Since the 1960s, some US states have passed and enforced certificate of need (CON) laws for healthcare entities, with regulations varying in their application procedures, the stringency of review, and coverage across states [1, 2, 3]. These laws require prospective healthcare providers aspiring to enter the healthcare industry and existing providers seeking to make major capital expenditures to receive the approval of the state’s healthcare agency before doing so [1]. The objectives of these laws are threefold: to improve the quality of healthcare services in regions with a volume-quality relationship, to expand access to healthcare by keeping providers from engaging in “cream-skimming,” and to reduce costs by eliminating unnecessary health facilities [2].  

To receive approval for operations or expenditures under CON laws, medical providers may have to expend years of effort and thousands of dollars [4]. This is because CON laws require the approving authority not to assess a particular provider’s qualifications, but rather the “needs” of the community in question [5]. A key idea behind this feature of the US healthcare certificate of need laws is to have providers prove that their services would meet a real need in the community. As a result, other providers already servicing the community are allowed to contest a pending application, potentially creating years of delays and heightening the evidentiary burden needed to achieve approval [5]. 

Consequently, the ability of CON laws to achieve their purported objectives is dubious. In terms of quality of healthcare services, empirical studies of how certificate of need laws in the US affect hospitals reveal how little they do to improve healthcare [1, 5]. Stratmann and Wille’s 2018 study found that “the quality of hospital care in states with CON laws is not systematically higher than the corresponding quality in non-CON states,” casting doubt on the laws’ ability to accomplish their first aim [1]. Furthermore, the researchers found that some CON states provide worse service to their communities, with mortality rates for heart failure, pneumonia, and heart attacks being higher in CON states than in non-CON states [1]. 

Similarly, CON laws are associated with decreased access to healthcare [5]. States with such laws tend to have fewer ambulatory surgery centers and hospitals, particularly in rural areas; dialysis clinics; and hospice care facilities [5]. Moreover, hospitals in these states tend to have fewer hospital beds and are less likely to offer CT, PET, and MRI scans to their patients [5]. And already-vulnerable communities are especially likely to suffer the negative consequences of CON laws [5]. For example, Delia et al. suggested that CON laws were to blame for Black patients’ reduced access to hospitals that could provide them with cardiac angiography [6]. 

Lastly, certificate of need regulations have an uncertain effect on US healthcare costs, so their ability to meet their third objective is unclear. In an examination of the cost-effectiveness of CON laws, Conover and colleagues estimated the expected costs of CON regulation to exceed its expected benefits by 8% (approximately $300 million) [2]. However, they also expressed that their estimation of net costs could be skewed [2]. As such, the true level of economic benefits or losses produced by CON laws remains ambiguous. 

With this class of regulations failing to achieve at least two of their three stated objectives, it is unsurprising why fourteen states have repealed their CON laws since the 1980s [2]. Nevertheless, these laws remain operational in thirty-six states and the District of Columbia [2]. When reevaluating these laws, state authorities should keep in mind the evidence suggesting that certificates of need are not as effective as they aspire to be. 

References 

[1] T. Stratmann and D. Wille, “Certificate-of-Need Laws and Hospital Quality,” Mercatus Center, Updated July 12, 2018. [Online]. Available: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3211657.  

[2] C. J. Conover and J. Bailey, “Certificate of Need Laws: A Systematic Review and Cost-Effectiveness Analysis,” BMC Health Services Research, vol. 20, no. 748, pp. 1-29, August 2020. [Online]. Available: https://doi.org/10.1186/s12913-020-05563-1.  

[3] F. J. Hellinger, “The Effect of Certificate-of-Need Laws on Hospital Beds and Healthcare Expenditures: An Empirical Analysis,” AJMC, Updated January 23, 2018. [Online]. Available: https://mhcc.maryland.gov/mhcc/pages/home/workgroups/documents/CON_modernization_workgroup/Articles/Article%208.pdf.   

[4] “Certificate-of-Need Laws: Why They Exist and Who They Hurt,” State Policy Network, Updated April 1, 2021. [Online]. Available: https://spn.org/articles/certificate-of-need-laws/.  

[5] M. Mitchell and W. Mitchell, “How more states can free up emergency health care,” The Hill, Updated April 10, 2020. [Online]. Available: https://thehill.com/opinion/healthcare/492070-how-more-states-can-free-up-emergency-health-care/.  

 [6] D. Delia et al., “Effects of regulation and competition on health care disparities: the case of cardiac angiography in New Jersey,” BMC Health Services Research, vol. 34, no. 1, pp. 63-91, February 2009. [Online]. Available: https://doi.org/10.1215/03616878-2008-992.  

Anesthetic drug development is experiencing a resurgence of interest given new demands in clinical practice that can potentially be met with better agents. Existing drugs each have their own drawbacks but have improved upon drugs of the past. Continuing advancements in medicine will improve patient outcomes and experiences. How, then, are new anesthesia drugs developed? 

Current efforts to develop anesthetic drugs are primarily focused on modifying the structures of existing drugs to enhance their pharmacodynamic and pharmacokinetic properties [1]. Drug metabolism and pharmacokinetic optimization strategies specifically may help improve the physical and chemical properties of drugs. The hope is to minimize the negative effects of existing anesthetics while maintaining or enhancing the desired effects. This is a particularly dynamic area of research in the context of sedatives, analgesics, and muscle relaxants, and significant developments have recently occurred. 

Two approaches are prodrug and soft drug design. Prodrugs are compounds that are activated only once in the body and may have the advantage of providing greater control over where and when the activated drug works. Soft drugs are compounds that are quickly and predictably broken down into an inactive, non-toxic form, which may result in fewer side effects. 

Prodrug design is a useful approach for augmenting the drug-like properties of a molecule to overcome formulation and delivery difficulties. Prodrug design strategies have a wide range of applications. In the case of the soft drug approach, a retrometabolic drug design strategy allows for a predictable metabolic route via a single inactivation. Soft drug design meets the unique needs of modern anesthesia practice, in which it is often good for anesthetics to be quickly broken down by the body so that the patient can recover from anesthesia faster [2]. 

Drugs recently under development using these design approaches include analogs of midazolam, propofol, and etomidate, such as remimazolam, PF0713, and cyclopropyl methoxycarbonyl-etomidate [3].  

However, tweaking existing drugs may not provide the best solution. So how are truly new anesthesia drugs developed? Another approach relies on large quantities of data to screen for potential novel drugs. Researchers rapidly screen of large molecular libraries for activity in structural or phenotypic assays that show potential for anesthetic and target receptor interactions. Such high-throughput screening may lead to the identification of entirely new classes of drugs, which can be beneficial because they would provide different angles into the same desired effects [3].  

Researchers have also recently gradually learned to apply artificial intelligence-assisted drug design strategies for drug metabolism studies [4]. As enzymes (usually cytochrome P450) are essential for drug metabolism, the three-dimensional crystal structures of various enzymes and carrier proteins have been studied,. This may facilitate the prediction of molecular interactions in the very initial stages of drug design and is an area where AI may be extremely helpful.  

In recent years, new drug development programs for analogs of anesthetics have resulted in only a handful of compounds with market approval [6]. Particularly for sedatives, hypnotics and neuromuscular blockers, there remains relatively little drug discovery activity to this day [5].  

Part of the reason for this may be that the mechanisms of action of anesthetics are still not fully understood. In addition, the industry perceives little need for new anesthetic drugs since needs are well addressed by existing agents or fail to compete with their safety profiles. For soft sedative-hypnotics in particular, abnormal excitatory activity has led to the discontinuation of drug development programs. This was the case for the etomidate and propanidid soft drug analogs.  

To compete with existing drugs, novel anesthetic drugs need a high therapeutic index and minimal side effects to optimize the benefit/risk ratio in patients. In addition, anesthesiologists need to communicate ongoing needs for new anesthetic drugs more effectively to better drive their development. Further work using existing strategies may provide improved anesthetics in the future, but it is also possible that rethinking how new anesthesia drugs are developed will open additional avenues to explore. 

References 

1. Deng, C., Liu, J. & Zhang, W. Structural Modification in Anesthetic Drug Development for Prodrugs and Soft Drugs. Frontiers in Pharmacology (2022). doi:10.3389/fphar.2022.923353
2. Stöhr, T. et al. Pharmacokinetic properties of remimazolam in subjects with hepatic or renal impairment. Br. J. Anaesth. (2021). doi:10.1016/j.bja.2021.05.027
3. Chitilian, H. V., Eckenhoff, R. G. & Raines, D. E. Anesthetic drug development: Novel drugs and new approaches. Surg. Neurol. Int. 4, S2 (2013). doi: 10.4103/2152-7806.109179
4. Smith, G. F. Artificial Intelligence in Drug Safety and Metabolism. in Methods in Molecular Biology (2022). doi:10.1007/978-1-0716-1787-8_22
5. Kilpatrick, G. J. & Tilbrook, G. S. Drug development in anaesthesia: Industrial perspective. Current Opinion in Anaesthesiology (2006). doi:10.1097/01.aco.0000236137.23475.95
6. Keam, S. J. Remimazolam: First Approval. Drugs (2020). doi:10.1007/s40265-020-01299-8

Since the beginning of the pandemic, at least 60% of Americans have been infected with COVID-19 (1). Contrary to initial predictions, reinfection from the virus is not uncommon, despite immunity induced by previous exposure or vaccination (2). As defined by the Centers for Disease Control and Prevention (CDC), reinfection can be diagnosed if a patient had COVID-19, recovered, and later became infected again, as confirmed by a polymerase chain reaction (PCR) test (3). Reinfections can occur from weeks to over a year since the first infection, though patients often present with mild symptoms (4). Throughout the pandemic, the rate of COVID-19 reinfection has changed over time with the emergence of each variant.

At the beginning of the pandemic, reinfections from the first variants of the virus appeared to be extremely rare (2). However, with the emergence of the delta variant in 2021, reinfections increased significantly due to the strain’s high transmissibility and ability to evade immune responses (5). Approximately 63 to 167% more transmissible than the alpha strain, the delta variant could avoid neutralization from antibodies and replicate at faster speeds, resulting in higher viral loads and more severe symptoms (6, 7). According to one major study with over 27,000 participants, delta reinfections constituted 1.16% of total cases, while alpha reinfections comprised only 0.46% (8). While higher than that of alpha, the rate of delta reinfections still remained low due to vaccinations, which demonstrated decreased but significant efficacy in preventing infection (8).  

After a decrease in COVID-19 cases, the omicron variant emerged in late 2021, causing a significant increase in infections (8). Although associated with less severe symptoms, the omicron variant had a transmissibility 2 to 4 times higher than the delta strain (9). Like delta, the omicron variant could evade immune responses due to mutations in its genome, but omicron contained novel, pernicious mutations that allowed it to prevent antibodies from binding to it (10). Due to these mutations, vaccines were significantly less effective in preventing omicron infection, with two-dose vaccine efficacy dropping to 55% after 20 weeks, compared to 88% efficacy against alpha (11). With its extremely high transmissibility and ability to evade immune responses produced by vaccines and previous infections, the omicron variant has proved to be the most common source of COVID-19 reinfection over time (8). According to the aforementioned study, omicron reinfections constituted 13% of all COVID-19 cases, but researchers estimate that the actual rate is significantly higher due to the prevalence of asymptomatic omicron reinfections and unreported at-home rapid tests (8). Additionally, the study reported that the median time from the first infection to omicron reinfection was significantly longer at 361 days compared to 204 for alpha and 291 for delta; however, omicron also constituted 96.6% of reinfections that occurred after less than one year (8). These statistics both demonstrate the power of omicron in reinfecting patients.  

As the world returns to normalcy, COVID-19 reinfection presents a critical problem that many health experts believe will compound over time. Although symptoms are typically mild, reinfections can increase the risk of adverse health events (12). With each additional reinfection, the risk of developing musculoskeletal conditions, diabetes, kidney disease, and mental health conditions increases (12). Researchers also fear that reinfections may predispose patients to “long COVID,” a condition in which COVID-19 symptoms persist for months after the patient no longer tests positive for the virus (12). As the omicron variant causes the most reinfections, researchers emphasize that individuals obtain the new Moderna and Pfizer bivalent boosters which, unlike the original vaccines, specifically target omicron (13). While the initial two-dose regimen still provides protection against severe symptoms and hospitalization, the bivalent boosters show 37% higher efficacy against severe infection than the monovalent boosters (13). In addition to bivalent boosters, researchers also recommend the continuation of COVID-19 protocols — masking, disinfecting, and social distancing (14). Although the worst of the pandemic may be over, the risk of COVID-19 reinfections presents a critical challenge in the post-pandemic world. 

References 

1: Clarke, K., Jones, J., Deng, Y., Nycz, E., Lee, A., Iachan, R., Gundlapalli, A., Hall, A. and MacNeil, A. 2022. Morbidity and mortality weekly report. MMWR 71(17):606-608. DOI: 10.15585/mmwr.mm7117e3. 

2: Hall, V., Foulkes, S., Charlett, A., Atti, A., Monk, E., Simmons, R., Wellington, E., Cole, M., Saei, A., Oguti, B., Munro, K., Wallace, S., Kirwan, P., Shrotri, M., Vusirikala, A., Rokadiya, S., Kall, M., Zambon, M., Ramsay, M., Brooks, T., Brown, C., Chand, M. and Hopkins, S. 2021. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN). Lancet 397(10283):1459-1469. DOI: 10.1016/S0140-6736(21)00675-9. 

3: Centers for Disease Control and Prevention. 2023. Reinfection. URL: https://www.cdc.gov/coronavirus/2019-ncov/your-health/reinfection.html.  

4: Abu-Rabbad, L., Chemaitelly, H. and Bertollini, R. 2021. Severity of SARS-CoV-2 reinfections as compared with primary infections. New England Journal of Medicine 2021(385):2487-2489. DOI: 10.1056/NEJMc2108120.  

5: Planas, D., Veyer, D., Baidaliuk, A., Staropoli, I., Guivel-Benhassine, F., Rajah, M., Planchais, C., Porrot, F., Robillard, N., Puech, J., Prot, M., Gallais, F., Gantner, P., Velay, A., Guen, L., Kassis-Chikani, N., Edriss, D., Belec, L., Seve, A., Courtellemont, L., Pere, H., Hocqueloux, L., Fafi-Kremer, S., Prazuck, T. and Schwartz, O. 2021. Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization. Nature 2021(596):276-280. DOI: 10.1038/s41586-021-03777-9. 

6: Earnest, R., Uddin, R., Matluk, N., Renzette, N., Turbett, S., Siddle, K., Loreth, C., Adams, G., Tomkins-Tinch, C., Petrone, M., Rothman, J., Breban, M., Koch, R., Billig, K., Fauver, J., Vogels, C., Bilguvar, K., Kumar, B., Landry, M., Peaper, D. and Grubagh, N. 2022. Comparative transmissibility of SARS-CoV-2 variants Delta and Alpha in New England, USA. Cell Reports Medicine 3(4):100583. DOI: 10.1016/j.xcrm.2022.100583. 

7: Mlcochova, P., Kemp, S., Dhar, M., Papa, G., Meng, B., Ferreira, I., Datir, R., Collier, D., Albecka, A., Singh, S., Pandey, R., Brown, J., Zhou, J., Goonawardene, N., Mishra, S., Whittaker, C., Mellan, T., Marwal, R., Datta, M., Sengupta, S., Ponnusamy, K., Radhakrishnan, V., Abdullahi, A., Charles, O. and Gupta, R. 2021. SARS-CoV-2 B.1.617.2 Delta variant replication and immune evasion. Nature 2021(599):114-119. DOI: 10.1038/s41586-021-03944-y.  

8: Ozudogru, O., Bache, Y. and Acer, O. 2022. SARS CoV-2 reinfection rate is higher in the Omicron variant than in the Alpha and Delta variants. Irish Journal of Medical Science 2022:1-6. DOI: 10.1007/s11845-022-03060-4.  

9: Liu, Y. and Rocklov, J. 2022. The effective reproductive number of the Omicron variant of SARS-CoV-2 is several times relative to Delta. Journal of Travel Medicine 29(3):taac037. DOI: 10.1093/jtm/taac037.  

10: Syed, A., Ceiling, A., Taha, T. and Doudna, J. 2022. Omicron mutations enhance infectivity and reduce antibody neutralization of SARS-CoV-2 virus-like particles. PNAS 119(31):e2200592119. DOI: 10.1073/pnas.2200592119.  

11: Zeng, B., Gao, L., Zhou, Q., Yu, K. and Sun, F. 2022. Effectiveness of COVID-19 vaccines against SARS-CoV-2 variants of concern: a systematic review and meta-analysis. BMC Medicine 20(2022):200. DOI: 10.1186/s12916-022-02397-y. 

12: Bowe, B., Xie, Y. and Al-Aly, Z. 2022. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nature Medicine 28(2022):2398-2405. DOI: 10.1038/s41591-022-02051-3. 

13: Reynolds, S. 2023. Bivalent boosters provide better protection against severe COVID-19. National Institutes of Health. URL: https://www.nih.gov/news-events/nih-research-matters/bivalent-boosters-provide-better-protection-against-severe-covid-19.  

14: Berg, S. 2023. What doctors wish patients knew about COVID-19 reinfection. American Medical Association. URL: https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-covid-19-reinfection.  

In the midst of political turmoil, an impending economic recession, and the COVID-19 pandemic, the 2022 midterm elections reflected this unprecedented era of American history, with major implications for health and healthcare policy. Although voters were divided by party, questions around health remained an important factor, with 51% of Democrats and 27% of Republicans reporting that they prioritized healthcare in deciding their vote (1). In the Senate, Democrats maintained the majority, but Republicans gained the majority of the House, resulting in a gridlocked political system and unclear consequences (2). For everyday Americans, the expected health impacts of the midterm elections are most prominent in three categories: COVID-19, abortion, and healthcare costs.  

First, despite President Biden warning that COVID-19 could infect 100 million Americans this winter (3), many pandemic policies and precautions were or are being discontinued throughout the country. COVID-19 remains a heavily partisan issue, with Democrats supporting the presidential administration’s request to Congress for additional COVID-19 funds (2). Meanwhile, many Republicans view pandemic precautions such as mask mandates as an affront to Constitutional rights, promising to eliminate them in campaign ads. Most politicians have stopped talking about preventing the spread of COVID-19 and instead have begun promising loosening restrictions (2). This shift reflects the changing societal perception of the pandemic, with a recent poll reporting that 44% of Americans want to “move on” from the pandemic, though only 39% believed that the pandemic is “over” (4). While this transition may result in loosened restrictions and higher-than-expected rates of COVID-19, it’s good news for government spending, as reducing COVID-19 funding may help protect the government from a recession. 

Second, on the heels of the decision to overturn Roe v. Wade, abortion emerged as another hot topic related to health for the 2022 midterm elections. Approximately 56% of registered voters ranked abortion as a significant deciding factor in the vote (5). In response to the Supreme Court decision, 60% of voters reported feeling “dissatisfied” or “angry” (6). As a result, pro-choice ballot measures won in several states, including historically Republican states such as Kentucky and Montana (7). Access to abortion was added to several state constitutions (8). However, politicians with anti-abortion stances also won by large margins in several states, such as Texas governor Greg Abbott and Floridian governor Ron DeSantis (7). While the midterm elections secured access to abortion in several states, other states enacted measures to limit or eliminate access, even in extreme circumstances.  

Third, economic factors weighed heavily on voters’ minds. Inflation ranked as the top issue for voters, while 55% of voters also ranked prescription drug costs as “very important” in deciding their votes (9). Costs for medications have skyrocketed in recent years, with Americans paying two to three times what citizens in other countries pay for the same medications (10).  

Pushed by Senate Democrats and signed by President Biden in 2022, the Inflation Reduction Act promised to reduce prescription drug costs and insurance costs, but projections estimate that portions of this policy could be targeted by the incoming Republican majority in the House (11).  

In summary, current American societal problems related to health clearly impacted voters’ decisions in the 2022 midterm elections, but enacted policies and elected officials may not offer many solutions. Healthcare costs will potentially be reduced across the country, but COVID-19 and abortion policies continue to remain heterogeneous by state. While the actions of a Republican House and a Democrat Senate remain unclear with an economic recession on the horizon, for now, access to abortion has been protected in several states and health care costs have been decreased.  

References 

1: Smith-Schoenwalder, C. 2022. “How COVID-19 Will Shape the 2022 Midterm Elections.” US News. URL: https://www.usnews.com/news/elections/articles/the-coronavirus-and-the-2022-elections  

2: Mangan, D., Kimball, S. and Wilkie, C. 2022. “Live updates — midterm elections.” CNBC. URL: https://www.cnbc.com/2022/11/09/live-updates-of-2022-midterm-election-day.html  

3: Smith-Schoenwalder, C. 2022. “Is a fall COVID-19 surge coming to the US?” US News. URL: https://www.usnews.com/news/the-report/articles/2022-09-02/is-a-fall-covid-19-surge-coming-to-the-u-s.  

4: Jackson, C., Newall, M., Duran, J. and Golden, J. 2022. “Most Americans not worrying about COVID going into 2022 holidays.” Ipsos. URL: https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index.  

5: Pew Research Center. 2022. “Midterm voting intentions are divided, economic gloom persists.” Pew Research Center. URL: https://www.pewresearch.org/politics/2022/10/20/midterm-voting-intentions-are-divided-economic-gloom-persists/.  

6: Ollstein, A. and Messerly, M. 2022. “A predicted ‘red wave’ crashed into wall of abortion rights support on Tuesday.” Politico. URL: https://www.politico.com/news/2022/11/09/abortion-votes-2022-election-results-00065983. 

7: Kurtzleben, D. 2022. “What we know (and don’t know) about how abortion affected the midterms.” National Public Radio. URL: https://www.npr.org/2022/11/25/1139040227/abortion-midterm-elections-2022-republicans-democrats-roe-dobbs.  

8: Nash, E. and Guarnieri, I. 2022. “In the US midterm elections, resounding victories for abortion on state ballot measures.” Guttmacher Institute. URL: https://www.guttmacher.org/2022/11/us-midterm-elections-resounding-victories-abortion-state-ballot-measures.  

9: Kirzinger, A., Schumacher, S., Quasem, M., Stokes, M. and Brodie, M. 2022. “KFF health tracking poll July 2022: inflation tops voters’ priorities, but abortion access resonates for key voting blocs.” Kaiser Family Foundation. URL: https://www.kff.org/womens-health-policy/poll-finding/kff-health-tracking-poll-july-2022/.  

10: The White House. 2022. “By the numbers: the Inflation Reduction Act.” The White House Briefing Room. URL: https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/15/by-the-numbers-the-inflation-reduction-act/.  

11: Dillon, J. and Sobczyk, N. 2022. “GOP fumes over climate law. Is there a will for repeal?” E & E News. URL: https://www.eenews.net/articles/gop-fumes-over-climate-law-is-there-a-will-for-repeal/.  

Complex regional pain syndrome (CRPS), once known as reflex sympathetic dystrophy, is a so-called “umbrella diagnosis” which encompasses a wide range of symptoms and conditions. It is used to describe prolonged pain and inflammation resulting from injury to the arm or leg [1]. Interestingly, the severity of CRPS is not correlated with the severity of the injury, but rather the overall robustness and nerve health of the affected individual. It is more common in women and people around the age of forty, and rarely seen in children or the elderly [1]. Complex regional pain syndrome can be chronic, debilitating, and difficult to manage, and scientists have begun researching whether stem cells may provide a viable treatment option. 

Individuals with CRPS are more sensitized to stimuli that would not normally be considered pain-inducing in the affected region: gentle touching, for example, or movement. The pain can be both intense and prolonged. The onset of these symptoms is caused by improper firing of the peripheral nerves which communicate pain signals to the brain and is thought to have an inflammatory/autoimmune component. Other common symptoms include changes in skin temperature or texture, abnormal nail or hair growth, abnormal sweating, joint stiffness, abnormal bone growth, and impairment of muscular strength [1]. Before the exact malfunctioning nerve has been identified, patients are diagnosed as having CRPS-I; once this specification has been made, they are given the diagnosis of CRPS-II. 

Though most patients recover from CRPS as their injury heals, some experience severe, chronic pain. For these patients, treatment involves long-term therapy, physical rehabilitation, or management of symptoms using low-grade analgesic drugs like acetaminophen [1]. Many of these treatments involve management of symptoms, and are not necessarily curative. Moreover, even acute CRPS can be debilitating and cause temporary disability, reduced quality of life, and absence from employment. 

To address the need for more reliable treatments for complex regional pain syndrome, scientists have turned towards a technology which has occupied the cutting edge of medical science throughout the past decade: stem cells. In recent years, the immunomodulatory capabilities of human mesenchymal stem cells, which are adult stem cells found in tissues like fat or bone marrow, have been of particular interest for treatment of CRPS. The relatively easy access to these stem cells makes them an ideal candidate for the treatment of a number of complex diseases. Scientists hypothesized that the introduction of human mesenchymal stem cells might help mitigate the autoimmune component of complex regional pain syndrome, reducing inflammation and allowing for restoration of the affected nerve. In 2020, a Chinese study showed that mesenchymal cells derived from bone marrow secreted neurotrophic factors in rats, which in turn promoted microglial polarization and helped to alleviate a common type of neuropathic pain [2]. Now, the Cleveland Clinic has just received a 5.5 million USD grant from the National Institute of Health to further the technology in humans [3]. If the project is successful, it could have a large implication for treating other types of neuropathic pain, according to Dr. Cheng, who is the director of the Cleveland Clinic’s Consortium for pain. He also noted that the approximately 50 million Americans living with chronic pain could certainly stand to benefit. 

References 

1. U.S. Department of Health and Human Services. (n.d.). Complex regional pain syndrome. National Institute of Neurological Disorders and Stroke. Retrieved from https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome 
2. Zhong, Z., Chen, A., Fa, Z., Ding, Z., Xiao, L., Wu, G., Wang, Q., & Zhang, R. (2020). Bone marrow mesenchymal stem cells upregulate PI3K/AKT pathway and down-regulate NF-κB pathway by secreting glial cell-derived neurotrophic factors to regulate microglial polarization and alleviate deafferentation pain in rats. Neurobiology of disease, 143, 104945. https://doi.org/10.1016/j.nbd.2020.104945
3. Stem cells could relieve CRPS pain and inflammation. Practical Pain Management. (2023, January 18). Retrieved from https://www.practicalpainmanagement.com/news/stem-cells-could-relieve-crps-pain-and-inflammation