General Health and Wellness Archives - Page 18 of 40

Stem cell research is a hot topic gaining traction and attention in the medical community. Stem cells are like physical therapists who have recently completed graduate school. They have not yet specialized in their specific field of interest, whether it be pediatrics, geriatrics, neurology, or, of course, pelvic floor physical therapy. So too with stem cells- they are undifferentiated cells that exist in multicellular organisms that have the potential to differentiate into one of many different types of specialized cells.

The two types of stem cells that exist within mammals are embryonic stem cells and adult stem cells. Embryonic stem cells are more versatile than adult stem cells- they are pluripotent and can differentiate into any type of cell. Adult stem cells can only differentiate into cells identical to the tissue from which they originate. In humans, adult stem cells are harvested from bone marrow (typically from the femur or the iliac crest), adipose tissue (obtained through liposuction), and blood.

Stem cell research is revolutionizing disease treatment. Organs may decline in function as they age or due to disease. Guided differentiation of stem cells can generate healthy tissues or organs as needed. This is known as regenerative medicine. The future of organ transplants, as well as spinal cord injury, stroke, heart disease, and arthritis may be strongly influenced by stem cell research advancements. In addition, adult stem cells have been used in bone marrow transplantations. Finally, some pharmaceutical companies have performed drug testing on human stem cells rather than on live subjects.

Unfortunately, hundreds of clinics throughout the United States have been providing stem cell related services without the approval of the Food and Drug Administration (FDA). Rob Stein, correspondent and senior editor of NPR’s science desk, discussed this problem in Shots (August 28^th). FDA Commissioner Scott Gottleib, in attempt to stem the tide of these clinics, expressed strong disapproval of these practices. According to him, “There are a small number of unscrupulous actors who have seized on the clinical promise of regenerative medicine, while exploiting the uncertainty, in order to make deceptive, and sometimes corrupt assurances to patients based on unproven and, in some cases, dangerously dubious products.” The FDA sent a warning letter to the US Stem Cell Clinic of Sunrise, Florida. This clinic, like many others, has attempted to treat Parkinson’s disease, lung and heart disease, and amyotrophic lateral sclerosis (ALS) with stem cells obtained from their clients’ adipose tissue. They have used the same method to treat macular degeneration, which has unfortunately resulted in blindness in several reported cases. In a letter to their clinic, the FDA strongly accused them of “marketing stem cell products without FDA approval and [of] significant deviations from current good manufacturing practice requirements.” The FDA has sent a similar message to StemImmune (San Diego, California) and California Stem Cell Treatment Centers (Rancho Mirage and Beverly Hills, California).

Many leading stem cell researchers have applauded the FDA for speaking out against these exploitive clinics, and they eagerly await stem cell treatment guidelines due to be issued by the FDA. These researchers support stem cell research and anticipate the many interventional doors it will open once fine-tuned. Clinics that advertise stem cell treatment may sound innovative and trendy, however it isn’t safe…just yet. Stay tuned, for the future of medicine is likely to incorporate the benefits of stem cell research under FDA approval.

Chronic pelvic pain is a condition that, according to Mathias et al[i], affects approximately 15% of females between the ages of 18-50. One type of pelvic pain, myofascial pelvic pain, is characterized by trigger points (taught muscle bands) within muscle fibers as well as pelvic pain. Typically, acetylcholine is a neurotransmitter released by motor neurons of the nervous system to activate muscles. According to Borg-Stein et al[ii], chronic pelvic pain is associated with excessive acetylcholine release at the motor end plate nerve terminal. This results in prolonged muscle contractions during times when the muscles are supposed to be at rest. This results in pain and decreased tissue oxygenation.

Historically, treatment for myofascial pelvic pain includes manual physical therapy (such as myofascial release), trigger point injections to the local taught muscle “knots,” and medication (which is less popular due to often poor patient outcomes, undesired side effects, and/or poor compliance). Researchers have recently explored a surprising alternative, namely onabotulinum toxin A, aka Botox. While most people associate Botox with wrinkles or spasticity, the drug is now being used to treat the pelvic floor. Botox works by preventing acetylcholine release at the motor end plate, thereby allowing the muscles that are chronically in an “on” state to be turned “off.”

A recent study by Halder et al[iii] explored the benefit of combined myofascial release along with Botox injections. Women eligible to participate in the study included women who experienced chronic pelvic pain, demonstrated presence of pelvic floor muscle trigger points (indicated by pain during muscle contraction), and failure of previous intervention. The experimental group treatment included Botox injections (under general anesthesia) followed by transvaginal soft tissue myofascial release for 10-30 minutes. Participants were re-assessed between 2-8 weeks following the treatment. At that time, only 44% of participants demonstrated trigger points upon digital palpation (vs. 100% pre-treatment) and 58% of participants reported decreased pelvic pain.

This study indicates that the future of overactive pelvic floor rehabilitation strongly suggests combining medical and manual physical therapy modalities. One of the things I love most about being a pelvic floor physical therapist is the holistic and collaborative nature of this specialty. It is important to remember that chronic pelvic pain is often a complex puzzle with many pieces to address. It often requires a team approach and multi-disciplinary attention. Studies such as these prove that a combination of interventions is an approach that should be considered. Medical care providers serve their patients best when they can distinguish what falls within versus beyond their scope of practice. May we have the humility to recognize when to join forces appropriately with other medical care providers in order to best benefit our patients.

[i] Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87:321–327.

[ii] Borg-Stein J, Simons DG. Focused review: myofascial pain. Arch Phys Med Rehabil. 2002;83(3 Suppl 1):S40–S47. S48–S49.

[iii] Halder GE, Scott L, Wyman A, et al. Botox combined with myofascial release physical therapy as a treatment for myofascial pelvic pain. Investigative and Clinical Urology. 2017;58(2):134-139. doi:10.4111/icu.2017.58.2.134.

Category: General Health and Wellness

Stem-ming the Tide

Joining Forces