Many people are faced with pain management issues at some point in their lives.

Whether their pain stems from an injury, sickness, or aging, finding the best solution for lasting relief can be challenging. An estimated 20.9% of all adults in the United States (approx. 51.6M people) reported experiencing chronic pain. Another 6.9% (17.1M people) reported that they experienced high-impact chronic pain. Chronic pain can be debilitating, affect daily work and life activities, and often leads to depression.

While prescribed medications can address a patient’s pain, they may be impractical as a long-term solution. There is a need for a better long-term option for chronic pain sufferers that is less invasive than surgery, and more effective than medication(s).

Over 10 years ago - together with Dr. Gaetano Scuderi and Cytonics corporation in Jupiter, Florida - Dr. Cuéllar helped develop a novel autologous treatment for osteoarthritis and inflammatory pain – concentrated autologous A2M.

Since then Dr. Cuéllar has used this novel therapy extensively to treat a variety of painful orthopedic conditions. A2M injections are long-lasting, easy to administer, and can have positive long-term effects – possibly stopping the arthritis process from further advancing.


What Is Alpha 2
Macroglobulin (A2M)?

A2M, or “Alpha 2 Macroglobulin”, is an extracellular macromolecule. It is a large plasma protein found in blood and it is produced naturally, mainly by the liver. A2M is a powerful anti-inflammatory molecule that can bind to and inactivate many proteins that are involved in the pain and joint destruction process.

How do A2M injections target pain at the molecular level?

A blood draw is performed under sterile conditions. This blood is then centrifuged for a period of time at high speed to separate the blood into plasma and cellular components. The plasma component is then withdrawn. Stopping at this point would be the same as standard PRP (Platelet Rich Plasma). However, the autologous A2M concentration process has an extra step which is crucial – the plasma is passed through a special high-pass filter using a pump machine. The final product contains a solution rich in A2M that can then be injected.

Neutralizing destructive enzymes to promote healing and pain relief

The human plasma protein molecules in an A2M injection neutralize destructive enzymes, which are otherwise busy breaking down cartilage cells. When the cartilage in the knee begins to break down, for example, the bones that connect to form the knee joint grate together with increased friction. This friction occurs because of the loss of cartilage and causes inflammation and irritation. Inflammation is what actually causes the pain – and this is mediated by many small proteins called pro-inflammatory and inflammatory cytokines and enzymes such as IL-6, TNF-alpha, MMPs etc.

Modulating inflammation and promoting tissue regeneration

On a molecular level, there are many pro-inflammatory cytokines and degradative enzymes linked to cartilage breakdown. The protein in A2M injections “traps” these chemicals. The body then eliminates them - which prevents tissue damage, diminishes inflammation, and promotes tissue regeneration, or healing.

Research suggests that the protein found in A2M injections may halt the damaging progression of arthritis in joints.

What is an A2M Injection?

When the cartilage between the bones in our joints begins to break down, there is less cushion to keep the bones apart from one another, which is what causes inflammation and pain. This cartilage also provides support in the bony areas of our bodies where flexibility is also important. The health of our joints depends on the health of our cartilage, and the protein molecule in A2M keeps enzymes from breaking that cartilage down.

A2M injections offer a new way to treat chronic inflammation around joints and other areas of the body where cartilage has become worn. This minimally invasive option can provide patients with long-term results and pain relief. Call Dr. Cuéllar for a consultation today!

What is A2M Protein Concentrate Therapy?

A2M protein concentrate therapy, a cutting-edge approach, exhibits potential in combating joint diseases by impeding cartilage degradation. Initial research indicates its efficacy in alleviating conditions such as osteoarthritis. In addition to its role in inhibiting cartilage breakdown, A2M protein concentrate therapy has garnered attention for its potential to modulate inflammation and promote tissue regeneration. This multifaceted approach offers a comprehensive strategy for managing joint diseases, highlighting its significance as a promising therapeutic avenue. However, as studies continue, seeking guidance from a healthcare provider ensures personalized treatment strategies tailored to individual needs and circumstances, fostering informed decision-making and optimal health outcomes.

What Conditions Can Benefit From A2M Injections?

Hip and Knee Osteoarthritis
Pain, swelling, and inflammation are the most common symptoms of arthritis. A2M injections can be applied directly into the knee or hip joint and are highly effective in reducing this inflammation.
Joint Injuries
A2M injections are an effective alternative to joint replacement surgeries for injuries caused to the shoulder, knee, elbow, or rotator cuff. A2M injections prevent further joint deterioration.
Labral Tear
A labral tear is an injury to the tissue that holds the ball and socket of the hip joint together. A torn labrum can cause pain and reduce one’s range of motion in the hip, but an A2M injection will stimulate the growth and healing of the torn tissue.
Torn Meniscus
A torn meniscus occurs from a forceful twist that causes tissues in the knee to tear. A2M injections can be applied directly into the knee joint and stimulate growth and healing in the joint.
Spinal Injuries
A2M injections may prove to be the best non-surgical option for managing chronic pain resulting from a spinal injury. Although it can take up to 2-3 days to feel the effects of the injection, the results are often more long-term than the effects of prescribed medication.
Lumbar and Sacral Osteoarthritis
A2M injections are very effective in helping patients suffering from chronic arthritic pain. Degenerative arthritis in the lower back, or lumbar osteoarthritis, causes stillness and inflammation between these joints.
Sciatica and Lumbar Radiculopathy
Sciatica is a condition that stems from too much pressure being put on the spinal nerve. A2M injections deliver targeted anti-inflammatory plasma protein molecules directly into the irritated and inflamed regions of the spine.
Herniated Disc
A herniated, or “slipped”, disc occurs when the soft center of the spinal disc pushes through a crack in the vertebral casing, causing intense pain or weakness. Many patients with herniated discs feel same-day relief from A2M injections.
Degenerative Disc Disease
A2M injections help to restore the cartilage between bones, including the discs between our spinal vertebrae. For patients suffering from the chronic degeneration of these discs, an A2M injection can act as a powerful shield against increasing cartilage deterioration.


The Treatment

Patient Evaluation and Selection Criteria

The first step in determining whether or not an A2M injection will be beneficial to you is to ascertain the correct diagnosis for your pain, no matter where in the body it may be. If you have an unstable spine for example, an A2M injection will not help you unless the spine is stabilized. Or if you have a large disc herniation which his compressing a nerve or the spinal cord, a disc replacement surgery may be more appropriate. So Dr.Cuéllar will always need to perform a history and physical examination and usually review some imaging prior to making a determination as to whether or not A2M may help you.

Preparing for an A2M injection procedure

Before your A2M injection, patients should stop taking all anti-inflammatory medications (including Advil, Motrin, Ibuprofen, etc.), and supplements (turmeric, ginger, fish oil), for up to 5 days before the procedure (particular if it is in the epidural space of the spine). Be sure to drink plenty of fluids before the procedure. However, if your injection is to be done under anesthesia be sure to check with the doctor about when you must stop eating and drinking before the procedure – usually 8-12 hrs.

Administration techniques and dosage considerations

Patients should expect to have their blood drawn before this procedure. An ultrasound or fluoroscopy may be performed over the affected area, in order to guide the clinician to the exact location where the medication will be administered.

Important questions to ask your spinal surgeon about A2M Injections

How long does the pain relief from A2M injections generally last?

Will I be able to repeat this procedure again and how soon will I need to do so?

Will I be able to operate a vehicle after the procedure?

Does it hurt to have an A2M injection in the spine and do I need to sit very still?

How soon can I expect to feel relief from an A2M injection?

What sort of imaging can you use to track the progress and/or growth of cartilage in my body after the A2M injection?

Why is an A2M injection better for me than another type of pain management injection therapy?

What should I expect on the day of the procedure?

What should I expect the day after the procedure?

Are A2M injections covered by my insurance?

Why Choose Dr. Cuéllar for Alpha 2 Macroglobulin (A2M) Treatments in Southern Florida

Dr. Cuéllar specializes in administering anti-inflammatory injections and providing regenerative medicines to his patients. He is an experienced, well-known, and respected spinal surgeon in South Florida. Dr. Cuéllar has administered Alpha 2 Macroglobulin (A2M) Treatments to many patients who have suffered from chronic pain caused by a wide variety of spinal and orthopaedic conditions.

Dr. Cuéllar is sought after for administering A2M injections as he was directly involved in the early research used by Cytonics Corp to develop these novel treatments for mainly arthritis-related pain.

By using the next generation of PRP, called APIC-PRP*. APIC-PRP* a potent anti-inflammatory fluid can be injected into any painful joint (such as the knee, hip, shoulder, ankle, elbow, etc). During this process, blood is drawn from the patient, then, it is concentrated into a powerful anti-inflammatory protein (A2M) along with other potentially helpful molecules. This solution is then injected into the site that is causing the patient pain. Numerous scientific research studies have demonstrated that this procedure may reduce pain by blocking inflammation, and may even slow down cartilage degradation in large joints, such as the knee.

Recent Research Published On APIC






“Attentive, knowledgeable, professional, and treats every patient with individual care! Saved my dad’s life with his minimally invasive procedure and his mindfulness of the medication my father was on before procedure. Thank you Dr. Cuéllar!”

- Eleena H.


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