Spine and Nerve podcast

In this episode of the Spine & Nerve Podcast, Dr. Brian Joves and Dr. Jason Kung dive into the evolving world of peripheral nerve stimulation (PNS). As the field of pain medicine continues to progress, new studies are offering more insights into advanced therapies for challenging conditions like peripheral neuralgia and chronic pain. This discussion focused on the COMFORT study, which evaluates the efficacy of the Nalu PNS System, and discuss recent data presented at the American Society of Regional Anesthesia and Pain Medicine (ASRA) meeting concerning the SPRINT PNS System. Key Topics Covered: COMFORT Study Insights: The doctors analyze the one-year data from the COMFORT trial, a randomized controlled study assessing the Nalu PNS System combined with conventional treatments versus conventional treatments alone for chronic neuropathic pain. They highlight significant findings, including an 87% responder rate with an average pain reduction of 69% among responders at 12 months. SPRINT PNS System Data: Discussion extends to new data from the SPRINT PNS System, particularly the RESET Clinical Trial, which compares 60-day percutaneous PNS to standard interventional management for chronic low back pain. The trial's primary endpoint results indicate that PNS provided clinically meaningful and statistically superior reductions in pain, as well as improvements in function and quality of life. Clinical Implications and Future Directions: Dr. Joves and Dr. Kung explore the broader implications of these studies for clinical practice, emphasizing the importance of personalized treatment plans and the potential for PNS therapies to offer durable pain relief. They also discuss the evolving landscape of pain management and the need for ongoing research to refine and validate these therapeutic approaches. Resources and Links: https://nalumed.com/clinical-trials/comfort-trial/ https://www.sprtherapeutics.com/2024/11/21/new-sprint-pns-data-for-low-back-shoulder-knee-and-headache-at-23rd-annual-asra-pain-medicine-meeting/ Follow us on LinkedIn: ⁠Jason Kung, MD and Brian Joves, MD⁠ Subscribe to the Spine & Nerve Podcast everywhere podcasts are available Keep striving to provide the best care for your patients and stay informed on the evolving practices in pain management! This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

Episode Overview: In this episode, Dr. Brian Joves sits down with Dr. Scott Pritzlaff, an esteemed pain management specialist and the residency program director at UC Davis, to tackle some big questions on the current state and future of pain medicine. They dive into Dr. Pritzlaff's recent thought-provoking editorial, "From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way," which critiques the field's shifting focus toward procedures at the expense of comprehensive patient care. Together, Dr. Joves and Dr. Pritzlaff discuss challenges in pain medicine, including recruitment issues, the evolving landscape of interventional procedures, and the complexities of training the next generation of pain specialists. Key Topics Discussed: The Evolution of Pain Medicine: Dr. Pritzlaff explains the rapid technological advancements in pain medicine, especially in peripheral nerve stimulation, spinal cord stimulation, and minimally invasive spine procedures. While these advancements offer more options for patients, he warns that they can overshadow the core values of patient-centered care and non-procedural management. Pain Medicine's “Identity Crisis”: In his editorial, Dr. Pritzlaff questions the growing emphasis on procedures and the trend of “pain surgery” within the specialty. He emphasizes that pain management is about more than just interventions—it's about the art of diagnosis, multidisciplinary treatment plans, and knowing when not to perform procedures. This emphasis on procedure-heavy training, he argues, risks alienating future specialists who are passionate about comprehensive patient care. The Challenge of Training in a One-Year Fellowship: With the increasing complexity of pain medicine, a one-year fellowship may no longer suffice. Dr. Pritzlaff advocates for an expanded training period to cover essential skills, such as advanced imaging interpretation, opioid and multimodal pharmacology, and honing the “soft skills” crucial for patient communication and holistic care. Recruitment Issues in Pain Medicine: Pain medicine residency applications have dropped, especially from anesthesiology—a trend driven largely by competitive anesthesiology salaries and demand. Dr. Pritzlaff and Dr. Joves discuss how pain medicine needs to rebrand itself to attract applicants who are passionate about improving patients' quality of life through comprehensive care, not just procedures. Future Training Models and Vision for Pain Medicine: A 2 year fellowship model or a dedicated residency program are presented as potential solutions to better prepare trainees. Dr. Pritzlaff imagines a program where the first year focuses on foundational knowledge and multi-disciplinary skills, and a second year sharpens advanced interventional skills. Takeaways for Listeners: Pain medicine is at a pivotal point, balancing advancements in interventional procedures with the traditional values of comprehensive patient care. The field must prioritize holistic training and mentorship to foster well-rounded pain physicians who can deliver thoughtful, personalized care. Links & Resources: Dr. Scott Pritzlaff's Editorial: "From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way" in the Journal of Pain Research Connect with Dr. Pritzlaff and Dr. Joves on Linkedin or Twitter This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this episode of the Spine & Nerve podcast, Dr. Brian Joves sits down with Dr. Richard Winters, an emergency physician, leadership coach, and author, to discuss leadership, coaching, and the unique challenges physicians face as they transition into leadership roles. Whether you're early in your career or a seasoned physician looking to expand your leadership skills, this episode offers practical advice on how to build a successful career in medicine while growing as a leader. Key Takeaways:

The Pros and Cons of Ambulatory Surgery Centers (ASCs) vs. Office-Based Procedure Suites Welcome back to another insightful episode! Today, we're diving deep into a topic that's been on the minds of many healthcare providers: the differences between Ambulatory Surgery Centers (ASCs) and office-based procedure suites. Joining us is Terry Yates, an expert in helping physicians navigate the complexities of practice management and facility development. Whether you're a solo practitioner or part of a growing group, understanding the pros and cons of these options is crucial for optimizing your practice. In This Episode, We Cover: - The Key Differences Between ASCs and Office-Based Procedure Suites: Learn what sets these two options apart, from regulatory requirements to billing practices, and why the choice matters for your practice. - The Benefits and Challenges of Setting Up an ASC: Discover why ASCs require a significant investment but can offer unparalleled control over your operations, leading to increased efficiency and patient satisfaction. - The Hybrid Model Explained: Some physicians are choosing to combine both ASCs and office-based suites in one facility. Find out how this approach can provide flexibility and maximize reimbursement. - Why a Feasibility Study is Essential: Before jumping into ASC development, a feasibility study is crucial. We discuss the key factors that should influence your decision, including case volume and state regulations. - Long-term Strategic Considerations: Thinking about the future? We explore how owning an ASC can be a valuable asset, offering opportunities for future sale, real estate investment, and even a retirement plan. Why You Should Listen: If you're considering expanding your practice or simply want to understand the best operational setup for your needs, this episode is packed with actionable insights. Terry Yates shares expert advice that could help you make informed decisions about the future of your practice. Connect with Terri Yates: - Website: Doc Centric Surgery Centers www.doccentricasc.com - Contact: Terry Yates - Accountable Physician Advisors terry@accountableconsultants.com Don't miss this episode if you're looking to enhance your practice's efficiency, revenue, and future potential!

In this episode of The Spine & Nerve Podcast, Dr. Jason Kung and Dr. Brian Joves break down the new California opioid guidelines with insights that every healthcare provider and pain management specialist should know. Our doctors explore the latest guidelines from the California Medical Board, published in July 2023 and designed to navigate the complexities of prescribing opioids in chronic pain management. Whether you're in California or beyond, this episode is a must-listen to understand the evolving landscape of pain treatment. Understanding the New Guidelines Published in July 2023, these guidelines are a response to the opioid crisis and aim to balance effective pain management with reducing opioid-related risks. Patient-Centered Approach Discover how the new guidelines emphasize a patient-focused approach. From initial evaluations to risk assessments- the guidelines highlight the importance of treating each patient as an individual, tailoring treatments to their specific needs and conditions. The Role of Documentation thorough documentation in pain management is critical. Proper documentation not only supports clinical decisions but also safeguards both the provider and the patient throughout the treatment process. Managing High-Risk Patients Explore strategies for managing patients at high risk of opioid misuse. The guidelines provide tools for assessing and mitigating risks, ensuring that opioid therapy is reserved for those who will benefit most and are least likely to experience adverse outcomes. Opioid Tapering and Legacy Patients The team discusses the sensitive topic of tapering long-term opioid therapy, particularly for legacy patients who have been on high-dose opioids for extended periods. Learn how to approach tapering with caution to minimize patient distress and maximize safety. Telehealth and Pain Management Understand the role of telehealth in pain management as outlined in the new guidelines. While a valuable tool, telehealth requires careful use to ensure that patients receive appropriate examinations and care. Social Media Spotlight: Dr. Kung shares his experience rejoining social media through LinkedIn, offering a glimpse into how pain management professionals stay connected and informed. Breaking Down the Guidelines: A detailed exploration of the California Medical Board's opioid guidelines, including patient evaluation, risk assessment, and non-opioid treatments. Explore the California Opioid Guidelines: Access the document directly from the show notes to understand the specifics and apply them in your practice. Engage with Us: Subscribe to the Spine & Nerve podcast, share this episode with your colleagues, and join the discussion on LinkedIn and other social media platforms. "Pain relief is important, but it is difficult to measure objectively. Our goal is to maintain or improve function while managing pain effectively." - Dr. Brian Joves Dive into this episode and equip yourself with the knowledge and tools to navigate the complex world of pain management with confidence and compassion. California Opioid Guidelines: Access the full guidelines here Follow us on LinkedIn: Jason Kung, MD and Brian Joves, MD Subscribe to the Spine & Nerve Podcast everywhere podcasts are available Keep striving to provide the best care for your patients and stay informed on the evolving practices in pain management! This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this episode of the Spine & Nerve podcast, join Brian Joves, MD for an enlightening conversation with Mike Ochoa, DPT, a passionate advocate for fitness in aging populations. Dr. Mike brings valuable insights into the importance of exercise, particularly weightlifting, in promoting longevity and overall well-being as we age. Discover the truth behind common misconceptions about aging and exercise, and learn how to tailor fitness routines to individual needs and goals. Key Takeaways: Learn why weightlifting is a powerful tool for enhancing muscle health and longevity in older adults. Understand the importance of challenging, albeit sometimes uncomfortable, exercise for optimal improvement. Explore the benefits of resistance training in preventing age-related conditions like sarcopenia and osteoporosis. Gain insights into debunking myths surrounding aging and exercise, fostering a mindset of empowerment and possibility. Discover practical strategies for creating personalized exercise programs that cater to individual abilities and aspirations. Tune in to gain valuable wisdom and actionable advice from Dr. Mike Ochoa, and embark on a journey toward maximizing fitness and vitality in your golden years. find Dr. Mike on YouTube, IG, TikTok @MovewithDrMike (https://www.youtube.com/@MovewithDrMike  ) Connect with Dr. Joves on Linkedin or X Follow @spinenerve on Youtube, IG This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

Episode Summary:Join Dr. Jason Kung and Dr. Brian Joves for an in-depth discussion on the latest in neuromodulation. This episode covers a range of topics from the North American Neuromodulation Society 2024 Annual Meeting highlights to a journal club traversing the topics of spinal cord stimulation, closed-loop technology, and the impact of paraspinal muscle atrophy on vertebral endplates. With a blend of expert insights and a review of recent studies, this episode offers a comprehensive look into the advancements and challenges within the field of neuromodulation. Key Points Discussed: North American Neuromodulation Society Meeting Recap: Dr. Kung shares his experiences and key takeaways from the event, highlighting the growing interest in SI joint fusion and the lack of major announcements in neuromodulation waveforms. MRI Compatibility in Neuromodulation Devices: The hosts delve into the importance of MRI compatibility, discussing the implications for patient care and device selection. The Evoke Study and Closed-Loop Stimulation: An in-depth review of the 36-month data from the Evoke trial, which compares closed-loop spinal cord stimulation to traditional open-loop systems. The study's findings on pain relief and the potential for closed-loop technology to revolutionize patient outcomes are explored. Paraspinal Muscle Atrophy and Spinal Health: A discussion on a recent study examining the association between paraspinal muscle atrophy and vertebral endplate degeneration, underscoring the importance of physical therapy and core strength in pain management. Notable Quotes:" The development of the space is not just about this waveform versus that waveform, but understanding that there are many factors that play into patient success." - Dr. Brian Joves "With ECAPs, we're moving towards a two-way feedback system in spinal cord stimulation, akin to how a pacemaker works." - Dr. Jason Kung Closing Thoughts:The episode wraps up with reflections on the potential of neuromodulation technologies and the importance of continued innovation to improve patient care. The hosts also express interest in seeing how closed-loop stimulation and other advancements will perform in real-world settings. Connect with Us: Find Dr. Jason Kung or Dr. Brian Joves on LinkedIn Connect with the podcast on YouTube, IG and Facebook @ SpineNerve Be sure to share, like and subscribe! Upcoming Episodes:Stay tuned for future discussions on groundbreaking studies in pain management and neuromodulation, along with guest appearances from leaders in the field. References: Mullins CF, Harris S, Pang D. A retrospective review of elevated lead impedances in impedance-dependent magnetic resonance-conditional spinal cord stimulation devices. Pain Pract. 2024; 24: 270–277. https://doi.org/10.1111/papr.13301. Mekhail NA, Levy RM, Deer TR, et al ECAP-controlled closed-loop versus open-loop SCS for the treatment of chronic pain: 36-month results of the EVOKE blinded randomized clinical trial Regional Anesthesia & Pain Medicine Published Online First: 27 August 2023. doi: 10.1136/rapm-2023-104751 Schönnagel, Lukas et al. Understanding the Interplay Between Paraspinal Muscle Atrophy and Lumbar Endplate Degeneration: A 3-Year Longitudinal Study. Spine 48(23):p 1627-1634, December 1, 2023. | DOI: 10.1097/BRS.0000000000004826 Pritzlaff et al. A Review of the Factors and Outcomes of Institutional Interdisciplinary Neuromodulation Committees: A Multicenter Experience. Neuromodulation. February 06, 2024 Disclaimer: Reminder that the information provided is for educational purposes and is not intended as medical advice. Always consult with a healthcare professional.

In this episode of The Spine & Nerve Podcast, Dr. Dr. Jason Kung and Dr. Brian Joves have a reflective and forward-looking discussion as we transition from 2023 into 2024, sharing our podcast's journey, personal insights, biggest happenings in pain medicine, and anticipations for the new year. 1. Podcast Journey and Global Reach: Transitioning through 2023: The evolution of our podcast through the year. Spotify Wrapped Insights: A deep dive into our audience demographics, celebrating a significant international listenership with a special shoutout to our friends in New Zealand, India, Spain, Brazil, and Hungary. 2. Engaging Medical Discussions: Spotlight Episode - Spinal Stenosis: Discussion on why our spinal stenosis episode resonated with so many listeners and the importance of addressing prevalent health issues. Medical Innovations and Literature: A look back at the year's significant advancements in radiofrequency ablation and the evolving landscape of pain management. 3. Personal Reflections and Resolutions: Embracing Challenges: The team's participation in a Spartan Race, symbolizing our dedication to personal growth and community engagement. 4. Community Impact and Listener Engagement: Top 10 Recognition: Celebrating being in the top 10 of listeners' favorite podcasts and what it means to us. Listener Interaction: Encouraging feedback, stories, and engagement from our global audience. 5. Looking Forward to 2024: Medical Community and Conferences: Anticipation for upcoming medical conferences, new technologies, and the continuing battle against the opioid crisis. Optimism for the Future: Our commitment to staying informed, optimistic, and ready to tackle the challenges and opportunities the new year brings. Closing Thoughts: A heartfelt thank you to all our listeners for their continued support and engagement. We look forward to another year of learning, growth, and community. Contact Information: We Encourage listeners to stay connected through our social media channels (LinkedIn, YouTube, Twitter (X), and Facebook are the easiest), website, and Spotify Podcast page for feedback, questions, and community stories. Disclaimer: Reminder that the information provided is for educational purposes and is not intended as medical advice. Always consult with a healthcare professional.

In this episode of the Spine & Nerve Podcast, Dr. Brian Joves has the distinct pleasure to welcome Dr. Andrea Furlan to the show. Dr. Furlan is a pain specialist in Toronto Canada. She is a physiatrist (specialist in Physical Medicine & Rehabilitation). She holds a medical degree from the University of Sao Paulo and a Ph.D. degree from the University of Toronto. She has 30 years of experience helping people with chronic pain to get better quality of life. In this insightful conversation, Dr. Furlan shares her vast experience in managing chronic pain, addressing key aspects of pain management that are crucial for medical providers to understand. Key Takeaways: 1. The Complexity of Chronic Pain: Chronic pain is a multifaceted condition with complex neurobiological and psychosocial components. Understanding the diverse factors contributing to chronic pain is essential for medical providers to provide effective care. 2. The Role of Empathy and Communication: Dr. Furlan emphasizes the importance of empathy and active listening when interacting with patients in pain. Effective communication skills are crucial for building trust and facilitating patient-doctor relationships. 3. Educating Patients: Educating patients about their condition and treatment options is a fundamental aspect of pain management. Medical providers should learn how to explain complex medical concepts in simple terms to ensure patient comprehension. 4. The Value of Multidisciplinary Approaches: Chronic pain often requires a multidisciplinary approach, involving various healthcare professionals such as physiatrists, psychologists, and physical therapists. 5. The Impact of Lifestyle Modifications: Lifestyle modifications, including diet, exercise, sleep, and stress management, play a significant role in pain management. 6. Emotions and Pain Perception: Emotions can influence pain perception, making it essential for medical students to consider the emotional well-being of patients. 7. Patient Support and Online Communities: Dr. Furlan discusses the value of patient support groups and online communities, where individuals with chronic pain can share their experiences and learn from one another. Medical providers can explore these resources to better understand patient perspectives. 8. Dr. Furlan's Book - A Resource for providers: Dr. Furlan's book, which outlines eight steps for managing chronic pain, is recommended for medical providers looking to deepen their knowledge of pain management. The book provides practical insights and strategies for patient care. Medical providers should embrace the holistic approach to chronic pain management, considering both the physical and emotional aspects of the condition. Dr. Furlan's expertise and insights shared in this episode offer valuable lessons for aspiring healthcare professionals in the field of pain medicine. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. You can find Dr. Furlan at: https://www.youtube.com/ @DrAndreaFurlan  https://www.doctorandreafurlan.com/ X  @adfurlan  IG @dr.andrea.furlan

In this episode of the Spine & Nerve Show, Dr. Robert Bowers joins Dr. Brian Joves to discuss the progression of young athletes in throwing sports, such as baseball. He emphasizes the importance of allowing children to play multiple sports and avoid specializing too early. Dr. Bowers also highlights the risks associated with overuse injuries and the need for rest periods. He discusses the role of mechanics and training programs in preventing injuries and increasing velocity. Dr. Bowers also touches on the use of biologics, such as PRP, in the treatment of injuries in young athletes.​ About The Guest: Dr. Robert Bowers is a sports medicine physician at Emory in Atlanta, Georgia. He specializes in the treatment of throwing athletes and has a particular interest in baseball injuries. Dr. Bowers has extensive experience working with athletes at all levels, including professional baseball players and college athletes. He is passionate about helping athletes optimize their performance and prevent injuries.​ Key Takeaways: - Young athletes should play multiple sports to develop athleticism and motor skills. - Rest periods are crucial for preventing overuse injuries in young athletes.- Proper mechanics and training programs can help prevent injuries and increase velocity. - Weighted ball programs can increase velocity but also carry an increased risk of injury. - Biologics, such as PRP, can be used to treat certain injuries in young athletes.​ Quotes: "If these kids can take three months of throwing off, four months, even better, that should be good to allow their arm to rest."- "The harder you throw, the more at risk your arm is." "Velocity gets kids noticed, but it also increases injury risk." "Weighted ball programs increase velocity but also increase injury risk." "The way to deal with increased intensity is to decrease volume."

In this episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves delve into a comprehensive discussion surrounding anticoagulation guidelines and their implications in interventional pain procedures. With over a hundred thousand downloads and over 1,000 YouTube subscribers, we would like to express our sincere gratitude to all the listeners for your engagement and support. Please continue to share and subscribe to help more people discover the podcast. Today's episode focuses on the safety of epidural steroid injections and the critical role of anticoagulation management.Understanding the rationale behind a patient's anticoagulation therapy is vital for interventional pain physicians. This approach empowers clinicians to make informed decisions about whether to continue or withhold anticoagulation medications prior to procedures. There is a delicate balance between patient-specific risks and the benefits of these interventions. One of the things that must be known and emphasized is the remarkable safety profile of epidural steroid injections. Approximately nine million epidural steroid injections are administered annually, resulting in an adverse event rate of about one in 780,000. This reassuring statistic is attributed to the collaborative efforts of medical societies and the implementation of strict anticoagulation guidelines. The hosts emphasize the role of fluoroscopic guidance, non-particulate steroids, and avoidance of deep sedation in enhancing the safety of these procedures. The episode further delves into the nuances of assessing bleeding risks in patients undergoing interventional pain procedures. As always, we must underscore the importance of a comprehensive physical examination, with a specific focus on identifying signs of easy bruising and mucosal bleeding. The hosts discuss the relevance of specific medications, including aspirin and NSAIDs, and their implications for procedural safety. The hosts engage in an insightful exploration of the guidelines for managing anticoagulation medications pre- and post-procedure. They stress the need for pain physicians to consider the anatomical location of the intervention and evaluate the potential risks versus benefits. The doctors conclude the episode by highlighting the crucial role of shared decision-making and patient education. By fostering collaboration between patients and physicians, the hosts emphasize the creation of a safe and informed healthcare environment.In this thought-provoking episode, the doctors try to help you navigate the complexities of anticoagulation management in interventional pain procedures, and offer some insights for practitioners seeking to provide the highest level of care to their patients. References: Anesthesia Quality Institute Closed Claims Database Review 2011 through 2021 for Epidural Steroid Complications. Naeem Haider. Pain Physician 26 (3), E251, 2023 Stephen Endres, MD and others, The Risks of Continuing or Discontinuing Anticoagulants for Patients Undergoing Common Interventional Pain Procedures, Pain Medicine, Volume 18, Issue 3, March 2017, Pages 403–409, https://doi.org/10.1093/pm/pnw108 Narouze S, Benzon HT, Provenzano D, et alInterventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of PainRegional Anesthesia & Pain Medicine 2018; 43:225-262. The ASRA App: https://www.asra.com/the-asra-family/asra-app

In this episode, we have a special guest, Dr. Nikhil Verma, who shares his inspiring journey from undergrad to establishing his own medical practice. Dr. Verma opens up about the challenges he faced, the pivotal moments that shaped his career, and the lessons he learned along the way. Join us as we delve into his story of perseverance, passion, and the pursuit of personalized medicine. Episode Highlights: Dr. Verma recounts his early struggles and the uncertainties he faced during his pursuit of medical school. Despite not getting accepted initially, he used the time to reflect and explore different options, eventually finding his way to St. George's University. The importance of resilience and perseverance shines through as he shares how he overcame setbacks and stayed motivated. Dr. Verma's interest in rehabilitation medicine and sports medicine grew during his residency. He shares how his personal experience with a sports-related injury shaped his perspective and ignited his passion for helping others through physical therapy and non-surgical interventions. Dr. Verma discusses the decision to open his own medical practice, highlighting the challenges and rewards of being an independent practitioner. From finding the ideal location to setting up the practice and acquiring necessary equipment, he shares the steps involved in laying the groundwork for his venture. Dr. Verma emphasizes the importance of tailoring treatments to individual patients, providing temporary relief while considering long-term solutions. He highlights advanced procedures and technologies that enable more targeted and effective interventions, showcasing the potential impact of personalized medicine. Dr. Verma encourages med students and early residents to stay open-minded and embrace change. He shares the significance of finding passion and purpose in one's work, reminding listeners that it's okay to evolve and pursue new interests within the medical field. Dr. Nikhil Verma's story is a testament to the power of determination, adaptability, and following one's true calling. His journey from facing initial rejections to establishing a successful practice showcases the importance of resilience and finding personal fulfillment in the medical profession. Join us in thanking Dr. Verma for sharing his insights and experiences. Tune in to the full episode to hear his story in his own words. You can find Dr. Verma on all your favorite social platforms, as well as our hosts. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, we have a return guest! Dr. Hunter Vincent returns to the show to chat with Dr. Brian Joves about health coaches and how they can help your patients to be more successful in their journey with and through chronic pain. In this episode we'll discuss: What is a health coach? Where does this fit into the treatment and provider paradigm? How can ancillary team members like health coaches help your patients and your team to be more successful? Dr. Vincent is the CEO of Pogo Health. He is a double board certified physician who received his residency training from UC Davis in Physical Medicine & Rehabilitation (PM&R) with a subspecialty certification in Pain Medicine from UCLA. Prior to starting his medical training, he received a Bachelor's of Science in Exercise Biology. He has spent the last decade actively involved in healthcare initiatives focused on maximizing patient engagement in their own health journey. He has worked with various healthcare teams in the fields of clinical obesity, chronic pain, and neurological disorders.  Pogo Health is a virtual platform Virtual that utilizes a team approach to treating chronic pain. Their interdisciplinary opioid-free approach integrates the pain physician, pain therapist and specialized health coach to create a completely virtual and customized treatment program. The Pogo Health multi-modal approach utilizes evidence based techniques to provide long term physical and mental health benefits to combat chronic pain. Learn more at https://pogo-health.com/ This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves try to digest all the recent happenings in the world of neuromodulation. They address: Internal Pulse Generators Artificial Intelligence The Cochran Study Listen as the doctors get excited, frustrated, and try to bring a silver lining to the whirlwind of headlines that have been discussing neuromodulation so far this year! There were many references in this episode, but most importantly here is the Cochran review on SCS for low back pain: Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023 Mar 7;3(3):CD014789. doi: 10.1002/14651858.CD014789.pub2. PMID: 36878313; PMCID: PMC9990744. Here is the Hara study: Hara S, Andresen H, Solheim O, Carlsen SM, Sundstrøm T, Lønne G, Lønne VV, Taraldsen K, Tronvik EA, Øie LR, Gulati AM, Sagberg LM, Jakola AS, Solberg TK, Nygaard ØP, Salvesen ØO, Gulati S. Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial. JAMA. 2022 Oct 18;328(15):1506-1514. doi: 10.1001/jama.2022.18231. PMID: 36255427; PMCID: PMC9579901. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve Podcast we would like to introduce you all to the newest member of the Spine & Nerve family... Dr. Jason Kung. Jason Kung, MD, is a board-eligible anesthesiologist and interventional pain physician who joined Spine & Nerve last year. Listen in as Brian Joves, MD gets to know Dr. Kung better and explore his journey into medicine and to discovering his passion for pain medicine. He graduated from the University of San Francisco in California with a bachelor's degree in biology. He then went to Boston University School of Medicine in Massachusetts for his medical degree. Dr. Kung completed his residency in Anesthesiology and fellowship in Interventional Pain at Harvard Medical School, Massachusetts General Hospital in 2020. Dr. Kung specializes in several interventional procedures, including spinal cord stimulation, epidural injections, radiofrequency ablations, implantable devices, and ultrasound-guided nerve/joint injections. He strives to provide compassionate evidence-based care to all his patients. He is certified as an instructor in medical simulation. Dr. Kung has completed research and published in the areas of bone healing and the effects of natural sources of vitamin D. During his free time, he enjoys playing guitar, surfing/snowboarding, and exploring California with his wife and dog. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of The Spine & Nerve Podcast, Evan Hauger, DPT joins Brian Joves, MD to discuss movement as medicine. Dr. Evan Hauger Evan specializes in  sports physical therapy, strength, and conditioning. He knows the ins  & outs of injury from years of personal experience. Growing up, he  was a multi-sport athlete and went on to play baseball at Shasta College. Through multiple personal injuries related to his athletic career, Evan realized that he had a passion for improving the way people  move and enhancing their performance in sport and life. Also a  StrongFirst Certified Level 1 instructor, Evan earned his Doctorate in  Physical Therapy from Sacramento State University and has worked with  athletes of all calibers, including MLB, NFL, NBA, UFC, and Olympians.  He has also spent time with some of the best minds in sports physical  therapy in Boston, MA, been a medical team leader for the USA Track and  Field National Championships, assisted with NFL combine training at Exos  in Phoenix, AZ, and been the performance coach for a group of Olympic athletes. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings connects with Dr. Krystyna Holland, PT, DPT to learn about trauma informed care. Trauma informed care has many definitions, including some fantastic work done by the Substance Abuse and Mental Health Services Administration. One definition is a consistent and intentional effort to reduce our propensity for harm. Another describes it as an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma. Listen in as Drs. Hastings and Holland discuss this very important topic and share some tips on how to better show up for our patients. Krystyna Holland, DPT (she/her)  is a physical therapist in Denver, Colorado specializing in the provision of trauma informed pelvic floor care to individuals across the gender identity spectrum. In addition to helping folks feel confident in their ability to live without leaking and have pleasurable sex, Krystyna aims to change the fundamental patient provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider. She is a well-known Instagram educator (@krystyna.holland) and an instructor of trauma-informed care webinars.  She owns a small private practice called Inclusive Care and lives in Denver, CO. https://instagram.com/krystyna.holland https://www.inclusivecarellc.com/

In this week's episode of the Spine & Nerve podcast, Drs. Nicolas Karvelas and Brian Joves discuss infectious spondylodiscitis, a relatively rare inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Spondylodiscitis has a prevalence of about 4-24 per million, and has been increasing as patients have more risk factors (advanced age, immunocompromised states such as HIV infection, intravenous drug users, healthcare-associated infections, expansion of spinal surgery indications) and improved diagnostic modalities. Patients generally present with pain and tenderness in the region, about 50% present with high fever, and about 1/4 with neurologic compromise. The symptoms can be fairly non-specific, so patients with risk factors must be evaluated with a high degree of suspicion. Infection is the most common cause of spondylodiscitis, which is often spontaneous and hematogenous in origin and most commonly affects the lumbar spine, followed by thoracic, cervical, and sacral. The infectious pathogens can be pyogenic (bacterial), granulomatous (tuberculosis, fungal), or parasitic, though many noninfectious processes affecting the spine such as pseudarthrosis in ankylosing spondylitis, amyloidosis, destructive spondyloarthropathy of hemodialysis, Modic changes type 1, neuropathic arthropathy, calcium pyrophosphate dehydrate (CPPD) spondyloarthropathy and gout can mimic infectious discitis/ osteomyelitis. To determine whether a particular patient's spinal process is due to an infectious versus non-infectious cause and to determine the pathogencan be challenging. Clinical findings and laboratory studies including erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can be helpful in the diagnosis due to their high sensitivity; however, their specificity is low. Magnetic resonance imaging and biopsy have become the standard when working up this process, particularly in cases where the origin of the pathogen is unknown. Listen as the doctors give a high-level overview of this disease process, and walk us through the challenging diagnostic process of a disease that may have an insidious onset, with subtle and misleading clinical features and briefly discuss management requiring a multidisciplinary approach involving radiologists, infectious diseases specialists, spine surgeons and rehabilitation personnel. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. 1. Salaffi, F., Ceccarelli, L., Carotti, M. et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician?. Radiol med 126, 843–859 (2021).  2. Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, et al. Spondylodiscitis revisited. EFORT Open Rev. 2017;2(11):447-461. Published 2017 Nov 15. doi:10.1302/2058-5241.2.160062

In this week's episode of the Spine & Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome. Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms. Listen as the doctors dive in and discuss these articles and discuss ways these articles might help patients living with persistent pelvic pain syndrome and the physicians caring for them. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Hong DG, Hwang SM, Park JM. Efficacy of ganglion impar block on vulvodynia: Case series and results of mid- and long-term follow-up. Medicine (Baltimore). 2021;100(30):e26799. 2. Agarwal-Kozlowski K, Lorke DE, Habermann CR, Am Esch JS, Beck H. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009 Sep;25(7):570-6. 3. Istek A, Gungor Ugurlucan F, Yasa C, Gokyildiz S, Yalcin O. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 2014;290(2):291–8 4. Hunter CW, Yang A. Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration. Neuromodulation. 2019 Jan;22(1):87-95. doi: 10.1111/ner.12801. Epub 2018 Aug 1. PMID: 30067887.

In this week's episode of the Spine & Nerve podcast, Dr. Joves welcomes Dr. Raman Gurai back to the show. Dr. Gurai walks us through his journey in medicine and how he took the road less traveled to achieve his goals and dreams! Dr. Gurai's Bio: Dr. Raman Gurai is a board certified Physical Medicine and Rehabilitation physician with a special interest in Interventional Spine. He was born and raised in northern California and his interest in medicine started in college where he majored in Molecular and Cell Biology with an emphasis in Neuroscience at the University of California at Berkeley in Berkeley, California. From there he headed to Grenada (West Indies) for his medical degree, and thereafter he completed his residency at the UCLA/VA Physical Medicine and Rehabilitation training program. He stayed on for an extra year to complete his current specialty, Interventional Spine. His medical interests include diagnosing and healing ailments of the spine with a multitude of modalities including EMG/NCS nerve testing and spine procedures including facet injections, epidurals, medial branch blocks, radiofrequency ablations, sacroiliac joint injections, and spinal cord stimulation among other cutting edge techniques. Dr. Gurai's personal approach to medicine is to treat each individual as if they were a family member.  It is with this approach that he hopes to restore the quality of life and function each person deserves. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings sits down with Shereen Sairafi, PT, DPT, WCS to discuss all things pelvic physical therapy related.  Pelvic floor physical therapists play an integral role in helping patients who have urinary, bowel, or sexual dysfunction, as well as pelvic pain.  Dr. Shereen Sairafi graduated from Boston University in 2013 with a  doctorate of physical therapy. Since that time she has been working in  the pelvic health field and advocating for broader access for patients  with pelvic floor dysfunction. Most recently she founded the pelvic  health physical therapy program at Denver's public health, safety-net  hospital. Her clinical interests include rehabbing and preventing  obstetric anal sphincter injuries, assisting patients in returning to  all functional activities (including sex) pain free, and caring for  gender diverse patients. In her free time she enjoys running, playing tennis, reading, crafting, and perfecting her tahdig recipe. Some of the big questions that they address in this episode: Who is an appropriate patient for pelvic PT? How to pitch the idea or prepare a patient for pelvic PT? How does pelvic floor dysfunction overlap with other musculoskeletal pathologies? To find a PT: https://aptapelvichealth.org/ptlocator/ https://pelvicguru.com/directory/ Return to run guidelines: https://www.researchgate.net/publication/335928424_Returning_to_running_postnatal_-_guidelines_for_medical_health_and_fitness_professionals_managing_this_population This podcast is for information and educational purposes only, it is not  meant to be medical or career advice. If anything discussed may pertain  to you, please seek council with your healthcare provider. The views  expressed are those of the individuals expressing them, they may not  represent the views of Spine & Nerve.  

 In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings and Dr. Brian Joves go back to basics and give us an overview of persistent pelvic pain. Persistent pelvic pain is defined as non malignant pain that is present for more than six months. It may or may not be associated with a woman's cycle or related to intercourse. Studies have shown that approximately 24% of female bodied individuals will experience significant pelvic pain. Persistent pelvic pain tends to have a multifactorial presentation and it can be hard to differentiate the primary source of pain. Pelvic pain is associated with other chronic overlapping pain conditions which contributes to the challenges of diagnosis, treatment and management. The differential diagnosis is vast and etiologies of persistent pelvic pain include sources from many body systems including but not limited to: Gynecologic Urologic Gastrointestinal Musculoskeletal Psychologic The severity and consistency of pain increases with multisystem presentation requiring a multi-specialty combined effort to evaluate and treat these patients effectively.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves celebrate the 100th episode and welcome Dr. Julie Hastings to the show! We are so appreciative of the support, and love to hear the feedback from all of you. We never imagined that we would make 100 episodes of the podcast, let alone reach as many listeners as we have. Thank you for subscribing, sharing the podcast and contributing to our continued success in our desire to educate others. Listen in as Dr. Joves and Dr. Hastings discuss her unconventional path to medicine, her passion for women's health, and why she went back to fellowship for further education and training after years of practicing medicine. They will also preview the upcoming series that Dr. Hastings will host which will take the podcast into pathologies, diagnoses and discussions we have never had before! Please see Dr. Hasting's bio below for more specific background information. You can reach her at JHastings@spinenerve.com to thank her for contributing and sharing her story. And don't forget to submit your questions and comments, either to one of our social media accounts or on the Spotify app! Dr. Julie Hastings Bio: Dr. Julie Hastings is a board-certified Physical Medicine and Rehabilitation physician with a special interest in Interventional Spine. Dr. Hastings completed a North American Spine Society (NASS) recognized fellowship in Interventional Spine and Musculoskeletal Medicine at Desert Spine and Sports Physicians in Phoenix, Arizona. Prior to this Dr. Hastings was faculty at University of Arizona and Creighton Medical School where she focused on pelvic pain and pelvic floor dysfunction. She completed residency training in Physical Medicine and Rehabilitation at the University of Colorado and earned her medical degree from Mount Sinai in New York City, and her Bachelor of Arts degree in Community Studies from UC Santa Cruz. Dr. Hastings strives to provide patients with the care she would want for her own family including an accurate diagnosis and treatment plan customized to each patient's specific goals. Whether your pain is keeping you from athletic endeavors, work, or simply enjoying time with your family, Dr. Hastings aims to get you back to those activities empowered with knowledge about your own body and skills to manage your pain. Dr. Hastings has presented research nationally on interdisciplinary chronic pain care, opioids and suicide, pelvic pain and joint hypermobility, and healthcare quality improvement, as well as co-authored a textbook chapter on nonsurgical pain management. She believes strongly in education and mentorship and works with medical students and residents around the country as a mentor. Outside of medicine Dr. Hastings enjoys spending time outdoors, fitness, cooking, and spending time with friends and family.

In this week's episode of the Spine & Nerve podcast Dr. Brian Joves is joined by a very special guest, Dr. Monica Verduzco-Gutierrez, to discuss Long COVID, otherwise known as Post Acute Sequalae of SARS CoV2 (PASC). Long COVID is defined as a condition in which a patient continues with symptoms of COVID-19 more than 2 months after being infected by the virus. Longitudinal studies quote anywhere from a 15-80% prevalence of long COVID. Although every patient presents with a different compilation of symptoms, the most common symptoms of Long COVID are fatigue, impaired respiratory function, “brain fog”, headache, attention disorder, hair loss and pain. Though the risk factors for developing Long COVID are not fully known, studies suggest anosmia and ageusia, GI symptoms, and more severe acute infection may contribute to long term symptoms. There are many proposed mechanisms for these symptoms including inflammation, peripheral organ dysfunction, and virus shedding from the gut emphasizing the gut-brain connection that still needs to be researched further. Listen as Dr. Gutierrez educates on her experience in helping these patients and provides us with practical considerations when patient's present to the clinic. Most importantly, Dr. Gutierrez recommends one simple way to optimize outcomes for patient's suffering from Long COVID, and all patients for that matter. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. You can find Dr. Monica Verduzco-Gutierrez: twitter.com/MVGutierrezM instagram.com/monicavgutierrez https://www.linkedin.com/in/monica-verduzco-gutierrez-m-d-74aab370/

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus). PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found that PHN occurs in about 20% of patients who have Herpes Zoster. With the relatively recent development of the preventative vaccine Shingrix (which has been found to be 97% effective in preventing Herpes Zoster) it is anticipated that the total prevalence of Herpes Zoster and PHN will decrease. However, research has repeatedly demonstrated that immunocompromised patients are at a significantly increased risk for Herpes Zoster and PHN (20-100 times increased risk of development of PHN). As of today, the Advisory Committee on Immunization Practices has not cleared immunocompromised patients to receive the Shingrex (or Zostavax) vaccine; therefore for multiple reasons PHN will most likely continue to be a prevalent diagnosis. Treatment options for PHN include physical modalities (TENS, desensitization), topical medications (including Lidocaine 5% patch, and Capsaicin), oral medications (including Gabapentin, Pregabalin, Tricyclic Antidepressants), and procedures. Listen as the doctors review Herpes Zoster, PHN, and a recent research article evaluating the effect of the Erector Spinae Plane Block in regards to prevention of PHN once Herpes Zoster has already developed. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Zeng-Mao Lin, MD, Hai-Feng Wang, MD, Feng Zhang, MD, Jia-Hui Ma, MD, PhD, Ni Yan, RN, and Xiu-Fen Liu, MD. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. 2021;24;E1109-E1118. 2. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108.

In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves take a look back at basic physiology to try to look into the future. An area of research that has really piqued the interest of Dr. Karvelas in recent years has been the discussion/possibility of selective voltage gated sodium channel (NaV) modulators. NaV are transmembrane proteins that are an integral part of the initiation and propagation of action potentials in neurons and other electrically excitable cells. We have seen that small changes in NaV function are biologically relevant because there are several human diseases that are the result of mutations in these channels. This has led to research into selective NaV modulators as a potential target as we continue to search for treatment options with significant analgesic potential and decreased risk of side effects / adverse effects. The medical / research community continues to work to optimize medication options to treat painful disease processes. From an analgesic medication perspective, although there are a variety of different medications available including: topical medications, acetaminophen, non-steroidal anti-inflammatory drugs, gabapentin, pregabalin, serotonin norepinephrine reuptake inhibitors, tricyclic anti-depressant medications, non-selective sodium channel blockers, NMDA receptor modulations (Memantine, Ketamine), alpha-2 agonists, glial cell modulators (Low Dose Naltrexone), Buprenorphine, full mu opioids. These Medications are not without their limitations for multiple reasons including but not limited to side effects, risks, and contraindications depending on patient's age and/or comorbidities. To the best of our knowledge there are 10 different NaV subtypes; and specifically NaV 1.3, 1.7, 1.8, 1.9 have been demonstrated to play a critical role in pain signaling. NaV 1.8 is a sensory neuron specific channel with preferential expression in the dorsal root ganglion and trigeminal ganglion neurons, and it is highly expressed on nociceptors. Similar to the other NaV subtypes that have been identified to play essential roles in pain, mutations in NaV 1.8 have been demonstrated to lead to significant alterations in the nervous system / pain pathways; specifically gain of function NaV 1.8 mutations clinically manifest as painful small fiber peripheral polyneuropathy. NaV 1.8 modulation is being aggressively researched with the goal of positive impact on painful diseases. VX-150 is a oral pro-drug that is a highly selective inhibitor of NaV1.8, and a recent study by Dr. Hijma and colleagues was published evaluating the analgesic potential and safety of VX-150. Listen as the doctors discuss this exciting and important area of research. The discussion includes a detailed review of the fore-mentioned recent research article. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Hijma HJ, Siebenga PS, de Kam ML, Groeneveld GJ. A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Pharmacodynamic Effects of VX-150, a Highly Selective NaV1.8 Inhibitor, in Healthy Male Adults. Pain Med. 2021 Aug 6;22(8):1814-1826.

In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves discuss a clinical case regarding a patient with Persistent Spinal Pain Syndrome (PSPS). To review, PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease with spinal origin. This disease can be linked to the predisposition of the human spine to develop painful pathology over time. The distribution of the symptoms in PSPS can be axial and/or radicular, and although commonly involves the lumbosacral spine, the cervical, and thoracic spine can also be the site of pathology. Importantly, spinal surgery may or may not have occurred, and may or may not be the primary contributor. Listen as the doctors talk through this clinical scenario of a gentleman in his 50s with PSPS and discuss treatment options including neuromodulation, specifically in this case Differential Target Multiplexed spinal cord stimulation (DTM SCS). DTM SCS targets not only neurons, but also glial cells (all forms of SCS most likely impact glial cells to some degree, however DTM SCS specifically works to optimize the neuromodulation of glial cells). Glial cells include oligodendrocytes, microglia, and astrocytes in the central nervous system; as well as Schwann cells and satellite glial cells in the periphery. All of these cells play critical roles in essential functions which include, but are not limited to regulation of fluid and ion homeostasis, protection of neurons, and creation and maintenance of blood-brain barrier. When glial cells are pathologically, chronically, and abnormally activated they play a critical role in the development and maintenance of chronic pain disease processes. In the setting of abnormal glial cell activity, the most common clinical manifestations for patients include pain sensitivity, fatigue, cognitive disruption, sleep disorders, and mood disorders. For a deeper dive specifically into glial cells, please see our prior conversation (https://anchor.fm/spine/episodes/Glial-cells--glial-cells--glial-cells----The-pain-cascade--modulation--and-chronic-pain-e5fb38) including a discussion with Dr. Ricardo Vallejo (https://anchor.fm/spine/episodes/More-glial-cells---Dr--Ricardo-Vallejo--science-that-matters--and-thinking-beyond-the-neuron-eb4m4i). And please listen to the conversation with Dr. Michael Fishman for a deeper dive on this study (https://anchor.fm/spine/episodes/Profound-Data-with-Dr--Michael-Fishman-elmp3f). This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Fishman M, Cordner H, Justiz R, Provenzano D, Merrell C, Shah B, Naranjo J, Kim P, Calodney A, Carlson J, Bundschu R, Sanapati M, Mangal V, Vallejo R. Twelve-Month results from multicenter, open-label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain. Pain Pract. 2021 Aug 7. 2. Vallejo R, Kelley CA, Gupta A, Smith WJ, Vallejo A, Cedeño DL. Modulation of neuroglial interactions using differential target multiplexed spinal cord stimulation in an animal model of neuropathic pain. Mol Pain. 2020 Jan-Dec;16:1744806920918057. doi: 10.1177/1744806920918057. PMID: 32290778; PMCID: PMC7160773.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss landmark articles regarding the treatment of patients with Persistent Spinal Pain Syndrome (PSPS). PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Please listen to the Back to Basics episode for a full description and discussion of the pathophysiology. Though this is a new term, many studies have looked at the outcomes of interventions such as dorsal column spinal cord stimulation and repeat spine surgery when managing patients who had continued chronic pain after spine surgery. Listen as the doctors dive in and discuss these legendary articles that have transformed the management of patients with PSPS.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98-106. 2. Alf L Nachemson (1993) Evaluation of results in lumbar spine surgery, Acta Orthopaedica Scandinavica, 64:sup251, 130-133. 3. Arts MP, Kols NI, Onderwater SM, Peul WC. Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients. Acta Neurochir 2012;154(7):1213–1217.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves go back to Basics with a twist - the doctors discuss Persistent Spinal Pain Syndrome (PSPS). PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Previously, certain diagnoses were utilized to describe these pathologies including but not limited to Failed Back Surgery Syndrome and Post-laminectomy syndrome.  These terms are not without their limitations: terms such as failed back surgery Syndrome can carry a very negative connotation, and also patients can have the clinical presentation consistent with this diagnosis without having a history of spine surgery (for example a chronic disc herniation can lead to the development of fibrosis around a nerve root ).   The aforementioned group of experts published an article in Pain Medicine in April of 2021 proposing the adoption of PSPS with the goal of continuing to optimize the most accurate diagnosis for all appropriate patients, advancement of research in this field, and communication between healthcare providers.     PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease processes of spinal origin linked to the predisposition of the human spine to develop painful pathology over time.  The distribution of the symptoms in PSPS can be axial and/or radicular, and although commonly involves the lumbosacral spine, the cervical and thoracic spine can be the site of pathology.  Importantly, spinal surgery may or may not have occurred, and may or many not be the primary contributor to the clinical presentation.     Listen as the doctors discuss the article regarding this important new nomenclature, as well as review some important pathophysiology for PSPS including epidural fibrosis and adjacent level syndrome.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Nick Christelis, MD, Brian Simpson, MD, Marc Russo, MD, Michael Stanton-Hicks, MD, Giancarlo Barolat, MD, Simon Thomson, MD, Stephan Schug, MD, Ralf Baron, MD, Eric Buchser, MD, Daniel B Carr, MD, Timothy R Deer, MD, Ivano Dones, MD, Sam Eldabe, MD, Rollin Gallagher, MD, Frank Huygen, MD, David Kloth, MD, Robert Levy, MD, Richard North, MD, Christophe Perruchoud, MD, Erika Petersen, MD, Philippe Rigoard, MD, Konstantin Slavin, MD, Dennis Turk, PhD, Todd Wetzel, MD, John Loeser, MD, Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11, Pain Medicine, Volume 22, Issue 4, April 2021, Pages 807–818. 2. Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011 Apr;12(4):577-606. doi: 10.1111/j.1526-4637.2011.01089.x. Epub 2011 Apr 4. PMID: 21463472. 3. Bosscher, H.A. and Heavner, J.E. (2010), Incidence and Severity of Epidural Fibrosis after Back Surgery: An Endoscopic Study. Pain Practice, 10: 18-24.

 In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves is joined by a very special guest to continue the discussion on Degenerative Cervical Myelopathy (DCM). Dr. Erich Anderer joins the podcast today to give us the surgeon's perspective on DCM. During his day job as the Chief of Neurosurgery at NYU Langone Hospital- Brooklyn, Dr. Anderer does his best to work with patients to develop a treatment plan that doesn't require surgery- incorporating yoga, Pilates, or meditation into someone's care. He has preached this "less is more" philosophy across Instagram, teaching yoga classes, or lecturing at wellness retreats. When not performing surgery on the brain or spine as an assistant professor of neurological surgery, Dr. Anderer is one of the most interesting men in the world - He practices Ashtanga yoga, spends as much time outdoors with his wife and two children as possible, and still has time to: be a founding member of the North Brooklyn Runners; an advisory board member of the Concussion Legacy Foundation; serve on the boards of the NY State Neurosurgical Society, the Japanese Medical Society of America, God's Love We Deliver, and the North Brooklyn Parks Alliance; and play in a band... You can find Dr. Anderer on social platforms under his name: Dr.Erich Anderer. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Degenerative Cervical Myelopathy (DCM).  DCM, previously called cervical spondylotic myelopathy, is defined as neurologic injury to the cervical spinal cord due to various age-related degenerative conditions of the cervical spine resulting in injury to the spinal cord secondary to static compression, and/or dynamic injury due to instability. DCM results in symptoms including loss of hand function / dexterity, imbalance/falls, weakness, numbness, pain, bladder / bowel dysfunction. DCM is a common disease process- it is the most common cause of spinal cord injury in the developed world. Natural history studies of DCM show that for patients with significant cervical stenosis, the risk of development of DCM is 8% at 1 year, and up to 23% at 3-4 year follow up. Dr. Karadimas and his colleagues found that between 20-60% of patients with initially mild DCM will have significant clinical deterioration over time; as measured by functional outcome measures including Timed 10 meter walk, and ADL's score.  This understanding of the typical natural history of DCM highlights the importance of close monitoring of patients with significant cervical stenosis, and prompt surgical referral once DCM is diagnosed.     Listen as the doctors discuss this important topic including the definition, epidemiology, clinical presentation, diagnosis, and management.     This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.     References: 1. Lebl, Darren R. MD; Bono, Christopher M. MD Update on the Diagnosis and Management of Cervical Spondylotic Myelopathy, Journal of the American Academy of Orthopaedic Surgeons: November 2015 - Volume 23 - Issue 11 - p 648-660. 2. Nouri A, Cheng JS, Davies B, Kotter M, Schaller K, Tessitore E. Degenerative Cervical Myelopathy: A Brief Review of Past Perspectives, Present Developments, and Future Directions. J Clin Med. 2020;9(2):535.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of an early 40s female physician who presented with about 1 year of back pain that was progressively impacting her marathon training. Listen as the doctors talk through this case presentation, including the history, physical, workup, conservative management and dive into some of the options they are considering as this case (and the science behind Interventional options) progresses.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Smuck M, Khalil J, Barrette K, Hirsch JA, Kreiner S, Koreckij T, Garfin S, Mekhail N; INTRACEPT Trial Investigators. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 12-month results. Reg Anesth Pain Med. 2021 May 24:rapm-2020-102259. doi: 10.1136/rapm-2020-102259. Epub ahead of print. PMID: 34031220. 2. https://anchor.fm/spine/episodes/Smoking-is-still-the-new-smoking-how-smoking-can-make-chronic-pain-worse-eb8h1b

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves dive deeper into lumbar discogenic pain and discuss a recent publication reviewing the evidence for regenerative therapies in the management of discogenic pain. Regenerative medicine and orthobiologic therapy utilizes the body's own healing factors to treat the underlying pathology. Listen as the doctors talk through this important topic, and dive into the basic science behind regenerative therapies specifically targeting disc degeneration, as well as the clinical evidence that has been presented.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.   Intervertebral Disc Degeneration: The Role and Evidence for Non–Stem-Cell-Based Regenerative Therapies Saarang Singh, MD CANDIDATE, Ankur A. Patel, DO, and Jaspal R. Singh, MD. Int J Spine Surg. 2021 Apr; 15(Suppl 1): 54–67. Published online 2021 Apr 30. doi: 10.14444/8055

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to basics and introduce the topic of lumbar discogenic pain. Lumbar discogenic pain is defined as a painful disease process due to compromise of the lumbar disc and is very common, with most studies documenting that around 40% of low back pain is predominantly due to discogenic pain.  Disc degeneration is part of the natural degenerative cascade of the spine, but can be more advanced and lead to significant symptoms and impairments. Discogenic pain is often characterized by centralized low back pain that tends to be worse with forward flexion (ie bending at the waist) and sitting (especially with vibration like in a car). MR Imaging can show internal disc disruption, annular fissures, and modic changes. Risk factors for disc degeneration and discogenic pain include aging, genetics, obesity, and smoking. Smoking and weight, are modifiable risk factors that should be emphasized and addressed when applicable.     Though the disc itself can be painful, if the disc puts pressure on other structures (like the nerve roots) it can cause different pain patterns. Listen as the doctors talk through this important topic, and dive into the basic science behind disc degeneration, as well as emphasize certain important concepts including but not limited to Modic changes.     This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.     References: 1. Nikolai Bogduk, MD, Charles Aprill, MD, Richard Derby, MD, Lumbar Discogenic Pain: State-of-the-Art Review, Pain Medicine, Volume 14, Issue 6, June 2013, Pages 813–836. 2. Sertac Kirnaz, MD, et al. Pathomechanism and Biomechanics of Degenerative Disc Disease: Features of Healthy and Degenerated Discs. International Journal of Spine Surgery. 2021.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of a relatively young patient with lumbar facetogenic pain in the setting of spondylolisthesis with some level of dynamic instability.   There is strong evidence for the treatment of lumbar facetogenic pain with lumbar medial branch radiofrequency ablation (RFA), including a recent study published in Pain Medicine in 2020 demonstrating sustained benefit after RFA for over 2 years (Conger et al., Pain Medicine. 2020).  However, when the anatomy is considered including the fact that the medial branch targeted with RFA also innervates the multifidus musculature; one may hypothesize that RFA could potentially negatively impact spinal stability.  This negative impact on spine stability would be of particular concern in a young patient with listhesis and dynamic instability. The available published literature investigating this topic has demonstrated that RFA does not result in a significant negative impact on listhesis or instability. As providers considering, ordering, and/or performing these procedures, it is important to be aware of the relevant neuroanatomy and the published research regarding this matter; and importantly to discuss these risks/benefits with the patient.     Listen as the doctors talk through this case, and discuss some of the recent literature including a study out of Emory University School of Medicine investigating RFA’s impact on spondylolisthesis / spinal stability.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.   References: 1. Patel T, Watterson C, McKenzie-Brown AM, Spektor B, Egan K, Boorman D. Lumbar Spondylolisthesis Progression: What is the Effect of Lumbar Medial Branch Nerve Radiofrequency Ablation on Lumbar Spondylolisthesis Progression? A Single-Center, Observational Study. J Pain Res. 2021;14:1193-1200. 2. Conger A, Burnham T, Salazar F, Tate Q, Golish M, Petersen R, Cunningham S, Teramoto M, Kendall R, McCormick ZL. The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks. Pain Med. 2020 May 1;21(5):902-909.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves continue the discussion on lumbar facetogenic pain with a journal club. Lumbar spondylosis with a primary pain generator of facet joint pain is a common pathology that can have a significant negative impact on a patient’s function and health.  There are multiple Interventional treatment options available to address lumbar facetogenic pain including lumbar medial branch blocks, intraarticular facet joint injections, and lumbar medial branch radiofrequency ablation (RFA). There is high quality evidence for the utilization of RFA for axial low back pain due to lumbar facetogenic pain. As with all medical interventions, It is important to continue evaluating patient factors that can alter the expected outcomes.  Listen as the doctors discuss a recent article investigating factors that predict outcome after facet joint treatment. The second article reviewed is one of the landmark studies regarding medial branch blocks prior to RFA. Medial branch blocks are a critical tool in the diagnosis of lumbar facetogenic pain, and are the gold standard diagnostic tool prior to consideration of RFA.       This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.   References: 1. Javed S, Chen J, Huh B. Predictors of response to medial branch block, radiofrequency ablation or facet joint injections: a retrospective study. Pain Manag. 2021 Mar;11(2):145-149. 2. Cohen SP, Moon JY, Brummett CM, White RL, Larkin TM. Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation: A Multicenter, Case-Control Study. Reg Anesth Pain Med. 2015 Jul-Aug;40(4):376-83.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves introduce the topic of pain coming from the lumbar facet joints - specifically when it is related to the general aging and degeneration of the spine (also known as spondylosis). Lumbar facetogenic pain is defined as pain originating from any structure integral to both the function and configuration of the lumbar facet joints including the fibrous capsule, synovial membrane, hyaline cartilage surfaces, and bony articulations.  This disease process is common and estimated to account for about 15% of chronic low back pain.   The facet joints are part of the 3-joint complex of the spine which includes the intervertebral disc and the paired facet joints.  The primary function of the facet joints is a protective role, limiting the movement of the spine in specific planes.  Facet joint pathology is typically due to chronic repetitive strain and low grade trauma that accumulates over time and ultimately leads to chronic inflammation of the joint complex as well as peripheral and central sensitization of the involved nerves (which we have discussed in detail in prior talks - see https://anchor.fm/spine/episodes/Back-to-basics-the-Chronification-of-Pain-eon8fq).   As with many chronic pain disease processes, the accurate diagnosis of this condition involves a detailed history, careful exam, diagnostic imaging, as well as the utilization of diagnostic image guided procedures.     Listen as the doctors discuss the definition, epidemiology, pathophysiology, anatomy, clinical presentation, diagnosis, as well as a brief introduction to the approach to treatment for lumbar facetogenic pain associated with lumbar spondylosis. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007 Mar;106(3):591-614. 2. Cohen SP, Bhaskar A, Bhatia A, et alConsensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working groupRegional Anesthesia & Pain Medicine Published Online First: 03 April 2020.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves wrap up the series on lumbar radiculopathy with a case presentation.   This is a case of a young man who presented with a severe acute on chronic lumbar radiculopathy after the holidays. As he was already managed by our office, he presented very acutely (about 1-2 weeks into his flare). Important concepts that are emphasized with this case are: natural history of lumbar radiculopathy, electrodiagnostic evaluation for lumbar radiculopathy, and a stepwise approach to diagnostic workup and management of a debilitating case of lumbar radiculopathy. Listen in as the docs walk us through this case and their management choices. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.   References: 1. McCormick Z, Cushman D, Caldwell M, Marshall B, Ghannad L, Eng C, Patel J, Makovitch S, Chu SK, Babu AN, Walega DR, Marciniak C, Press J, Kennedy DJ, Plastaras C. Does Electrodiagnostic Confirmation of Radiculopathy Predict Pain Reduction after Transforaminal Epidural Steroid Injection? A Multicenter Study. J Nat Sci. 2015 Aug;1(8):e140.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a recent meta-analysis of transforaminal epidural steroid injections. This continues off of their conversation about lumbar radiculopathy.   Epidural injections to treat pain have been around for over a hundred years. It is one of the most common procedures done to help patients with back and leg pain, both acute and chronic. This meta-analysis from 2021 evaluates the safety of these procedures and looks at the evidence for their use in treating different pathologies of the lumbar spine. Listen as the doctors discuss transforaminal epidural steroid injections to treat disease processes such as lumbar radiculopathy, lumbar stenosis, lumbar discogenic pain and lumbar post laminectomy syndrome, as well as their personal experience treating these patients. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: Helm Ii S, Harmon PC, Noe C, Calodney AK, Abd-Elsayed A, Knezevic NN, Racz GB. Transforaminal Epidural Steroid Injections: A Systematic Review and Meta-Analysis of Efficacy and Safety. Pain Physician. 2021 Jan;24(S1):S209-S232. PMID: 33492919.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review lumbar radiculopathy. Lumbar radiculopathy is a common diagnosis in which there is irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas such as pain, weakness, numbness, and tingling.. Lumbar radiculopathy is typically due to a structural abnormality: specifically disc herniation and/or impingement due to spondylosis. Disc herniation (a rupture in the fibrous outer wall of a lumbar disc allowing the soft nucleus of the disc to bulge outward, which can press against a nerve root) is one of the most common causes of lumbar radiculopathy. Because of how common this pathology is, it is important to understand the usual natural history of radiculopathy due to disc herniation. Acute disc herniations typically improves significantly by 6-12 weeks with conservative treatment, making patient education a key component of helping them through this painful condition. That being said, the differential diagnosis for lumbar radiculopathy is very broad, and as always it is important to consider and rule out more concerning etiologies. Listen as the doctors discuss the definition of lumbar radiculopathy, the differential diagnosis, as well as a more detailed discussion of the natural history of radiculopathy and conclude with a look at the pathophysiology of lumbar radiculopathy. References: 1. Gupta A, Upadhyaya S, Yeung CM, et al. Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment. Global Spine Journal. 2020;10(7):881-887. 2. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA. 2006;296(20):2441–2450. 3. Gugliotta M, da Costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open 2016;6:e012938. 4. Lin JH, Chiang YH, Chen CC. Lumbar radiculopathy and its neurobiological basis. World J Anesthesiol 2014; 3(2): 162-173.

In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves conclude the discussion regarding Myofascial Pain Syndromes through a case presentation. The doctors present a common clinical scenario where myofascial pain is causing significant negative impact on a patient's function, quality of life, and health. In the prior background and journal club episodes, the pathophysiology of myofascial pain was discussed in detail (see https://anchor.fm/spine/episodes/Back-to-Basics-Myofascial-Pain-Syndrome-eq461q and https://anchor.fm/spine/episodes/Journal-Club-Neuroinflammation-in-Myofascial-Pain-Disorders-eqlc5l). This episode’s discussion brings things a little more clinical than the prior two. The doctors present a clinical picture of a young woman with chronic neck pain. Listen as they walk through the process of identifying pathology and initiating a treatment protocol that focuses on physical modalities, topical ointments and trigger point therapy. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Ting et al. Review of Trigger Point Therapy for the Treatment of Myofascial Pain Syndromes. J Anesthesiol & Pain. 2020;1 (3):22-29.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves expand on the recent discussion of myofascial pain and discuss a recently published article that explored neuroinflammation.   In the prior discussion, it was highlighted how prone chronic myofascial pain processes are to the development of central and peripheral sensitization.  This contributes to the debilitating nature and treatment resistance commonly seen in patients with myofascial pain syndromes.   Myofascial pain may not be the primary underlying process for many patients living with chronic pain, but it is very common for many to have a strong component of myofascial pain. For example, fibromyalgia has been demonstrated to have a strong central sensitization mechanism in regards to pathophysiology, however it has been demonstrated through the research that myofascial pain is a significant and important feature of fibromyalgia.   Listen as the doctors discuss the findings of this interesting recent journal article investigating the objective evidence of neuroinflammation in fibromyalgia patients, and explore the implications of the article's results for the approach to chronic pain disease processes with strong myofascial pain components.     This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Seo S, Jung YH, Lee D, Lee WJ, Jang JH, et al. (2021) Abnormal neuroinflammation in fibromyalgia and CRPS using [11C]-(R)-PK11195 PET. PLOS ONE 16(2): e0246152. 2. Younger J, Noor N,McCue R, Mackey S. Low‐dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double‐blind, placebo‐controlled, counterbalanced, crossover trial assessing daily pain. Arthritis & Rheumatism 65 (2), 529-538, 2013

In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves discuss a very underappreciated component of the chronic pain picture- myofascial pain syndrome. Myofascial pain is pain of the muscle and associated connective tissue. It typically presents as regional pain with associated tension, decreased range of motion, and presence of trigger points. This prevalent condition affects about 85% of patients in chronic pain clinics and will affect an estimated 85% of the general population at some point in their lives. Persistent myofascial nociceptive input appears particularly effective at inducing central sensitization. Notably, a 2012 article in The Pain Practitioner suggests that active trigger points are associated with elevated levels of biochemicals that contribute to sensitization. Constant myofascial pain input can result in decreased activation threshold of excitatory CNS nociceptive neurons, apoptosis of inhibitory nociceptive neurons, and an abnormal stress response. Over time, this may lead to muscle disuse, weakness, and dysfunction. Listen as the doctors explore the pathophysiology of myofascial pain and its connection to central and peripheral sensitization. For an in-depth explanation of peripheral and central sensitization, check out our recent episode on pain chronification (https://anchor.fm/spine/episodes/Back-to-basics-the-Chronification-of-Pain-eon8fq). This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. 1. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. VI and VII Baltimore: Williams & Wilkins; 1999. 2. Shah et al. New Frontiers in the Pathophysiology of Myofascial Pain. The Pain Practitioner. 2012.

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas expand on their recent discussion of pain chronification. The doctors discuss a fairly common scenario in which a patient with very chronic pain develops a relatively new pain condition. In this setting, the new onset pain process can be significantly amplified and difficult to treat. Previously, the doctors summarized processes including central and peripheral sensitization, which contribute significantly to the severity and refractory nature of chronic pain conditions. Listen as the doctors review chronification of pain in the context of a patient case example and discuss treatment approaches, particularly optimizing medication management. Chronic pain disease processes are very challenging to diagnose and treat, especially when multiple body parts are involved. However, there are a growing number of tools available to make a positive impact for our patients, and with a carefully crafted treatment plan, progress can be made. Although optimizing patients' health, function, and safety may be a long and winding road, this goal is achievable! This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Borsook D, Youssef AM, Simons L, Elman I, Eccleston C. When pain gets stuck: the evolution of pain chronification and treatment resistance. Pain. 2018;159(12):2421-2436. 2. Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014 Jun;8(2):143-51. 3. Morlion B, Coluzzi F, Aldington D, Kocot-Kepska M, Pergolizzi J, Mangas AC, Ahlbeck K, Kalso E. Pain chronification: what should a non-pain medicine specialist know? Curr Med Res Opin. 2018 Jul;34(7):1169-1178. 4. A Comprehensive Review of the Celiac Plexus Block for the Management of Chronic Abdominal Pain. Current Pain and Headache Reports. 2020. 5. Khanna IK, Pillarisetti S. Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain. J Pain Res. 2015 Dec 4;8:859-70.

In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves build on last week's episode on pain chronification and discuss a promising therapy for chronic axial low back pain: Peripheral Nerve Stimulation (PNS). PNS is an implanted device (in our discussion, a temporary implant for 60 days) that uses therapeutic electrical stimulation to target specific peripheral nerves, such as the medial branch of the dorsal ramus.  PNS has been shown to be effective for the treatment of chronic low back pain and is believed to have a positive impact on the processes of peripheral and central sensitization, which play a major role in pain chronification. Be sure to check out last week's episode on pain chronification for a deeper dive into this important topic (https://anchor.fm/spine/episodes/Back-to-basics-the-Chronification-of-Pain-eon8fq) and our interview with Dr. Ricardo Vallejo discussing the important interaction of glial cells in this process (https://anchor.fm/spine/episodes/More-glial-cells---Dr--Ricardo-Vallejo--science-that-matters--and-thinking-beyond-the-neuron-eb4m4i) PNS is an exciting treatment option for patients with chronic axial low back pain, including patients who continue to have symptoms despite radiofrequency ablation treatment. In this episode the doctors discuss an article published by Dr. Deer and his colleagues demonstrating that PNS, utilized for 6-12 hours per day for 60 days, resulted in significant improvement in pain and function in a group of patients with recurrent axial low back pain after radiofrequency ablation. Listen as the doctors discuss the specifics of PNS as a treatment option for chronic axial low back pain, including theories about its mechanism of action. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.  This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1) Deer et al.  Percutaneous PNS of the Medial Branch Nerves for the Treatment of Chronic Axial Back Pain in Patients following Radiofrequency Ablation. Poster abstract. NANS 2021. 2) Tiffany Lin, MD, Akshat Gargya, MD, Harmandeep Singh, MD, Eellan Sivanesan, MD, Amitabh Gulati, MD, Mechanism of Peripheral Nerve Stimulation in Chronic Pain, Pain Medicine, Volume 21, Issue Supplement_1, August 2020, Pages S6–S12. 3) Vallejo R, Kelley CA, Gupta A, Smith WJ, Vallejo A, Cedeño DL. Modulation of neuroglial interactions using differential target multiplexed spinal cord stimulation in an animal model of neuropathic pain. Mol Pain. 2020 Jan-Dec;16:1744806920918057. 4) Moore et al. Spinal cord stimulation. BJA Education, 16 (8): 258–263 (2016).

 In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to the basics to discuss a fundamental topic: pain chronification. Pain chronification is defined as the process of acute pain progressing into chronic pain. Acute pain is a normal, predicted physiological response to adverse stimuli (chemical, thermal, mechanical) and has a clear protective function. Chronic pain, however, is pain without apparent biological value (not immediately protective) that has persisted beyond the normal tissue healing time (usually about 3 months).  The Change Pain Chronic Advisory Board provides the following definition of pain chronification: “Pain chronification described the process of transient pain progressing to persistent pain; pain processing changes as a result of an imbalance between pain amplification and pain inhibition; genetic, environmental, and biopsychosocial factors determine the risk, degree, and time-course of chronification.” Listen as the doctors go over important definitions, and discuss critical aspects of chronification of pain including peripheral and central sensitization. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References:
1. Borsook D, Youssef AM, Simons L, Elman I, Eccleston C. When pain gets stuck: the evolution of pain chronification and treatment resistance. Pain. 2018;159(12):2421-2436.  2. Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014 Jun;8(2):143-51. 3. Morlion B, Coluzzi F, Aldington D, Kocot-Kepska M, Pergolizzi J, Mangas AC, Ahlbeck K, Kalso E. Pain chronification: what should a non-pain medicine specialist know? Curr Med Res Opin. 2018 Jul;34(7):1169-1178. 4. International Association for the Study of Pain

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a common cause of low back pain, sacroiliac joint (SI) pain. The SI joint is a large complex joint that involves the iliac bone and sacrum. The SI joint is a critical component of the connection between the spine and lower limbs, and one of the primary functions of the SI joint is stability. Chronic SI joint pain is a relatively common cause of low back pain with epidemiologic studies demonstrating that SI joint pain significantly contributes to 10-38% of cases of chronic low back pain. Risk factors for SI joint pain include: leg length discrepancy, gait abnormality, scoliosis, spinal fusion, hip pathology, pregnancy, high force/velocity injury, seronegative HLA-B27 spondyloarthropathies, repetitive shear stress injuries in athletes. The common clinical presentation for SI joint pain includes aching pain below the belt line, with radiating/referred pain to gluteal/buttock region, groin, posterior leg, and less commonly thigh. This pain is often worsened with prolonged sitting, sleeping positions, movement. Physical exam results supportive of a diagnosis of SI joint pain include at least 3 positive tests, with at least one of these tests being thigh thrust or compression test. The 5 recommended provocative maneuvers include: 1) Distraction test 2) thigh thrust test 3) FABERE 4) Compression test 5) Gaenslen's maneuver. A recent expert opinion article titled A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain, works to clarify the approach to diagnosis and treatment of SI joint pain. This review article highlights the importance of optimizing the diagnosis as soon as possible to guide treatment, and image guided injection remains the gold standard for the diagnosis of SI joint pain. Listen as the doctors review SI joint pain, and discuss the algorithm presented in the recent expert opinion review article. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Falowski S, Sayed D, Pope J, Patterson D, Fishman M, Gupta M, Mehta P. A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain. J Pain Res. 2020;13:3337-3348. 2. Wallace P, Bezjian Wallace L, Tamura S, et al. Effectiveness of Ultrasound-Guided Platelet-Rich Plasma Injections in Relieving Sacroiliac Joint Dysfunction. American Journal of Physical Medicine & Rehabilitation. 2020 Aug;99(8):689-693.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss how pain medicine has been affected by COVID-19. This pandemic has caused so much devastation for our patients, including some who directly experienced COVID-19 infection and those who have had to weigh seeking medical care against risking infection. It has also impacted our practice as we work to create a safe environment for patients and accommodate their needs. More and more research is emerging on a persistent syndrome following acute COVID-19 infection. Although we don't understand its entire clinical picture, it appears most patients with post-COVID-19 syndrome (over 50%) have significant fatigue, and a significant percentage of patients (about 20%) have persistent pain. We can anticipate this syndrome presenting a growing challenge to the broader medical community, given both the vast number of COVID-19 patients worldwide and the historical difficulty of treating similar post-viral syndromes. Multiple risk factors associated with acute COVID-19 infection could increase the chance of developing a post-infectious syndrome. For instance, the virus enters cells through the ACE-2 receptor which is present throughout the body, making it possible to spread beyond the respiratory system to the vasculature, neural, and muscle tissues. At the individual and community level, many patients are experiencing isolation, barriers to health care, and worsening of mental health conditions which can exacerbate symptoms such as chronic pain. Listen as the doctors discuss the evidence behind the emerging entity of post-COVID-19 syndrome, as well as the challenges and necessity of delivering multi-disciplinary treatment in this COVID-19 era. As always, we greatly appreciate the effort of all involved in the management of this challenging pandemic, and our thoughts and prayers are with all who have been affected. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: implications for rehabilitation. Br J Anaesth. 2020;125(4):436-440. 2. Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. Journal of Pain and Symptom Management. 2020. 3. Persistent Symptoms in Patients After Acute COVID-19. JAMA. August 2020.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves return to their Bay Area roots and mourn with Dub Nation after a devastating injury to Klay Thompson (shooting guard for the Golden State Warriors).  Klay Thompson sustained a season ending right Achilles’ tendon tear. Thompson suffered the injury during a workout... after a year of rehabbing from an ACL injury to his left knee that occurred during the 2019 NBA Finals.  If anyone can fight their way back through 2 consecutive grueling rehab processes and return to the level of play we expect from a player of Klay Thompson’s magnitude, it is Klay, but even for him this will be an incredible physical and mental challenge.   Tendon injuries are very prevalent with epidemiologic studies finding it to be the 2nd most common musculoskeletal condition to result in pursuit of medical care (behind spine pain). The pathophysiology of acute and chronic tendon injury does differ, with acute tendon injuries have a stronger proportion of extrinsic factors, while chronic tendon injury is driven more by a variety of intrinsic factors as well.  Inherent characteristics of tendons, including but not limited to relatively low metabolic rate and poor vascularization serve to optimize the tendon’s ability to perform their valuable function in the body, but also contribute to the poor healing potential of tendons.     Listen as the doctors discuss the basics of tendon anatomy and function, the pathophysiology of tendon injury, as well as the evidence behind some of the treatment options (including platelet rich plasma).   Lastly, the doctors explain and emphasize their respect and love for Klay Thompson and how he approached the game of basketball.  Whether it is in basketball, medicine, or life, it is always special to witness someone give it their all for what they love, and Klay Thompson always left it all on the floor.  Rest up, and heal up Klay, and we will see you soon for another championship run with the Warriors.   This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.   References: 1. MacLean S, Khan WS, Malik AA, Snow M, Anand S. Tendon Regeneration and Repair with Stem Cells. Stem Cells International. 2012. Article ID 316281. 2. Sharma, P, Maffulli, N. Tendon Injury and Tendinopathy: Healing and Repair. The Journal of Bone and Joint Surgery. 2005; 87:187-202. 3. Keene David J, Alsousou Joseph, Harrison Paul, Hulley Philippa, Wagland Susan, Parsons Scott R et al. Platelet rich plasma injection for acute Achilles tendon rupture: PATH-2 randomised, placebo controlled, superiority trial BMJ 2019; 367 :l6132. 4. Fitzpatrick J, Bulsara M, Zheng MH. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. The American Journal of Sports Medicine. 2017;45(1):226-233.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves highlight a patient centered approach to tapering opioids. Treatment of the chronic pain disease process is challenging, but optimizing patient buy in and creating an active participant in the treatment plan can be very powerful.     In many clinical scenarios the goal of tapering / minimizing opioids is medically appropriate to optimize patient safety and health, as well as improve the patient’s function and pain severity.  The tapering of opioids can be very difficult and challenging for the patient and the healthcare provider for a multitude of reasons.   With an intensive regimented opioid reduction program (although indicated in some scenarios, especially when significant aberrancy is identified) there is some level of concern for potential negative clinical outcomes.  These include, but are not limited to, relatively high rate of relapse to utilization of opioids (up to 30%), as well as concern for increased risk for suicide after the taper (Hazard Ratios as high as 6.77 for patients on long term opioids).  The importance of these statements is absolutely not to suggest that opioids should typically be continued for chronic non-cancer pain, but rather to emphasize that the method utilized to achieve the taper is critical.     Listen as the doctors discuss this difficult medical challenge, including a recent study by Dr. Ziadni and colleagues that demonstrates that a patient centered approach to the opioid taper leads to stable and significant opioid reduction with overall improvement in pain as well.   As stated this emphasizes an overall broader and important concept that the active participation of the patient in the treatment plan can result in improved and more sustainable health benefits.         This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.   References: 1. Ziadni, Maisaa; Chen, Abby L.; Krishnamurthy, Parthasarathy; Flood, Pamela; Stieg, Richard L; Darnall, Beth D. Patient-centered prescription opioid tapering in community outpatients with chronic pain: 2- to 3-year follow-up in a subset of patients, PAIN Reports: September/October 2020 - Volume 5 - Issue 5 - p e851. 2. Huffman KL, Rush TE, Fan Y, Sweis GW, Vij B, Covington EC, Scheman J, Matthews M. Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy. PAIN 2017;18:308–18. 3. Oliva E, Bowe T, Manhapra A, Kertesz S, Hah JM, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon AJ, Trafton JA. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ 2020;368:m283.

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves want to stay pink past October- they are continuing breast cancer awareness month and discussing one of the overlapping diagnoses: Post-Mastectomy Pain Syndrome (PMPS).     Breast cancer is the most frequently diagnosed life threatening cancer in women.  There are many different approaches to the treatment of breast cancer, and surgical resection often plays an important role in the management. One potential complication after surgical resection is chronic pain, specifically referred to as PMPS.  The definition of PMPS according to the International Association for the Study of Pain (IASP) is: persistent pain soon after mastectomy/lumpectomy affecting the anterior thorax, axilla, and/or medial arm; typically described as burning, stabbing, pulling sensation.   PMPS is a growing concern, and epidemiologic studies demonstrate that it can affect 20-68% of breast cancers after surgical intervention.  Risk factors for development of PMPS include: younger age (35 years old or younger), type of surgery (total mastectomy and axillary lymph node dissection having increased risk), prior history of chronic pain.   The treatment of PMPS, similar to other chronic neuropathic disease processes, is challenging.  As always it is important to think about the treatment algorithm: -lifestyle modifications (including diet, exercise, weight optimization (especially considering BMI can be a risk factor for PMPS)) -physical therapy (including desensitization techniques) -medications (including topical medications, and potentially compounded topical meds) -procedures (including the Erector Spinae Block) -minimally invasive surgical techniques (including Peripheral Nerve Stimulation and Dorsal Column Spinal Cord Stimulation) -and stay vigilant for monitoring for recurrence / progression of the cancer itself This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. Neuropathic pain podcast episode: https://anchor.fm/spine/episodes/Narcissistic-nerves---what-exactly-is-peripheral-neuropathy-and-why-you-should-care-e4njhf References: 1. Gong, Youwei MM; Tan, Qixing MD; Qin, Qinghong MD; Wei, Changyuan PhD. Prevalence of postmastectomy pain syndrome and associated risk factors, Medicine: May 15, 2020 - Volume 99 - Issue 20. 2. Mainkar, O., Sollo, C.A., Chen, G., Legler, A. and Gulati, A. (2020), Pilot Study in Temporary Peripheral Nerve Stimulation in Oncologic Pain. Neuromodulation: Technology at the Neural Interface, 23: 819-826.