Episodi
-
Summary
In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures.
Chapters Introduction to the Pain Exam Podcast and Topic OverviewDr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease.
Upcoming Conferences and Educational OpportunitiesDr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities.
Overview of Postherpetic NeuralgiaDr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life.
Treatment Options OverviewDr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics.
Phases of Herpes Zoster and DefinitionsDr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash.
Incidence and Risk FactorsDr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia.
Impact on Quality of LifeDr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia.
Literature Review and PathophysiologyDr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia.
Central Sensitization and Nerve DamageDr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome.
Different Phenotypes and ClassificationDr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration.
Deafferentation PhenotypeDr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial.
Diagnosis and Physical ExaminationDr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients.
Sensory Testing and AssessmentDr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons.
Prevention Through VaccinationDr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions.
Treatment ObjectivesDr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation.
Antiviral MedicationsDr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised.
Benefits of Antiviral TherapyDr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible.
Corticosteroids and OpioidsDr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction.
Methadone and AntidepressantsDr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction.
Antiepileptics and Pharmacological Treatment SummaryDr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011.
Topical AgentsDr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group.
Intracutaneous InjectionsDr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study.
Summary of Local AnestheticsDr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy.
Interventional Treatments: Epidural and Paravertebral InjectionsDr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster.
Comparative Studies on Injection ApproachesDr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster.
Timing of Interventions and Continuous Epidural BlockadeDr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality.
Interventions for Postherpetic NeuralgiaDr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence.
Summary of Epidural and Paravertebral InjectionsDr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy.
Pulsed Radiofrequency (PRF) EvidenceDr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy.
PRF Studies for Acute Herpes ZosterDr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group.
PRF for Trigeminal NeuralgiaDr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group.
PRF Compared to Other InterventionsDr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate.
Summary of PRF and Final RecommendationsDr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature.
Sympathetic Blocks and ConclusionDr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia.
Personal Clinical Approach and ClosingDr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast.
Q&ANo Q&A session in this lecture
Pain Management Board Prep Ultrasound TrainingREGISTER TODAY!
Create an Account and get Free Access to the PainExam- NRAP Academy Community
HighlightsDavid Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.
Awards
New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025
Schneps Media: 2015, 2016, 2017, 2019, 2020
Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025
Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023
Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County’s Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!
Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.
Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators.
He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call
Brooklyn 718 436 7246
Reference
Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.
-
Summary
In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself.
Pain Management Board Prep Ultrasound TrainingREGISTER TODAY!
Create an Account and get Free Access to the PainExam- NRAP Academy Community
Highlights Introduction and Upcoming EventsDr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction.
Board Prep Community AnnouncementDr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic.
Journal Article Overview on Celiac Plexus BlockDr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis.
Dr. Rosenblum's Personal Experience with Celiac Plexus BlocksDr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor.
Study Methods and ResultsDr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy.
Study Limitations and ConclusionsDr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread.
Detailed Procedure TechniqueDr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures.
Procedure Execution and MonitoringDr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol.
Post-Procedure Care and Study EvaluationDr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block.
Ultrasound Considerations and Alternative ApproachesDr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread.
Conclusion and Community Resource ReminderDr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer.
Reference
https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113
-
Episodi mancanti?
-
PRP in the Epidural Space for Radiculopathy
Brooklyn Based Pain Physician, David Rosenblum, MD known for his work publishing and teaching Regenerative Pain Medicine and Ultrasound Guided Pain Procedures hosts this podcast covering the latest and most advanced concepts in Pain Medicine.
SummaryDr. David Rosenblum delivered a comprehensive lecture covering several key topics in pain management. He discussed his upcoming speaking engagements at PainWeek, ASPN and great upcoming meetings like the Latin American Pain Society, and other conferences. Dr. Rosenblum shared his extensive experience with PRP (Platelet-Rich Plasma) epidural injections, reviewing multiple research studies that support their efficacy. He highlighted three significant studies: a randomized control trial comparing PRP epidural injections to traditional treatments, a CT-guided epidural PRP study, and a 2025 meta-analysis comparing PRP to steroids. Dr. Rosenblum emphasized that PRP treatments are showing comparable or better results than traditional steroid injections, with potentially fewer required treatments and longer-lasting relief. He noted that while PRP is currently not covered by insurance, it represents a growing trend in 'natural' treatment approaches that patients increasingly prefer.
Chapters Introduction and Upcoming EventsDr. Rosenblum announced his upcoming lectures at Pain Week focusing on ultrasound and regenerative medicine, followed by presentations at the Latin American Pain Society in Chile and the New York, New Jersey Pain Conference. He mentioned the SoMeDocs online pain conference accessible through nrappain.org, and upcoming ultrasound training sessions in New York City.
PRP Epidural Research ReviewDr. Rosenblum discussed a randomized control trial involving 30 patients receiving transforaminal epidural injections. The study showed that PRP patients demonstrated significant improvements in leg pain scores at 6, 12, and 24 weeks. He noted that while the study didn't use contrast, he personally prefers using contrast diluted with saline for better visualization.
CT-Guided Epidural Study AnalysisDr. Rosenblum reviewed a study comparing CT-guided epidural PRP versus steroid injections, questioning the necessity of CT guidance. The study included 60 patients and showed similar results between PRP and steroid groups at six weeks, though he criticized the short follow-up period, noting that PRP typically takes months to show full effects.
Meta-Analysis DiscussionDr. Rosenblum presented a 2025 meta-analysis comparing PRP to steroids in epidural injections. The analysis included 310 patients across five RCTs, demonstrating comparable efficacy between PRP and steroid injections without increased adverse events. He emphasized that his clinical experience shows patients typically require fewer PRP injections compared to steroid treatments.
Register for Next Weeks SoMeDocs Pain Conference
References
Wongjarupong, Asarn, et al. "“Platelet-Rich Plasma” epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial." BMC Musculoskeletal Disorders 24.1 (2023): 335.
Bise, Sylvain, et al. "Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain." European radiology 30 (2020): 3152-3160.
Muthu S, Viswanathan VK, Gangadaran P. Is platelet-rich plasma better than steroids as epidural drug of choice in lumbar disc disease with radiculopathy? Meta-analysis of randomized controlled trials. Exp Biol Med (Maywood). 2025 Feb 4;250:10390. doi: 10.3389/ebm.2025.10390. PMID: 39968415; PMCID: PMC11832311.
-
Summary
Dr. David Rosenblum delivered a comprehensive lecture on gender differences in opiate effects and prescribing practices. He discussed several key studies examining how opiates affect males and females differently, both in animal models and humans. Dr. Rosenblum shared findings showing that morphine has stronger analgesic effects in males, while females experience longer-lasting effects. He also addressed racial disparities in opiate prescribing, noting that white patients are more likely to receive opiates. From his personal clinical experience in Brooklyn, Dr. Rosenblum observed that certain populations tend to be at higher risk for opiate abuse. The lecture covered gender-specific risk factors for opiate misuse, with women tending toward emotional/psychological factors and men showing more behavioral issues.
Pain Management Board Prep Ultrasound TrainingREGISTER TODAY!
Chapters Introduction and Upcoming ConferencesDr. Rosenblum introduced himself as the host of the Pain Exam Podcast and announced several upcoming conferences including ASPN in July, PainWeek in September, and other events where he will be teaching ultrasound and regenerative medicine.
Board Preparation and Opiate TopicsDr. Rosenblum discussed his role in board preparation through painxam.com and nreppain.org. He emphasized that opiates are a frequently tested topic across different board examinations (FIP, ABPM, ABIP, ABA).
Gender Differences in Opiate Effects - Animal StudiesDr. Rosenblum presented research showing that in animal studies, morphine exhibited stronger analgesic effects in males, while females showed longer-lasting effects and could tolerate higher doses. He noted that physical dependence was more severe in male rats during spontaneous withdrawal.
Racial and Gender Disparities in Opiate PrescribingDr. Rosenblum discussed a 2025 study revealing racial disparities in opiate prescribing, with white patients more likely to receive opiates. He shared his personal clinical experience in Brooklyn, noting that young white males were often higher-risk for abuse.
Gender-Specific Risk Factors for Opiate MisuseDr. Rosenblum detailed how women tend to show emotional and psychological risk factors for opiate misuse, while men demonstrate more behavioral risk factors. Women were more likely to report distress and past trauma, while men showed higher rates of criminal behavior and substance abuse history.
References
Djurendic-Brenesel, Maja, et al. "Gender-related differences in the pharmacokinetics of opiates." Forensic science international 194.1-3 (2010): 28-33.
Kosten, Thomas R., Bruce J. Rounsaville, and Herbert D. Kleber. "Ethnic and gender differences among opiate addicts." International Journal of the Addictions 20.8 (1985): 1143-1162.Cicero, Theodore J., Shawn C. Aylward, and Edward R. Meyer. "Gender differences in the intravenous self-administration of mu opiate agonists." Pharmacology Biochemistry and Behavior 74.3 (2003): 541-549.
Jamison, Robert N., et al. "Gender differences in risk factors for aberrant prescription opioid use." The Journal of Pain 11.4 (2010): 312-320. -
Podcast Show Notes: Peripheral Vascular Disease in PainManagement
Episode Highlights:
- Host: Dr. David Rosenblum
- Podcast: Pain Exam Podcast
- Focus: Peripheral Arterial Disease (PAD) in Pain ManagementDownload the App
Key Topics Covered:
1. Peripheral Arterial Disease (PAD) Overview
- Definition: Arterial sclerosis condition developing over long term
- WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9
- Prevalence:
* 3-4% in 60-65 year olds
* Increases to 15-20% in 85-90 year olds
* Up to 50% of patients may progress to symptomatic stages2. Diagnostic Considerations
Diagnostic Tests:
- Ankle Brachial Index (ABI)
- Ultrasound
- CT Angiography
- Physical examination
- Pulse volume recordings
- Transcutaneous oximetryABI Interpretation:
- 1.0-1.4: Normal
- 0.9-1.0: Acceptable
- 0.8-0.9: Some arterial disease
- 0.5-0.8: Moderate arterial disease
- < 0.5: Severe arterial disease3. Pain Characteristics
Types of Pain:
- Intermittent claudication
- Chronic limb ischemia
- Nociceptive pain
- Neuropathic pain
- Mixed pain syndrome4. Pain Management Strategies
Pharmacological Approaches:
- Mild Pain: Paracetamol, NSAIDs
- Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine
- Severe Pain: Morphine, fentanyl, ketamineNon-Pharmacological Interventions:
- Music therapy
- Aromatherapy
- Psychotherapy
- Massage
- Acupuncture
- TENS
- Intermittent pneumatic compressionUpcoming Conferences Mentioned:
- ASPN
- ASIPP
- Pain Week
- Latin American Pain SocietyAdditional Resources:
- Pain Exam newsletter: painexam.com
- Virtual pain fellowship at nrappain.orgDisclaimer: Always consult with a healthcare professional for personalized medical advice.
Reference
Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi,
Peripheral Artery Disease: A Comprehensive Updated Review,
Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082,Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512
Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512
-
Summary
At some point this medication may show its face on the Anesthesia boards. Whether or not Suzetrigine will appear on the Anesthesiology boards, all of us need to know about this new class of analgesic.
Brought to you by NRAP Academy, home of the AnesthesiaExam Board Prep
Here, Dr. David Rosenblum delivered a comprehensive lecture about a new pain medication called Journavx (Suzetrigine). He discussed its mechanism of action as a NAV 1.8 receptor inhibitor, its clinical applications, contraindications, and dosing guidelines. Dr. Rosenblum emphasized that this non-opioid medication represents a new class of pain management drugs with no addiction potential. He also shared information about upcoming educational events, including ultrasound courses and various pain management conferences. The lecture included detailed information about drug interactions, safety considerations, and clinical trial results comparing Journavx to placebo and hydrocodone-acetaminophen combinations. Key findings from clinical trials showed that Jornavix achieved pain relief in 119 minutes compared to 480 minutes for placebo in abdominoplasty trials, and 240 minutes versus 480 minutes in bunionectomy trials. The recommended dosing is 50mg tablets twice daily, with an initial loading dose of 100mg. While the drug showed promising results for moderate to severe acute pain management, it did not demonstrate superiority over hydrocodone in clinical trials. Important contraindications include CYP3A inhibitors, and special considerations are needed for patients with hepatic impairment or those taking hormonal contraceptives. The medication should be taken on an empty stomach, either one hour before or two hours after food, and patients should avoid grapefruit juice while on this medication.
For more infomation....
Chapters Introduction and Upcoming EventsDr. Rosenblum announced several upcoming events, including an ultrasound course in New York City on May 17th, 2025. He mentioned offering ultrasound and IV training for healthcare professionals, particularly nurses, ICUs, PAs, and hospital doctors. He also highlighted upcoming conferences including ASPN, Pain Week, Latin American Pain Society, New York, New Jersey Pain Congress, ASIPP, and EPA.
Introduction to Journavx (Suzetrigine)Dr. Rosenblum introduced Suzetrigine (Journavx), a new 50mg tablet medication. He emphasized that this discussion was not sponsored by any pharmaceutical company but rather focused on educating about a new class of pain medication. He noted its potential importance as a future board examination topic.
Mechanism of ActionDr. Rosenblum explained that Jornavx works by inhibiting the NAV 1.8 receptor. He detailed how the drug blocks sodium ions from entering pain-sensing neurons, disrupting action potential initiation and propagation. He emphasized that the drug is highly selective, binding over 31,000 times more selectively to NAV 1.8 than other NAV subtypes.
Contraindications and Drug InteractionsDr. Rosenblum outlined various contraindications, particularly focusing on CYP3A inhibitors and inducers. He listed specific medications in each category and emphasized the importance of careful monitoring when prescribing Journavx alongside these medications.
Clinical Trial Results and Dosing GuidelinesDr. Rosenblum presented clinical trial results showing Journavx's effectiveness in treating moderate to severe acute pain. He detailed the dosing guidelines: 50mg tablets twice daily, with an initial loading dose of 100mg. He emphasized the importance of taking the medication on an empty stomach and avoiding grapefruit juice.
Q&ANo Q&A session in this lecture
-
Summary
The video covers a conversation between Dr. David Rosenblum and Dr. Hamed Sadeghipour, discussing board preparation experiences and the current state of pain management practice. Dr. Rosenblum begins by announcing upcoming events, including a May 17th ultrasound course in New York City and his lectures at various conferences. He also mentions shadowing opportunities at his office. Dr. Sadeghipour shares his board preparation experience, discussing three main resources he used: Huntoon book (800 questions), Board Vitals (700 questions), and Pain Exam. He achieved notably high scores using these resources. Regarding his current practice, Dr. Sadeghipour describes working both in academic anesthesia (40-50% time) and private pain practice, managing four offices with four nurse practitioners The discussion then shifts to the changing landscape of pain management, with both doctors noting concerning trends: increasing focus on surgery center procedures over office-based ones due to reimbursement differences, the challenge of maintaining competency in advanced procedures, and competition from non-specialists entering the field. They also discuss the future of the specialty, suggesting it's moving toward becoming a hybrid of neurosurgery and orthopedic surgery with traditional pain management procedures.
For pain medicine Board Prep go to NRAPpain.org
For ultraound training go to NRAP Academy
Highlights Introduction and Upcoming EventsDr. Rosenblum introduces the podcast and announces several upcoming events, including an ultrasound course in New York City on May 17th, appearances at ASPN and Pain Week conferences, and opportunities for shadowing at his practice.
Board Preparation Experience DiscussionDr. Sadeghipour details his board preparation strategy using three main resources: Huntoon book (800 questions), Board Vitals (700 questions), and Pain Exam(700 questions videos, lectures, ultrasound training, regenerative medicine training and more). He explains the strengths and limitations of each resource and mentions achieving exceptionally high scores.
Current Practice StructureDr. Sadeghipour describes his dual practice model:
Evolution of Pain Management PracticeBoth doctors discuss the shifting landscape of pain management, noting increased focus on surgery center procedures, reimbursement challenges, and competition from non-specialists. They address concerns about fellowship training adequacy and the financial pressures affecting new practitioners.
Future of Pain Management SpecialtyThe discussion concludes with perspectives on the specialty's future, suggesting it's evolving toward a combination of minimally invasive spine surgery and traditional pain management, with concerns about maintaining specialty integrity and the need for stronger regulatory oversight.
-
Dr. Rosenblum Reviews Questions from my previous lecture, he gave at the trigeminal academy in Indonesia.
Dr. Rosenblum explores techniques for rich plasma injection and preparation. He discusses centrifuge settings with plasma volume and concentration as well as the addition of hyaluronic acid to platelet rich plasma.
Dr. Rosenb;um also received multiple comments on the recent video that he filmed on performing a cervical selective nerve root block under ultrasound.
For more informatin go to NRAPpain.org
Disclaimer: This Podcast,video, website and any content from NRAP Academy 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.
-
Episode Summary: In this episode of NRAP's PainExam Podcast, host David Rosenblum, MD, interviews Dr. Thomas Strouse about his extensive experience with Scrambler Therapy and the evidence supporting its use in treating chronic pain. They delve into the intricacies of this innovative therapy, discussing treatment protocols, patient responses, and the overall effectiveness of Scrambler Therapy for various pain conditions. Key Topics Discussed: - Overview of Scrambler Therapy and its analgesic response. - The importance of adjusting treatment intensity based on patient feedback. - Sensations experienced by patients during therapy (from burning to tapping). - Safety considerations for patients with pacemakers during treatment. - Insights into the effectiveness of Scrambler Therapy for conditions such as discogenic back pain and peripheral neuropathy. - Discussion on treatment costs for patients and providers. - Experiences with patients who have experienced pain recurrence after treatment. - The role of booster sessions in maintaining pain relief. - Challenges faced by failed back surgery patients and the potential benefits of Scrambler Therapy. Resources Mentioned: - Contact information for Stefan Erickson at [email protected] to integrate Scrambler therapy into your practice. Links to additional resources and research on Scrambler Therapy. Info] Additional Information: - For more information about upcoming webinars, including the next session on cervical ultrasound, visit www.NRAPpain.org Thank you for tuning in to NRAP's PainExam Podcast! We hope you find the insights shared in this episode valuable in your journey toward understanding and managing chronic pain. NY based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Creators Biography: David Rosenblum, MD, currently treats patients in Garden City and Brooklyn. He serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn , NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Dr. Rosenblum has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County’s Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is working closely with the American Society of Interventional Pain Physicians (ASIPP), Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, and various state societies, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more! Doctor Rosenblum is a co-founder of the International Pain Academy and created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Office based Pain Physicians, Physiatrists, Emergency Room Physicians, Anesthesiologists, Neurologists and Orthopedics who treat pain, utilize Neuromodulation and use PRP, Bone Marrow Aspirate or any other Biologics will benefit from this course. #longislandpaindoctor #interventionalpain #paindoctor #scrambler #scramblertherapy
-
Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM
Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively.
Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic.
AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc.
Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.
- Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.
Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles
Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources
Federation Pain Care Access Website:
https://www.painfed.org
# board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission.
Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.
Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.
Patients can schedule a consultation by going to
www.AABPpain.com or calling: Brooklyn Office 718 436 7246
Garden City Office 516 482 7246
-
Unlock new, well-reimbursed services: Spravato, a needle-mover for pain practices. Discover how Spravato, an FDA-approved esketamine treatment for depression, can drive significant financial reimbursement for your practice while improving patient outcomes. Join me as I meet with Yakov Kagan, CEO and co-founder of Big Leap Health, as he highlights the clinical efficacy of Spravato, its comparison to ketamine, and its financial impact. Learn key considerations for launching—whether independently or via an MSO—and actionable steps to get started, from staff training to billing essentials. Yakov will also share insights into future developments like monotherapy developments, helping your practice stay ahead in this rapidly evolving field.
For more information and to integrate Spravato into your Pain Practice go to https://www.bigleaphealth.com
Host David Rosenblum, MD Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.
Patients can schedule a consultation by going to www.AABPpain.com or calling:
Brooklyn Office 718 436 7246
Garden City Office 516 482 7246
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)Regional Anesthesia & Pain Ultrasound Course
Private Training Available
Email [email protected]
**Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.
-
Episode Title: Ketamine for Cancer and Pain Management - Journal Club
Host: David Rosenblum, MD
Upcoming Free Webinars:
1. Exploring Innovative Mental Health Treatments which are well reimbursed
Discussing Spravato, Transmagnetic Stimulation, and Ketamine Infusion, sponsored by Big Leap Health. Register!2. Understanding Scrambler Therapy
Learn about this revolutionary approach to pain management. Register!3. Cervical Ultrasound: Anatomy and Interventional Pain Targets
Sponsored by Clarius, this session will explore advanced imaging techniques. Register!Sign up for the webinars and check out our full calendar of events.
Join us for this insightful episode as we explore the potential of ketamine in transforming pain management practices!
Summary
In today's episode, we delve into the emerging role of ketamine in managing cancer and chronic pain. Our discussion is anchored around a comprehensive review article titled "Ketamine Use for Cancer and Chronic Pain Management," published in Frontiers in Pharmacology on February 1, 2021. This review, authored by Clayton Culp, Hee Kee Kim, and Salahadin Abdi, explores ketamine's potential as an analgesic in chronic pain conditions, particularly cancer-related neuropathic pain.
Key Points from the Review Article:
- Mechanism of Action: Ketamine functions as an N-methyl-D-aspartate receptor antagonist, providing analgesic effects at sub-anesthetic doses. Its ability to counteract central nervous system sensitization makes it effective in opioid-induced hyperalgesia.
- Clinical Efficacy: Recent studies highlight ketamine's potential to reduce pain scores and opioid consumption, offering a promising alternative for patients with refractory pain.
- Safety Profile: At lower doses used for analgesia, ketamine's safety and adverse event profile are significantly improved compared to its use as an anesthetic.
- Pharmacogenomics and Interactions: The article discusses how genetic variations can affect ketamine metabolism and highlights potential drug interactions that clinicians should be aware of.Reference
Culp, Clayton, Hee Kee Kim, and Salahadin Abdi. "Ketamine use for cancer and chronic pain management." Frontiers in Pharmacology 11 (2021): 599721.
-
Episode Title: Evidence-Based Regenerative Pain Medicine with Guilherme Ferreira Dos Santos, MD CIPS
Host: David Rosenblum
Guest: Guilherme Ferreira Dos Santos, MD CIPSEpisode Overview:
In this insightful episode of the PainExam Podcast, Dr. David Rosenblum sits down with Dr. Guilherme Ferreira Dos Santos, a distinguished expert in pain medicine who is well known for his research, educational endeavors and expertise in Regenerative Pain Medicine and Ultrasound-Guided interventions. Together, they delve into the evolving landscape of regenerative pain medicine, focusing on evidence-based practices and the standardization of Platelet-Rich Plasma (PRP) quality.Key Topics Discussed:
- Evidence-Based Regenerative Pain Medicine: An exploration of current research and practices that inform effective pain management strategies.
- PRP Quality and Standardization: Discussion on the importance of PRP quality in treatment outcomes and the need for standardized protocols.
- Ultrasound-Guided Spine Interventions: Insights into the benefits and techniques of ultrasound guidance in performing spinal interventions, including a conversation on avoiding cervical epidurals.
- Access to Pain Care: A comparative analysis of the differences in access to pain care across Portugal, Spain, the USA, and Canada, highlighting challenges and opportunities in each region.
- Pain Expo Dubai: An overview of the upcoming Pain Expo in Dubai, where both Dr. Rosenblum and Dr. Ferreira Dos Santos will be presenting, sharing their expertise with a global audience.
Guest Biography:
Dr. Guilherme Ferreira Dos Santos is an Interventional Pain Medicine Specialist and Clinical Scientist with a career spanning Portugal, the United States, Canada, and Spain. He began his journey at the University of Lisbon, earning his Medical Degree in 2014, followed by a five-year residency program in Physical Medicine and Rehabilitation, which he completed in 2020. His fascination with Interventional Pain Medicine led him to the Department of Pain Medicine at Mayo Clinic, where he served as an Invited Clinical Research Scholar in 2018 and 2021 under the mentorship of Dr. Mark Friedrich Hurdle. At Mayo Clinic, he contributed to refining ultrasound-guided techniques for chronic spinal pain.Dr. Ferreira dos Santos further advanced his expertise with a Clinical Fellowship in Chronic Pain Medicine at the University of Toronto in 2022, training under esteemed mentors such as Dr. Anuj Bhatia, Dr. Paul Tumber, and Dr. Philip Peng. In this role, he was instrumental in advancing education on ultrasound-guided techniques nationally and internationally, which deepened his clinical skills and passion for mentorship.
Currently based in Barcelona, Dr. Ferreira Dos Santos serves as the Senior Specialist and Responsible Clinical Lead for the Education and Training Excellence Center in Pain Medicine at Hospital Clínic de Barcelona. He is also the Director of the Clinical Fellowship Program in Interventional Pain Medicine. Throughout his career, he has lectured at international conferences in over 25 countries and authored more than 35 peer-reviewed Q1 articles. His contributions have earned him several accolades, including the 2018 Grant for Young Clinical Researcher of the Year in Pain Medicine from the Grünenthal Foundation, the 2020 Gofeld Academic Scholarship Award, and the 2022 Nikolai Bogduk Young Investigator Grant. His journey across four countries has shaped his approach to clinical care, research, and mentorship, fueling his mission to improve pain management globally.
Listen to the Episode:
Tune in to gain valuable insights from Dr. Ferreira Dos Santos and learn more about the future of pain medicine. Available on all major podcast platforms.Links and Resources:
- NRAP Academy
- Follow Dr. David Rosenblum on X and LinkedIn
- Follow Dr. Guilherme Ferreira Dos Santos on LinkedInJoin the Conversation:
We encourage our listeners to reach out with their thoughts and questions! Use the hashtag #PainExamPodcast on social media to engage with us.S ubscribe and Review:
If you enjoyed this episode, please subscribe and leave a review on your favorite podcast platform. Your feedback helps us improve and reach more listeners!Next Episode Preview:
Stay tuned for our next episode, where we will continue to explore the latest advancements in pain management and treatment options. -
Podcast Show Notes Episode Title: Optimizing Genicular Nerve Chemical Ablation: Insights from Dr. David Rosenblum Episode Summary:
In this episode, we are joined by Dr. David Rosenblum, a New York-based interventional pain physician, who discusses optimizing genicular nerve chemical ablation. Dr. Rosenblum shares insights as well as his upcoming ultrasound course schedyke in New York City, focusing on regional anesthesia, interventional pain, and IV ultrasound placement. He emphasizes the significance of ultrasound in enhancing pain management procedures and the latest advancements in the field.
Key Topics Discussed: Overview of Dr. Rosenblum's upcoming ultrasound courses in NYC, including regional anesthesia and IV ultrasound placement. More information can be found here or at NRAPpain.org. The role of ultrasound in interventional pain management, specifically in optimizing genicular nerve chemical ablation. Discussion on the recent study comparing genicular nerve phenol neurolysis and radiofrequency ablation. Importance of updating anatomical targets for pain management. Recommendations for expanding the number of targets in pain interventions. Insights on the safety and efficacy of chemical neurolysis versus radiofrequency procedures. Challenges and considerations in performing neurolytic blocks. Future directions in personalized treatment for chronic pain patients.For Anesthesia Board Prep go to AnesthesiaExam at NRAPpain.org
Featured Article:Dr. Rosenblum references an article from The Korean Journal of Pain discussing the optimization of genicular nerve chemical ablation. Key takeaways include:
The evolution of anatomical understanding related to genicular nerves. The recommendation to consider multiple targets for pain management instead of the traditional three. The need for careful patient examination to map pain effectively before intervention.Discussion on Knee Pain Management
• ArticlebyAndresRochaRomero:
• Discussion on knee pain targeting genicular nerve ablation.
• Co-authored by Tony Ng and King K Stanley Lam.
• Published in Korean Journal of Pain.
• Highlights differences in pain management practices outside the U.S.Other Points on Genicular Nerve Chemical Ablation discussed
Phenol ablation being used more internationally vs. radiofrequency ablations.
Considerations for more extensive targeting of genicular nerves:
• Importance of the median branch of the nerve to the vastus intermedius. • Expansion of targeting to include 6 nerves, not just 3.
• Anatomical variations require different approaches.Recommendations and Observations
• Importance of considering patient-specific anatomy and pain. • Repeat procedures and rehabilitation:
• Concerns about bio intensity and fascia integrity.
• Emphasizes muscle strengthening exercises to support knee.• CRPS Considerations:
Host Bio:
• Elderly patients may develop CRPS post-knee replacement.
• Importance of lumbar sympathetic block in diagnosis and treatment.Dr. David Rosenblum, MD is an interventional pain physician based in New York City. With extensive experience in pain management techniques, Dr. Rosenblum is dedicated to advancing the field through education and innovative practices. He is particularly focused on the integration of ultrasound technology into pain management procedures.
Course Information:Dr. Rosenblum's upcoming ultrasound courses are CME supported, monthly hands on workshops to give clinicians experience with ultrasound imaging to identify targets for nerve block joint injection, soft tissue injection and more..
• Monthly IV Ultrasound Course in Manhattan:
• Ideal for nurses, PAs, anesthesiologists, ER docs.
• Provides practice with phantoms, short lecture on IV ultrasound. • Offers CME credits.• Ultrasound Courses:
• Held one Saturday a month, mostly in New York, but travels if needed. • Upcoming dates: December 21st, January 11th in Manhattan.• Presentation Invitation at Pain Expo in Dubai: April 26-27. •
• Next LAPS conference in September in Chile.
Call to Action: Subscribe to our podcast for more episodes on advancements in pain management. Follow us on social media for updates on upcoming courses and events. Share this episode with colleagues who may benefit from learning about ultrasound techniques in pain management.Upcoming Opportunities and Closing Remarks
Dr. Rosenblum encourages attending his ultrasound courses and conferences.
Mention of upcoming conferences in ASPN inMiami, Pain Expo in Dubai, and LAPS inChile.
Recommendations to subscribe to newsletters for updates and free info.
The podcast aims to support pain management professionals.
-
Exploring the Efficacy of Autologous Platelet Leukocyte Rich Plasma Injections in Chronic Low Back Pain & Understanding Degenerative Lumbar Spinal Stenosis
Host David Rosenblum, MD
Episode Date: October 25, 2024
In this episode, Dr. David Rosenblum discusses two significant studies related to chronic low back pain and degenerative lumbar conditions. The first study focuses on the use of autologous platelet leukocyte rich plasma (PLRP) injections for treating atrophied lumbar multifidus muscles, while the second study investigates the correlation between muscle atrophy and the severity of degenerative lumbar spinal stenosis (DLSS).
Featured Article 1:
- Effect of Autologous Platelet Leukocyte Rich Plasma Injections on Atrophied Lumbar Multifidus Muscle in Low Back Pain Patients with Monosegmental Degenerative Disc Disease
- **Authors:** Mohamed Hussein, Tamer Hussein
Key Points Discussed
1. Background: Correlation between lumbar multifidus muscle dysfunction and chronic low back pain.
2. Study Overview: 115 patients treated with weekly PLRP injections for six weeks, followed for 24 months.
3. Outcome Measures: Significant improvements in NRS and ODI scores, with high patient satisfaction.
4. Conclusions: PLRP injections into the atrophied multifidus muscle are safe and effective for managing chronic low back pain.Featured Article 2:
- Degenerative Lumbar Spinal Stenosis
Authors:* Gen Xia, Xueru Li, Yanbing Shang, Bin Fu, Feng Jiang, Huan Liu, Yongdong QiaoKey Points Discussed
1. Background: DLSS is a common condition in older adults, often leading to muscle atrophy and disability.
2. Study Overview: A retrospective analysis involving 232 patients to investigate the correlation between muscle atrophy and spinal stenosis severity.
3. Results:
- Significant differences in the ratio of fat-free multifidus muscle cross-sectional area between stenotic and non-stenotic segments.
- A strong positive correlation was found between multifidus atrophy and the severity of spinal stenosis.
- The atrophy was more pronounced on symptomatic sides of the spine compared to contralateral sides.
4. Conclusions: The findings suggest that more severe spinal stenosis is associated with greater muscle atrophy, emphasizing the importance of addressing muscle health in DLSS patients.Discussion:
Dr. Rosenblum provides insights into how these studies inform clinical practices for treating chronic low back pain and managing degenerative conditions. He emphasizes the need for comprehensive treatment strategies that consider both muscle health and spinal integrity which may be achieved via peripheral nerve stimulation of the medial branch nerve and multifidus muscle or PRP injection in to the multifidus muscle.Closing Remarks:
Listeners are encouraged to stay informed about innovative treatment options and the importance of muscle assessment in managing spinal disorders.**Follow Us:**
- Subscribe to the Painexam Podcast for more episodes discussing the latest in pain management research and treatments.
- Connect with us on social media [insert social media links].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)Regional Anesthesia & Pain Ultrasound Course
Private Training Available
Email [email protected]
**Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.
References
Xia, G., Li, X., Shang, Y. et al. Correlation between severity of spinal stenosis and multifidus atrophy in degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 22, 536 (2021). https://doi.org/10.1186/s12891-021-04411-5
Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016 Mar 22;2:12. doi: 10.1051/sicotj/2016002. PMID: 27163101; PMCID: PMC4849261.
-
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.
Upcoming Conferences
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.
-
PainExam Show Notes: Mandibular Division of the Trigeminal Nerve Block with Dr. David Rosenblum 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.
-
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.
-
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! -
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!
- Mostra di più
