E 95 Guidelines for PRP, RFA, Stem Cells, Neuromodulation Dr Brian Rich MD

Learn the in’s and outs of the following procedures, answer patient questions and make appropriate referrals: PRP, radiofrequency ablation, stem cells, kyphoplasty, epidural steroid injections. Regenerative Medicine Dr. Brian Rich, MD

Dr. Brian Rich, MD started in Family Medicine but always had a passion for orthopedics. Back in 2007 the options were limited for certain injuries: it was either operable or not. Once regenerative medicine started to show up he decided to specialize in these non-surgical methods for pain control.

First thing we do on the interview is define all the non-surgical approaches out there for spine and extremity joint pain. If we aren’t all on the same page, confusion can happen.

PRP (platelet rich plasma) – growth factors in platelet and injecting it in injured areas with guidance.

Stem Cells- signaling cells are actually what are injected not mesenchymal stem cells but the signaling cells ‘call’ the stem cells to go to the injured area… again with ultrasound guidance, not just guessing with palpation. Dr. Kaplan, PhD from Case Western is the father of regenerative medicine and mesenchymal signaling cells. Dr. Kaplan usually lectures at the TOBY Conference (National Regenerative Medicine Conference

Radiofrequency Ablation- with good guidance system you can ablate the sensory nerve to that painful spinal facet joint (basal vertebral nerve in a few years), shoulder, hip, foot or knee joint. During the interview he goes into detail about the risk, and how long the procedure lasts. RFA is for the older population and is not a fix but a functional improvement.

Kyphoplasty for Compression Fractures: Compression fractures are generally unstable and painful and over time the comorbidity is a high risk downward spiral. Ignore the 2009 New England Journal of Medicine that says otherwise, it’s been proven wrong. The vertebral body has lots of nerve plexus and so plumbing it back to its near normal height has huge benefits for the patient.

Peripheral Nerve or Spinal Cord Stimulation- These procedures are electrical units embedded into the nerve supply to reduce pain. Spinal cord stimulation “battery is implanted” while the peripheral nerve stimulation units have a device you “wear and plug in.” This procedure neuromodulators and desensitizes the pain

Epidural Steroid Injections- disc compression with radicular pain are the types of patients that should get this. Fifty percent reduction in pain for 6 months via up to 3 shots is considered a success. Remember it’s still an off label use.

Dr. Rich will discuss when, why, risk factors and benefits of each procedure mentioned.

When would you use peripheral nerve stimulation versus the radiofrequency ablation RFA? Genicular nerve, clunial nerve for example.

Which nerve is the most common for cervicogenic headaches?

When would you use bone marrow concentrate instead of plasma and why is it so important to have a good ultra-sonographer helping you. Should you use

If you do have to have a full blown surgery to repair a shoulder, can you get a shot of PRP before they sew you up to improve the results? Dr. Philippe Hernigou in France started this procedure. Differences of PRP in France and USA, it will surprise you.

Dr. Rich warns us about the ‘drive thru’ clinics where you can just show up and get injected without ever having your own blood spun down and concentrated. Why are amniotic stem cells so popular? Should you fly to another country and use someone else’s placenta stem cells for your injections?

Why is guided needle insertion so important vs just blinded or palpating?

Why is regenerative medicine not really regulated by the FDA? Which is also why the Orthobiologics Consortium was created for ethical procedures of regenerative medicine?

Why doesn’t Dr. Rich charge the maximum going rate? With only a few years of data on these therapies and with varying degrees of success length, I think it’s wise that he is more conservative in how he explains the benefits to the patients.

What are the criteria for compression fracture kyphoplasty? We describe some patients that are atypical but still get results.

What are pulmonary and cardiac PRP injections?

Mesenchymal signaling cell injections do cause pain in the area that already hurts, but that’s a good thing, why is that?

When should you refer to a regenerative medicine specialist?

Why does Dr. Brian Rich choose not to do very many epidural steroid injections, ESI? When should you do ESI and when not?

We even discuss a little about insurance, cash rates and changes over the past few years.

Dr. Brian Rich, MD first did family medicine and then transitioned into a sports medicine residency at the University of Oklahoma at Tulsa. He then did his fellowship in interventional pain with a focus on fluoroscopic guided procedures and musculoskeletral ultrasound guided procedures. He was one of the first physicians to part of the Orthobiologics Consortium which is an ethics group for responsible use of PRP and Stem Cells. He also does a lot of radiofrequency ablation “RFA”, neuromodulation of both spinal and peripheral nerves (like the knee and shoulder), and kyphoplasty for compression fractures. Between the three clinics he also spends a lot of time as a faculty member at OU.

www.acellortho.com aCELLerated Interventional Orthopedics: 3 locations in Oklahoma

He is most active on LinkedIn.

Show notes can be found at www.adoctorsperspective.net/95 here you can also find links to things mentioned.