REVIEW
Introdução: A dor lombar crônica (DLC) é um dos problemas médicos mais frequentes nos países ocidentais e cursa com um grande impacto social. As doenças do disco intervertebral (DIV) e suas patologias associadas representam as causas mais comuns de dor lombar. A terapia com células-tronco tem ganhado atenção no campo da medicina regenerativa devido ao seu potencial para restaurar o tecido danificado. Objetivo: avaliar a eficácia do tratamento ortomolecular, especialmente BMAC, nos quadros de dores crônicas. Métodos: Foram revisados os artigos científicos publicados no PubMed, Scielo e BVS, usando os descritores: “BMAC”, “steam cell treatment”, “chorinc pain” e “regenerative therapy”, e selecionando os estudos de acordo com os critérios de inclusão: ensaio clínico e estudos retrospectivos e prospectivos dos últimos 10 anos (2014-2024), disponíveis na íntegra. Discussão: Seguindo esses critérios, nove estudos foram incluídos na revisão. Os resultados sugerem que o tratamento ortomolecular baseado no BMAC surgiu como uma alternativa viável dentro da medicina regenerativa. Conclusão: a terapia com BMAC representa uma ferramenta biológica promissora devido à sua alta concentração de células-tronco mesenquimais pluripotentes e fatores de crescimento, que contribuem para a regeneração tecidual e alívio dos sintomas em pacientes com condições relacionadas à degeneração discal.
Introduction: Chronic low back pain (CLBP) is among the most prevalent medical conditions in Western countries, exerting a substantial socioeconomic burden. Intervertebral disc diseases (IVDDs) and their associated pathologies constitute the primary etiologies of low back pain. In recent years, stem cell therapy has garnered considerable interest in regenerative medicine due to its potential to restore damaged tissue. Objective: to evaluate the efficacy of orthomolecular treatment, particularly bone marrow aspirate concentrate (BMAC), in the management of chronic pain. Methods: A comprehensive literature review was conducted across the PubMed, SciELO, and BVS databases, employing the search terms “BMAC,” “stem cell treatment,” “chronic pain,” and “regenerative therapy.” Results: Studies were selected based on predefined inclusion criteria, including clinical trials and retrospective or prospective studies published in the last decade (2014–2024) with full-text availability. Discussion: Following these criteria, nine studies were included in the review. Findings suggest that orthomolecular treatment based on BMAC has emerged as a viable alternative within regenerative medicine. Conclusion: In conclusion, BMAC therapy represents a promising biological tool due to its high concentration of pluripotent mesenchymal stem cells and growth factors, which contribute to tissue regeneration and symptom alleviation in patients with disc degeneration-related conditions.
1. Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intradiscal injection of autologous, hypoxic cultured bone marrow-derived mesenchymal stem cells in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med. 2016;14(1):253.
http://doi.org/10.1186/s12967-016-1015-5. PMid:27585696.
2. Schmidt S, Wölfle N, Schultz C, Sielmann D, Huber R, Walach H. Assessment of a taping method combined with manual therapy as a treatment of non-specific chronic low back pain - a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):410. PMid:33947367.
3. Wu PH, Kim HS, Jang IT. Intervertebral Disc Diseases PART 2: a review of the current diagnostic and treatment strategies for intervertebral disc disease. Int J Mol Sci. 2020;21(6):2135. http://doi.org/10.3390/ ijms21062135. PMid:32244936.
4. Schmidt H, Heuer F, Simon U, et al. Application of a new calibration method for a three-dimensional finite element model of a human lumbar annulus fibrosus. Clin Biomech (Bristol, Avon). 2006;21(4):337-44. http://doi.org/10.1016/j.clinbiomech.2005.12.001. PMid:16439042.
5. Taşpınar G, Angın E, Oksüz S. The effects of Pilates on pain, functionality, quality of life, flexibility and endurance in lumbar disc herniation. J Comp Eff Res. 2023;12(1):e220144. http://doi.org/10.2217/ cer-2022-0144. PMid:36453667.
6. Munda M, Velnar T. Stem cell therapy for degenerative disc disease: bridging the gap between preclinical promise and clinical potential. Biomol Biomed. 2024;24(2):210-8. http://doi.org/10.17305/bb.2023.9518. PMid:37669102.
7. Wolff M, Shillington JM, Rathbone C, Piasecki SK, Barnes B. Injections of concentrated bone marrow aspirate as treatment for Discogenic pain: a retrospective analysis. BMC Musculoskelet Disord. 2020;21(1):135. http://doi.org/10.1186/s12891-020-3126-7. PMid:32111220.
8. El-Kadiry AE, Lumbao C, Rafei M, Shammaa R. Autologous BMAC therapy improves spinal degenerative joint disease in lower back pain patients. Front Med (Lausanne). 2021;8:622573. http://doi.org/10.3389/ fmed.2021.622573. PMid:33816523.
9. Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain with cultureexpanded autologous mesenchymal stem cells: a pilot study on safety and efficacy. J Transl Med. 2017;15(1):197. http://doi.org/10.1186/ s12967-017-1300-y. PMid:28938891.
10. Atluri S, Murphy MB, Dragella R, et al. Evaluation of the effectiveness of autologous bone marrow mesenchymal stem cells in the treatment of chronic low back pain due to severe lumbar spinal degeneration: a 12-month, open-label, prospective controlled Trial. Pain Physician. 2022;25(2):193-207. PMid:35322978.
11. Navani A, Ambach M, Calodney A, et al. The safety and effectiveness of orthobiologic injections for discogenic chronic low back pain: a multicenter prospective, crossover, randomized controlled trial with 12 months follow-up. Pain Physician. 2024;27(1):E65-77. http://doi. org/10.36076/ppj.2024.27.E65. PMid:38285032.
12. Huddleston HP, Tauro T, Credille K, et al. Patient demographic factors are not associated with mesenchymal stromal cell concentration in bone marrow aspirate concentrate. Arthrosc Sports Med Rehabil. 2023;5(3):e559-67. http://doi.org/10.1016/j.asmr.2023.02.008. PMid:37388861.
13. Muthu S, Jeyaraman M, Narula A, et al. Factors influencing the yield of progenitor cells in bone marrow aspiration concentrate-a retrospective analysis of 58 patients. Biomedicines. 2023;11(3):738. http://doi.org/10.3390/biomedicines11030738. PMid:36979718.
14. Cavallo C, Boffa A, de Girolamo L, et al. Bone marrow aspirate concentrate quality is affected by age and harvest site. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2140-51. http://doi.org/10.1007/ s00167-022-07153-6. PMid:36156111.
15. Haines CM, Bhatt FR, Orosz LD, et al. Low back pain, disability, and quality of life one year following intradiscal injection of autologous bone marrow aspirate concentrate. Stem Cells Int. 2022;2022:9617511. http://doi.org/10.1155/2022/9617511. PMid:36579141.
1Faculdade Atenas, Passos, MG, Brasil.
2Division of Neurosurgery, Faculdade de Medicina, Universidade de São Paulo – FMUSP, São Paulo, SP, Brasil.
Received Dec 23, 2024
Corrected Feb 6, 2025
Accepted Feb 24, 2025
