The phrase there are many different ways to skin a cat applies to medicine as well. For any medical problem there are typically at least a few different options available. Naturally this doesn’t apply to life threatening emergent issues, but for your typical musculoskeletal problems there are different approaches to consider. There are medically focused options that utilize medications or surgery, and there are non-medical therapies that use exercise, diet, vitamins, and other complementary care options. And then there are cell based treatments such as PRP and stem cells that meet in the middle that are natural in that they are derived directly from the patient, but are a focused directed treatment by a physician.

So how does one decide which way to go? It depends on the severity of the problem, what prior treatments have already been used, what is the potential for the problem to progress, and what are the side effects of potential treatment. In regards to severity, typically the worse a problem is the more likely a medical approach is favored. A mild problem can utilize a non-medical approach before trying something stronger. If a condition has a high likelihood of progressing without a medical intervention, then early treatment should be considered. Alternatively, if the risk of treatment is high, then alternative approaches should be considered first. Some examples can illuminate.

Someone with rheumatoid arthritis with active inflammation has a very high likelihood of developing destructive and disabling arthritis long term if not medically treated. This can occur within months of disease onset. With medication the long term terrible sequelae of this condition can be prevented. The medications that are used have well defined risks, but with appropriate monitoring the benefits generally outweigh the risks. There are of course exceptions depending on an individual’s other medical problems. In the end personalizing treatment to choose an effective treatment with reasonable risks can prevent future complications and achieve a great result. In this case, a treatment with low to moderate risk and typically good to great results is preferable over the alternative, no risk without medical intervention but high risk of progressive pain, disability, and quality of life.

A different example is someone who has moderate to advanced osteoarthritis. In this case, surgery is typically recommended if someone has failed non-medical treatments such as physical therapy and activity modification, as well as medical treatments such as steroid injections. Surgical replacement can alleviate pain by cutting out the joint and replacing it with metal hardware. The surgical option has rare but potentially bad risks such as infection, nerve damage, and death that are rare but can occur. In this case the potential risk to benefit of treatment for a non life threatening condition should favor a non-surgical approach. Yet few people initially consider cell based treatments such as PRP and stem cells due to the novelty of the treatments and lack of awareness by most physicians. For an individual patient, choosing a low risk treatment with potentially good results should be preferred over a moderate risk approach with potentially good results that has rare catastrophic outcomes.

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