In regenerative medicine, there are grades of “potency” that are generally accepted. Below is an oversimplified hierarchy, and some other options that can be used as adjuncts or on their own. This is not a comprehensive list of options but provides a simple structure to help think about the various choices available to patients.
1. prolotherapy – uses dextrose containing solution, an irritant, to stimulate the body to react and produce a healing response. Does not require a blood draw. Generally can be billed through insurance.
2. PRP – uses patient’s own platelet rich plasma which contains certain growth factors that stimulate a healing response.
3. Fresh frozen amniotic fluid or other amniotic growth factor products – uses live healthy birth babies’ residual amniotic tissue to isolate growth factors that are then isolated, preserved either by freezing or by a drying process, and then stored until it is time to inject. Contains different growth factors than PRP and therefore useful for specific indications that PRP may be as helpful for, or to augment efficacy of PRP for its intended use.
4. Stem cells – uses patients’ own cells, or in certain rarer circumstances umbilical cord derived stem cells from live healthy birth babies, to inject at site of desired healing response. Stimulates body’s own healing response including the body’s own stem cells to stimulate a regenerative process.
Other offerings that don’t necessarily fit within a specific hierarchy but can be useful adjunctive treatments to consider. These be combined with above options or used on their own.
A2M/iRap – potentially useful for inhibiting cartilage degradation or reducing neuropathic pain. Can be added to PRP or stem cells.
Hyaluronic acid – provides the same cushioning type material already existing within joints to improve pain. May also promote a healing response. Can be added to PRP.
Exosomes – granules containing stem cells’ signaling factors. Can be injected or even infused. Relatively new with much controversy still surrounding use including whether FDA considers them “drugs.”
Platelet Lysate – PRP that has undergone additional steps to cause platelets to release its growth factors and signaling proteins that are then isolated further and injected. Potentially useful for certain treatments where avoiding platelet aggregation is important and potentially for neurogenic pain.