Podcasts about herpes

On this episode of Vitality Radio, Jared shares three powerhouse supplements that may not be “new,” but are being used in some of the most impactful ways yet. First up is a clinically studied lutein and zeaxanthin complex that supports eye health, blue light protection, and even cognitive performance—delivered in a delicious gummy called Screen Eyes. Next, Jared breaks down monolaurin, a coconut-derived compound that supports immune resilience by targeting lipid-coated viruses like herpes, Epstein-Barr, and influenza—especially when paired with L-lysine and vitamin C. And finally, he explores two innovative magnesium-based powders from Kal - Clean Out Magnesium and Gut Magnesium, each designed to promote healthy regularity and support cleansing protocols. If you've struggled with constipation or want to fine-tune your immune and visual wellness, this is an episode you don't want to miss.Products:Zhou Screen Eyes Blue Light FormulaMonolaurin & LysineVital-C ImmunityNano-SilverKAL Clean Out Magnesium PowderKAL Gut Magnesium PowderVital 5 Magnesium BisglycinateAdditional Information:#209 VR Short: Centrum SucksVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

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The Mancave Caucus discusses all the big news of the week, Trump has a huge week with the ceasefire agreement between Israel & Iran, SCOTUS rulings in his favor, and NATO, the One Big Beautiful Bill passes the first vote in the Senate, Ron DeSantis builds Alligator Alcatraz for a detention facility for illegals, a Jewish extremist commits a gruesome murder of a pastor, and much more!

Imagino que se están preguntando: ¿qué hacen estos señoros hablando de vacunas? Es que no podíamos dejar pasar la oportunidad de preguntarle a Arturo Rodríguez -quien vino a hablar del servicio a domicilio de vacunas de Vivien- que nos explicara con sencillez de qué van estas enfermedades. Seguimos con el susto al 100. Pero ya fuimos a vacunarnos.

Coming up on this episode of Flirtations, we're getting real, raw, and radically open with the incredible Tricia Wise.  You may know Tricia as the @safe.slut across social media, Tricia is a master aesthetician, reiki practitioner, sexual health advocate, herpes stigma breaker, and meme queen—and today, she's joining us to talk about something that, depending on the type, affects over 3 billion people around the world. It's Herpes! In this episode, we're diving into Tricia's personal journey with HSV (that's herpes), the work she's doing to destigmatize sexual health, and how we can create more empowered, shame-free conversations around sex, our bodies, and dating.  From navigating disclosure and diagnosis, to reclaiming confidence, pleasure, and power, Tricia shares the truth behind the stigma—and why it's time we start normalizing the conversation around herps and STIs (sexually transmitted infections). We'll also talk about the different types of herpes, how you may contract it, treatment options, how to get tested, how and when to disclose status, how to practice safe sex, and why herpes isn't the end of world. So, whether you're navigating a diagnosis, are dating someone who is, or simply want to learn how to be a more informed and safe out there dating, this episode is for you! Let's drop the shame, turn up the self-love, and welcome the one and only Tricia Wise to the show. Let's do this, Flirties! Don't forget to subscribe, rate, and review Flirtations on your favorite podcast platform, and share this episode to spread BFE - big flirt energy, all over the world! Enjoying the show and want to support my work? Buy the Flirt Coach a coffee! About our guest:  Safe Slut is a writer, sex worker, content creator, and reiki master. Safe Slut was diagnosed with genital herpes in November 2019. After noticing the stigma and shame surrounding being herpes positive, she created her Instagram account @safe.slut to help people take their power back while promoting sex positivity, helping to destigmatize STIs and slut shaming, and promoting safer sex practices. She also is smashing stigma and being a slut on OF as @safeslvt and on Patreon as Safe Slut. All links:  Instagram Shop Tiktok Twitter Patreon YouTube About your host:  Benjamin is a flirt and dating coach sharing his love of flirting and BFE - big flirt energy - with the world! A lifelong introvert and socially anxious member of society, Benjamin now helps singles and daters alike flirt with more confidence, clarity, and fun! As the flirt is all about connection, Benjamin helps the flirt community (the Flirties!) date from a place that allows the value of connection in all forms - platonic, romantic, and with the self - to take center stage. Ultimately, this practice of connection helps flirters and daters alike create stronger relationships, transcend limiting beliefs, and develop an unwavering love for the self. His work has been featured in Fortune, NBC News, The Huffington Post, and Yoga Journal. You can connect with Benjamin on Instagram, TikTok, stream the Flirtations Flirtcast everywhere you listen to podcasts (like right here!), and find out more about working together 1:1 here.

After three years of decriminalisation, Thailand criminalises use and sale of cannabis for recreational purposes. Almost one-third of Tuvalu’s population enters ballot for climate visa to live in Australia and the “best” place to get herpes is New Zealand. Katie Macdonald shares all the details with John Maytham. Good Morning Cape Town with Lester Kiewit is a podcast of the CapeTalk breakfast show. This programme is your authentic Cape Town wake-up call. Good Morning Cape Town with Lester Kiewit is informative, enlightening and accessible. The team’s ability to spot & share relevant and unusual stories make the programme inclusive and thought-provoking. Don’t miss the popular World View feature at 7:45am daily. Listen out for #LesterInYourLounge which is an outside broadcast – from the home of a listener in a different part of Cape Town - on the first Wednesday of every month. This show introduces you to interesting Capetonians as well as their favourite communities, habits, local personalities and neighbourhood news. Thank you for listening to a podcast from Good Morning Cape Town with Lester Kiewit. Listen live on Primedia+ weekdays between 06:00 and 09:00 (SA Time) to Good Morning CapeTalk with Lester Kiewit broadcast on CapeTalk https://buff.ly/NnFM3Nk For more from the show go to https://buff.ly/xGkqLbT or find all the catch-up podcasts here https://buff.ly/f9Eeb7i Subscribe to the CapeTalk Daily and Weekly Newsletters https://buff.ly/sbvVZD5 Follow us on social media CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567See omnystudio.com/listener for privacy information.

Originally Aired June 26, 2025: Veterinarian Doctor Andrea answers pet questions. Herpes roulette. Everything you wanna know about a 200-year-old condom. Listen & subscribe to the show on Apple Podcasts, Spotify or Amazon Music. For more, visit https://www.93x.com/half-assed-morning-show/Follow the Half-Assed Morning Show:Twitter/X: @93XHAMSFacebook: @93XHAMSInstagram: @93XHAMSEmail the show: HAMS93X@gmail.com See omnystudio.com/listener for privacy information.

Stupid: New inductee to Trey's Twats, when robots learn to merge, and celebrity birthdays! Stupider: New Zealand has an embarrassingly low sheep-to-human ratio and that's not the BIG news!The Treehouse is a daily DFW based comedy podcast and radio show. Leave your worries outside and join Dan O'Malley, Trey Trenholm, Raj Sharma, and their guests for laughs about current events, stupid news, and the comedy that is their lives. If it's stupid, it's in here.The Treehouse WebsiteGet a FREE roof inspection from the best company in DFW:Cook DFW Roofing & Restoration Defender OutdoorsUse code TREEHOUSE to unlock special discounts at Defender Outdoors!CLICK HERE TO DONATE:The RMS Treehouse Listeners FoundationLINKS:'Best place to have herpes': New Zealand advert wins top prizeTaiwan parents hire sexy dancers to perform at son's graduation, prompting police action | South China Morning PostDoctor recommends surprising drink instead of water in a heatwave | Metro NewsTesla Robotaxi Drops Off Passengers in Middle of Intersection... Handpicked Riders Say the “Performance Was Great” - FuelArc News

The Most Reliable Car Brands in 2025.We Break Down The Disgusting Details from Netflix's ‘Trainwreck: Poop Cruise' Doc.Escaped elk from Grant's Farm euthanized due to severe injury.Police shoot giant catfish which injured five in lake.Tragic update on woman who fell into active volcano.New Term: Screen Divorce.Follow us @RizzShow @MoonValjeanHere @KingScottRules @LernVsRadio @IamRafeWilliams - Check out King Scott's Linktr.ee/kingscottrules + band @FreeThe2SG and Check out Moon's bands GREEK FIRE @GreekFire GOLDFINGER @GoldfingerMusic THE TEENAGE DIRTBAGS @TheTeenageDbags and Lern's band @LaneNarrows ⁠http://www.1057thepoint.com/RizzSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Best place to have herpes is New Zealand according to their award winning commercial. Scotland's alcohol consumption dangerously excessive. Italy cracks down on violence against referees. // SUPPORT by joining the Weird AF News Patreon http://patreon.com/weirdafnews - OR buy Jonesy a coffee at http://buymeacoffee.com/funnyjones Buy MERCH: https://weirdafnews.merchmake.com/ - Check out the official website https://WeirdAFnews.com and FOLLOW host Jonesy at http://instagram.com/funnyjones

Soccer fan from Argentina was so intent on travelling to watch team compete in Club World Cup games, he committed insurance fraud to get money, Chinese hotel told 'wake-up service' of red pandas climbing onto guest beds must stop, 'The Best Place in the World to have Herpes' award goes to New Zealand

In this hour Joe Rogan shuts down Bernie Sanders over Elon Musk's support for Trump. Genevieve Wood, Senior Advisor at The Heritage Foundation joins to talk about Trump Admin. announces insurance prior authorization reform. John Mills, FEMA External Affairs Officer Region 7 joins to talk about FEMA disaster recovery center in St. Louis. Finally, in Kim on a Whim One country claims it's the best in the world to have Herpes.

Weird flex, but ok. Support the show and follow us here Twitter, Insta, Apple, Amazon, Spotify and the Edge! See omnystudio.com/listener for privacy information.

Wednesday brings us tales of Red Bull heists at Wegmans, getting stuck in a chimney, and Cass deciding if she wants to lead a life of crime. We find out the reasons New Zealand wants to be known as the best place to have herpes, play Can’t Beat Cassiday, and find out how one kid will become a legend at his school for the stunt his parents pulled for graduation. We discuss social contracts, smells we love, music memories, and have some more weird tales of Loony Toon and switch games stolen. Support the show and follow us here Twitter, Insta, Apple, Amazon, Spotify and the Edge! See omnystudio.com/listener for privacy information.

A driver did donuts on the National Mall in DC...New Zealand just got named the best place in the world to have Herpes...and Whidbey Island 911 calls!

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.

Encore: H is for Hiv, Herpes, and other Sexuall Transmitted Infections with Dr Lori Beth Bisbey

How can you live an empowered life with an incurable but manageable sexually transmitted disease like Herpes?If you're interested in how to live an empowered life even with conditions like the Herpes virus listen to my guest Alexandra Harbushka, the founder of Life With Herpes, a platform whose mission is to breaking the stigma & removing the shame. Alexandra provides a safe place where people can find accurate information, community and emotional support. According to World Health Organisation around 846 million people aged 15–49 are living with herpes infections, accounting for more than 1 in 5 individuals in this age group globally. Alexandra works to break the stigma by helping people navigate dating, disclosure and emotional healing. Her goal is for them to stop feeling ashamed and start living their lives fully. Alexandra shares how she has grown her Life with Herpes platform into a global community where thousands of people feel supported and empowered to live their best lives, despite having herpes. She shows the millions of people who are struggling in silence, don't have to feel alone, ashamed, and lost, but instead can feel embraced, secure, and comfortable. You can find out more about Alexandra's work on https://www.lifewithherpes.com/And follow her on Instagram @LifewithHerpesYou can follow Host Lou Hamilton on Instagram @brave_newgirl and on Linkedin @LouHamiltoncreatelabPS. Lou helps you transform your health & wellbeing: LOU'S LIFE LAB SERVICES HEREFor Lou's creative transformation and art practice go to ART HIVE or LOUHAMILTONARTJoin our Brave New Girls retreats to reset and reconnect with what really matters to you.Music licensed from Melody Loops.Support the showBrave New Girls podcast is an Audio Archive Art Project with pioneering, creative & entrepreneurial women at the head of the curve, who are inspiring us on the airwaves, to work towards the health & wellbeing of ourselves and the planet. Brave New Girls podcast ranks in top 2.5% globally, and No 7 in the "45 Best UK Women's Podcasts to Listen to, in 2024", with Host Lou Hamilton, artist, author & wellbeing coach. Thank you for listening and please subscribe to keep up to date on new episodes as they're released.Lou is the founder of Brave New Girl Media- bringing you inspiration, support and growth. 1. INSPIRATION from courageous, creative women on Brave New Girls podcast working for the benefit of people and the planet. ️2. SUPPORT with 1:1 creative transformation coaching and our holistic, healthy, creative wellbeing retreats www.bravenewgirlmedia.com/wellbeing-retreat 3. GROWTH blogs to help you THRIVE.Sign up to our emails for inspiration, support & growth and LOU'S LIFE LAB free downloadable guide https://bravenewgirlmedia.comInsta @brave_newgirlBooks: Dare to Share- bestselling guide to podcast guesting FEAR LESS- coaching guide to living more bravely Brave New Girl- How to be Fearless Paintings & Public Art www.LouHamiltonArt.comInsta @LouHamiltonArt

In dieser Folge tauchst du in die faszinierende Welt der Zitronenmelisse ein, einer wunderbaren #Heilpflanze, die als #adaptogen bekannt ist und dir in vielen Lebensbereichen Unterstützung bieten kann. Du erfährst, wie die Zitronenmelisse zur #Beruhigung beiträgt und dir dabei hilft, deine #Energie zu steigern, während sie gleichzeitig einen gesunden #Schlaf fördert. Wir sprechen über ihre positive Wirkung gegen #Nervosität und wie sie während der #Schwangerschaft helfen kann, insbesondere bei #Übelkeit. Zudem zeigen wir dir, wie du Zitronenmelisse in verschiedenen Formen nutzen kannst – sei es als #Tinktur, #Saft oder #Tee. Auch die Vorteile für deinen #Magen und #Darm werden thematisiert, sowie ihre Anwendung bei #Herpes. Lass dich inspirieren von den vielfältigen Verwendungsmöglichkeiten dieser wohltuenden Pflanze!

Sam and Sierra answer a letter from someone whose newly contracted herpes has changed her relationship with herself and her body, with sex, and with future partners Join us on Patreon for an extra weekly episode, monthly office hours, and more! SUBMIT: justbreakuppod.com FACEBOOK: /justbreakuppod INSTAGRAM: @justbreakuppod Learn more about your ad choices. Visit megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

To have your question featured in a future video, please email: questions@morses.tv Please include at least: Age, Weight and as much history as possible.

This is the episode I never thought I'd record. For years, I suffered in silence with herpes outbreaks, believing they were something shameful and unrelated to anything else going on in my body. But I've since learned that menopause can be a major trigger for viral reactivation—especially herpes. And I realized I wasn't alone. In this deeply personal conversation, I open up about how I finally connected the dots, released the shame, and discovered that millions of women are silently going through the same thing. If you've ever felt confused or embarrassed about recurring outbreaks in menopause, this episode will give you clarity, comfort, and most importantly, community.

In this essential episode of the Sex with Emily podcast, Dr. Emily sits down with Dr. Ina Park, associate professor at UCSF School of Medicine and author of "Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs." From her early days as a peer educator dressed as a giant condom at UC Berkeley to becoming a leading expert in sexual health, Dr. Park brings both humor and expertise to one of the most stigmatized topics in sexual wellness. We dive deep into the myths and realities surrounding STIs, exploring why HPV is truly "the common cold of the genitals" that nearly everyone will encounter, how herpes stigma far outweighs its actual health impact, and why people who know their status are actually safer partners than those who don't. Dr. Park shares fascinating insights about everything from The Bachelor's problematic STI testing to the connection between pubic hair grooming and infection risk. This conversation tackles the shame and fear that keep us from having honest discussions about sexual health, while providing practical advice on testing, disclosure, and maintaining healthy relationships regardless of STI status. We also explore the vaginal microbiome, why some people are more susceptible to infections, and promising new treatments on the horizon. Key Topics Covered: HPV: Why it's unavoidable and how to think about it differently Herpes disclosure and reducing transmission risk The truth about oral sex and STI transmission Pubic hair, Brazilian waxes, and infection risk Vaginal health and the microbiome Why knowing your status makes you a safer partner Breaking down STI stigma and shame Dr. Park's refreshing approach reminds us that STIs are simply part of being sexually active humans, and that knowledge, communication, and compassion are our best tools for sexual wellness. Show Notes:  00:00:00 - Dr. Park's journey from condom costume to STI expert 07:00:00 - HPV: The common cold of the genitals 14:00:00 - Herpes myths, realities, and disclosure strategies 22:00:00 - Oral sex and STI transmission risks 26:00:00 - Pubic hair grooming and infection risk 31:00:00 - Vaginal microbiome and bacterial balance 36:00:00 - Listener Q&A: Real STI concerns answered 42:00:00 - Breaking stigma and having better conversations This episode emphasizes that sexual health is part of overall wellness, and that honest, shame-free conversations about STIs can transform how we approach intimate relationships. Join the SmartSX Membership : ⁠https://sexwithemily.com/smartsx ⁠ Access exclusive sex coaching, live expert sessions, community building, and tools to enhance your pleasure and relationships with Dr. Emily Morse. List & Other Sex With Emily Guides: ⁠https://sexwithemily.com/guides/ ⁠  Explore pleasure, deepen connections, and enhance intimacy using these Sex With Emily downloadable guides. SHOP WITH EMILY!:https://bit.ly/3rNSNcZ (free shipping on orders over $99) Want more? Visit the Sex With Emily Website: ⁠https://sexwithemily.com/ ⁠ Let's get social:  Instagram ⁠https://www.instagram.com/sexwithemily/⁠  X ⁠https://twitter.com/sexwithemily⁠ Facebook ⁠https://www.facebook.com/sexwithemily⁠ TikTok ⁠https://www.tiktok.com/@sexwithemily ⁠ Threads https:⁠//www.threads.net/@sexwithemily  ⁠ Let's text: Sign up here ⁠https://sexwithemily.com/text 

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FLOW SPACE 15 161 Healing Herpes: Diandra's Journey of Acceptance, Inner Work & Empowerment

Sponsor Details:This episode is brought to you with the support of Insta360 - for incredible 360 degree videos you really need to check their cameras out. To see the range and claim your free offer, visit store.insta360.com and use the coupon code SpaceTime at checkout.In this episode of SpaceTime, we explore some mind-bending revelations about the universe, including a new estimate for its ultimate fate, the peculiar gravity of the asteroid Bennu, and India's ambitious plans for its first manned spaceflight.The Universe's Unexpected Expiration DateA groundbreaking study suggests that the universe could meet its end in a mere 10^78 years, significantly sooner than the previously estimated 10^1100 years. This revelation, based on calculations involving Hawking radiation, sheds light on how black holes and other celestial bodies lose mass over time. We discuss the implications of this research and the fascinating mechanics behind black hole evaporation, including the surprising equivalence in decay rates between neutron stars and black holes.Gravity's Quirks on Asteroid BennuAstronomers have uncovered bizarre gravitational dynamics at play on the near-Earth asteroid Bennu, based on data from NASA's Osiris Rex mission. This small celestial body exists in a delicate balance between gravity and centrifugal forces, creating a unique environment that could lead to its eventual disintegration. We delve into how Bennu's increasing rotation might impact its structural integrity and potential future interactions with Earth.India's Manned Spaceflight AmbitionsThe Indian Space Research Organization (ISRO) has announced plans for its first manned spaceflight, set to launch in early 2027. This historic mission will follow an unmanned test flight of the Gaganyan spacecraft, which is designed to carry a crew into low Earth orbit. We discuss the training and preparations of the selected Indian Air Force pilots and the technical challenges ISRO faces as it embarks on this new frontier in space exploration.www.spacetimewithstuartgary.com✍️ Episode ReferencesJournal of Cosmology and Astroparticle Physicshttps://www.cosmos.esa.int/cosmologyNature Astronomyhttps://www.nature.com/natastronomy/Become a supporter of this podcast: https://www.spreaker.com/podcast/spacetime-space-astronomy--2458531/support.00:00 This is Space Time Series 28, Episode 63 for broadcast on 26 May 202501:00 New estimates on the universe's end12:30 The strange gravity of asteroid Bennu22:45 India's plans for its first manned spaceflight30:00 Science report: Herpes virus linked to Alzheimer's disease

The music of the '80s and '90s was a glorious mix of synths, angst, big hair, and bigger emotions. The '80s gave us neon-soaked pop, iconic hair metal, and the rise of MTV, where music videos were just as important as the music itself. Think Madonna, Prince, and Guns N' Roses ruling the airwaves while everyone tried to moonwalk like Michael Jackson.Then came the '90s — grungier, moodier, and way more plaid. Nirvana killed the hair band, Tupac and Biggie redefined hip-hop, and boy bands took over bedrooms everywhere. From slow jams to garage rock, it was two decades of unforgettable sound, questionable fashion, and songs you still secretly belt out in the car.

Good morning, it's been a big one and I've got just the remedy for you to tackle another big week! SR Morning After is coming at you with Oscar Willis and Petesy Carroll! We talk 170, Islam, JDM, 155, Topuria, Charles, what is happening with Jon Jones and more! Download the Saily app and use the code [submission] or go to https://Saily.com/submission to get an exclusive 15% off your first purchase! Don't forget to use code "SUBMISSION" at https://Manscaped.com for 15% AND FREE SHIPPING (Plus you're helping the show)

Subscriber question: "I have ED and Herpes as a 52 year old MAN... I am very hesitant to date out of fear of rejection and shame." Answered Live on YouTube.

Dr. Dale Bredesen, a renowned expert in the field of neurodegenerative diseases, is on a mission to reshape the way we think about aging and brain health. He challenges conventional perceptions about aging, emphasizing the importance of maintaining a "brain span" that matches one's lifespan. Often posing thought-provoking questions about longevity, Dr. Bredesen highlights the undesirability of living to an advanced age if it means suffering from dementia. His work, driven by ongoing research and encapsulated in his latest book, aims to shift the narrative from expecting cognitive decline with age to implementing proactive strategies for preserving brain function. Timestamps: 05:24 Brain Health Over Longevity 07:53 Exercise, Memory, and APOE4 Gene Impact 10:26 Optimizing Cognition: Early Detection's Role 14:56 Herpes and Toxins Linked to Cognitive Decline 17:38 Neurotransmitters, Choline, and Stress Impact 20:43 Tau's Role in Brain Health 24:57 Understanding Cognitive Health Markers 26:43 Misdiagnosed Alzheimer's Story 30:51 Optimal Diet and Fasting Guidelines 33:35 Expanding Exercise Benefits in Neurology 39:11 Early Detection in Alzheimer's Prevention

What Would You Do? Imagine facing a tough decision like todays anonymous submission. Would you let the love of your life go simply because they have herpes? Would you choose to take medication, wear protection, or would it just feel too daunting? In this episode, we dive deep into an open and honest conversation about this important topic. Together, we share our perspectives on navigating love and relationships when health concerns come into play. Whether you have herpes, know someone who does, or simply want to learn how to support someone facing this challenge, this episode is meant for you.Join us as we discuss the complexities of love, acceptance, and what it truly means to support one another. It’s a heartfelt conversation that aims to provide guidance, understanding, and compassion. Don’t miss this insightful episode! ❤️ Follow us on Instagram @sherises.podcast Join us in our Facebook forum

Thursday – We got a new Pope! Do you have soda loyalty? Should A.I. be used for victim impact statements in court? Rauce Padgett joins us on Thursdays. Date Night Guide with Dani Meyering with date night ideas for Mother's Day weekend. Attorney Glenn Klausman with a recap of Herpes vs. Geico for Colbert Court. Plus, JCS News, JCS Trivia & You Heard it Here First.

Over 70% of the world has herpes—yet it's still taboo. In this episode, Dr. G breaks down the truth about HSV-1 & HSV-2, from how it spreads to how to heal physically and emotionally. He shares the Heal Thyself protocol, featuring powerful supplements, nervous system tools, and mindset shifts to reduce outbreaks and reclaim your peace. #wellnessjourney #herpes #wellness ==== Thank You To Our Sponsors! Calroy Head on over to at calroy.com/drg and Save over $50 when you purchase the Vascanox and Arterosil bundle! ==== Timestamps: 00:00:00 - Understanding the Herpes Virus 00:02:56 - Prevalence, Latency & Treatment 06:00 - Transmission: Myths & Facts 08:58 - Triggers, Treatments & Misconceptions 12:02:47 - Antiviral Drugs & Holistic Healing 15:09 - Treatment: Sleep, Stress & Supplements 18:09 - Natural Herpes Remedies 21:15 - Treatment & Emotional Roots 24:10 - Healing Herpes: Shame & Self-Ownership Be sure to like and subscribe to #HealThySelf Hosted by Doctor Christian Gonzalez N.D. Follow Doctor G on Instagram @doctor.gonzalez https://www.instagram.com/doctor.gonzalez/ Sign up for our newsletter! https://drchristiangonzalez.com/newsletter/

El virus del papiloma humano (VPH o HPV del ingles human papillomavirus) son grupos diversos de virus AND pertenecientes a la familia de los Papillomaviridae y representa una de las enfermedades de transmisión sexual mas comunes, y se conocen mas de 100 tipos virales. Entre 30 y 40 tipos de VPH se transmiten normalmente por contacto sexual. El herpes genital es una infección de transmisión sexual (ITS), causada por el virus del herpes simple (VHS). Hay dos tipos de VHS. El VHS-1 generalmente afecta la boca y los labios y causa herpes labial (aftas) o herpes febril. Sin embargo, se puede transmitir de la boca a los genitales durante el sexo oral. El VHS-2 casi siempre causa el herpes genital y se puede transmitir a través de secreciones (líquidos) orales o genitales. Puede obtener este Programa en LA Farmacia Natural en Los Angeles, Van Nuys, Huntington Park, El Monte, Arleta, Pico Rivera, Long Beach y en Burbank o llamando a la Línea de la Salud, al 1-800-227-8428 si desean que se lo enviemos a su casa.

Un estudio basado en datos de Gales sugiere que la vacunación contra el herpes zóster podría disminuir en un 20 % las probabilidades de desarrollar demencia en los siguientes siete años. El doctor Elmer Huerta, asesor médico de RPP, habló de esta reciente investigación en Espacio Vital.

Stupid News 4-28-2025 6am ...He admitted to Fleeing Police, but He was Testing a Theory …She got Herpes from the Karaoke Mic …He only Used the Cameras to Look at Penis Sizes of Other Men

Paige sits down with Allie Mazur, a coach and advocate who turned her herpes diagnosis into her power. They are chatting about the real stuff—dating with herpes, navigating shame, and why a diagnosis doesn't define your worth, your sex life, or your future. Whether you're navigating stigma, curious about disclosure, or just want to hear a story about turning pain into purpose, this episode is the one for you - its Beyond Herpes.Follow the Pod: instagram.com/adultishwhines/Follow your Host: instagram.com/paige_crutcher/Follow Allie: instagram.com/allie_beyond/Produced by Creator's Guild: instagram.com/creatorsguild.htx/Go to https://betterhelp.com/adultish for 10% off your first month of therapy with BetterHelp and get matched with a therapist who will listen and help #sponsored Use code ADULTISH at adameve.com for 50% off, free gifts and free shipping. Use code AWCLUB at kingsofneon.com for 10% off a custom neon sign.

Kirt & Mr. Sal discuss Season 1 Episode 3 of Your Friends and Neighbors in which Coop has pasta, Scotch, and Jean-Claude Van Damme. Shoe Hammer some Show Hoppers into your day! Youtube: https://www.youtube.com/channel/UCJb6TAVe_sYmo4G7lAfEYtg Website: showhoppers.com Show Hoppers Twitter: @ShowHoppers Mr. Sal Twitter: @ShowHoppersSal e-mail: showhopperspodcast@gmail.com

Kirt & Mr. Sal discuss Season 1 Episode 3 of Your Friends and Neighbors in which Nick makes a protein-rich breakfast of champions. Shoe Hammer some Show Hoppers into your day! Youtube: https://www.youtube.com/channel/UCJb6TAVe_sYmo4G7lAfEYtg Website: showhoppers.com Show Hoppers Twitter: @ShowHoppers Mr. Sal Twitter: @ShowHoppersSal e-mail: showhopperspodcast@gmail.com

Sona and Victor discuss the latest episode of 'Your Friends and Neighbors'. We are still completely on board with watching these rich narcissists making terrible decisions having no appreciation for the luxuries around them. I still wonder if this is actually a period piece before ring cameras became standard equipment on every home. mailto:needssomeintroduction@gmail.com

04-14-25 - BR - MON - Man Runs Into Gas Station Runs Away In Crocs - FLA Man Named Cocaine Arrested For Assault - Science Develops Gum To Halt Herpes Outbreaks - New Startup Sperm Racing League Happening Next WeekSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

04-14-25 - BR - MON - Man Runs Into Gas Station Runs Away In Crocs - FLA Man Named Cocaine Arrested For Assault - Science Develops Gum To Halt Herpes Outbreaks - New Startup Sperm Racing League Happening Next WeekSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

After the bicep of One Better, we head straight to the crotch for Lust Stings. Les seems to want to highlight the body parts that the people want to see. Lust Stings gleefully swamps the listener with percussion and instrumentation that makes you want to take a hot shower, and adds to it off-putting yet matter-of-fact lyrics about the spread of STI. While all of that doesn't sound too appealing, it all comes together to create a unique experience in the catalog. Make good choices, kids!Get involvedInstagramFacebookEmailBurn your money 

This week, we're IN IRELAND Telling Everybody Everything about the follow-up treatment since discovering a second melanoma last Friday. Also, Katherine broke her golden rule and watched not one but TWO femicide documentaries on Netflix. Gabby Petito's case raises lots of red flags to watch out for in potential romantic partners, but what red flags should we watch out for in their parents? Plus, your letters on de-friending a slag, being dumped for liking Katherine Ryan, and one young woman's warning to take melanoma very seriously. x Hosted on Acast. See acast.com/privacy for more information.

This episode is sponsored by https://BetterHelp.com Give online therapy a try at betterhelp.com/opl and get on your way to being your best self. Shop SKIMS Mens at https://SKIMS.com and select podcast and Other People's Lives in the survey after you place your order. Visit https://Huel.com/OPL today and use code OPL to get 15% off your first order plus a Free Gift. This week, Joe Santagato and Greg Dybec speak with a man who has herpes and purposely does not disclose the info to women. They talk about his actions, why they are wrong, and whether or not he thinks he will ever change. Learn more about your ad choices. Visit megaphone.fm/adchoices

On Today’s Show: 00:00:00  Introduction 02:58:22  I’d Be A Rich Pervert 05:11:12  A New Batch Of Fake Disorder Tiktards 14:25:08  A Person With Every Disorder Gets Denied For Disability 16:46:19  The Rare Verbal Non-Verbal 20:10:23  DID Douche Full Of Furry Personalities 23:44:02  Meade Is In To Black Chicks! 28:16:03  Teacher Is Upset About The Student’s […] The post Tainting The Office Water Cooler With Your Gross Ass Herpes Urine first appeared on Distorted View Daily.

Na'im Ali and Josie Marcellino join Luis J. Gomez and Zac Amico and they discuss what Josie thinks Luis is attracted to, Josie's St Patricks Day gifts for the studio, the possibile boxing match between Harrington and Ryan Foster, the black vs white Philly accents, Na'im's bad dating and comedy advice and how it left someone with herpes, Na'im and Luis' former sexual additions, Josie's body count, the man lit on fire in Times Square, Luis learning crazy stuff about his mom against his will, when Nai'm's brother was killed, whether they'd want to killed by a shark or a crocodile, Na'im getting attached by a pitbull and so much more!(Air Date: March 17th, 2025)Support our sponsors!KetoBrainz.com - Use promo code: LAZ20 to get 20% off and try Keto Brains Nootropic creamer to experience what optmized brain power really feels like!SmallBatchCigar.com - Use promo code: GAS10 for 10% off plus 5% bonus points!YoKratom.com - Check out Yo Kratom (the home of the $60 kilo) for all your kratom needs!*Send your video submissions for the Cuntest or the Look-a-Like Contest to LuisAndZac@gmail.com!Help Replace Shannon's Cannons - https://www.gofundme.com/f/help-shannon-lee-replace-her-boobsTo advertise your product or service on GaS Digital podcasts please go to TheADSide.com and click on "Advertisers" for more information!Submit your artwork via postal mail to:GaS Digital Networkc/o Luis And Zac151 1st Ave, #311New York, NY 10003You can sign up at GaSDigital.com with promo code: LAZ for a discount of $1.50 on your subscription and access to every Luis and Zac show ever recorded! On top of that you'll also have the same access to ALL the shows that GaS Digital Network has to offer!Follow the whole show on social media!Na'im AliTwitter: https://twitter.com/Naim__AliInstagram: https://instagram.com/Naim__AliYouTube: https://www.youtube.com/@naimali3135Josie MarcellinoInstagram: https://instagram.com/JosieMarcellinoYouTube: youtube.com/josiemarcellinoLuis J. GomezTwitter: https://twitter.com/luisjgomezInstagram: https://instagram.com/gomezcomedyYouTube: https://www.youtube.com/c/LuisJGomezComedyTwitch: https://www.twitch.tv/prrattlesnakeWebsite: https://www.luisofskanks.comZac AmicoTwitter: https://twitter.com/ZASpookShowInstagram: https://instagram.com/zacisnotfunnySee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Rob - My Wife Has Herpes and Thinks I CheatedSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.