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    By the time he underwent the treatment in March 2016, Nicklaus’ back pain was so bad he had trouble standing. “I could not hit a golf ball without hurting. I could not stand up for more than 10 minutes,” he said.

    During the treatment developed by Alt, the source of the pain is first diagnosed using ultrasound. Liposuction is then used to take a sample of fat tissue from the abdomen or buttocks and is then processed to leave a solution rich in fat-derived stem cells. These are of the same lineage of cells that can produce cartilage or bone, says David Pearce, Executive VP of research at Sanford Health in Sioux Falls, South Dakota.

    The cells were injected back into Nicklaus’ back in an outpatient procedure that meant he was allowed to leave hospital the next day. Thanks to the therapy, Nicklaus says he can play golf again free of pain, and can stand for “as long as I want”.

    Topping up

    The therapy seems to work by alleviating inflammation at the site of the pain, but it could also help to repair damaged tissue. “In animal studies there has been regeneration of the tissue that is inflamed,” Pearce says. What’s more, it is safe because it uses the patient’s own cells, rather than a donor, he says.

    Nicklaus is now about to return to Munich to have the same treatment for a rotator cuff injury in his shoulder. While he is there, he plans to get a top up of stem cells in his back.

    Pearce, who is leading trials of the therapy for rotator cuff injury in the US, says the therapy tends to be a one-time treatment. The US Food and Drug Administration has now approved Sanford Health to conduct a trial on back pain in the US using Alt’s method, which should start in June, Pearce says. “In the US the most common reason people show up in the ER is back pain,” he adds.

    Nicklaus said the reason he hadn’t spoken out about his treatment before was simply that nobody had asked him about it. Both of his sons have now received the same therapy.

    “I’ve become a believer and I’ve had nice results,” Nicklaus told the conference. “I tell people ‘you better get a plane to Munich or wait for the FDA to approve it’,” although he reckons the first option is the most realistic right now.

    Read more: Chronic back pain stem cell treatment could cut need for opioids

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