Does Kratom Relieve Pain? Risks, Benefits and more!
The PMRExam Podcast
🎙️ PainExam Podcast Show Notes Kratom (Mitragyna speciosa): What Pain Physicians Must Know for the Boards In this episode, Dr. David Rosenblum reviews the current science, pharmacology, risks, and clinical relevance of Kratom — an herbal substance widely discussed by pain patients and increasingly appearing on pain-medicine board exams. The discussion focuses on evidence-based mechanisms, safety considerations, and counseling points essential for ABA/ABPM/ABIPP/FIPP board preparation. 🔍 Key Board-Relevant Takeaways 1. Pharmacology & Mechanism Kratom’s primary alkaloids are...
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Caudal Epidurals with PRP, Ultrasound Guidance & more!
The PMRExam Podcast
Caudal Epidural Steroid Injection with PRP Case Reports and a Testimonial! Upcoming Training Courses and Services and : New York and Detroit locations scheduled Private Coaching Services: Ultrasound guidance Preceptorship Board preparation coaching Contact available via email for interested physicians PRP Caudal Epidural Research Review Study Overview: Randomized double-blind controlled pilot study comparing leukocyte-rich PRP versus corticosteroids in caudal epidural space 50 patients randomly assigned to two groups Treatment options: triamcinolone 60mg or...
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Supplements for Pain, the Evidence!
The PMRExam Podcast
Episode Overview In this episode, Dr. David Rosenblum discusses the role of supplements and complementary strategies in the management of chronic pain. Drawing from clinical practice at AABP Integrative Pain Care, as well as his teaching and training programs, Dr. Rosenblum reviews how nutraceuticals, regenerative therapies, ultrasound-guided procedures, and neuromodulation can work together to improve patient outcomes and reduce opioid reliance. This episode also highlights educational opportunities and exam-prep resources for pain fellows, residents, anesthesiologists, physiatrists, and APPs...
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ACL Tear Treatment with BMC and Platelet Products: Journal Club
The PMRExam Podcast
Pain Exam Podcast Recent Conference Activities London Conference Weekend: Successfully attended and spoke at ISPN and SOMOS care conferences Somos Care Conference: Delivered presentation on pain management for primary care physicians Presentation consisted of 50+ slides with only one slide dedicated to opiates Emphasized shift away from opiate-based treatments in interventional pain management Recommended primary care physicians refer patients to pain specialists for comprehensive treatment options ISPN Conference: Participated in international pain management conference Met with...
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TENS: Mechanism of Action and Evidence
The PMRExam Podcast
Project Sync / Status Update Summary Podcast Episode Overview The host discussed Transcutaneous Electrical Nerve Stimulation (TENS) as a recurring pain board topic and reviewed mechanisms, efficacy, and clinical considerations. Emphasis that TENS appears on pain boards annually and is a foundational topic from early podcast episodes. Board Prep and NRAP Community at or ABA ABPM ABIPP FIPP Pain Management Board prep, Question Banks, and Virtual Pain Fellowship Educational Offerings and Events Training and Courses: Monthly ultrasound courses in New York and upcoming courses in Detroit...
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ADSC (Adipose Stem Cells) vs BMAC for Knee OA
The PMRExam Podcast
Exploring the Efficacy of BMAC and ADSC Injections in Knee Osteoarthritis Hosts: David Rosenblum,MD Overview: In this episode, we delve into a recent study published in the Indian Journal of Orthopaedics that compares the therapeutic efficacy of Bone Marrow Aspirate Concentrate (BMAC) and Adipose-Derived Stem Cells (ADSCs) for treating knee osteoarthritis (OA). The study aims to provide insights into the effectiveness of these regenerative treatments and their correlation with mesenchymal stem cell (MSC) cellularity. Key Points Discussed: Background on Osteoarthritis:...
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Steroid vs Ketorolac for Intra-Articular Injections: Journal Club
The PMRExam Podcast
Podcast Summary This episode of the Pain Exam Podcast, hosted by Dr. David Rosenblum, discusses an interesting article about Ketorolac injections for musculoskeletal conditions. The podcast covers: Ketorolac is an NSAID that provides analgesic and anti-inflammatory effects through inhibition of prostaglandin synthesis Multiple studies comparing Ketorolac injections to corticosteroids and hyaluronic acid for various conditions Research shows Ketorolac injections are equally effective as corticosteroids for subacromial conditions, adhesive capsulitis, carpal-metacarpal joint issues, and...
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Post Herpetic Neuralgia- An Update
The PMRExam Podcast
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...
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The Neurolytic Celiac Plexus Block
The PMRExam Podcast
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...
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PRP Epidural Injections for Radicular Pain
The PMRExam Podcast
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. Summary Dr. 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...
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David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs discusses Central post-stroke pain (CPSP).
Central Post Stroke Pain is a debilitating condition that affects a significant number of stroke survivors. It is characterized by persistent neuropathic pain, often described as burning, shooting, or electric shock-like sensations, in the areas of the body affected by the stroke. CPSP can significantly impact a patient's quality of life and functional recovery, making it crucial for physicians to have a comprehensive understanding of its pathophysiology.
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Neuropathic Pain and Central Sensitization:CPSP is classified as a neuropathic pain syndrome, which means it arises from a dysfunction or damage to the nervous system. The exact pathophysiology of CPSP is complex and multifactorial, but it often involves the phenomenon of central sensitization. Central sensitization refers to the increased excitability and responsiveness of neurons within the central nervous system (CNS) in response to peripheral input.
Cortical Reorganization and Plasticity:
One key aspect of CPSP pathophysiology is cortical reorganization and plasticity. Following a stroke, the brain undergoes structural and functional changes as a result of the injury. This neuroplasticity, particularly in the somatosensory cortex, can contribute to the development of CPSP. Maladaptive plasticity may occur, leading to abnormal sensory processing and the generation of pain signals in response to non-painful stimuli.
Disrupted Pain Modulation Pathways:The pain perception and modulation pathways in the CNS play a crucial role in regulating pain signals. In CPSP, these pathways can be disrupted, leading to abnormal pain processing. Alterations in the descending inhibitory pathways, such as reduced inhibitory neurotransmitter release or impaired endogenous opioid system function, can result in increased pain sensitivity and the persistence of pain signals even after the resolution of the initial injury.
Inflammatory Processes and Neurotransmitter Imbalances:Inflammation within the CNS and imbalances in neurotransmitter systems also contribute to CPSP. Following a stroke, there is an inflammatory response that involves the release of pro-inflammatory cytokines and activation of immune cells. This inflammation can lead to sensitization of nociceptive neurons and exacerbate pain signaling. Additionally, imbalances in neurotransmitters, such as glutamate, serotonin, and norepinephrine, may disrupt the normal pain processing pathways, further amplifying pain perception.
Peripheral and Central Lesions:CPSP can arise from both peripheral and central lesions. Peripheral lesions, such as damage to the spinothalamic tract or thalamus, can directly affect the transmission of pain signals. Central lesions, on the other hand, involve damage to the somatosensory cortex, thalamus, or other brain regions involved in pain processing. Both types of lesions can contribute to the development of CPSP through various mechanisms, including altered neuronal activity, disrupted connectivity, and aberrant sensory processing.
The complex interplay of cortical reorganization, disrupted pain modulation pathways, inflammatory processes, and peripheral and central lesions contribute to the development and persistence of CPSP. Further research is needed to unravel the intricacies of CPSP's pathophysiology, leading to the development of targeted therapies to alleviate the burden of this debilitating condition.
References
Liampas, A., Velidakis, N., Georgiou, T. et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 37, 3278–3291 (2020). https://doi.org/10.1007/s12325-020-01388-w
SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke
Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.678198