Therapeutic applications of mesenchymal stem cell-derived extracellular vesicles in pain management: A narrative review of emerging evidence and future directions

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World Journal of Stem Cells

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1948-0210

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Stem Cells. Feb 26, 2026; 18(2): 116184
Published online Feb 26, 2026. doi: 10.4252/wjsc.v18.i2.116184

Table 3 Translational barriers in clinical development of mesenchymal stem cell-derived extracellular vesicle therapies for pain

Challenges	Concerns
Study design	Lack of placebo/sham controls; open label designs dominate
Study design	Limited inference of true clinical effect
Follow up duration	< 6 months endpoints
Follow up duration	Short for chronic pain assessment
Dosing and potency	No standardized unit of potency
Dosing and potency	Prevents cross-trial comparison
Manufacturing	Heterogeneity in EV isolation protocols, and hence, unpredictable therapeutic consistency
	Inconsistent EV product quality
	Inconsistent therapeutic predictability
Regulatory	Unclear categorization (biologic vs cell-derived drug vs advanced therapy)
Regulatory	Unclear oversight requirements

EVs: Extracellular vesicles.

Citation: Khan SA, Gangadaran P, Tiwari P, Rajendran RL, Jamal A, Hattiwale SH, Anand K, Jha SK, Hong CM, Ahn BC, Parvez S. Therapeutic applications of mesenchymal stem cell-derived extracellular vesicles in pain management: A narrative review of emerging evidence and future directions. World J Stem Cells 2026; 18(2): 116184
URL: https://www.wjgnet.com/1948-0210/full/v18/i2/116184.htm
DOI: https://dx.doi.org/10.4252/wjsc.v18.i2.116184

Khan SA, Gangadaran P, Tiwari P, Rajendran RL, Jamal A, Hattiwale SH, Anand K, Jha SK, Hong CM, Ahn BC, Parvez S. Therapeutic applications of mesenchymal stem cell-derived extracellular vesicles in pain management: A narrative review of emerging evidence and future directions. World J Stem Cells 2026; 18(2): 116184 [PMID: 41808887 DOI: 10.4252/wjsc.v18.i2.116184]

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