The PMRExam Podcast

PMR Board Prep instructor and PMRExam's creator, David Rosenblum, MD discusses issues relevant to Physiatrists and Pain Physicians. Dr. Rosenblum's Physical Medicine and Rehabilitation Podcast, The PMRExam Podcast, features, interviews, board prep and practice management issues relevant to rehab physicians. For more information on Physiatry board prep and CME credits, go to PMRExam.com

Hydrogen Therapy for Pain? 09/12/2024

Hydrogen Therapy for Pain? PainExam Podcast Episode: An In-Depth Look at Hydrogen-Rich Water for Chronic Inflammatory Pain In a recent episode of the PainExam podcast, Dr. David Rosenblum delves into an intriguing study published in the journal Antioxidants, exploring the therapeutic potential of hydrogen-rich water (HRW) in alleviating chronic inflammatory pain and associated mood disorders in mice. The study, conducted by Santiago Coral-Pérez and colleagues from the Institut d’Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, presents compelling evidence supporting the analgesic, antidepressant, and anxiolytic effects of HRW. Study Overview The study investigates the efficacy of HRW in treating nociceptive responses and affective disorders associated with chronic inflammatory pain. Using a mouse model induced by the subplantar injection of complete Freund's adjuvant (CFA), the researchers evaluated the impact of HRW on several parameters: Nociceptive Responses: Mechanical allodynia and thermal hyperalgesia. Affective Disorders: Depressive-like behaviors (measured by Tail Suspension Test and Forced Swimming Test) and anxiety-like behaviors (assessed using Elevated Plus Maze and Open Field tests). Biomarker Analysis: Levels of oxidative stress, inflammatory, and apoptotic markers in the paws and amygdala. Key Findings 1. Analgesic Effects: Mechanical Allodynia and Thermal Hyperalgesia: The study found that both intraperitoneal and subplantar administration of HRW significantly reduced mechanical allodynia and thermal hyperalgesia in CFA-injected mice. Remarkably, the local (subplantar) administration showed greater effectiveness, achieving complete inhibition of nociceptive responses with just one day of treatment. 2. Antidepressant and Anxiolytic Effects: Depressive-like Behaviors: HRW treatment normalized the increased immobility times in both the Tail Suspension Test and Forced Swimming Test, indicating potent antidepressant properties. Anxiety-like Behaviors: HRW also reversed the anxiety-like behaviors in the Elevated Plus Maze and Open Field tests, showcasing its anxiolytic effects without impairing motor function. 3. Biochemical Pathways: The study highlighted the significant role of the Nrf2/HO-1-NQO1 pathway in mediating the analgesic effects of HRW. Inhibitors targeting this pathway reversed the pain-relieving actions of HRW, underscoring its pivotal role. Oxidative Stress and Inflammation: HRW treatment reduced the expression of oxidative (4-HNE), inflammatory (p-IKBα), and apoptotic (BAX) markers in both the paw and amygdala tissues, demonstrating its broad-spectrum protective effects. Implications for Clinical Practice Dr. Rosenblum emphasizes the potential of HRW as a novel therapeutic strategy for chronic inflammatory pain and its associated comorbidities. The study's findings suggest that HRW could offer a multifaceted approach, addressing both pain and mood disorders through its antioxidant, anti-inflammatory, and anti-apoptotic properties. Conclusion The episode concludes with a discussion on the broader implications of these findings for pain management, particularly in conditions where chronic inflammatory pain is prevalent. Dr. Rosenblum highlights the need for further clinical trials to validate these promising preclinical results and explore the potential of HRW in human subjects. For more detailed insights into this study, including potential applications and future research directions, tune into the PainExam podcast with Dr. David Rosenblum. For more information go to: Other Announcements from : PainExam App is ready for iphone Pain Management Board Prep migrated to AnesthesiaExam Board Prep migrated to PMRExam Board Prep migrated to For Anesthesia Board Prep References Coral-Pérez, S., Martínez-Martel, I., Martínez-Serrat, M., Batallé, G., Bai, X., Leite-Panissi, C. R., & Pol, O. (2022). Treatment with hydrogen-rich water improves the nociceptive and anxio-depressive-like behaviors associated with chronic inflammatory pain in mice. Antioxidants, 11(11), 2153. /episode/index/show/pmrexampodcast/id/33019922

Using Ultrasound for Safe and Accurate Platelet Rich Plasma Injections 08/20/2024

Corticosteroid Injections in Chronic Pain Management- New Guidelines 07/31/2024

Corticosteroid Injections in Chronic Pain Management- New Guidelines 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 In this episode, we dive into the recently published guidelines on the use of corticosteroid injections for managing chronic pain, developed by the American Society of Regional Anesthesia and Pain Medicine, along with several other prominent pain societies. These guidelines address the safety and efficacy of corticosteroid injections for sympathetic and peripheral nerve blocks, as well as trigger point injections. Key Discussion Points: Background and Need for Guidelines: Overview of potential adverse events from corticosteroid injections, such as increased blood glucose levels, decreased bone mineral density, and suppression of the hypothalamic–pituitary axis. Importance of using lower doses of corticosteroids, which studies have found to be just as effective as higher doses. Development of the Guidelines: The guidelines were approved by multiple pain societies and structured into three categories: sympathetic and peripheral nerve blocks, joint injections, and neuraxial injections. Extensive literature review and consensus-building through a modified Delphi process. Key Recommendations: The addition of corticosteroids to local anesthetics is recommended for certain nerve blocks, such as the greater occipital nerve block for cluster headaches and ilioinguinal/iliohypogastric nerve blocks for post-herniorrhaphy pain. Corticosteroid addition is not recommended for sympathetic nerve blocks, greater occipital nerve blocks for migraines, and pudendal nerve blocks for pudendal neuralgia. Imaging guidance (ultrasound or fluoroscopy) improves the safety and accuracy of certain procedures. Efficacy and Safety: Detailed analysis of various studies on the effectiveness of corticosteroid injections for different types of chronic pain. Discussion on the minimal benefit of corticosteroids in trigger point injections and the potential risks associated with their use. Clinical Implications: How these guidelines can assist clinicians in making informed decisions regarding corticosteroid use in chronic pain management. Emphasis on the need for personalized treatment plans based on individual patient characteristics and clinical data. Future Directions: Identification of gaps in the current research and the need for well-designed studies to further assess the benefits and risks of corticosteroid injections. Join us as we explore these comprehensive guidelines and their potential impact on improving chronic pain management practices. Resources: Link to the full guidelines: Other Announcements from : PainExam App is ready for iphone Pain Management Board Prep migrated to AnesthesiaExam Board Prep migrated to PMRExam Board Prep migrated to For Anesthesia Board Prep References Disclaimer 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. /episode/index/show/pmrexampodcast/id/32363307

The Trigeminal Nerve Block for Facial Pain 07/19/2024

The Trigeminal Nerve Block for Facial Pain 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 : PainExam App is ready for iphone Pain Management Board Prep migrated to AnesthesiaExam Board Prep migrated to PMRExam Board Prep migrated to For Anesthesia Board Prep 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, 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. 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. /episode/index/show/pmrexampodcast/id/32212102

Regenerative Pain Medicine Journal Club: Intraarticular vs Intraosseous vs ESW and more! 06/27/2024

Pain Fellowship, Research & Exosomes for Pain Management with Christopher Robinson, MD PhD 06/04/2024

The role of L-PRP. Is Degenerative Disc Disease an Infectious Disease? A Journal Club 05/20/2024

Dry Needling the Iliopsoas Muscle with Therapeutic Stretching in the Treatment of Lumbar Radiculitis 05/02/2024

Managing Refractory Post Op Shoulder Pain with Radiofrequency Ablation 04/17/2024

Physicians Lobby Capital Hill for more Transparency and Oversight of Independent Review Organizations 04/03/2024

Physicians Lobby Capital Hill for more Transparency and Oversight of Independent Review Organizations Advocating for Transparency and Oversight in Pain Management Introduction: Welcome back to Painexam, where we delve into the latest advancements and challenges in pain management. Today's episode highlights a significant advocacy effort made by leading Interventional Pain Physicians and industry experts. Summary of Lobbying Effort: On March 20, 2024, a group of widely known and respected pain physicians and industry leaders, including Drs. Sean Li, Peter Staats, Mehul J. Desai, David Reece, Hemant Kalia, and David Rosenblum, alongside industry figures Mark Stultz, Christopher Conrad, and Cecelia Ruble, visited Capitol Hill to advocate for greater oversight and transparency in independent review organizations. Despite their busy schedules, they recognized the critical need to address the 0% turnover rate in appeals for denied treatments, which disproportionately affects patients seeking alternatives to surgery and opioid medication. Importance of Transparency: The issue extends beyond pain management, impacting patients across various medical fields. While opioid therapy may seem economically favorable initially, the long-term consequences, including delayed care and medication side effects, often outweigh the costs. The group emphasized the importance of an unbiased review for accessible, cutting-edge treatments to improve patient outcomes and reduce overall healthcare expenses. Purpose of the Lobbying Effort: Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes. For Board Prep, Ultrasound Training and more, visit: Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound- guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain. Conclusion and Actionable Steps: To schedule a consultation with Dr. Rosenblum, patients can visit or contact the Brooklyn Office at 718-436-7246 or the Garden City Office at 516-482-7246. Stay tuned for more updates on advancements and advocacy efforts in pain management. Outro: Thank you for joining us on this episode of Painexam. Be sure to subscribe for future discussions on navigating the complexities of pain management. /episode/index/show/pmrexampodcast/id/30659313

Rudy Malayil, MD PM&R, Pain, WVSIPP President discusses the Stellate Ganglion Block for Hot Flashes, the Appalachian Regional Spine and Pain Meeting and more! 02/28/2024

Innovative ways of Managing Hip Pain without Surgery 02/08/2024

Innovative ways of Managing Hip Pain without Surgery In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain. He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic. The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches. The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case. Additionally, the show notes mention an events calendar located at this link: . Upcoming Course schedule for NRAP Academy includes the following events: Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session. MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management. Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia. Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia. Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance. Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques. In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates. Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information. Reference Fu E, Elsharkawy H #35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain Regional Anesthesia & Pain Medicine 2023;48:A193. /episode/index/show/pmrexampodcast/id/29857693

Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves- Journal Club 01/24/2024

Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves- Journal Club Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves" Special Thanks to Robert Stall, MD Introduction: Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves. Background: The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons. Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system. Methods: Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017. The technique was applied to eight fresh cadavers before dissecting the median nerve. Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens. Results: The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion. Ventricular cannulation was performed successfully using specific coordinates. Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma). Conclusions: Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves. CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells. Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons. The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways. Significance: This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues. Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves. The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system. Closing: Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes! Reference Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590. /episode/index/show/pmrexampodcast/id/29626638

Journal Club- Ultrasound Guided Nerve Blocks for Headaches and Facial Pain 01/10/2024

Journal Club- Ultrasound Guided Nerve Blocks for Headaches and Facial Pain Exploring the Role of Ultrasound in Headache Evaluation and Treatment A Journal Club based on Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253. to Claim CME for reflecting on content presented in this journal club. David Rosenblum, MD Accepting New Patients Patients Interested in scheduling a consultation with Dr. David Rosenblum can call 516 482 7246 (Garden City) or 718 436 7246 (Brooklyn) In this Podcast, Dr. Rosenblum discusses patient's in his practice who responsed to ultrasound guided nerve blocks in the treatment of headaches. He discusses the use of ultrasound injections as opposed to medication to manage the pain and references Dr. Trescott's comprehensive article on the various nerves and clinical presentations of headaches related to terminal nerve entrapment or irritation. Dr. Rosenblum discusses Supraorbital Neuralgia Auriculotemproal Nerve Anatomy Clinical presentation Interventional Pain Therapies Summary of Dr. Trescott's Article and Key Points: Headaches, affecting 28 million people in the US, pose a significant burden on society in terms of medical costs and lost labor. They are complex neurologic disorders with diverse origins and causes. Headaches are often viewed as the primary pathology, but they are fundamentally a symptom. Understanding them is an evolving science, and their patterns can be recognized for effective diagnosis and treatment. In 2003, Pareja et al proposed the term "epicrania" for headaches triggered by extracranial causes, suggesting a link between intracranial components and extracranial nerves. Peripheral Triggers and Plastic Surgery: Plastic surgeons noted relief of migraines through corrugator muscle resection and botulinum toxin injection, indicating peripheral headache triggers. Severe migraines post-head or neck injury may have an extracranial origin, suggesting peripheral nerve irritation. Traditional migraine medications may offer modest relief. Primary treatment involves inhibiting nerve irritation through interventional pain techniques, turning off the pain origin and associated migraine centers. Ultrasound Advantages: Evaluation and injection of nerves have traditionally used landmarks and fluoroscopic images, but ultrasound offers unique advantages. Nerves often travel with arteries, potentially contributing to "throbbing" pain. Ultrasound provides a more precise and dynamic visualization of these structures. Exploring Extracranial Causes: The International Classification of Headache Disorders (ICHD) categorizes headaches as primary or secondary. While valuable, it broadly defines peripheral nerve contributions as "Other Terminal Branch Neuralgias." The study of extracranial peripheral nerve entrapments and dysfunction reveals overlap between ICHD-defined headaches and potential nerve entrapments causing these pain patterns. Collaboration with disciplines like pain management enriches the understanding and treatment options for headaches. Conclusion: Headaches, often seen as isolated intracranial phenomena, may have extracranial triggers. Understanding and treating these triggers, especially through ultrasound-guided techniques, present a promising avenue in headache management. NRAP Academy also offers: Board Review Regenerative Medicine Training The (online training program with discount to live workshops) Private Ultrasound Training Available Email Reference: Trescot A. Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253. Publication Details: Received: 15 Aug 2015, Reviewed: 2 Jun 2016, Accepted: 28 Jun 2016. This podcast explores the dynamic relationship between intracranial and extracranial factors in headaches, shedding light on potential breakthroughs in their evaluation and treatment. #interventionalpain #painboards #painfellowship #painexam #regionalanesthesia #ultrasoundguidedpain #ultrasoundpain #ultrasoundmsk #paincme #paincmecourse /episode/index/show/pmrexampodcast/id/29426348

Phenol Injection to Treat Hip Pain 12/27/2023

Traumeel Epidural? The FDA, Spine applications and more about this Homeopathic treatment 12/11/2023

The Iliohypogastric Nerve Entrapment Syndrome 11/27/2023

Hydroxyapatite Deposition Disease and Joint Pain 11/13/2023

Shoulder Articular Branch Radiofrequency Ablation 10/25/2023

Peptides: A Brief Overview 10/12/2023

Genicular and Peripheral Nerve Reimubursement Issues, ASPN Pain Board Prep Webinar Oct 4! 09/28/2023

The 2024 Physician Fee Schedule: Maximizing Physician Profit 09/26/2023

Pain after Hip Replacement and PNS 08/24/2023

Neck Pain and Cervical Plexus Blocks 08/12/2023

Neck Pain and Cervical Plexus Blocks Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management and , discusses: a case of paresthesia in the upper neck realted to C3 and C4 stenosis and considers a selective nerve root block while wondering if a deep cervical plexus block would suffice. Rational : Desire to avoid epidural due to proximity to spinal cord Ultrasound approach of cervial plexus may anesthetize C3 and C4 roots and may be sufficient to do with ultrasound alone Unfortunately, no data found to support this particular situation, however, it may be safe and effective if performed properly. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/lubWXJ Also discussed on this podcast: The Superficial Cervical Plexus and applications for headache, neck pain, and clavicular fractures. Caution: Phrenic Nerve Anatomy The cervical plexus is a complex network of nerves located in the neck region, originating from the anterior rami (branches) of the cervical spinal nerves, specifically those stemming from the upper cervical segments (C1 to C4). This intricate network serves to provide sensory and motor innervation to various structures within the neck and surrounding areas. The cervical plexus is positioned within a groove between the longus capitis and the middle scalene muscles in the neck. It is organized into different nerve loops and branches that radiate outwards to supply various regions. The cervical plexus can be divided into deep and superficial components, each with distinct functions and innervation patterns. Cervical Plexus: The plexus involves nerve loops and branches that provide both sensory and motor functions. The superficial sensory branches originating from adjacent anterior spinal nerves (C2 to C4) are responsible for providing sensation to specific areas of the skin, particularly in the head, neck, and shoulder regions. These sensory branches include the lesser occipital nerve (C2, C3), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). These nerves typically run posteriorly and then penetrate the prevertebral fascia before reaching the skin and superficial structures. For Pain Management and Anesethesiology Board Review, go to For the Virtual Pain Fellowship Experience, Go to: Subscribe to Receive Free Content, Discounts and Course Updates! * indicates required Email Address * Ultrasound Workshops and Courses For up to date Calendar, ! Refereces Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug;71(4):274-288. doi: 10.4097/kja.d.18.00143. Epub 2018 Jul 4. PMID: 29969890; PMCID: PMC6078883. /episode/index/show/pmrexampodcast/id/27713916

Reda Tolba, MD International Society of Pain & Neuroscience Chair- Dubai 2023 08/03/2023

Passive Income for Physiatrists 07/11/2023

Post Stroke Central Pain Syndrome 06/29/2023

Post Stroke Central Pain Syndrome Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management and 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. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: Ultrasound Workshops and Courses For up to date Calendar, ! 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). SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke Volume 12 - 2021 | /episode/index/show/pmrexampodcast/id/27322353

Genicular Nerve Ablation with Phenol 06/21/2023

Ketamine for Chronic Pain 06/14/2023

Prolotherapy and Pain! Evidence, Ligaments, Spine and more! 05/23/2023

The PMRExam Podcast

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