source of topics to blog about. It regularly features ads for untested dietary supplements and for chiropractors who offer non-chiropractic treatments and don’t identify themselves as chiropractors. Recently, a full-page ad for NW Pain Relief Centers trumpeted “Stem Cell Technology Takes Joint Treatment to the Next Level.” It said stem cell treatments could heal and regenerate tissue in conditions such as knee osteoarthritis, carpal tunnel, peripheral neuropathy, spinal stenosis, hip pain, and tendinitis. A table titled “Consider these facts” compared stem cell therapy to surgery, saying stem cell treatments involve no known side effects, little or no pain, and immediate recovery; whereas surgery involves complications, poor outcomes, addiction to pain medications, severe pain for months, and a prolonged recovery over months and years. It said, “Call now if you experience any degree of joint pain or discomfort…Space is limited to the first 30 callers!”

A few days later there was another full-page ad for NW Pain Relief Centers, this time for hyaluronic acid injections into the knee for osteoarthritic knee pain. It reprinted the same table of comparisons with surgery, with an additional line comparing costs (that didn’t actually compare costs, but only vaguely mentioned insurance coverage, deductibles, copays, and time off work. It featured the same “Call now, space limited” ploy.

These ads reminded me so much of chiropractic ads that I had to wonder what was going on. They mentioned an “allied team of health professionals.” I guessed there must be at least one MD on their team if they were injecting stem cells and hyaluronic acid into joints. I guessed chiropractors were a prominent part of the team. I guessed right.

Chiropractors are involved

When I phoned the clinic and asked about the providers, I was told they were MDs, nurse practitioners, physician assistants, anesthesiologists, and chiropractors. Chiropractors were the last to be mentioned. But chiropractic is apparently far from last in the philosophy of the organization.

There were some glaring clues in their downloadable Welcome Packet for prospective customers:

“If you are here for Chiropractic Wellness Services, please skip to…” (So obviously many of their customers are not there for pain, but to see a chiropractor for “wellness” services.)

• “It’s common for people to have multiple doctors on their health care team. Which of the following have you seen for your challenges? ___Chiropractor ___ Medical ___Other” (Note that chiropractors are listed first and are categorized as doctors.)
• “Given that prescription medications are in the top 5 leading causes of preventable death in the United States we are interested in knowing what, if any medications you are currently taking and why” (Every time I see a doctor I am asked about my current meds, but never with any derogatory comments like that. The anti-mainstream-medicine bias is obvious.)
• “Slips and falls, although common have a direct impact on your health and wellbeing. Even MINOR falls or accidents cause stress, strain and damage to the spine that take up to 18 months to heal.” (A typical argument to encourage unnecessary chiropractic care.)
• In a section asking about other symptoms, it starts out “Because the nervous system controls everything in your body…” (a false statement straight out of D.D. Palmer’s 1895 chiropractic mythology that conveniently ignores all the many things that are not controlled by the nervous system, like hormones).
• It asks about a whole laundry list of symptoms like allergies, heartburn, menstrual irregularity, hot flashes, and other symptoms that are not controlled by the nervous system, as well as enough common and vague symptoms so that almost everyone will find something to check.
• It ends with “I consent to a professional and complete chiropractic examination and to any radiographic examination that the doctor deems necessary. I understand that any fee for service rendered is due at the time of service and cannot be deferred to a later date.”
• And at the bottom of the form it says Copyright FreeForm Chiro, LLC, an organization that sells marketing tools to chiropractors.

What do they offer?

NW Pain Relief Centers is a chain of clinics offering non-invasive, drug-free physical medicine treatments for various kinds of pain including Knew [sic] Arthritis and Knee Pain, as well as for allergies and food sensitivities. Its list of services includes stem cell injections, rehabilitation, spinal decompression, chiropractic, massage, trigger point injections, cold laser therapy, ALCAT and food sensitivity testing, and medical weight loss.

Stem cells for joint pain

Stem cells can be obtained from several different sources:

• Blood
• Bone Marrow
• Adipose tissue (Fat)
• Amniotic stem cells from placental tissue

Stem cells are classified as allograft therapy by FDA, and are not covered by insurance.

According to the woman who answered the phone, the NW Pain Relief Centers offer the commercial stem cell preparation PalinGen, a cryopreserved human amniotic fluid allograft. An independent review of amniotic stem cell products found that PalinGen and similar products didn’t contain any viable stem cells once they were thawed per the manufacturer’s recommendations. The PalinGen website does not claim to contain viable stem cells, but only to contain many factors needed for wound healing, such as collagen, growth factors, amino acids, carbohydrates, cytokines, micronized amniotic membrane, and extracellular matrix.  It advertises it as useful in a variety of surgical specialties but does not mention using it for medical conditions like osteoarthritis.

Stem cell treatments may be effective for knee osteoarthritis. We don’t know yet. There are some preclinical lab and animal studies, and there is some preliminary evidence from human studies suggesting that stem cells may be helpful in osteoarthritis. But those studies used stem cells derived from bone marrow or from the patient’s own infrapatellar fat pad. There are no studies using amniotic stem cells. And injecting stem cells obviously can’t work if there are no viable stem cells in the injections.

FDA has not approved any stem cell-based products for use, other than cord blood-derived hematopoietic progenitor cells (blood forming stem cells) for certain indications including certain blood cancers and some inherited metabolic and immune system disorders

The FDA has issued consumer warnings about stem cell treatments:

If you are considering stem cell treatment in the U.S., ask your physician if the necessary FDA approval has been obtained or if you will be part of an FDA-regulated clinical study. This also applies if the stem cells are your own. Even if the cells are yours, there are safety risks, including risks introduced when the cells are manipulated after removal…There is a potential safety risk when you put cells in an area where they are not performing the same biological function as they were when in their original location in the body… Cells in a different environment may multiply, form tumors, or may leave the site you put them in and migrate somewhere else.

Hyaluronic acid injections

The American Academy of Orthopaedic Surgeons (AAOS) recently issued a 1200 page report evaluating the evidence for various treatments for knee osteoarthritis short of total knee replacement surgery. I reviewed their recommendations here.

They didn’t see fit to even mention stem cell therapy. And they found strong evidence against hyaluronic acid injections. You can read about the studies they based their recommendation on here.

“The latest FDA cleared treatments” for peripheral neuropathy

While I was writing this article, yet another full page ad appeared in which the NW Pain Relief Centers claimed to treat peripheral neuropathy with the “latest FDA cleared treatments.” That’s very misleading. On the website they say they treat peripheral neuropathy with “physical medicine techniques that include chiropractic care, massage therapy, physical rehab, and nutritional counseling.” I called to inquire about the claims in the ad and they told me they used four FDA cleared modalities that are not mentioned on the website: monochromatic light therapy, compression boots, class 4 lasers, and a vibration plate.

Those treatments may have been “cleared” by the FDA for marketing for other purposes, but the FDA has not approved them for treating peripheral neuropathy, and there is no evidence that they are effective for that purpose. I checked PubMed and found one uncontrolled study suggesting that monochromatic light therapy was effective, but several placebo-controlled studies found it was no more effective than sham. Here’s one of them.  For the other three modalities, there were no studies in PubMed on their use for peripheral neuropathy.

Other questionable treatments

Some of the other treatments they offer are not science-based and others are supported only by poor-quality evidence that is not convincing enough to have earned them a place in conventional medicine. I won’t try to address all of them, but I’ll mention two that are very questionable.

I have written about spinal decompression therapy before: it doesn’t work, but chiropractors continue to make unsupported claims for it.

ALCAT is listed as a dubious test on Quackwatch. ALCAT testing is said to measure how blood cells react to foods “under conditions designed to mimic what happens when the foods are consumed in real life.”  The Australasian Society of Clinical Immunology and Allergy says ALCAT is an inappropriate test:

These results have been shown to not be reproducible, give different results when duplicate samples are analysed blindly, don’t correlate with those from conventional testing, and “diagnose” food hypersensitivity in subjects with conditions where food allergy is not considered to play a pathogenic role.

Conclusion

I can’t recommend NW Pain Relief Centers. It appears to me that they are promoting chiropractic, offering non-science-based treatments, and misleading prospective customers with claims that go beyond the evidence. They don’t provide any evidence from scientific studies to support what they are doing. They do provide three testimonials from satisfied chiropractic patients, one of whom raves about her chiropractor’s use of the bogus Myovision device. It is ironic that they pride themselves on noninvasive treatments while they are injecting stem cells into knee joints. And that they pride themselves on drug-free treatments while they are injecting a prescription drug, hyaluronic acid.

If I were considering stem cell treatments, I would seek out experts in stem cell research and hope to enroll in a clinical study; I wouldn’t consult a chiropractic-oriented group that uses a commercial preparation that hasn’t been tested for use in osteoarthritis and that may not even contain any stem cells.

 

Note: I e-mailed Epic Marketing to inquire about how their ads were developed, and how they determined the truth of the statements. They didn’t answer.

from Science-Based Medicine http://ift.tt/1mUpOg2