Episoder
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PainExam Podcast Episode: An In-Depth Look at Hydrogen-Rich Water for Chronic Inflammatory Pain
In a recent episode of the PainExam podcast, Dr. David Rosenblum delves into an intriguing study published in the journal Antioxidants, exploring the therapeutic potential of hydrogen-rich water (HRW) in alleviating chronic inflammatory pain and associated mood disorders in mice. The study, conducted by Santiago Coral-Pérez and colleagues from the Institut d’Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, presents compelling evidence supporting the analgesic, antidepressant, and anxiolytic effects of HRW.
Study OverviewThe study investigates the efficacy of HRW in treating nociceptive responses and affective disorders associated with chronic inflammatory pain. Using a mouse model induced by the subplantar injection of complete Freund's adjuvant (CFA), the researchers evaluated the impact of HRW on several parameters:
Nociceptive Responses: Mechanical allodynia and thermal hyperalgesia. Affective Disorders: Depressive-like behaviors (measured by Tail Suspension Test and Forced Swimming Test) and anxiety-like behaviors (assessed using Elevated Plus Maze and Open Field tests). Biomarker Analysis: Levels of oxidative stress, inflammatory, and apoptotic markers in the paws and amygdala. Key Findings1. Analgesic Effects:
Mechanical Allodynia and Thermal Hyperalgesia: The study found that both intraperitoneal and subplantar administration of HRW significantly reduced mechanical allodynia and thermal hyperalgesia in CFA-injected mice. Remarkably, the local (subplantar) administration showed greater effectiveness, achieving complete inhibition of nociceptive responses with just one day of treatment.2. Antidepressant and Anxiolytic Effects:
Depressive-like Behaviors: HRW treatment normalized the increased immobility times in both the Tail Suspension Test and Forced Swimming Test, indicating potent antidepressant properties. Anxiety-like Behaviors: HRW also reversed the anxiety-like behaviors in the Elevated Plus Maze and Open Field tests, showcasing its anxiolytic effects without impairing motor function.3. Biochemical Pathways:
The study highlighted the significant role of the Nrf2/HO-1-NQO1 pathway in mediating the analgesic effects of HRW. Inhibitors targeting this pathway reversed the pain-relieving actions of HRW, underscoring its pivotal role. Oxidative Stress and Inflammation: HRW treatment reduced the expression of oxidative (4-HNE), inflammatory (p-IKBα), and apoptotic (BAX) markers in both the paw and amygdala tissues, demonstrating its broad-spectrum protective effects. Implications for Clinical PracticeDr. Rosenblum emphasizes the potential of HRW as a novel therapeutic strategy for chronic inflammatory pain and its associated comorbidities. The study's findings suggest that HRW could offer a multifaceted approach, addressing both pain and mood disorders through its antioxidant, anti-inflammatory, and anti-apoptotic properties.
ConclusionThe episode concludes with a discussion on the broader implications of these findings for pain management, particularly in conditions where chronic inflammatory pain is prevalent. Dr. Rosenblum highlights the need for further clinical trials to validate these promising preclinical results and explore the potential of HRW in human subjects.
For more detailed insights into this study, including potential applications and future research directions, tune into the PainExam podcast with Dr. David Rosenblum.
For more information go to:
https://molecularhydrogeninstitute.org/links-mhi/
Other Announcements from NRAP Academy: PainExam App is ready for iphone Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!References
Coral-Pérez, S., Martínez-Martel, I., Martínez-Serrat, M., Batallé, G., Bai, X., Leite-Panissi, C. R., & Pol, O. (2022). Treatment with hydrogen-rich water improves the nociceptive and anxio-depressive-like behaviors associated with chronic inflammatory pain in mice. Antioxidants, 11(11), 2153.
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Dr. Rosenblum serves at AMETD's 2024 Conference as faculty and discusses the safe and accurate usage of Ultrasound to Guide PRP injecitons
Discussed in this lecure:
Knee, Hip, Shoudler, Ligament and Tendon Targets, the ultrasound technique, the evidence for PRP and controversy. Controversy with respect to the Achilles Tendon!
Other Announcements from NRAP Academy: PainExam App is ready for iphone Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!References
https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdfDisclaimer
Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
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Manglende episoder?
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Podcast Show Note Summary:
Episode Title: "New Guidelines for Corticosteroid Injections in Chronic Pain Management"
This podcast is a discussion about the recent review article
Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society
In this episode, we dive into the recently published guidelines on the use of corticosteroid injections for managing chronic pain, developed by the American Society of Regional Anesthesia and Pain Medicine, along with several other prominent pain societies. These guidelines address the safety and efficacy of corticosteroid injections for sympathetic and peripheral nerve blocks, as well as trigger point injections.
Key Discussion Points:
Background and Need for Guidelines:
Overview of potential adverse events from corticosteroid injections, such as increased blood glucose levels, decreased bone mineral density, and suppression of the hypothalamic–pituitary axis. Importance of using lower doses of corticosteroids, which studies have found to be just as effective as higher doses.Development of the Guidelines:
The guidelines were approved by multiple pain societies and structured into three categories: sympathetic and peripheral nerve blocks, joint injections, and neuraxial injections. Extensive literature review and consensus-building through a modified Delphi process.Key Recommendations:
The addition of corticosteroids to local anesthetics is recommended for certain nerve blocks, such as the greater occipital nerve block for cluster headaches and ilioinguinal/iliohypogastric nerve blocks for post-herniorrhaphy pain. Corticosteroid addition is not recommended for sympathetic nerve blocks, greater occipital nerve blocks for migraines, and pudendal nerve blocks for pudendal neuralgia. Imaging guidance (ultrasound or fluoroscopy) improves the safety and accuracy of certain procedures.Efficacy and Safety:
Detailed analysis of various studies on the effectiveness of corticosteroid injections for different types of chronic pain. Discussion on the minimal benefit of corticosteroids in trigger point injections and the potential risks associated with their use.Clinical Implications:
How these guidelines can assist clinicians in making informed decisions regarding corticosteroid use in chronic pain management. Emphasis on the need for personalized treatment plans based on individual patient characteristics and clinical data.Future Directions:
Identification of gaps in the current research and the need for well-designed studies to further assess the benefits and risks of corticosteroid injections.Join us as we explore these comprehensive guidelines and their potential impact on improving chronic pain management practices.
Resources:
Link to the full guidelines: Journal Online Other Announcements from NRAP Academy: PainExam App is ready for iphone Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!References
https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdfDisclaimer
Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
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PainExam Show Notes: Mandibular Division of the Trigeminal Nerve Block with Dr. David Rosenblum
VIsit the NRAP Academy for the PainExam Board Prep!
Introduction Host: Dr. David Rosenblum Topic: Mandibular Division of the Trigeminal Nerve Block for Cancer Pain Management Techniques: Ultrasound and Fluoroscopic Guidance Overview Purpose: Alleviate chronic facial pain, specifically in cancer patients suffering from trigeminal neuralgia or other related conditions. Focus: Detailed discussion on the anatomy, clinical presentation, and procedural techniques for effective nerve block. Anatomy of the Mandibular Nerve Origin: Mandibular nerve is a branch of the trigeminal nerve (cranial nerve V). Pathway: Exits the middle cranial fossa through the foramen ovale and descends between the lateral and medial pterygoid muscles. Sensory Innervation: Anterior two-thirds of the tongue Teeth and mucosa of the mandible Skin of the chin and lower lip Skin over the mandible (excluding the mandibular angle) Tragus and anterior part of the ear Posterior part of the temporalis muscle up to the scalp Ultrasound-Guided Technique Patient Positioning: Patient lies on their side with the affected side facing upward. Transducer Selection: Curvilinear transducer preferred for deeper structures. Transducer Placement: Place distal and parallel to the zygomatic arch to bridge the coronoid and condylar processes. Anatomical Landmarks: Identify the lateral pterygoid muscle and plate. Use power Doppler to locate the sphenoid palatine artery. Needle Trajectory: Introduce the needle using an out-of-plane approach to target the pterygopalatine fossa (anterior to the lateral pterygoid plate). For the mandibular nerve block, target the area posterior to the lateral pterygoid plate between the medial and lateral pterygoid muscles. Electrostimulation (Optional): Utilize a 22G, 10 cm insulated short beveled needle connected to a peripheral nerve simulator. Position confirmed by motor response from the temporalis and masseter muscles. Fluoroscopic-Guided Technique Patient Positioning: Similar to ultrasound guidance, patient lies on their side with the affected side facing upward. C-arm Positioning: Position the C-arm to visualize the foramen ovale. Needle Insertion: Insert the needle under fluoroscopic guidance towards the foramen ovale. Contrast Injection: Confirm needle placement with contrast injection. Anesthetic Administration: Administer local anesthetic and/or neurolytic agents. Clinical Symptoms and Diagnosis Symptoms: Unilateral sharp, stabbing, or burning pain in the mandibular nerve distribution. Pain triggered by activities such as eating, talking, washing the face, or cleaning the teeth. Diagnostic Imaging: MRI or CT scans to identify causes like vascular compression, mass lesions, or fractures. Complications and Considerations Potential Complications: Bleeding, hematoma, infection, and hypersensitivity reaction to the injectate. Serious complications from neurolytic agents like permanent sensory deficit and tissue necrosis. Alternative Treatments: PNS? Radiofrequency or cryoablation for recalcitrant cases. Conclusion Efficacy: Ultrasound and fluoroscopic guidance provide precise targeting of the affected nerves, minimizing collateral damage. Safety: Routine use of power Doppler imaging to avoid injury to surrounding vessels. Recommendation: Consider these techniques for patients unresponsive to oral medications or unsuitable for surgery.These show notes provide a comprehensive overview of the discussion, highlighting key points on the anatomy, technique, and clinical considerations for mandibular nerve blocks in cancer patients.
Other Announcements from NRAP Academy: PainExam App is ready for iphone Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!References
Nicholas A Telischak, Jeremy J Heit, Lucas W Campos, Omar A Choudhri, Huy M Do, Xiang Qian, Fluoroscopic C-Arm and CT-Guided Selective Radiofrequency Ablation for Trigeminal and Glossopharyngeal Facial Pain Syndromes, Pain Medicine, Volume 19, Issue 1, January 2018, Pages 130–141, https://doi.org/10.1093/pm/pnx088
Allam, Abdallah El-Sayed, et al. "Ultrasound‐Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques." Pain Research and Management 2018.1 (2018): 5480728.
isclaimer
Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
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Dr. Rosenblum addresses 2 Studies on this Pain Management Journal Club Podcast
Article 1:
The Treatment of Bone Marrow Lesions Associated with Advanced Knee Osteoarthritis: Comparing Intraosseous and Intraarticular Injections with Bone Marrow Concentrate and Platelet Products
Article 2:
Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: Aminimum of 2-year follow-up retrospective comparative study
Editorial:
Dr. Rosenblum poses some important questions:
Why are regenerative therapies not covered? Why is CMS limiting trigger point injections and not paying for certain peripheral nerve blocks? Who is making the decision? Do lobbying groups or big pharma have a role?
Other Announcements from NRAP Academy: PainExam App is ready for iphone Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!References
Alessio-Mazzola M, Repetto I, Biti B, Trentini R, Formica M, Felli L. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study. Journal of Orthopaedic Surgery. 2018;26(1).
Centeno, Christopher, et al. "The treatment of bone marrow lesions associated with advanced knee osteoarthritis: comparing intraosseous and intraarticular injections with bone marrow concentrate and platelet products." Pain Physician24.3 (2021): E279.
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Join us on this episode of the PainExam Podcast where rising star, Christopher Robinson, MD PhD discusses his upcoming paper on exosomes featuring some of the largest names in pain managment. Dr. Rosenblum also alludes to degenerative disc disease being a partially infectious podcast.
Other topics discussed on this podcast:
The Anesthesiology Job Market
Pain Management Fellowship
Duration of Pain Management Fellowships
Should Pain Management be an Independent Residency?
Other Announcements from NRAP Academy: PainExam App almost ready Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! -
Journal Club: Treating Degenerative Disc Disease with Leukocyte Rich PRP
Dr. Rosenblum discusses an article written by Dr. Gregory Lutz describing Leukocyte RIch PRP's role in treating Degenerative Disc Disease and the theory that there is an infectious disease component to disc injury.
Dr. Lutz describes multiple articles, as well as anectodal experience in which bacterial infectious was demonstrated in pathological discs, and PRP was successful in alleviating symptoms, modic changes and improved clinical as well as radiographic appearance.
Other Announcements from NRAP Academy: PainExam App almost ready Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!
ReferencesLutz, Gregory E. "Intradiscal Leukocyte Rich Platelet Rich Plasma for Degenerative Disc Disease." Physical Medicine and Rehabilitation Clinics of North America 34.1 (2023): 117-133.https://www.binasss.sa.cr/bibliotecas/bhm/feb23/61.pdf
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Dr. Rosenblum reviews an article by Dr. Reuben Ingber regarding the use of iliopsoas trigger point dry needling and therapeutic stretching in the treatement of 6 consecutive patients wiht acute lumbar radiculitis and foot drop. Other Announcements from NRAP Academy: PainExam App almost ready Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!
References
Reuben S. Ingber,
Iliopsoas trigger point dry needling and therapeutic stretching in the treatment of a series of six consecutive patients presenting with acute lumbar radiculitis and foot drop,
Journal of Bodywork and Movement Therapies,
Volume 36,
2023,
Pages 1-4,
ISSN 1360-8592,https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57702#:~:text=No%20more%20than%203%20Trigger,group%20are%20not%20billed%20separately.
CMS National Coverage Policy
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Dr. Rosenblum describes a patient with chronic shoulder pain who failed shoulder replacement, steroid injections, nerve blocks, cryotherapy, and peripheral nerve stimulation of the axillary and suprascapular nerve block. In this podcast, he discusses his perfomance of Shoulder Radiofrequency Ablation targeting the articular branches of the suprascapular nerve, axillary nerve, nerve to subscapularis and lateral pectoral nerve. Reference: https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2020/11/01/how-i-do-it-shoulder-articular-nerve-blockade-and-radiofrequency-ablation Other Announcements from NRAP Academy: PainExam App almost ready Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!
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Advocating for Transparency and Oversight in Pain Management
Introduction:
Welcome back to Painexam, where we delve into the latest advancements and challenges in pain management. Today's episode highlights a significant advocacy effort made by leading Interventional Pain Physicians and industry experts.Summary of Lobbying Effort:
On March 20, 2024, a group of widely known and respected pain physicians and industry leaders, including Drs. Sean Li, Peter Staats, Mehul J. Desai, David Reece, Hemant Kalia, and David Rosenblum, alongside industry figures Mark Stultz, Christopher Conrad, and Cecelia Ruble, visited Capitol Hill to advocate for greater oversight and transparency in independent review organizations. Despite their busy schedules, they recognized the critical need to address the 0% turnover rate in appeals for denied treatments, which disproportionately affects patients seeking alternatives to surgery and opioid medication.Importance of Transparency:
The issue extends beyond pain management, impacting patients across various medical fields. While opioid therapy may seem economically favorable initially, the long-term consequences, including delayed care and medication side effects, often outweigh the costs. The group emphasized the importance of an unbiased review for accessible, cutting-edge treatments to improve patient outcomes and reduce overall healthcare expenses.Purpose of the Lobbying Effort:
Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes.For Board Prep, Ultrasound Training and more, visit:
Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound-
guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain.
Conclusion and Actionable Steps:
To schedule a consultation with Dr. Rosenblum, patients can visit www.AABPpain.com or contact the Brooklyn Office at 718-436-7246 or the Garden City Office at 516-482-7246. Stay tuned for more updates on advancements and advocacy efforts in pain management.Outro:
Thank you for joining us on this episode of Painexam. Be sure to subscribe for future discussions on navigating the complexities of pain management. -
Dr. Rosenbum discusses Interventional Psychiatry, the role of Stellate Ganglion Blocks in PTSD, Ketamine Infusions for Depression, and the role of Magnesium as a co-factor in ketamine infusions. Other Announcements from NRAP Academy: PainExam App almost ready Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full References Górska N, Cubała WJ, Słupski J, Wiglusz MS, Gałuszko-Węgielnik M, Kawka M, Grzegorzewska A. Magnesium in Ketamine Administration in Treatment-Resistant Depression. Pharmaceuticals (Basel). 2021 May 3;14(5):430. doi: 10.3390/ph14050430. PMID: 34063604; PMCID: PMC8147622. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.513068/full https://www.sutterhealth.org/services/behavioral-health/interventional-psychiatry Hanling SR, Hickey A, Lesnik I, et al Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial Regional Anesthesia & Pain Medicine 2016;41:494-500. https://www.psychiatrist.com/jcp/oral-ketamine-for-depression/
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Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course.
Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City.
After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360.
https://pain360.org https://www.malayilmd.com Ultrasound Interventional Pain Course Registration For Pain Management Board Prep Go to: References https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full -
In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain.
He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic.
The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches.
The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case.
Additionally, the show notes mention an events calendar located at this link: https://www.nrappain.org/pages/ultrasound-course-calendar.
Upcoming Course schedule for NRAP Academy includes the following events:
Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session.
MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management.
Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia.
Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia.
Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance.
Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques.
In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates.
Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information.
Reference
Fu E, Elsharkawy H #35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain Regional Anesthesia & Pain Medicine 2023;48:A193. -
Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves"
Special Thanks to Robert Stall, MD
Introduction: Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves. Background: The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons. Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system. Methods: Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017. The technique was applied to eight fresh cadavers before dissecting the median nerve. Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens. Results: The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion. Ventricular cannulation was performed successfully using specific coordinates. Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma). Conclusions: Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves. CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells. Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons. The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways. Significance: This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues. Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves. The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system. Closing: Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes!Reference
Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.
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Exploring the Role of Ultrasound in Headache Evaluation and Treatment
A Journal Club based on Dr. Andrea Trescott's article:
Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.
Click Here to Claim CME for reflecting on content presented in this journal club.
David Rosenblum, MD
Accepting New Patients
Patients Interested in scheduling a consultation with Dr. David Rosenblum can call
516 482 7246 (Garden City) or 718 436 7246 (Brooklyn)
In this Podcast, Dr. Rosenblum discusses patient's in his practice who responsed to ultrasound guided nerve blocks in the treatment of headaches. He discusses the use of ultrasound injections as opposed to medication to manage the pain and references Dr. Trescott's comprehensive article on the various nerves and clinical presentations of headaches related to terminal nerve entrapment or irritation.
Dr. Rosenblum discusses
Supraorbital Neuralgia Auriculotemproal Nerve Anatomy Clinical presentation Interventional Pain TherapiesSummary of Dr. Trescott's Article and Key Points:
Headaches, affecting 28 million people in the US, pose a significant burden on society in terms of medical costs and lost labor. They are complex neurologic disorders with diverse origins and causes. Headaches are often viewed as the primary pathology, but they are fundamentally a symptom. Understanding them is an evolving science, and their patterns can be recognized for effective diagnosis and treatment. In 2003, Pareja et al proposed the term "epicrania" for headaches triggered by extracranial causes, suggesting a link between intracranial components and extracranial nerves.Peripheral Triggers and Plastic Surgery:
Plastic surgeons noted relief of migraines through corrugator muscle resection and botulinum toxin injection, indicating peripheral headache triggers. Severe migraines post-head or neck injury may have an extracranial origin, suggesting peripheral nerve irritation. Traditional migraine medications may offer modest relief. Primary treatment involves inhibiting nerve irritation through interventional pain techniques, turning off the pain origin and associated migraine centers.Ultrasound Advantages:
Evaluation and injection of nerves have traditionally used landmarks and fluoroscopic images, but ultrasound offers unique advantages. Nerves often travel with arteries, potentially contributing to "throbbing" pain. Ultrasound provides a more precise and dynamic visualization of these structures.Exploring Extracranial Causes:
The International Classification of Headache Disorders (ICHD) categorizes headaches as primary or secondary. While valuable, it broadly defines peripheral nerve contributions as "Other Terminal Branch Neuralgias." The study of extracranial peripheral nerve entrapments and dysfunction reveals overlap between ICHD-defined headaches and potential nerve entrapments causing these pain patterns. Collaboration with disciplines like pain management enriches the understanding and treatment options for headaches.Conclusion:
Headaches, often seen as isolated intracranial phenomena, may have extracranial triggers. Understanding and treating these triggers, especially through ultrasound-guided techniques, present a promising avenue in headache management.NRAP Academy also offers:
Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)Private Ultrasound Training Available
Email [email protected]
Reference:
Trescot A. Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.Publication Details:
Received: 15 Aug 2015, Reviewed: 2 Jun 2016, Accepted: 28 Jun 2016.This podcast explores the dynamic relationship between intracranial and extracranial factors in headaches, shedding light on potential breakthroughs in their evaluation and treatment.
#interventionalpain #painboards #painfellowship #painexam #regionalanesthesia #ultrasoundguidedpain #ultrasoundpain #ultrasoundmsk #paincme #paincmecourse
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Phenol in the treatment of Hip Pain Bonus CME Available ($15 Processing Fee)
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wo9gDI Dr. Rosenblum discusses the use of phenol injected into the pericapsular nerve group, hip joint and outcome a isolated case reports. Also discussed, phenol, its mechanism of action and a refractory case of neuralgia paresthetica. Pain from hip cancer, pain from DVT and IPACK or articular branch of the tibial nerve block discussed for knee pain. Dr. Rosenblum discusses his ultrasound training programs, the migration of the PainExam platform to the new NRAPpain.org website and offers a testimonial from a previous ultrasound course from the student who inspired this podcast. Patients interested in scheduling a consultation with Dr. Rosenblum can call 516 482 7246 or 718 436 7246 For our Live Course Calendar, Click here Board Prep for PM&R, Pain and Anesthesiology BoardsReferences
Monagle, John; Ee, Joanne1. Treatment of chronic hip osteoarthritic pain with intra-articular phenol. Indian Journal of Pain 27(1):p 41-43, Jan–Apr 2013. | DOI: 10.4103/0970-5333.114866 Marcio V. Pimenta, Amanda T. Nakamura, Hazem A. Ashmawi, Joaquim E. Vieira, Hermann dos Santos Fernandes, Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report, Brazilian Journal of Anesthesiology (English Edition), 2021, Rocha Romero, A., Carvajal Valdy, G. & Lemus, A.J. Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. Can J Anesth/J Can Anesth 66, 1270–1271 (2019). https://doi.org/10.1007/s12630-019-01448-y -
PainExam Podcast Show Notes: Exploring Traumeel as an Alternative for Back Pain Relief
Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HoEWFdBoard Prep and Continuing Education
Introduction:
Today, Long Island Based Pain Physician David Rosenblum, MD delves into the latest advancements and alternative treatments for pain management. In today's episode, we shine a spotlight on Traumeel®, a homeopathic alternative gaining traction for its anti-inflammatory properties, with fewer reported side effects compared to corticosteroids.Understanding Traumeel:
Traumeel, a fixed combination of diluted plant and mineral extracts, has been available over-the-counter in Europe for over 60 years. Contrary to corticosteroids, Traumeel's popularity has surged due to its limited side effect profile, with reported contraindications primarily linked to allergies [9].View Full Calendar
Scientific Insights:
A study by Lussignoli et al. demonstrated Traumeel's efficacy in decreasing systemic interleukin-6 production and reducing edema, countering an unregulated inflammatory response [10]. In vitro studies revealed Traumeel's inhibition of pro-inflammatory mediators (IL-1β, TNFα, IL-8) in immune cells, suggesting its potential in stabilizing the immune system [8]. Notably, Traumeel's effectiveness seems to surpass the sum of its individual components, indicating a synergistic interaction [9-10].Clinical Applications:
Traumeel has shown efficacy comparable to nonsteroidal anti-inflammatory drugs (NSAIDs) in treating various inflammatory conditions. It is available in oral, topical, and injectable preparations, making it a versatile option for pain relief [8-9].Research Gaps and Potential:
Despite its established use, current research lacks information on Traumeel's efficacy in epidural injections for short-term back pain relief. No studies have compared Traumeel to corticosteroid injections, although the TRARO study protocol proposes a potential avenue for comparison in rotator cuff syndrome patients [11].Pain Management Board Prep
Clinical Cases:
Five patients seeking back pain relief opted for Traumeel injections due to either a contraindication to or a preference against steroids. This real-world scenario lays the groundwork for further exploration into Traumeel's efficacy in epidural injections, providing additional pain-relieving options for patients unable to tolerate corticosteroid injections.Conclusion:
Traumeel presents a promising alternative for pain management, particularly in cases where corticosteroids may be unsuitable, however the FDA has yet to approve it and therefore it has failed to gain traction in the US. [14] As we wrap up, stay tuned for future developments in the research landscape surrounding Traumeel and its potential role in enhancing pain relief options.Disclaimer:
Consult with a healthcare professional before considering any alternative treatments. The information provided in this podcast is for educational purposes only and does not replace medical advice.David Rosenblum, MD
References 1. Cassidy JD, Carroll LJ, Côté P: The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998, 23:1860-66. 10.1097/00007632-199809010-00012 2. Rudy TE, Weiner DK, Lieber SJ, Slaboda J, Boston JR: The impact of chronic low back pain on older adults: a comparative study of patients and controls. Pain. 2007, 131:293-301. 10.1016/j.pain.2007.01.012 3. Fyneface-Ogan S: Anatomy and Clinical Importance of the Epidural Space. Epidural Analgesia - Current Views and Approaches. IntechOpen. IntechOpen (ed): IntechOpen, Internet; 2012. 1-14. 10.5772/39091 4. Waldman SD: Complications of cervical epidural nerve blocks with steroids: a prospective study of 790 consecutive blocks. Reg Anesth. 1989, 14:149-51. 5. McGrath JM, Schaefer MP, Malkamaki DM: Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011, 12:726-31. 10.1111/j.1526-4637.2011.01077.x 6. Watters WC 3rd, Resnick DK, Eck JC, et al.: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. J Neurosurg Spine. 2014, 21:79-90. 10.3171/2014.4.SPINE14281 7. Understanding Potential Complications Of Epidural Steroid Injections . (2011). Accessed: October 1, 2019: https://www.practicalpainmanagement.com/treatments/interventional/injections/understanding-potentialcomplications-ep…. 8. Schneider C: Traumeel - an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. Int J Gen Med. 2011, 4:225-34. 10.2147/IJGM.S16709 9. Grech D, Velagala J, Dembek DJ, Tabaac B: Critical literature review of the homeopathic compound Traumeel for treatment of inflammation. Pharmacology & Pharmacy. 2018, 9:67-83. 10. Lussignoli S, Bertani S, Metelmann H, Bellavite P, Conforti A: Effect of Traumeel S®, a homeopathic formulation, on blood-induced inflammation in rats. Complement Ther Med. 1999, 7:225-30. 10.1016/S0965-2299(99)80006-5 11. Vanden Bossche L, Vanderstraeten G: A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol. BMC Musculoskelet Disord. 2015, 16:8. 10.1186/s12891- 015-0471-z 12. Birnesser H, Oberbaum M, Klein P, Weiser M: The homeopathic preparation Traumeel® S compared with NSAIDS for symptomatic treatment of epicondylitis 13. Ehlert, Dianna, and Ariel Majjhoo. "Traumeel® Epidural Injection: A Viable Alternative to Corticosteroids-A Five-Patient Case Study." Cureus 11.11 (2019) 14. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/medinatura-inc-596269-06112020
President, NRAP Academy
Clinical Assistant Professor
Department of Anesthesiology
SUNY Downstate Medical Center
Director of Pain Management
Maimonides Medical Center -
Dr. Rosenblum reviews the anatomy of the ilioinguinal nerve and entrapment syndromes related to the nerve and its relationship to the iliohypogastric nerve. He describes cases in which patients have a tender spot (tinel’s) over the lateral iliac crest.
Live Regenerative Medicine and Ultrasound WorkshopsFor up to date Calendar, Click Here!
#painboards #painfellowship #abpm #aspn #abipp #Asipp
#nans #painexam #painexampodcast #regionalanesthesia #regemed #regenerativepainmedicine #jointinjections #prppain #bmac #painqbank #uspaininjections #Usjointinjections #interventionalpain
References
https://assets.cureus.com/uploads/review_article/pdf/94743/20220610-32009-17da8fm.pdf https://www.bizwan.com/en/index.php?view=article&id=82:proximal-entrapments-of-the-lower-extremity&catid=86&start=1 -
Hydroxyapatite Deposition Disease Dr. Rosenblum discusses shoulder pain, and the pathophysiology of Hydroxyapatite Deposition Disease. He discusses personal experience with infraspinatous tendon tear, and treatments such as NSAIDs, Lidocaine patch and steroid injections of the infraspinatous tendon. Dr. Rosenblum discusses his experience with a failed suprascapular nerve block as well as evidence to support PRP injections and ethical safe care. Dr. Rosenbum also is the NRAP Academy Course director for Ultrasound, Regenerative Pain Medicine and Regional Anesthesia CME Workshops and developed online PainExam, AnesthesiaExam and PMRExam Board Reviews Pain Management Board Review Upcoming Workshops and Events NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, December 16, 2023 7:30 AM NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, January 6, 2024 7:30 AM For up to date Calendar, Click Here!
References
Valerio Sansone, Emanuele Maiorano, Alessandro Galluzzo & Valerio Pascale (2018) Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment, Orthopedic Research and Reviews, 10:, 63-72, DOI: 10.2147/ORR.S138225 Seijas R, Ares O, Alvarez P, Cusco X, Garcia-Balletbo M, Cugat R. Platelet-Rich Plasma for Calcific Tendinitis of the Shoulder: A Case Report. Journal of Orthopaedic Surgery. 2012;20(1):126-130. doi:10.1177/230949901202000128 Hegazi T. Hydroxyapatite Deposition Disease: A Comprehensive Review of Pathogenesis, Radiological Findings, and Treatment Strategies. Diagnostics (Basel). 2023 Aug 15;13(16):2678. doi: 10.3390/diagnostics13162678. PMID: 37627938; PMCID: PMC10453434. -
Dr. Rosenblum reviews an ASRA Newsletter article discussing the technique, relevant anatomy and more for performing Shoulder Articular Branch Radiofrequency ablation for chronic pain.
David Rosenblum, MD practices Interventional Pain Medicine in New York.
To schedule a conusultation call 718 436 7246 for Brooklyn and 516 482 7246 for Garden City locations or go to www.AABPpain.com
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/PFcXGy
Upcoming Workshops and Events
NYC Regional Anesthesia and Pain Ultrasound CME Workshop
Saturday, October 28, 2023 8:00 AM
NRAP Academy: Regenerative Pain Medicine Course NYC
Saturday, November 11, 2023 8:00 AM
NYC Regional Anesthesia and Pain Ultrasound CME Workshop
Saturday, December 16, 2023 7:30 AM
NYC Regional Anesthesia and Pain Ultrasound CME Workshop
Saturday, January 6, 2024 7:30 AM
For up to date Calendar, Click Here!
Reference
https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2020/11/01/how-i-do-it-shoulder-articular-nerve-blockade-and-radiofrequency-ablation - Vis mere
