How Regenerative Medicine is Changing Pain Treatment

In this episode of Back to the Expert, Dr. Tom Schuler sits down with Dr. Niteesh Bharara, a physiatrist specializing in non-operative musculoskeletal care. 

Dr. Bharara breaks down what physiatry actually is — and why it might be the first stop you should make before ever considering surgery.

From exercise modifications and mobility work to cutting-edge interventional treatments like platelet-rich plasma (PRP) and stem cell therapy, Dr. Bharara explains how the body can be guided to heal itself. 

He walks us through a real patient case — a 25-year-old with sacroiliac joint pain — and shares how stem cell therapy delivered life-changing results without going under the knife.

Dr. Bharara even treated Dr. Schuler himself, offering a first-hand look at how these regenerative techniques work in practice.

🎙️ Whether you're dealing with chronic pain or just want to explore your options before surgery, this episode is a must-watch.

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Don't miss: 

Episode 1: Advanced Spinal Treatments: Preserving Motion & Restoring Life
https://podcasts.apple.com/us/podcast/back-to-the-expert/id1887854756?i=1000757280472

Episode 2: Chronic Back Pain: Causes, Myths, and Breakthrough Treatments
https://podcasts.apple.com/us/podcast/back-to-the-expert/id1887854756?i=1000760654549

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Transcript

SPEAKER_00 0:00

Back to the expert. Hi, this is Dr. Tom Schuler. I'm a spine expert. We're so glad you joined Back to the Expert. And I'm here today with our expert, Dr. Natish Barrara, who is a physical medicine doctor or physiatrist, and he's going to give us expert insight and how to live your best life. So, Dr. Barrara, thanks for joining us. Absolutely. Can you explain to the public what a physiatrist is or a physical medicine doctor? What does that mean?

SPEAKER_01 0:29

Yeah, not many people know what a physiatrist is. A physiatrist is actually a doctor that goes to medical school, and we work on the musculoskeletal system. So we work non-operatively, and we do anything from your toes all the way to your spine to your neck, um, and even into the neurologic side of things. So we work on a rehabilitation program. So it could be from an injury all the way up to recovering back back to your normal life.

SPEAKER_00 0:55

That's that's great. So when when people have a pain and they come to you, and well, for purposes today, we're gonna talk about back pain. Sure. When they come to you with back pain, what does that mean, non-operative treatment?

SPEAKER_01 1:07

Yeah, so non-operative treatment can be it's a why, it's vast. So normally with non-operative treatment, it starts with the most conservative management. So, you know, changing your life, modifying what you're doing, and doing it in a maybe easier or better way. So that could be just adjusting your exercise program. With then we will work on mobility, go into strengthening, and really to treat you conservatively that way. We can then move into other interventional techniques such as injections, like steroid-based injections, all the way up to using regenerative medicine, such as PRP or stem cell or those types of treatments, really to you know get to the root cause of it and cause that to cause that problem to heal.

SPEAKER_00 1:50

So regenerative medicine, that's a term that's kind of new out there, that's that's using your body's own tissue to heal itself. So so what is PRP? What does that mean? What is stem cell?

SPEAKER_01 2:01

Yeah. So, you know, these are all PRP stem cell we just mentioned, these are all in the regenerative medicine categories, but there's a lot of things in the regenerative medicine category. What does PRP stand for? So PRP is platelet-rich plasma. So this is a substance, this, this, it's where it's a substance that's derived from your own blood. So what you do is you do a blood draw and then you separate it. You separate the platelets, which have a lot of growth factors in it, and we use that specific substance to start the healing process and heal an injury. How do you separate it? So we use a centrifuge to separate it. So we do a blood draw. We use a centrifuge to spin it down and it divides it into different layers. And then what we can do is we could we could take off the platelet layer and mix it with plasma, and then you get platelet-rich plasma. And then that has healing potential? It does. So we can use it for lots, lots of different things. So we can use it for a knee osteoarthritis all the way to a tendon issue, to a disc problem. You know, there's a tremendous amount of applications for it. But the these growth factors actually give the give the environment the best chance of healing. So we restart the healing process and get it to heal properly.

SPEAKER_00 3:05

So regenerative medicine is exciting, but really you don't do that to most of the people. Most of the people you're starting with basic therapy and and activity modification, things like that. Is that true? That's very true.

SPEAKER_01 3:17

So the majority of patients really, once you, if you're able to modify what you do, change how you're doing it, work in an exercise program, you don't necessarily need to go to that next step, which you develop as an injection or regenerative medicine. Most of the time we can treat you conservatively, get you back to doing whatever you think you want to do.

SPEAKER_00 3:33

That's exciting. That's exciting. So, do you have a recommendation for what people should be doing to live their best life from a spine standpoint?

SPEAKER_01 3:42

Well, I think, you know, in the, you know, as you, as you go, as you get, as you get older, in the early part, everybody works on a strengthening program. I go to the gym, I get stronger, and that's really, really important. So I think you do want to get stronger. But as we get a little older, the most important thing we do is work on mobility, we're into motion, stretching, make sure that we can actually get through our range of motion. Because what we don't want to do is we want to get restricted. And what and when you get restricted and you don't get full range of motion, you get to a point where you can injure yourself. So you have to work not just on that strengthening program that you did when you were in your 20s, you can go into strengthening and then into mobility, and then you can even work on endurance as you even get older.

SPEAKER_00 4:19

That's great. I know that that as I get older, I have to work more and more on my flexibility than I did when I was younger because everything tightens up.

SPEAKER_01 4:26

Oh, it is. And that's and then that's the problem, the big misconception. Everybody goes into the gym and says, I just need to get stronger. But sometimes, even though we're getting stronger through this minimal range, it's when we'd go do a functional activity we hurt ourselves.

SPEAKER_00 4:38

And that's the problem.

unknown 4:39

Yeah.

SPEAKER_00 4:40

So let's talk about. We we mentioned regenerative medicine, and it's a field that you're passionate about. You're one of the leaders in the country. What can you give me an example of a patient you've treated and how that worked?

SPEAKER_01 4:50

Yeah, so we I've treated a lot of different patients. Um, one that comes to mind is a patient. She was in her mid-20s, about 25 years old, um, unfortunately, had severe buttocks pain that we found to be coming from the SI joint when she was pregnant. Unfortunately, during pregnancy, we have limitations in terms of how we can treat it. So, in in this situation, we treated it with some adjustments of the SI joint. So, physical therapy we used, uh, we ended up using doing a shot in the SI joint and calmed her down and got her through pregnancy. Unfortunately, after pregnancy, she had still a lot of laxity of her sacroiliac joint. And so in these situations What is the sacral iliac joint? So the sacral ilia joint is a joint that connects, it's in the pelvis, in the in the butt area, and it connects the ilium to the sacrum. So it's this So the pelvis to the spine. Exactly. And this joint is is it doesn't move a lot, but we but when it doesn't move at all, or if it moves too much, it's a problem. And in this situation, it was moving too much. And so once we figured that out, the next step, we we actually treated this with a stem cell procedure. And that stem cell procedure is where we we do a bone marrow harvest. So we get bone marrow from the bone and the pelvis, and then we centrifuge that, we get the stem cells out of it with the growth factors, and we go and inject it in the sacred leg joint complex. And that that complex means it it's the it's all the ligaments that support the SI joint as well as in the SI joint, because the SI joint's a really, really difficult structure because the majority of the SI joint isn't just the joint, it's actually made up of the ligaments that support the joint. So treating it is is difficult, but it can be done and it can be done very successfully.

SPEAKER_00 6:32

So you're talking about bone marrow harvest.

SPEAKER_01 6:34

That's a scary term, but but it really isn't that scary. It isn't. And I think when I talk to my patients, this as soon as I mentioned, oh, I'm gonna harvest your bone marrow, they they look at me with huge eyes and they're like, oh my gosh, you you're gonna you're gonna stick a needle in my and into my bone. And actually, it's so easy. And what we do is we know we just numb the bone. The bone is where all the nerve endings lie. So once we numb the bone, and then we just go, we put a little truck or through the bone and pull the marrow out. It's it's a fairly painless procedure, and usually it doesn't last more than just a few minutes to get the bone marrow from. So it people think that that's the worst part of the procedure. By the end, they usually say that was really easy.

SPEAKER_00 7:13

Yeah. And and the bone marrow is a liquid, so it's not I I used to always think that it was this thick substance, but it's actually a liquid that comes out through a needle. Exactly.

SPEAKER_01 7:21

So we can just you can easily pull it out through a needle. It's a little thicker than blood, but it's it it looks like blood when you pull it out.

SPEAKER_00 7:27

So I I have a confession to make. I'm I'm a freaking flyer with Dr. Barrar, and he's he's done a lot of regenerative medicine on me. He he's done my heel, he's done my knees, he's done my back. And and and so um let's talk about why you did that to me and and the success of it.

SPEAKER_01 7:46

Yeah. So, you know, for the the heel in itself, we uh we used PRP, and in that situation, he had plantar fasciitis that unfortunately did not resolve with the normal conservative management that we tried. Months of it. Months of it. Yeah, and you really put your you put the effort into it. I mean, that's the most important thing is put the effort into the conservative aspect of it first. If that doesn't work, then we have options. And in that situation, we used PRP directly into the plantar fascia, and then when we used an exercise program afterwards to maximize the benefit. And at this point, pain-free.

SPEAKER_00 8:18

Oh, it's a game changer. In fact, I had it on one side and we treated it, it was so successful that when the other side flared up, I tried two months of non-operative. I go, I'm now waiting, it worked too well. We did it and boom, it was gone. So it was it's amazing how how effective it was for plantar fasciitis. But then you'd done it for my my cartilage and my knee, my meniscae, those little C-shaped cartilages which were torn, and and that one knee and then the other knee, and that solved it. But let's talk about what we're here today for, which is discogenic pain or back pain. So, what what made you think I would be a good candidate for that?

SPEAKER_01 8:52

Yeah, uh normally when somebody has disc pain, there they have difficulty with prolonged sitting, they have just deep, achy pain. You just can't get to it. That's the way I normally hear about from patients is like, oh my gosh, my my pain, you know, it just nothing gets to that pain. It's deep. It never goes away, right? You know, it just can get exacerbated. And that's something very similar to what you had. And in those situations, you look at the MRI, you put the physical exam together, and you realize that this is discogenic pain. We don't have a lot of treatments for discogenic pain. Discogenic pain is a really, really challenging treatment because, I mean, really challenging diagnosis because you can't get to it with your normal means of a steroid injection or that sort of thing. When you do physical therapy, you're strengthening around it. And so if you're able to support it well, yeah, you can get some relief. But unfortunately, if you stop strengthening, the pain comes back because dist still hurts. And in this situation, that's where we used bone marrow, like we talked about earlier, and we injected it directly into your disc. And that's what I thought you would be really successful with. And you were.

SPEAKER_00 9:54

That it was. I mean, we it it took about three months, but then far better, and years of pain went away. And the great thing was it wasn't surgery. Yeah, I was able to avoid a fusion or uh disc replacement uh and and get success. Now I may eventually need those, but I've bought years of of relief and function. So thank you. Yeah, that was that was so much appreciated.

SPEAKER_01 10:16

Honestly, I mean, these do take a little bit of time to see the benefit, just like you mentioned, three months. But those during the three months, it's not that your pain is just going to go immediate away immediately. We need the time, we need the time for let the the let the bone marrow, let the stem cells actually do its work. So it's not an immediate immediate uh treatment, but the recovery is easy. And you get to that point where you can get function your function back.

SPEAKER_00 10:37

Well, this has been exciting talking about all these non operative treatments, regenerative medicine, therapy, activity modification, more importantly, avoiding the problem by doing the right exercise in the first place. But I'd like to thank Dr. Barrar for his insight and his excellent care. And thank you for joining us for another episode of Back to the Expert. Back to the Expert.