Podcasts about corticosteroids

Broadcast from KSQD, Santa Cruz on 12-18-2025: Dr. Dawn opens by examining how market competition is actually working in the weight loss drug sector. Novo Nordisk's Ozempic and Wegovy compete against Eli Lilly's Monjaro and ZepBound, with prices dropping nearly 50% as companies launch direct-to-consumer websites. The main barriers remain needles and refrigeration, driving development of oral versions. Novo's Wegovy pill awaits FDA approval for early 2026 launch at $150 monthly. Next-generation drugs show remarkable results: Eli's retatrutide causes 24% weight loss in 48 weeks, while Novo's Cagrisema combines semaglutide with amylin to reduce muscle loss. Pfizer paid $10 billion for Metsera's once-monthly drug despite significant side effects. A quick fiber tip suggests adding plain psyllium to morning coffee for cardiovascular and microbiome benefits. Start with half a teaspoon and work up to two teaspoons (10 grams) over several weeks to avoid gas. The prebiotic fiber improves glucose tolerance and may reduce cancer risk. UC San Diego scientists discovered why cancers mutate so rapidly despite being eukaryotic cells with protected chromosomes. The answer is chromothripsis, a catastrophic event where the enzyme N4BP2 literally explodes chromosomes into fragments. These reassemble incorrectly, generating dozens to hundreds of mutations simultaneously and creating circular DNA fragments carrying cancer-promoting genes. One in four cancers show evidence of this mechanism, with all osteosarcomas and many brain cancers displaying it. This explains why the most aggressive cancers resist treatment. Research from 2013 shows any glucocorticoid use significantly increases venous thromboembolism risk, with threefold increases during the first month of use. The risk applies to new and recurrent clots, affecting both oral and inhaled steroids, though IV poses highest risk and topical the lowest. Joint injections fall somewhere between inhaled and oral. Anyone with prior blood clots should avoid steroids except for life-threatening situations like severe asthma attacks requiring ventilation. A meta-analysis of 20 randomized controlled trials shows creatine supplementation helps older adults (48-84) maintain muscle mass when combined with weight training two to three times weekly. The supplement provides no benefit without exercise. Recommended dosing starts at 2 grams and works up to 5 grams daily. Vegans benefit most since they consume little meat or fish. Important caveat: creatine throws off standard kidney function tests (creatinine), so users should request cystatin C testing instead for accurate renal health assessment. A new JAMA study suggesting risk-based mammogram screening is fatally flawed. First, researchers offered chemopreventative drugs like tamoxifen only to the high-risk group, contaminating the study design. Second, the demographics skewed heavily toward white college-educated women, missing the reality that Black women face twice the risk of aggressive breast cancer with 40% higher mortality. Third, wild-type humans failed to follow instructions—low-risk women continued getting annual mammograms anyway while high-risk women skipped recommended extra screenings. The conclusion of "non-inferior" outcomes is meaningless given poor adherence. Stick with annual mammograms, and consider alternating with MRIs for high-risk women. The EAT-Lancet report condemns red meat based purely on observational data showing correlations with heart disease, cancer, and mortality. But people who eat lots of red meat differ dramatically from low consumers: they weigh more, smoke more, exercise less, and eat less fiber. Studies can't control for sleep quality, depression, or screen time. Notably, heavy meat eaters also die more in accidents, suggesting a risk-taking lifestyle phenotype. The inflammatory marker TMAO is higher in meat eaters, but starch is also pro-inflammatory. Eating red meat instead of instant ramen might improve health. A balanced diet with limited amounts beats epidemiology-based blanket statements. Dr. Dawn grades Dr. Oz's performance as CMS administrator. Starting at minus one for zero relevant experience, he earns plus two for promoting diet, exercise, and gut health on his show. He studied intensively after nomination, calling all four previous CMS directors repeatedly and surrounding himself with experienced staff (plus one). He finalized Medicare rules favoring prevention over surgery and earned bipartisan praise as "a real scientist, not radical" (plus one). He divested healthcare holdings but kept some blind trust interests (minus 0.5). He's developing a CMS app and partnering with Google on a digital health ecosystem (plus one), but supports ending ACA subsidies that will raise premiums for millions (minus one). He correctly promoted COVID vaccines and contradicted Trump's Tylenol-autism claims (plus one). Final score: 3.5 out of 5 possible points, the only positive score for any Trump health administrator.

We talked with, Dr Eleni Yiasemides (board-certified consultant Dermatologist specialist from Sydney) about *Inappropriate indications for topical corticosteroids (cortisones) like perioral dermatitis when less is usually more *The verdict on combination products corticosteroids + anti fungal creams and when to use them *Busting myths on topical corticosteroids like "apply sparingly" *The issue of tachyphylaxis *Practice points about alcohol based treatments, preservatives and fragrance *Alternative topical therapy other than corticosteroids *Best practice for managing skin health (moisture, hydration and occlusion) alongside medicated treatment like corticosteroids   Read further Perioral dermatitis https://dermnetnz.org/topics/periorificial-dermatitis RACGP  https://www1.racgp.org.au/ajgp/2021/september/selection-of-a-corticosteroid The Australasian College of Dermatologists https://www.dermcoll.edu.au/wp-content/uploads/2024/04/ACD-Fact-Sheet-Topical-corticosteroids-and-eczema-April-2024.pdf

Lessons learned from a challenging lived experience is a terrible thing to waste…which is why we would NEVER do so! In this episode of the JDD Podcast's Steroid Stewardship Series,... The post From Crushing Childhood Challenges to Champion of Corticosteroid Stewardship: An Eczema Patient's Perspective appeared first on JDDonline - Journal of Drugs in Dermatology.

Program notes:0:35 Update on RSV, flu and COVID-19 vaccines1:35 500 studies included2:35 Rare myocarditis3:35 Flu vaccine in older adults4:30 Tai chi or CBT-I for chronic insomnia5:30 Trained in one or the other6:30 Inexpensive and accessible7:30 $150 billion cost of chronic insomnia7:45 GLP-1s and WHO guidance8:50 Multimodal approach required9:45 Prevention is important9:55 Corticosteroids in pregnancy10:50 1.3 million pregnancies11:50 Used for multiple indications12:46 End

Corticosteroids have been the effective, accessible, and familiar backbone of dermatologic therapy for decades. But with great power comes great responsibility. In this episode, podcast host Dr. Adam Friedman, Professor... The post Steer-oid Stewardship: Reining In and Reinforcing the Guardrails on Dermatology's Workhorse appeared first on JDDonline - Journal of Drugs in Dermatology.

Too busy to read the Lens? Listen to our weekly summary here! In this week's episode we discuss…Corticosteroids and DMARDs together were found to be superior to corticosteroids alone in treating non-anterior sarcoid uveitis. Thousands of Americans have come to the ED over the past few years for pickleball-related ocular traumas, suggesting eye protection could be beneficial in this sport. Glaucoma is associated with sleep-wake and Circadian rhythm disorders, likely secondary to damage to the RGCs and optic nerve causing irregular regulation of sleep-wake physiology.Novel statin nanoparticles injected intravenously can preserve and even double cone photoreceptors in retinitis pigmentosa mouse models by reducing inflammation.

We have so many wonderful non-steroid options to manage itch and inflammation in veterinary dermatology. HOWEVER, there is still a time and place that steroids are necessary. It is important to not be afraid of steroids, but now when and how to use them appropriately.From stenotic ears to cost concerns, check out the situations where, even as a boarded dermatologist, I lean on steroids on this week's episode of The Derm Vet podcast!00:00 Intro01:00 Taking away guilt for steroid use02:04 Scenarios where steroid use is considered03:07 Severe Inflammation05:05 While waiting for a slower medication to work07:27 Stenotic Ears9:11 Management of autoimmune diseases11:14 Cost Concerns13:10 Sometimes nothing else works14:56 Summary/Outro

In the second deep dive of the series, Susanna Esposito discusses the latest guidelines for diagnosing and treating bacterial meningitis in children. She highlights balancing urgent empirical therapy with stewardship principles, appropriate use of corticosteroids, emerging resistance patterns, and how hospitals can leverage local data to optimise antibiotic prescribing. Timestamps: 00:00 – Introduction 00:53 – Tackling meningitis 02:42 – Corticosteroid use 03:37 – Access, Watch, and Reserve (AWaRe) classification 05:49 – Resistance patterns 06:51 – Point prevalence surveys

How can targeted treatments address persistent airway obstruction, small airway disease, and mucus plugs? Credit available for this activity expires: 10/14/26 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/beyond-inhaled-corticosteroid-plateau-targeted-strategies-2025a1000r55?ecd=bdc_podcast_libsyn_mscpedu

Episode 25:41 The (Natural) Autoimmune Solution It is estimated that nearly 50 million Americans suffer with an autoimmune disorder. Conditions such as Hashimoto's, Crohn's, Ulcerative Colitis, Multiple Sclerosis, Type 1 Diabetes, Rheumatoid Arthritis, Psoriasis and Vitiligo.  The cause, according to the medical profession, is unknown. I don't believe that. The treatment, according to the medical profession, focuses on drugs. Drugs such as Immunosuppressants, Anti-Inflammatories, Corticosteroids, and Pain killers. I don't agree with that. The mechanism of action is that the Immune System starts attacking healthy cells. I don't think that's correct. So, what do I think? THAT is what this episode is all about. The cause, treatment and mechanism of action regarding autoimmune disorders. It's an episode that will certainly ruffle some feathers while also shedding some light on an interesting subject. Be sure to give it a good listen… especially if you, or someone you know, suffers with an autoimmune disorder.  And, as always, please share it with a friend.  Thanks!  ———————- Want to learn more? Continue the conversation regarding this episode, and all future episodes, by signing up for our daily emails. Simply visit: GetHealthyAlabama.com  Once there, download the “Symptom Survey” and you will automatically added to our email list. ———————- Also, if you haven't already, we'd appreciate it if you'd subscribe to the podcast, leave a comment and give us a rating. (Thanks!!!)                

 * This podcast is for informational and educational purposes only. It is not intended to diagnose or treat any disease. Please consult with your health care provider before making any health-related changes.

Steven Shein, MD, FCCM, is the Chief of Pediatric Critical Care at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, Ohio, and holds the Linsalata Family Distinguished Chair in Pediatric Critical Care and Emergency Medicine. He is also the Co-Director of the PICU Clinical, Basic & Translational Research Program and an Associate Director of the Pediatric Critical Care Medicine Fellowship program. His research focuses on critical bronchiolitis and long-term neuro-cognitive morbidity after critical illness. Jatinder Dhami, MD, is a Pediatric Intensivist at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, Ohio. She completed her pediatrics residency at Penn State in Hershey, PA, and her PICU fellowship at Riley Children's Hospital in Indianapolis, Indiana. She is interested in clinical ethics in pediatric critical illness.Learning Objective:By the end of this podcast, listeners should be able to discuss an evidence-based and expert-guided approach to managing critical bronchiolitis.References:Managing Critical Bronchiolitis David G. Speicher, MD; and Steven L. Shein, MD, FCCMZurca et al. Management of Critical Bronchiolitis. Hosp Pediatr. 2023Plint et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009.Schramm et al. Clinical Examination Does Not Predict Response to Albuterol in Ventilated Infants With Bronchiolitis. Pediatr Crit Care Med. 2017Shein at al. Antibiotic Prescription in Young Children With Respiratory Syncytial Virus-Associated Respiratory Failure and Associated Outcomes. Pediatr Crit Care Med. 2019.Gelbart et al. Pragmatic Randomized Trial of Corticosteroids and Inhaled Epinephrine for Bronchiolitis in Children in Intensive Care. J Pediatr. 2022.Shein et al. Derivation and Validation of an Objective Effort of Breathing Score in Critically Ill Children. Pediatr Crit Care Med. 2019.Shein SL, Rotta AT. Long-term NeurocognitQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Send us a textAntenatal Corticosteroid in Twin-Pregnant Women at Risk of Late Preterm Delivery: A Randomized Clinical Trial.Lee SM, Park HS, Choi SR, Lee J, Kim HJ, Park JY, Oh KJ, Cho GJ, Oh MJ, Chung JH, Kim SM, Kim BJ, Kim SY, Hong S, Jung YM, Lee SJ, Seong JS, Kim H, Oh S, Lee J, Jin YR, Kim JH, Cho HY, Park CW, Park JS, Jun JK.JAMA Pediatr. 2025 Sep 22:e253284. doi: 10.1001/jamapediatrics.2025.3284. Online ahead of print.PMID: 40982289Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on IL-1 Pathway Inhibition in Recurrent Pericarditis Management: Real-World Adoption of Corticosteroid Sparing in RESONANCE.

Drs. Whitney Hartlage (@whithartlage11) and Sam Windham join Dr. Ryan Moenster to discuss updates in the diagnosis and management of community-acquire pneumonia. Hear from our guests on the role of rapid diagnostic tests such as multiplex PCR and urinary antigen tests in the inpatient and outpatient setting, considerations for initiating steroids and withholding macrolides, and when to use short antibiotic durations. Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/. Visit our website! https://breakpoints-sidp.org/ References: Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, Carcillo JA, Correa R, Drover K, Esper AM, Gershengorn HB, Hammond NE, Jayaprakash N, Menon K, Nazer L, Pitre T, Qasim ZA, Russell JA, Santos AP, Sarwal A, Spencer-Segal J, Tilouche N, Annane D, Pastores SM. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492. Odeyemi Y, Tekin A, Schanz C, Schreier D, Cole K, Gajic O, Barreto E. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clin Infect Dis. 2025 May 16:ciaf252. doi: 10.1093/cid/ciaf252. Epub ahead of print. PMID: 40378193. Butler AM, Nickel KB, Olsen MA, Sahrmann JM, Colvin R, Neuner E, O'Neil CA, Fraser VJ, Durkin MJ. Comparative safety of different antibiotic regimens for the treatment of outpatient community-acquired pneumonia among otherwise healthy adults. Clin Infect Dis. 2024 Oct 23:ciae519. doi: 10.1093/cid/ciae519. Epub ahead of print. PMID: 39442057; PMCID: PMC12355227. Furukawa Y, Luo Y, Funada S, Onishi A, Ostinelli E, Hamza T, Furukawa TA, Kataoka Y. Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis. BMJ Open. 2023 Mar 22;13(3):e061023. doi: 10.1136/bmjopen-2022-061023. PMID: 36948555; PMCID: PMC10040075 Schober T, Wong K, DeLisle G, et al. Clinical outcomes of rapid respiratory virus testing in emergency departments. JAMA Intern Med. 2024;184(5):528-536. Clark T, Lindsley K, Wigmosta T, et al. Rapid multiplex PCR for respiratory viruses reduces time to result and improves clinical care: results of a systematic review and meta-analysis. J Infect. 2023;86(5):462-475. May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at David Medical Center. J Clin Virol. 2023:168:105597. Cartuliares MB, Rosenvinge FS, Mogensen CB, Skovsted TA, Andersen SL, Østergaard C, et al. Evaluation of point-of-care multiplex polymerase chain reaction in guiding antibiotic treatment of patients acutely admitted with suspected community-acquired pneumonia in Denmark: a multicentre randomised controlled trial. PLoS Med. 2023;20:e1004314. doi: 10.1371/ journal.pmed.1004314. Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-acquired pneumonia: a review. JAMA. 2024;332(15):1282-1295. Davis MR, McCreary EK, Trzebucki AM. Things we do for no reason – ordering Streptococcus pneumoniae urinary antigen in patients with community-acquired pneumonia. Open Forum Infect Dis. 2024;11(3):ofae089. Centers for Disease Control and Prevention. Laboratory Testing for Legionella. Updated June 9, 2025. Accessed July 13, 2025. https://www.cdc.gov/legionella/php/laboratories/index.html. Jain S, Self WH, Wunderink RG. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-427. Kamat IS, Ramachandram V, Eswaran H, Guffey D, Musher DM. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis. 2020;70(3):538-542. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single blinded intervention trial. Lancet. 2004;363:600–7. doi: 10.1016/S0140- 6736(04)15591-8. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302:1059–66. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalci- € tonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Datab System Rev. 2017;10(10):CD007498. doi: 10.1002/14651858. cd007498.pub2. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-guided use of antibiotics for lower Respiratory tract infection. New Engl J Med. 2018;379:236–49. doi: 10.1056/NEJMoa1802670. Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med. 2023;389(19):1623-1634. doi:10.1056/NEJMoa2215145. Gupta AB, Flanders SA, Petty LA, et al. Inappropriate diagnosis of pneumonia among hospitalized adults. JAMA Intern Med. 2024;184(5):548-556. Jones BE, Chapman AB, Ying J, et al. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: A National Cohort Study of 115 U.S. Veterans Affairs Hospitals. Ann Intern Med. 2024;177(9):1179-1189. doi:10.7326/M23-2505. Hartlage W, Imlay H, Spivak ES. The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e214. doi:10.1017/ash.2024.453. Dinh A, Barbier F, Bedos JP, et al. Update of guidelines for management of community acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF). Endorsed by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF); endorsed by the French Intensive Care Society (SRLF), the French Microbiology Society (SFM), the French Radiology Society (SFR), and the French Emergency Society (SFMU). Respir Med and Res. 2025. El Moussaoui R, de Borgie CAJM, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355. Dinh A, Ropers J, Duran C, et al. Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia: a randomized, non-inferiority trial. Lancet. 2021;397(10280):1195-1203.

In this episode of Healthful Woman, Dr. Nathan Fox and Dr. Celia Muoser discuss antenatal corticosteroids, which are short courses of steroids given to pregnant women at risk of preterm delivery to help accelerate the baby's lung development and improve outcomes. They explain why timing and patient selection are crucial for physicians in maximizing benefits while minimizing risks.

In this Healthed lecture, Dr Andrew Scroop explains why oral corticosteroid stewardship in asthma is important. He will also outline, in practical terms, how this can be done by preventing acute exacerbations, ensuring better overall asthma control and, in severe cases, looking at alternatives to oral corticosteroid maintenance therapy such as biologics. See omnystudio.com/listener for privacy information.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Jo Cheah chats to dermatologist Jonathan Chan about the latest therapies for psoriasis. Jonathan outlines the different treatments for mild to moderate and moderate to severe psoriasis, and when to refer patients to a non-GP specialist. They discuss the benefits and risks associated with biologic medicines for psoriasis, and considerations for patients with comorbidities. Read the full article by Jonathan in Australian Prescriber.

Story at-a-glance Corticosteroids shut down natural cortisol production; even short-term use as brief as 14 days suppresses adrenal function, creating dangerous dependency on synthetic hormones A European study reveals widespread risk; over 500,000 patients showed six times higher adrenal insufficiency rates with oral steroids; even "safe" inhaled versions increased risk by 55% Sudden steroid withdrawal triggers emergency situations requiring immediate medical care due to collapsed fluid and electrolyte balance Nearly half (48.7%) of oral steroid patients develop adrenal suppression, yet most aren't warned about or tested for this serious condition Recovery requires metabolic repair; focus on reducing inflammation, fixing insulin resistance, optimizing sleep cycles and supporting natural cortisol rhythms rather than more medications

Story at-a-glance Spinal pain affects millions despite over $134 billion spent annually in the USA alone, with most patients remaining stuck in chronic pain cycles due to treatments that address symptoms rather than root causes Common pain generators are frequently missed, including weak ligaments, tight muscles, structural misalignments, trapped emotions, and inflammatory conditions — leaving patients to cycle through increasingly dangerous interventions without addressing underlying issues Conventional medications create more problems than they solve — NSAIDs are the leading cause of drug-related hospital admissions, Tylenol causes 56,000 ER visits annually from toxicity, and Gabapentin provides minimal benefit while causing cognitive effects such as drowsiness Corticosteroids, despite being "wonder drugs," cause devastating long-term damage, including 5% to 15% yearly bone loss, 70% weight gain rates, and dramatic increases in heart attacks (226%), heart failure (272%), and strokes (73%) Spinal surgeries remain highly profitable but questionable in effectiveness, with significant risks that patients often don't learn about until after complications occur, and no ability to "undo" surgical damage

Have a red, painful eye that's sensitive to light? Could be uveitis. Hear ophthalmologist Dr. Timothy Janetos discuss uveitis and how it relates to psoriasis and psoriatic arthritis. Join host Takieyah Mathis for an eye opening discussion about uveitis, cataracts, and eye health with ophthalmologist Dr. Timonthy Janetos from Northwestern Medicine, Department of Ophthalmology. Listen as they discuss what is uveitis and cataracts from key symptoms, the significance of the HLA-B27 marker, diagnosis, to treatment options that help reduce inflammation and preserve long term vision. This episode offers information to help you advocate for your eye health by recognizing when you need help from an ophthalmologist and what actions you can take to reduce your risks associated with uveitis. Timestamps: ·       (0:00)          Intro to Psound Bytes & guest welcome ophthalmologist                      Dr. Timothy Milton Janetos. ·       (1:21)          Definition of uveitis and the relationship to psoriatic                            disease. ·       (5:35)          Symptoms of uveitis. ·       (7:45)          How uveitis is diagnosed. ·       (9:24)          Treatment options for uveitis. ·       (13:11)       What happens if eye injections are needed as treatment. ·       (14:47)        Association between inflammation, psoriatic disease,                           and cataracts. ·       (15:48)        Symptoms of a cataract. ·       (16:33)        Treatment for cataracts. ·       (21:11)        New advancements in treating uveitis and cataracts. ·       (25:50)        General eye health actions to help reduce risks                                       associated with inflammation. Early detection is key. 4 Key Takeaways: ·       Uveitis is a huge spectrum of different diseases with about half of the associations due to chronic, immune related diseases like psoriasis or psoriatic arthritis.   ·       If you wake up with a red, painful eye that's sensitive to light, seek help from an ophthalmologist right away to minimize risk of scar tissue formation. ·       Work with a health care team to treat all aspects of psoriatic disease to reduce inflammation whether it's in the skin, joints, and/or the eye. ·       Lifestyle changes such as stop smoking and yearly eye exams are actions that can help reduce inflammatory factors and maintain overall eye health. Guest Bio: Dr. Timothy Milton Janetos is a board-certified and nationally recognized ophthalmologist with Northwestern Medicine, Department of Ophthalmology who specializes in uveitis and cataract surgery.  He is also an Assistant Professor at the Feinberg School of Medicine, Department of Ophthalmology. Dr. Janetos offers comprehensive care using a personalized treatment plan for both children and adults with intraocular inflammation and infections. He is a professional member of the American Uveitis Society (AUS) and the Association for Research in Vision and Ophthalmology (ARVO), as well as the Editor for Frontiers in Ophthalmology and an Editorial Board Member for Annals of Eye Science. Resources: Ø  Psoriatic Arthritis and Uveitis: What's it All About? Podcast with rheumatologist and ophthalmologist Dr. James Rosenbaum. (Released in 2019.)   https://www.psoriasis.org/watch-and-listen/psoriatic-arthritis-and-uveitis-whats-it-all-about-psa/   Ø  Eye Inflammation and Psoriatic Arthritis         https://www.psoriasis.org/advance/eye-inflammation-and- psoriatic-arthritis/  

Listen as Michael S. Blaiss, MD provides case-based perspectives on chronic cough recognition, burden, management, and pathophysiology and describes the evolving treatment landscape for refractory chronic cough.PresenterMichael S. Blaiss, MDClinical Professor of PediatricsDivision of Allergy-ImmunologyMedical College of Georgia at Augusta UniversityAugusta, GeorgiaLink to full program: https://bit.ly/4kweynG

Story at-a-glance Corticosteroids are widely used in medicine, but their safety has long been questioned, with more and more dangers being discovered Understanding the effects of the body's natural corticosteroids explains many of the common side effects from synthetic steroids like diabetes, fractures, and tissue loss Steroids exemplify a common criticism of modern medicine — treating symptoms rather than addressing the root cause can lead to far more severe chronic health issues While they are frequently misused, in some cases, steroids can also be lifesaving, hence requiring knowledge of their appropriate uses Superior natural and conventional alternatives to steroid therapy now exist, reducing the justification for using these unsafe drugs

This episode doesn't sugarcoat the truth about tricky diabetes management! Wrangle wild blood sugars among older adults, pregnant individuals, and those taking corticosteroids! Join our Kashlak resident endocrinologist Dr. Jeff Colburn, as we dive into diabetic dilemmas. We will help you dodge dangerous lows and navigate tricky treatment traps in these special populations. Get the un-sugar-coated truth on managing complex diabetes cases!  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Diabetes in Older Adults (Geriatrics) General Approach Risks of Hypoglycemia 4Ms Framework Insulin Management Oral Medications Diabetes in Pregnancy Preconception Counseling Eye Health Monitoring Insulin Therapy During Pregnancy Postpartum Care Steroid-Induced Hyperglycemia General Approach Postprandial Insulin Adjustment NPH Insulin Usage Initiating Insulin Role of GLP-1RA and SGLT2-inhibitors Take-home Points Outro Credits Producer, Writer, and Show Notes: Isabel Valdez, PA-C Infographic and Cover Art: Zoya Surani, BA, MS Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Jeff Colburn, MD Disclosures Dr. Jeff Colburn reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Sponsor: Continuing Education Company Special offer for Curbsiders listeners: Save30%on all online courses and live webcasts with promocodeCURB30. Visit www.CMEmeeting.org/curbsiders to explore all offerings and claim your discount.  Sponsor: Freed Visit Freed.ai and Usecode: CURB50 to get $50 off your first month when you subscribe.  Sponsor: Quince Go to Quince.com/curb for free shipping on your order and 365 day returns.

What do you do when most trials suggest benefit for an intervention, but then a new trial suggests harm? We thought steroids in pneumonia was a settled question, but REMAP-CAP had other plans!We also review a new RCT for BP targets in patients with hypertension and diabetes, a new aldosterone synthase inhibitor for hypertension, and reduced dose apixaban for cancer-associated thrombosis. Hydrocortisone for Severe CAP (REMAP-CAP)Predicting Benefit of Corticosteroids in PneumoniaIntensive BP Control in Patients with Diabetes (BPROAD)Lorundrostat for Uncontrolled Hypertension (ADVANCE-HTN)Reduced Dose Apixaban for Cancer Associated Thrombosis (API-CAT)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

Chapters 00:00 Introduction to Rotator Cuff Tendinopathy 03:13 Understanding Shoulder Pain and Its Complexities 06:04 The Shift from Impingement to Rotator Cuff Related Pain 09:00 The Role of Imaging in Shoulder Pain Diagnosis 11:58 Common Mismanagement in Shoulder Pain Treatment 15:10 Loading Programs for Rotator Cuff Rehabilitation 18:04 Positional vs. Energy Storage Tendons 20:59 The Nature of Rotator Cuff Tears 24:07 The Tipping Point to Pain in Rotator Cuff Pathology 32:53 Understanding Rotator Cuff Tears 39:26 The Role of Exercise in Recovery 46:47 Pain Management and Rehabilitation Strategies 55:19 Exploring the Mechanisms of Tendon Pain 01:00:18 The Importance of Tendon Stiffness   Takeaways Rotator cuff related shoulder pain accounts for 70-80% of shoulder pain presentations. Pain is complex and multifactorial, making diagnosis challenging. The traditional impingement model is being challenged in favor of a broader understanding of shoulder pain. Imaging often does not influence management decisions for rotator cuff issues. Corticosteroid injections provide only short-term relief and can have negative effects on tendon quality. Exercise-based management is crucial for effective rehabilitation of shoulder pain. The rotator cuff tendons are positional and strain less than energy storage tendons. Rotator cuff tears are common and can exist without pain or dysfunction. Age is the biggest risk factor for developing rotator cuff pathology. Understanding the tipping point to pain is essential for effective treatment. Rotator cuff tears are often associated with poor vascular supply and degeneration over time. Metabolic factors like diabetes and smoking can increase the risk of rotator cuff tears. Exercise can be as effective as surgery for massive rotator cuff tears. Expectations of recovery significantly influence rehabilitation outcomes. Education about the commonality of tendon tears can help reduce patient anxiety. Pain during exercise can be tolerated up to a certain level without adverse effects. Sleeping positions can impact shoulder pain and should be modified accordingly. Adjunct treatments like shockwave therapy and corticosteroids have limited long-term benefits. Tendon stiffness is important for efficient force transfer, but its role in pain management is still being studied. Understanding the psychological aspects of pain can enhance recovery from tendon injuries. Website: https://www.shoulderphysio.com Twitter: https://x.com/JaredPowell12 Instagram: https://www.instagram.com/shoulder_physio/?hl=en Notes: https://jackedathlete.com/podcast-140-rotator-cuff-tendons-with-jared-powell/

Send us a textShort Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants.Chawla S, Wyckoff MH, Lakshminrusimha S, Rysavy MA, Patel RM, Chowdhury D, Das A, Greenberg RG, Natarajan G, Shankaran S, Bell EF, Ambalavanan N, Younge NE, Laptook AR, Pavlek LR, Backes CH, Van Meurs KP, Werner EF, Carlo WA; National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN).JAMA Netw Open. 2025 Feb 3;8(2):e2461312. doi: 10.1001/jamanetworkopen.2024.61312.PMID: 39982720 Free PMC article.As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Ever wonder if the “asthma shot” from the ER, or those go-to steroid pills for your asthma flares, might be doing more harm than good? Dr. Dipa Sheth joins us to discuss the common pitfalls of relying too heavily on oral corticosteroids (OCS), also known as oral steroids. We unpack why these systemic medications should generally be reserved for short-term use. She also shares how improving asthma control can help you avoid frequent steroid use in the first place. Although oral steroids can effectively treat asthma flare-ups in emergency settings, overuse poses significant risks, from adrenal insufficiency to osteoporosis. We dig into ways patients can proactively manage their asthma, reduce ER visits, and talk to healthcare providers about preventive treatments (like inhalers or biologics for asthma) that keep inflammation in check without the side effects of frequent steroid use. Note: Although we discuss oral corticoid steroids, they can also be given as injections or via IV drip for asthma. We would also like to refer to them as systemic steroids as they impact the entire body, unlike inhaled steroids, which target the airways and lungs.  What we cover in our episode about oral steroid overuse Understanding Oral Corticosteroids (OCS): Learn what these steroids (often called the “asthma shot” in the ER) are and how they can help with severe flare-ups. Why Overusing Steroids Can Be Risky: Discover the potential long-term side effects of relying on systemic steroids (pills, injections, or IV), from adrenal insufficiency and osteoporosis to more frequent infections. Short-Term Fix vs. Lasting Relief for Asthma Care: Learn how urgent care or ER visits may mask an under-managed condition and why seeing a specialist can improve asthma control. Safer Alternatives to OCS: Explore inhaled corticosteroids, biologics, and other preventive treatments that target asthma at its source, reducing the need for frequent steroids. Taking Control and Reducing ER Visits: Get practical strategies for working with your healthcare provider to minimize steroid use, prevent flare-ups, and break free from the cycle of repeated steroid courses. This podcast is made in partnership with The Allergy & Asthma Network. Thanks to Sanofi and Regeneron for sponsoring today's episode. This podcast is for informational purposes only and does not substitute for professional medical advice. If you have any medical concerns, always consult with your healthcare provider.

If your knee osteoarthritis is bothering you, you may be considering a corticosteroid injection to deal with the pain. But did you know that an arthrosamid injection might actually be better for you? MSK Doctors explains why in their guide. Learn more at https://mskdoctors.com/doctors/charlotte-barker/articles/arthrosamid-versus-traditional-osteoarthritis-treatments-a-patients-guide MSK Doctors City: Sleaford Address: MSK House London Road Website: https://www.mskdoctors.com

In this episode with Dr Sharon Chan-Braddock, we dive deep into corticosteroid injections. We discuss: How corticosteroid injections workHow long corticosteroid injections lastHow has has the use of corticosteroid injections changed over timeUse of local anesthetics with corticosteriod useWhen we should be using corticosteroid injectionsRepeated corticosteroid injectionsDr Sharon Chan-Braddock is a highly experienced Musculoskeletal Medicine clinical academic and Advanced Practice physiotherapist, with many years of diverse experience of MSK across clinical, academic, education and quality agenda areas regionally and nationally. In 2024, Sharon became the first physiotherapist in the UK, and internationally, to gain dual SOMM Fellowship and MACP Membership, which is a recognition of meeting consultant level of practice and International MSK standards of practice set by IFOMPT.If you like the podcast, it would mean the world if you're happy to leave us a rating or a review. It really helps!Our host is @James_Armstrong_Physio

Join our Math Clinic Event on January 20-22 to sharpen your skills in dosage calculations, conversions, and everything you need for nursing success! Don't wait—sign up now at ReMarNurse.com/Clinic   Professor Regina talks about the NCLEX safety points of Corticosteroids Dive into the world of corticosteroids in this informative video! Learn about what corticosteroids are, their pharmacodynamics, and how they act on the body to reduce inflammation and modulate the immune response. We'll discuss common indications for their use, including allergies, asthma, and autoimmune disorders, as well as the various routes of administration, from oral to injectable forms. Understand the potential side effects and complications, such as weight gain, mood changes, and increased infection risk. We'll also cover essential precautions to keep in mind and the critical nursing interventions required for safe corticosteroid therapy. Don't forget to like, comment, and subscribe for more informative content on nursing and healthcare topics. Download the ReMar V2 App: ►For iOS: https://apps.apple.com/us/app/remar-v... ►For Android: https://play.google.com/store/apps/de... ► Find JOBS: http://ReMarNurse.com/jobs ► NCLEX for Africa - http://ReMarNurse.com/KENYA ► Get NCLEX V2: http://www.ReMarNurse.com ► Join the 30-day Challenge - http://ReMarNurse.com/30DAYS

The Cochrane Heart Group's reviews cover a very wide range of topics, including several relevant to cardiac surgery. In March 2024, their review of using prophylactic corticosteroids for cardiopulmonary bypass was updated. In this podcast, Carla Lucarelli from Imperial College London speaks with new lead author, Riccardo Abbasciano from the University of Leicester in the UK about this latest version of the review.

The Cochrane Heart Group's reviews cover a very wide range of topics, including several relevant to cardiac surgery. In March 2024, their review of using prophylactic corticosteroids for cardiopulmonary bypass was updated. In this podcast, Carla Lucarelli from Imperial College London speaks with new lead author, Riccardo Abbasciano from the University of Leicester in the UK about this latest version of the review.

Part 2 of Eoin's chat with Malala De La Pava (@malaladelapava).Malala was diagnosed with Type 1 Diabetes at the age of 8 when she was in Venezuela, before she moved to Toronto, Canada with her family.Malala speaks about the different experiences she had with her management in Venezuela, compared to in Toronto.When the Covid pandemic started in 2020, she was diagnosed with APS-2 (Autoimmune Polyendocrine Syndrome Type 2) and Addison's disease. This completely changed her life as she now relied on Corticosteroids.This condition is not particularly well known or researched, which led to a lot of uncertainty for Malala. Much of which was learning how Corticosteroids affect her blood sugar levels, and how low cortisol levels can cause extremely low blood sugar levels.Hear more about Malala's story and experience in her blog: https://www.pumpingthecure.ca/APS-2, or Autoimmune Polyendocrine Syndrome Type 2, is a rare autoimmune disorder in which the immune system mistakenly attacks multiple endocrine glands, leading to deficiencies in the hormones produced by these glands.It is characterised by the presence of at least two or more endocrine gland dysfunctions, with the most common combination involving:1. Addison's Disease (Primary Adrenal Insufficiency).2. Hashimoto's Disease (Autoimmune Thyroid Disease).As always, be sure to rate, comment, subscribe and share. Your interaction and feedback really helps the podcast. The more Diabetics that we reach, the bigger impact we can make!Questions & Stories for the Podcast?:theinsuleoinpodcast@gmail.comConnect, Learn & Work with Eoin:https://linktr.ee/insuleoin Hosted on Acast. See acast.com/privacy for more information.

In today's episode Eoin speaks with Malala De La Pava (@malaladelapava).Malala was diagnosed with Type 1 Diabetes at the age of 8 when she was in Venezuela, before she moved to Toronto, Canada with her family.Malala speaks about the different experiences she had with her management in Venezuela, compared to in Toronto.When the Covid pandemic started in 2020, she was diagnosed with APS-2 (Autoimmune Polyendocrine Syndrome Type 2) and Addison's disease. This completely changed her life as she now relied on Corticosteroids.This condition is not particularly well known or researched, which led to a lot of uncertainty for Malala. Much of which was learning how Corticosteroids affect her blood sugar levels, and how low cortisol levels can cause extremely low blood sugar levels.Hear more about Malala's story and experience in her blog: https://www.pumpingthecure.ca/APS-2, or Autoimmune Polyendocrine Syndrome Type 2, is a rare autoimmune disorder in which the immune system mistakenly attacks multiple endocrine glands, leading to deficiencies in the hormones produced by these glands.It is characterised by the presence of at least two or more endocrine gland dysfunctions, with the most common combination involving:1. Addison's Disease (Primary Adrenal Insufficiency).2. Hashimoto's Disease (Autoimmune Thyroid Disease).As always, be sure to rate, comment, subscribe and share. Your interaction and feedback really helps the podcast. The more Diabetics that we reach, the bigger impact we can make!Questions & Stories for the Podcast?:theinsuleoinpodcast@gmail.comConnect, Learn & Work with Eoin:https://linktr.ee/insuleoin Hosted on Acast. See acast.com/privacy for more information.

In this episode, we discuss four tips for finding evidence based answers quickly. Then we discuss some new literature about pap smears and new guidelines regarding iron supplementation in pregnancy. We also discuss the history of corticosteroids for fetal maturity and the hype cycle in medicine.00:00:02 Finding Evidence-Based Clinical Answers Quickly00:13:36 Understanding Evidence-Based Clinical Practice00:23:30 Cervical Cancer Screening During Pandemic00:33:51 Optimal Timing for Cervical Cancer Prevention00:40:12 Iron Supplementation in Pregnancy00:47:13 Corticosteroids and Hype in MedicineFollow us on Instagram @thinkingaboutobgyn.

In episode eight of Getting to Know Your Research, Dr. Wenelia Baghoomian discusses her 2021 PeDRA Research Fellowship project titled The Impact of Topical Prescription Drug Delivery Devices in the Adherence and Ease of Use of Corticosteroids in Pediatric Patients with Atopic Dermatitis. Listen to learn about the inspiration for this project and the partnerships that made it successful.

Episode #54 Asthma with Dr. Randy Horwitz In this episode, Dr. Dr. Andrew Weil and Dr. Victoria Maizes sit down with Dr. Randy Horwitz, an expert on asthma and immunology. Together, they dive deep into the topic of asthma including the reasons for its rising prevalence and advances in treatment. Dr. Horwitz provides a comprehensive overview of how integrative medicine can aid in managing this chronic condition. The three discuss different types of asthma, common triggers, mind-body interventions, and the role of nutrition. Join the conversation for insights on asthma as well as practical tips to improve respiratory health. [00:01:13] What is asthma, and what causes it?[00:03:58] Discussion about different types of asthma (exercise-induced, allergic, stress-induced).[00:05:57] Early antibiotic use and its potential link to asthma development.[00:07:49] Role of pets – do they increase or decrease asthma risk.[00:09:03] Can asthma disappear?[00:09:44] Current asthma treatments: Corticosteroids and biologics.[00:12:11] The importance of peak flow meters in managing asthma symptoms.[00:13:34] Dietary modifications and supplements like Omega-3s and Vitamin D for asthma control.[00:17:00] Natural antihistamines like quercetin and their effectiveness compared to pharmaceutical interventions.[00:21:00] Mind-body interventions, including hypnotherapy and breathing exercises.[00:24:34] Impact of air pollution and environmental toxins, including wildfires, on asthma exacerbations.Watch the podcast on YouTube: https://www.youtube.com/playlist?list=PLgn_N4fbfpRvHjSc9g23139Q_GedeEGGH Follow along on Instagram: https://www.instagram.com/bodyofwonderpodcast/

Julia Blackwell, a renowned fascia release practitioner and educator. Julia shares her transformative journey from enduring nearly 20 years of pain due to severe nerve damage to discovering the healing power of fascia release therapy. Julia talked about holistic treatment modalities, sharing insights from her extensive work in fascia therapy, which has helped many people find relief and regain mobility. Dr. Trip adds his expertise on the evolution of regenerative treatments and the downsides of over-reliance on cortisone and steroid injections. We'll touch upon the importance of collaborative healthcare, where patients take charge of their health journeys with the right support team.------------------------------------Listeners can use the Coupon Code "LeNae" at https://www.movementbyjulia.com/ for15% off firs purchase - & https://www.movementbyjulia.com/a/2147522464/Th6JuuWhTakeaways1. Corticosteroids can cause tissue necrosis if overused2. Ideal posture should be effortless3. Learn and apply self-treatment techniques consistentlyConnect with Julia Blackwell:Website: https://www.movementbyjulia.comInstagram | Youtube ConnectDr. Trip Goolsby & LeNae Goolsby are the co-founders of the Infinite Health Integrative Medicine Center, and are also the co-authors of the book “Think and Live Longer”.

This StAR episode features the CID State-of-the-Art Review on Unintended Consequences: Risk of Opportunistic Infections Associated with Long-term Glucocorticoid Therapies in Adults.Our guest stars this episode are:Daniel Chastain (University of Georgia College of Pharmacy)Megan Spradlin (University of Colorado)Hiba Ahmad (University of Colorado)Andrés F Henao-Martínez (University of Colorado)Journal article link: Chastain DB, Spradlin M, Ahmad H, Henao-Martínez AF. Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults. Clin Infect Dis. 2024;78(4):e37-e56. doi:10.1093/cid/ciad474Journal companion article - Executive summary link: https://academic.oup.com/cid/article/78/4/811/7643625From Clinical Infectious DiseasesEpisodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.comFebrile is produced with support from the Infectious Diseases Society of America (IDSA)

Get on the waitlist for journal club here: https://www.dentaldigestpodcast.com/contact-4  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin  DOT - Use the Code DENTALDIGEST for 10% off Specialty Orofacial Pain Diplomate of the American Board of Orofacial Pain Fellow of the American Academy of Orofacial Pain Practicing since 1990 Education Doctor of Dental Surgery, University of Costa Rica, 1989 Specialty Certificate in Orofacial Pain, University of California, Los Angeles, 1998 Master of Education, Latin University, 2005 Professional memberships American Academy of Orofacial Pain International Association for the Study of Pain American Headache Society American Dental Education Association Dr. Padilla's Publications  Repurposing lectures and reviews into educational blogs J Dent Educ. 2023 06; 87 Suppl 1:895-896. . View in PubMed Temporomandibular joint findings in CBCT images: A retrospective study Cranio. 2021 Dec 11; 1-6. . View in PubMed Deploying a curated glossary: An orofacial pain wiki J Dent Educ. 2021 Dec; 85 Suppl 3:2016-2017. . View in PubMed Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: a systematic review with meta-analysis J Dent Anesth Pain Med. 2021 Dec; 21(6):479-506. . View in PubMed Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses J Dent Anesth Pain Med. 2021 Oct; 21(5):379-396. . View in PubMed Efficacy of topical interventions for temporomandibular disorders compared to placebo or control therapy: a systematic review with meta-analysis J Dent Anesth Pain Med. 2020 Dec; 20(6):337-356. . View in PubMed Trigeminal neuralgia management after microvascular decompression surgery: two case reports J Dent Anesth Pain Med. 2020 Dec; 20(6):403-408. . View in PubMed Clinical skills evaluation and examination center: From demos to competence validation J Dent Educ. 2020 Oct 02. . View in PubMed A modern web-based virtual learning environment for use in dental education J Dent Educ. 2020 Sep 11. . View in PubMed Efficacy of Antidepressants in the Treatment of Obstructive Sleep Apnea Compared to PlaceboA Systematic Review with Meta-Analyses. Sleep Breath. 2020 Jun; 24(2):443-453. . View in PubMed Effects of respiratory muscle therapy on obstructive sleep apnea: a systematic review and meta-analysis J Clin Sleep Med. 2020 05 15; 16(5):785-801. . View in PubMed Empathy Levels of Dental Faculty and Students: A Survey Study at an Academic Dental Institution in Chile J Dent Educ. 2019 Oct; 83(10):1134-1141. . View in PubMed Prevalence of trismus in patients with head and neck cancer: A systematic review with meta-analysis Head Neck. 2019 09; 41(9):3408-3421. . View in PubMed Local Anesthetic Injections for the Short-Term Treatment of Head and Neck Myofascial Pain Syndrome: A Systematic Review with Meta-Analysis J Oral Facial Pain Headache. 2019; 33(2):183–198. . View in PubMed Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis: Systematic review with meta-analysesJ Am Dent Assoc. 2018 Nov; 149(11):940-952. e2. . View in PubMed Chilean Dentistry students, levels of empathy and empathic erosion: Necessary evaluation before a planned intervention: Levels of empathy, evaluation and intervention Saudi Dent J. 2018 Apr; 30(2):117-124. . View in PubMed Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis Sleep Breath. 2018 09; 22(3):555-568. . View in PubMed Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis J Oral Facial Pain Headache. 2018 Winter; 32(1):53–66. . View in PubMed Reconsidering the ‘Decline' of Dental Student Empathy within the Course in Latin America Acta Med Port. 2017 Nov 29; 30(11):775-782. . View in PubMed Medication Treatment Efficacy and Chronic Orofacial Pain Oral Maxillofac Surg Clin North Am. 2016 Aug; 28(3):409-21. . View in PubMed  

This podcast is ridiculously HY. It will generate lots of easy points on your test and is short, sweet, and to the point. I discuss 50 HY Steroid facts and integrations by using tons of clinical scenarios. I also spend time explaining pathophysiology where necessary. There’s an attached worksheet that you can fill out and … Continue reading Divine Intervention Episode 539: 50 HY Corticosteroid Facts To Know For Step 1-3 (+ PDF worksheet)

Severe pulmonary infections are a leading cause of death in adults worldwide. Romain Pirracchio, MD, MPH, PhD, of the University of California-San Francisco, joins JAMA Deputy Editor Kristin L. Walter, MD, MS, to discuss Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections. Related Content: Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections

On this podcast episode, I cover risedronate pharmacology, adverse effects, drug interactions, and much more. There is a strict administration procedure with risedronate which is designed to reduce adverse effects and enhance absorption. I discuss this in the podcast. Many medications may cause osteoporosis and may precipitate treatment with risedronate. Corticosteroids and excessive thyroid hormone replacement are two examples. Patients should remain upright (sitting or standing) for at least 30 minutes following administration to reduce the risk of esophagitis and ulceration.

Corticosteroids are commonly prescribed in conventional medicine for various inflammatory imbalances and dis-eases.   However, the potential long-term consequences of their use are often overlooked and rarely spoken about…   So join me on today's #CabralConcept 2944, where I go over the dangers of corticosteriods, what you need to look out for, and what you may choose to do instead. Enjoy the show, and feel free to share your thoughts!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/2944 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Welcome back to today's #FridayReview where I'll be breaking down the best of the week!   I'll be sharing specifics on these topics:   Best Nasal Breathing Strips (product review) Radical Acceptance (book review) Corticosteroid Dangers (research) Reading Your Mind (research)   For all the details tune in to today's #CabralConcept 2926 – Enjoy the show and let me know what you thought!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/2926 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!