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 CIPS

Episode 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 LinkedIn

 Join 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.

 Painexam Podcast Episode Show Notes 

 Episode Title:  Exploring Naturopathy in Pain Medicine with Dr. Sarah Trahan

 Host: David Rosenblum, MD   David Rosenblum is a dedicated pain management specialist with extensive experience in treating chronic pain conditions. He is passionate about integrating various approaches to improve patient outcomes and enhance quality of life. His expertise and commitment to patient-centered care make him a trusted voice in the field of pain medicine. His NY Practice is located in Brooklyn and Garden City and through his international educaitonal platform he has attracted physicians and pateints from all over the world to seek out consultation on the latest breakthroughs in interventional pain management. 

 Guest: Dr. Sarah Trahan   Dr. Sarah Trahan is a licensed naturopathic physician with a focus on holistic approaches to pain management and regenerative therapies. With a background in both conventional and alternative medicine, Dr. Trahan is committed to empowering patients through education and personalized treatment plans that address the root causes of pain.

 Episode Summary:  In this episode, David Rosenblum, MD, interviews Dr. Sarah Trahan to explore the role of naturopathy in pain medicine and the potential of regenerative therapies. Dr. Trahan shares her insights on how naturopathic principles can complement traditional pain management approaches, offering a comprehensive view of patient care.

 Key Discussion Points: 

-  ntroduction to Naturopathy:    Dr. Trahan explains the philosophy of naturopathic medicine and its emphasis on treating the whole person rather than just symptoms.

-  The Role of Naturopathy in Pain Management:    The conversation delves into how naturopathy can be integrated into pain management strategies, including dietary changes, lifestyle modifications, and natural supplements.

- Regenerative Therapies:    Dr. Trahan discusses the latest advancements in regenerative therapies, focusing on how these approaches can be applied in the context of pain management without delving into stem cell treatments.

- Patient-Centered Care:    Emphasizing the importance of a collaborative approach, Dr. Trahan shares strategies for working with patients to develop tailored treatment plans that align with their individual needs and preferences.

- Success Stories     Dr. Trahan recounts some of her most impactful approaches and  success stories, illustrating the benefits of combining naturopathic and conventional approaches to pain relief.

- NRAP Academy Online Courses and Workshops:      Dr. Trahan highlights the educational opportunities available through the NRAP Academy, which offers online courses and workshops aimed at healthcare professionals interested in enhancing their understanding of naturopathic principles in pain management. Private ultrasound training is also available for those seeking hands-on experience. For more information, visit NRAPpain.org

 Resources  

Pain Management CME Workshop Calendar  

Pain Medicine CME Board Prep and Online Courses  

 

Tune in to this insightful conversation to learn more about how naturopathy and regenerative therapies can play a vital role in managing pain and improving patient outcomes.

Stay connected with Painexam for more episodes on pain management and treatment innovations. Don't forget to subscribe and leave a review!

  For questions or feedback, reach out to us at [email protected]

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This episode promises to provide valuable insights for healthcare professionals and patients alike, highlighting the importance of a holistic approach to pain management.

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: • Elderly patients may develop CRPS post-knee replacement. • Importance of lumbar sympathetic block in diagnosis and treatment.

Host Bio:

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 Qiao

 Key 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:

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.pdf

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.

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

1. Patient Positioning:
   • Patient lies on their side with the affected side facing upward.
2. Transducer Selection:
   • Curvilinear transducer preferred for deeper structures.
3. Transducer Placement:
   • Place distal and parallel to the zygomatic arch to bridge the coronoid and condylar processes.
4. Anatomical Landmarks:
   • Identify the lateral pterygoid muscle and plate.
   • Use power Doppler to locate the sphenoid palatine artery.
5. 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.
6. 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

1. Patient Positioning:
   • Similar to ultrasound guidance, patient lies on their side with the affected side facing upward.
2. C-arm Positioning:
   • Position the C-arm to visualize the foramen ovale.
3. Needle Insertion:
   • Insert the needle under fluoroscopic guidance towards the foramen ovale.
4. Contrast Injection:
   • Confirm needle placement with contrast injection.
5. 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.