“First do no harm” is one of the most famous principles in the history of medicine. Spoken by Hippocrates, often regarded as the father of medicine, this phrase forms part of the Hippocratic Oath that doctors take when they begin their practice. This maxim, although straightforward, carries profound implications for medical practice. It emphasizes the importance of considering the potential harm of any medical intervention, urging physicians to weigh the risks and benefits before proceeding with treatment.
The Philosophy Behind “First, Do No Harm”
The essence of “First, do no harm” lies in its call for physicians to always prioritize the well-being of their patients. While any treatment has the potential to cause harm, doctors must avoid being paralyzed by fear and recognize that some interventions are necessary and beneficial. Nonetheless, it is crucial to acknowledge that some treatments are inherently riskier than others.
According to Wikipedia, the intention of this famous tenet is to remind physicians to consider the potential harm of any intervention. Hippocrates wanted doctors to be mindful of the possible adverse effects of their actions and to carefully evaluate all options. Essentially, he advised them to weigh the risks and rewards of any treatment—a piece of advice that remains relevant today. This principle is especially pertinent for chronic conditions, where there is ample time to deliberate and choose the safest, most effective treatment.
Regenerative Orthopedics: A Safe and Effective Approach
Stem cell orthopedics, while not a magic solution for all orthopedic problems, represents a safe and highly effective treatment in expert hands. It can address around 80% of orthopedic issues by targeting the root cause of pain, which often lies in connective tissue such as myofascial enthesopathy and joint instability. Regenerative approaches, such as Regenerative Injection Therapy (RIT), offer a direct and efficient way to alleviate orthopedic pain. Given RIT’s safety and ease of administration, it makes sense to explore this avenue before considering more invasive and riskier alternatives.
In alignment with Hippocrates’ principle, if a safe, minimally invasive treatment has a reasonable chance of success, it should be the first option. For musculoskeletal (MSK) conditions, this means starting with treatments that cause the least disruption to natural connective tissue and progressively moving to more invasive options only as a last resort.
The Body’s Natural Healing Mechanisms
A fundamental principle of regenerative orthopedics is the belief that the body has an inherent capacity to heal itself, and the best healing outcomes arise from enhancing these natural mechanisms. The body often heals minor injuries, such as sprains, with minimal assistance. However, when mechanical stresses are frequent or severe, the body’s ability to heal can be overwhelmed, leading to chronic weakness or tissue degeneration.
Connective tissue, with its tenuous blood supply, is particularly vulnerable to damage. Regenerative injection therapies, such as stem cells, Platelet-Rich Plasma (PRP), and dextrose prolotherapy, strengthen and rebuild these tissues by enhancing blood flow, which brings healing cells and growth factors to the affected area. This is the essence of regenerative and stem cell orthopedics—promoting healing by either increasing blood flow to bring the body’s own healing cells or directly injecting concentrated stem cells and growth factors into the problem area.
Diagnosing and Treating with Precision
The key to successful regenerative orthopedics lies in accurately diagnosing the weak structures and pinpointing the “epicenter” of the pain. Once the diagnosis is made, precise injections of regenerative solutions can help the body repair and regenerate damaged tissues. By facilitating and accelerating natural healing processes, regenerative orthopedics offers a superior method of treatment.
When considering treatment options, it is essential to weigh the risk/reward ratio. One of RIT’s main advantages is its high efficacy and safety. With proper administration, the risk of adverse effects is minimal. However, since regenerative treatments are not yet part of mainstream medicine, they are not covered by insurance and must be paid for out of pocket. The primary risk of regenerative injections is the potential financial cost if the treatment does not work, with a ten to fifteen percent chance of ineffectiveness.
The Spectrum of Orthopedic Treatments
Orthopedics encompasses both surgical and nonsurgical approaches, with regenerative orthopedics falling under the nonsurgical category. Regenerative orthopedics itself includes interventional regenerative orthopedic medicine (IROM) and prolotherapy, forming a continuum from surgical to nonsurgical treatments.
Prolotherapy, the precursor to modern regenerative orthopedics, involves injecting solutions to stimulate tissue growth and repair. This approach, championed by George Hackett in the 1950s, has evolved over decades, with notable proponents like C. Everett Koop, the former surgeon general, advocating for its efficacy.
Despite its proven benefits, regenerative orthopedics remains relatively unknown and underutilized within mainstream medicine. The lack of insurance coverage and recognition by the medical establishment can be attributed to political and business interests rather than scientific merit. However, the field is gaining momentum, particularly with the advent of stem cell research, which has reignited interest in regenerative treatments.
Integrating Regenerative Solutions
The choice of regenerative solution—whether stem cells, PRP, or dextrose prolotherapy—depends on the severity of the tissue damage, the patient’s overall health, and their specific needs. It also depends how quickly the patient wants to get better and since regenerative therapies are not covered by insurance, how much resources the patient is willing to allocate to get better. If the patient can afford the costs, patients with more severe degeneration or damage, may have a much faster and complete healing with a stem cell/PRP combo. In my own practice I like to use stem cells from a patient’s own fat as DNA-matched stem cells from fat are far superior for musculoskeletal structures such as ligaments, tendons and cartilage.
