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In this episode of The Healers Café, Manon Bolliger, FCAH, RBHT (facilitator and retired naturopath with 30+ years of practice) speaks to Dr. Eva Selhub: A Journey of Healing and Transformation - From Harvard Medical School to Holistic Resiliency, Exploring the Power of Mind-Body Medicine, Personal Growth, and Empowering Patients Through Curiosity, Compassion, and Innovative Approaches to Health and Well-being.   For the transcript and full story go to: https://www.drmanonbolliger.com/dr-eva-selhub        Highlights from today's episode include:   A transformative conversation with Dr. Eva Selhub, exploring her journey from traditional medicine to holistic healing, revealing how resilience, curiosity, and empowerment can reshape our approach to health and personal growth.   Dr. Selhub's emphasis on empowering patients and clients rather than keeping them in a victim mindset   Manon Bolliger we can definitely explore questions so that that they're thinking what other choices might be available to them, and it may position the work with fascia and with Bowen in a very positive light   ABOUT DR. EVA SELHUB: Dr. Eva Selhub is an internationally recognized resiliency expert  thought leader, physician, author, executive coach, keynote speaker, and spiritual advisor. With almost three decades of experience, she previously held roles as an Instructor of Medicine at Harvard Medical School and as a Clinical Associate at the prestigious Benson Henry Institute for Mind-Body Medicine at Massachusetts General Hospital, where she also served as Medical Director for six years. Dr. Selhub also served as an adjunct scientist of neuroscience at Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, one of six human nutrition research centers supported by the United States Department of Agriculture (USDA).   Dr. Selhub now collaborates with clients and organizations, leveraging her expertise to redefine leadership and wellbeing paradigms. Dr. Selhub possesses a unique talent for distilling complex scientific and spiritual concepts into practical, accessible knowledge. Her transformative energy, intuitive guidance, scientific expertise, and practical mindset inspire profound change and growth in her clients and audiences worldwide.  She is the author of six books, including: Burnout for Dummies, Resilience for Dummies, Your Health Destiny, The Stress Management Handbook, The Love Response.  Additionally, she co-authored:  Your Brain on Nature and has been featured in esteemed publications like The New York Times, authored multiple scientific publications, and has been showcased on national and international media platforms. Core purpose/passion: I want to bring hope to humanity of the infinite possibilities that are available to us to  heal and live a full and rich life. That magic can be normal. Website | Facebook | LinkedIn | Instagram | YouTube | TikTok | Twitter   ABOUT MANON BOLLIGER, FCAH, RBHT  As a de-registered (2021) board-certified naturopathic physician & in practice since 1992, I've seen an average of 150 patients per week and have helped people ranging from rural farmers in Nova Scotia to stressed out CEOs in Toronto to tri-athletes here in Vancouver.  My resolve to educate, empower and engage people to take charge of their own health is evident in my best-selling books:  'What Patients Don't Say if Doctors Don't Ask: The Mindful Patient-Doctor Relationship' and 'A Healer in Every Household: Simple Solutions for Stress'.  I also teach BowenFirst™ Therapy through and hold transformational workshops to achieve these goals.  So, when I share with you that LISTENING to Your body is a game changer in the healing process, I am speaking from expertise and direct experience"  Manon's Mission: A Healer in Every Household!  For more great information to go to her weekly blog:  http://bowencollege.com/blog.  For tips on health & healing go to: https://www.drmanonbolliger.com/tips    Follow Manon on Social – Facebook | Instagram | LinkedIn | YouTube | Twitter | Linktr.ee | Rumble   ABOUT THE HEALERS CAFÉ:  Manon's show is the #1 show for medical practitioners and holistic healers to have heart to heart conversations about their day to day lives.  Subscribe and review on your favourite platform: iTunes | Google Play | Spotify | Libsyn | iHeartRadio | Gaana | The Healers Cafe | Radio.com | Medioq |   Follow The Healers Café on FB: https://www.facebook.com/thehealerscafe   Remember to subscribe if you like our videos. Click the bell if you want to be one of the first people notified of a new release.   * De-Registered, revoked & retired naturopathic physician after 30 years of practice in healthcare. Now resourceful & resolved to share with you all the tools to take care of your health & vitality!  

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.

Have you ever noticed everybody talks about weather & seasons... Why? Because we all have one thing in common; Although we physically live in same season, we are not all emotionally/spiritually in same season   Dr Aaron Cole

If you've ever felt lost, this unforgettable conversation will help you come home to yourself. This episode will change how you think about your past, your purpose, and what's possible for your future. Because if you've been carrying pain, guilt, or questions you can't quite name, this is the conversation that helps you finally let go of all that. Today, Mel sits down with singer-songwriter Mon Rovîa, whose breathtaking journey from war-torn Liberia, where he narrowly escaped becoming a child soldier, to the global stage will stop you in your tracks. But this isn't just about his story—it's about what his story will awaken in you. Adopted and raised in the U.S., Mon spent years trying to outrun his trauma. What followed was guilt, despair and a deep feeling of not belonging anywhere. Until he realized he had a choice: He could stay stuck in suffering or turn his pain into power. His answer came through music, and what he's created is reaching millions around the world. In fact, he's one of Mel's favorite artists. But this isn't just about Mon's voice. It's about what his story inspires in you. In this episode, you'll learn: -How to stop running from your past, and start turning it into purpose -Why guilt keeps you stuck (and how to let it go) -What it really means to “belong” in your own life -That no matter what you've been through, you belong here This episode will stay with you. By the end, you'll feel seen. Grounded. Clearer about where you've been, and more certain about where you're headed. For more resources, click here for the podcast episode page. If you liked the episode, this one will help you go deeper: Why You Feel Lost in Life: Dr. Gabor Mate on Trauma & How to HealConnect with Mel:  Get Mel's #1 bestselling book, The Let Them TheoryWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel's personal letter Subscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer

"My death and my life are in the power of my tongue."-Dr. Chris Cody

Dr. Tony Nader is a medical doctor, neuroscientist, and the global leader of the Transcendental Meditation movement. He holds an MD from the American University of Beirut and a PhD in neuroscience from MIT. In this conversation, we explore Dr. Nader's provocative claim that consciousness is not a byproduct of the brain—but the ground of all being. Drawing on neuroscience, quantum physics, and thousands of years of contemplative practice, he shares a paradigm that reframes life's biggest questions—from free will and death to the nature of truth, karma, and the self. Expect to learn: — What Maslow got wrong and the practical value of transcending before striving — Why expanding consciousness is the purpose of life — Dr Nader's views on the relationship between the brain and consciousness. — What this model says about death, reincarnation, and the expansion of self And more. You can learn more about Dr. Nader's work at https://drtonynader.com or by exploring his book, Consciousness is All There Is. --- Dr. Tony Nader is a globally recognized leader in the field of consciousness and a renowned neuroscientist with a distinguished academic background. He is the president of Maharishi International University, a medical doctor trained at Harvard University and Massachusetts Institute of Technology (Ph.D. in neuroscience) and a globally recognized expert in the science of Consciousness and human development. Dr Nader's training includes internal medicine, psychiatry, and neurology, and he is a New York Times bestselling author. His award winning book Consciousness Is All There Is has received the highest praise much like his latest book Super Habits for Success. Dr Nader has had recent discussions with some of the great thinkers, scientists, medical doctors and leaders in the world today. He has been featured by WIRED magazine, BBC, CNN, Gaia Network, and served as keynote for the United Nations, YPO and Stanford university's “Hacking Consciousness”. He's the recipient of numerous award's for his outstanding contribution in human development, environment, education, and health. He currently leads the global Transcendental Meditation organization, succeeding Maharishi Mahesh Yogi, and is dedicated to advancing the understanding of consciousness through both scientific and spiritual lenses. --- Interview Links: — Maharishi International University - https://www.miu.edu — Dr Nader's website - https://drtonynader.com — Dr Nader's book - https://amzn.to/45kVWCO

Take Out the Trash, Transform Your Life: Dr. Noah St. John on Rewiring Your Mind for Wealth, Worth, and Real ResultsWhy positive thinking alone doesn't work, and how changing your questions (not just your affirmations) can change your life.Mindset coach Joe Longo sits down with Dr. Noah St. John—author of Millionaire AFFORMATIONS and creator of the AFFORMATIONS® method—to talk about why affirmations alone don't work, how we sabotage success with “head trash,” and why asking better questions is the secret to rewiring your mind for wealth, clarity, and massive action. It's not magic. It's science. And you're already doing it you just need to flip the script.Register for HEADTRASHRESET.comFind out more about Dr. Noah St John Work with Joe - Seven Day Reset Free Simplicity Starter Kit

Dicken Bettinger, Ed.D. on Let's get Real with Coach Menachem, Sunday June 8, 2025, #233 One Insight Away: How a simple shift in understanding can dissolve stress, bring clarity, and transform the way you experience life.

What does it really mean to live a happy life? In this powerful episode of I Am Refocused Radio, we sit down with Dr. Foojan Zeine—an international speaker, licensed psychotherapist, and founder of Awareness Integration Theory (AIT). With decades of experience in clinical psychology, intimate relationships, and human behavior, Dr. Zeine shares deep insights on how to overcome anxiety, heal from trauma, and build true self-confidence.

More than 60% of children who grow up in church will walk away from it in their young adult years, according to Barna. Why is this happening—and what can be done to reverse the trend? Dr. Josh Mulvihill, Executive Director of Church and Family Ministry at RenewaNation, joins us to unpack the root of the crisis: a breakdown in biblical discipleship. He shares a compelling vision for how families, churches, and schools can work together to raise children with resilient, gospel-centered worldviews—and why it starts with parents and grandparents reclaiming their God-given role's as the primary disciplers.Main Topics:The Discipleship Disconnect – Why many Christian parents now believe it's the church's job to disciple their kidsThe Three-Stranded Cord – How family, church, and education can align to build a strong biblical foundationThe Power of Grandparents – Why grandparents are overlooking their vital biblical role in passing down faith to future generationsRaising gospel-centered families isn't about perfection—it's about faithfulness, and the courage to make your home the frontlines of spiritual formation.Make a matching gift donation by June 10!View the transcript, leave comments, and check out recommended resources on the Episode Landing Page!Why Social Justice is Not Biblical Justice

Legendary 'Real Life Dr Doolittle' Conservationist Jane Goodall Reveals Horrific Sexism She Had to EndureAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dr Caroline Boyd is a chartered clinical psychologist with over 10 years experience working in the NHS and other mental health settings. She specialises in anger, particularly how it manifests itself in parents. Anger is still quite a taboo topic, and many of us may try and suppress our anger due to feelings of shame or discomfort.In this special bonus episode, Caroline joins Dr Alex George to unpack why we get angry, how to approach anger in the different relationships in our lives and why you should acknowledge and address anger when it arises.Plus, Caroline discusses the importance of meeting anger with compassion and reveals the surprising ways in which anger could actually be your superpower…Follow @_drboyd and check out her website hereFollow the podcast on Instagram @thestompcastGet the new, pocket guide version of The Mind Manual nowDownload Mettle: the mental fitness app for men Hosted on Acast. See acast.com/privacy for more information.

Brushing your teeth is more than a daily habit — it could be the key to your long-term health. In this must-listen episode of the Kreatures of Habit Podcast, Michael Chernow sits down with Dr. Kenny Brown, oral surgeon and founder of Feno, the revolutionary toothbrush that's changing the oral health game.We're finally having the conversation we should be having: how your mouth is the gateway to your entire body. From chronic inflammation to heart disease, poor oral hygiene has downstream effects that most people don't realize.Discover how Feno is flipping the script on traditional dental care, and why this seemingly simple act — brushing your teeth — could be your first line of defense against major health issues. Hit play to learn:The real link between oral health and systemic diseaseWhat makes Feno different from any toothbrush on the marketWhy top performers obsess over routines — including their oral careHow to start optimizing your health from the mouth outThis is a topic everyone should be talking about. It's time to treat oral health like the powerful wellness tool it is.TIMESTAMPS: 4:49 How your mouth health connects to the rest of your body 9:15 Dr. Kenny Brown's science-backed oral care routine 21:34 Michael's personal journey into health optimization 27:28 The common denominator among successful people 34:46 The future of oral health: What we'll all be talking about soon

What is it like to tell two parents that their child won't live to see their 12th birthday? It's a question nobody wants to know the answer to, and yet is a challenge pediatricians face every day. Recently, after one of his close family members got diagnosed with a brain tumor at just eight-years-old (one that is, thankfully, noncancerous), Ben was struck by the child's bravery—as well as the calm strength of the pediatricians, who shoulder immense responsibility and yet possess unwavering positivity. Today, Dr. Jerry Loughlin, a renowned expert in pediatric respiratory diseases, joins Ben to share how pediatricians develop these resilient qualities — especially when tasked with delivering devastating news or losing a patient. Follow Benjamin on X: @BenjaminHallFNC Learn more about your ad choices. Visit podcastchoices.com/adchoices

In today's episode, you'll learn how to heal from an emotionally immature parent. If you've ever felt invisible in your own family, like your needs didn't matter, or if nothing you did was ever enough, this episode is for you. Dr. Lindsay C. Gibson is here to assure you that you're not imagining it. You're not too sensitive. You're not overreacting. And you're not alone. If you find yourself struggling to set boundaries, you're still craving your parent's approval, or you're always walking on eggshells to keep the peace, Dr. Gibson says the reason you feel this way is because you grew up with an emotionally immature parent. And today you'll finally understand what that means. You're about to learn the 4 subtle signs you had an emotionally immature parent and how that shapes your adult life – and the exact path to healing. Today's episode is not about blame. It's about clarity and finally having the language to describe what you've felt for years but couldn't quite explain. You'll learn how to name the behaviors that left you feeling dismissed or unseen, and you'll have the tools to begin healing. And that's a big deal, because doing this work doesn't just change how you feel; it changes how you live. For the last 30 years, Dr. Gibson has helped millions of people around the world break free from the invisible emotional suffering that has held them back since childhood. She is a pioneering expert on the topic of emotionally immature parents, and is the author of the New York Times bestseller "Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents."  If you've spent your entire life feeling like something was off in your relationship with your parents, but you could never quite put your finger on it, Dr. Gibson is here to say: You were right. And if you feel guilty for just considering that something might have been off, you need to hear this conversation today. This is an episode you don't want to miss. For more resources, click here for the podcast episode page. If you liked this episode, you'll love listening to this one next: Why You Feel Lost in Life: Dr. Gabor Maté on Trauma & How to HealConnect with Mel: Get Mel's #1 bestselling book, The Let Them TheoryWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTokSign up for Mel's personal letterSubscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer

Send us a textI'm thrilled to share some exciting highlights from our latest episode of the "Endless Possibilities Podcast." This week, we dive deep into the fascinating world of spiritual awakening with our incredible guest, Dr. Pierce Salguero. Trust me, you won't want to miss this one!Key Takeaways from Our Conversation:A Transformative Experience: Dr. Salguero recounts a life-changing moment while driving, where he experienced a profound shift in consciousness. Imagine perceiving sights, sounds, and sensations independently, rather than as a cohesive whole. This sparked his deep dive into the nature of awakening.Unique Spiritual Journeys: We discuss how each person's spiritual path is unique. Dr. Salguero emphasizes that comparing your journey to others can hinder personal growth. Embrace your unique experiences—they're reflective of your individual psychological processes.Finding the Right Practice: Struggling with concentration-based meditation? Dr. Salguero did too, until he discovered loving-kindness meditation (metta bhavana). This shift led to a significant heart-opening experience, highlighting the importance of finding a practice that resonates with you.The Treads Model: We explore Dr. Salguero's "treads model" of spiritual awakening. He advocates for a balanced approach, akin to cross-training in athletics, where exploring various practices can help you discover what works best for you.Compassion in Everyday Life: After his heart-opening experience, Dr. Salguero immersed himself in compassion-based practices, focusing on Mahayana Buddhism. He found fulfillment in embodying compassion in daily life, rather than seeking dramatic spiritual experiences.Integration of Experiences: Dr. Salguero shares how his academic background in Chinese Buddhism and traditional healing work in Thailand enriched his spiritual journey. He emphasizes the importance of integrating personal experiences with intellectual understanding.Why You Should Listen:Personal Stories: Hear firsthand accounts of spiritual awakening that are both relatable and inspiring.Expert Insights: Gain valuable knowledge from Dr. Salguero, an expert in Buddhism, medicine, and contemporary spirituality.Practical Advice: Learn how to incorporate spiritual practices into your daily life for a more fulfilling and compassionate existence.

Can Your DNA Predict How You Should Eat, Train & Sleep? Absolutely. Back by popular demand: one of our most talked-about episodes ever.Dr. Lois Nahirney from DNA Power reveals how your genes can guide smarter, more effective choices in your diet, fitness, and lifestyle—and how epigenetics puts the power back in your hands.You’ll learn: • Why your DNA is just the start, not the sentence • How small lifestyle shifts can change how your genes express • How to personalise your wellness plan for maximum impact If you’ve ever wondered whether DNA testing is worth it, this episode answers it all—clearly, practically, and powerfully.Because real wellness starts with understanding what your body’s actually built for. Watch the full episode here:https://youtu.be/rA3y_n5dZ2MSee omnystudio.com/listener for privacy information.

Dr. Roger Patterson shares the three core truths that every Christian mother imparts to her children. 

Ayahuasca, NASA & the Origins of Life | Dr. Bruce Damer on Psychedelics, Science & Consciousness What if psychedelics aren't just medicines for healing—but elixirs of discovery? In this boundary-breaking episode of The Awaken Podcast, Dr. Bruce Damer—astrophysicist, visionary researcher, and President of the Center for MINDS—joins Natasja Pelgrom for a groundbreaking conversation on psychedelic-catalyzed insight and its role in shaping the future of science, technology, and human understanding.

This week on The One Thing Podcast, host Dr. Adam Rinde welcomes back renowned rheumatologist Dr. Aly Cohen to dive deep into her groundbreaking new book, "Detoxify" (releasing May 2025!).Forget extreme deprivation and unsustainable measures. Dr. Cohen shares her balanced, practical, and science-backed approach to navigating the environmental toxins that challenge our bodies daily. Learn how to reduce your body's burden, support your immune system, and gain peace of mind by focusing not just on avoiding toxins, but also on adding supportive nutrients and lifestyle habits that fit into real life. This is essential listening for anyone looking to optimize their health in the modern world!Tune in to discover:(00:00) How you can support the podcast through affiliate sponsors like Healthgevity (use code ONETHING for 10% off).(02:34) An introduction to Dr. Cohen's new book, "Detoxify," and how it complements her previous work, offering a more user-friendly framework.(04:18) Dr. Cohen's "Four A's" framework (Assess, Avoid/Swap, Add, and Allow) for navigating environmental health simply and effectively.(06:59) Why our bodies, unexposed to such a high load of synthetic chemicals throughout evolution, yearn for removal and support.(09:47) The accessible and motivating 21-day plan in "Detoxify" designed to help you get started without overwhelm.(11:24) Who is most susceptible to immune toxicity and can benefit most from this approach, including those with and without diagnosed autoimmune conditions.(14:32) Dr. Cohen explains autoimmunity in simple terms – what's happening when your immune system feels "supercharged" against itself.(18:11) The mechanisms: How toxins impact the immune system and why lowering the overall chemical load is key.(22:52) Shifting from fear to resilience: Making sustainable choices and building a healthier internal environment.(25:03) Practical, high-yield changes: The surprising benefits and accessibility of USDA organic frozen foods.(26:34) Dr. Cohen's sensible approach to assessment – utilizing questionnaires and strategic, insurance-covered blood tests over expensive, broad panels.(39:28) The "Three S's" for natural detoxification and well-being: Sleep, Stress management, and Sweat (and how our bodies are designed for them!).(44:06) Powerhouse foods for detoxification: Why cruciferous vegetables are standouts and how food truly can be medicine.(47:51) Maintaining hope for future generations: Dr. Cohen's perspective on educating children about environmental health.(53:54) Where to find Dr. Aly Cohen online, including her Smart Human Podcast and resources at smarthuman.com.Learn more about Dr. Cohen at The Smart HumanSee her new book Detoxify: https://www.amazon.com/Detoxify-Everyday-Toxins-Harming-Against/dp/1668033534.If you found this episode valuable, please share it with friends, family, and anyone you think might benefit from this essential information!#Detoxify #DrAlyCohen #TheOneThingPodcast #EnvironmentalHealth

Get ready to transform your mind in this compelling conversation with Dr. Daniel Amen, a world-renowned Christian psychiatrist trusted by stars like Miley Cyrus, Justin Bieber, and many more. With 35+ years of expertise and a quarter of a million brain scans, Dr. Amen shares why the world's approach to mental health is failing, and how daily choices like rejecting alcohol, sugar, and negative thoughts can renew your mind, as Romans 12:2 urges. Rooted in faith and backed by science, this conversation reveals the importance of disciplining your thoughts, your diet, and caring for your brain - the temple of the Holy Spirit. Dr. Amen gives practical, biblically-grounded strategies to conquer negative thoughts, raise mentally resilient children, and how to break free from common dopamine traps like social media and ultra-processed foods. He also takes time to explain how fasting sharpens your spiritual clarity, why intermittent fasting supports brain health, and how a God-honoring diet can reduce inflammation and protect against prevalent diseases like Alzheimer's and diabetes. This is a must-listen for anyone wanting to unlock their true God-given potential, take every thought captive, and live a more fulfilling life filled with purpose and clarity!

Get ready to transform your mind in this compelling conversation with Dr. Daniel Amen, a world-renowned Christian psychiatrist trusted by stars like Miley Cyrus, Justin Bieber, and many more. With 35+ years of expertise and a quarter of a million brain scans, Dr. Amen shares why the world's approach to mental health is failing, and how daily choices like rejecting alcohol, sugar, and negative thoughts can renew your mind, as Romans 12:2 urges. Rooted in faith and backed by science, this conversation reveals the importance of disciplining your thoughts, your diet, and caring for your brain - the temple of the Holy Spirit. Dr. Amen gives practical, biblically-grounded strategies to conquer negative thoughts, raise mentally resilient children, and how to break free from common dopamine traps like social media and ultra-processed foods. He also takes time to explain how fasting sharpens your spiritual clarity, why intermittent fasting supports brain health, and how a God-honoring diet can reduce inflammation and protect against prevalent diseases like Alzheimer's and diabetes. This is a must-listen for anyone wanting to unlock their true God-given potential, take every thought captive, and live a more fulfilling life filled with purpose and clarity!

The power of being present in our day to day life is profound. We miss so many moments because we are too busy already in the next moment. Being present helps us find the magical awesomeoness in everyday aspects of life. Sometimes we just need to stop and smell the roses.      ....   Do you want to change your mindset and have a positive outlook on life? Are you looking forward to being the change you wish to see in the world? Subscribe and start your life-changing journey ➡️ ➡️ SUBSCRIBE: https://bit.ly/DRAshaPrasad Visit my website: https://drashaprasad.com

Thank you for joining us for another season of the Tabernacle Pulpit Podcast!This episode marks the end of Season 2. We have so many more sermons from the pulpit of Dr. Sightler that we are excited to share. Join us in the fall as we pick up Season 3 with newly digitized sermons by the late Dr. Harold B. Sightler!Originally preached on January 11, 1976 at Tabernacle Baptist Church.For more sermons, visit WTBI.org.

What if I told you that anxiety is just an alarm system? Our guest today, Dr. John Delony, refers to anxiety as our body's internal notification that our brain is detecting danger, that our body is in desperate need of sleep and restoration, that we are disconnected from our community, or that we are lonely. Dr. John Delony is a national best-selling author, mental health & wellness expert, and the host of The Dr. John Delony Show. He holds two PhDs, and has over two decades of experience in counseling, crisis response and higher education. You could say that Dr. Delony essentially spends his time teaching people how to find freedom and reclaim their lives. In this episode, Dr. Delony shares his thoughts on how to create a life that doesn't leave you feeling constantly overwhelmed, how to overcome toxic perfectionism, and a few strategies to avoid loneliness.Suggested Resources:Follow Dr. Delony on on YouTube, Instagram, TikTok, Facebook and XThe Dr. John Delony ShowBuilding a Non-Anxious LifeFear vs Anxiety The meaning of anxiety Dr. Rollo MaySend me a text!This episode is proudly sponsored by: SizzlefishLet's talk about fueling your body with the best nature has to offer. If you're looking for premium, sustainable seafood delivered straight to your door, you need to check out Sizzlefish! Head to sizzlefish.com and use my code “wellnstrong” at checkout for an exclusive discount on your first order. Trust me, you're going to taste the difference with Sizzlefish! This episode is proudly sponsored by: Tahiti TraderWant to know one of my daily health secrets for keeping my immune system strong and my energy levels high? Noni juice. When you use my link to order you'll get 15% off my special offer, a free branded shot glass and a copy of the book “Build an Amazing Immune System” use the code wellnstrong15!Join the WellnStrong mailing list for exclusive content here!Want more of The How To Be WellnStrong Podcast? Subscribe to the YouTube channel. Follow Jacqueline: Instagram Pinterest TikTok Youtube To access notes from the show & full transcripts, head over to WellnStrong's Podcast Page

Scripture reference:John 10:10First Methodist Church of Opelika is an exciting, historic, and growing Methodist church that is inviting our community to find and follow the Spirit-led life in Jesus. Founded in 1837, First Opelika has a rich history of influencing and impacting families in the Opelika/Auburn and surrounding community. The church is currently in a season of revitalization and is laying the foundation for effective ministry in the next season of her life as an independent Methodist church.For more information, check us out at www.firstopelika.org or www.facebook.com/firstopelika

To support this ministry and help us continue to reach people all around our region, click here: http://bethel.ag/give/Stay Connected Website: www.bethel.ag Bethel Church Facebook: www.facebook.com/bethelchurch605/ Bethel Church Instagram: www.instagram.com/bethelchurch605/

This week's Dark Nation Radio is ready for streaming and features new tracks from bands including VNV Nation, Bella Eterna, Denuit, Dawn of Ashes, KY, Cyborg Amok, Cylix, Vampyros Lesbos, Mercury's Antennae, Jesika von Rabbit, Kim Lunner, Matthew Nowhere, and The Birthday Massacre. I hope you enjoy it! As always, if you like what you hear, I hope you will support the bands and consider following me on your preferred platform. Reposts of the show so that others can find out about it are particularly appreciated. Questions and promo materials may be directed to darknationradio@gmail.com. Thanks for your support! DJ cypher's Dark Nation Radio Playlist 27 April 2025 Bella Eterna, “Mysterious Beauty” The Paper Road, “So Tired” She Past Away, “Insanlar” Siouxsie & the Banshees, “The Killing Jar” Les Lésions Divisées, “The Tree of Life” Drøme, “Depression Dance” Silver Tears, “Waste of Time” VNV Nation, “Station 21” Dawn of Ashes, “Hypertensive Crisis” Kim Lunner, “With You” KY, “Dance to a Sacred Bass” Huir, “Arch (Fragrance mix)” Mercury's Antennae, “The Reflecting Skin (William Faith mix)” Encephalon, “Illusions” Mortes, “Bite Me” Cyborg Amok, “Cellophane Grind” Vioflesh, “Midnight” Balduvian Bears, “Winter's End” Denuit, “Nocturnal Vision” Jesika von Rabbit, “Wacko” Aesthetic Perfection, “Master” The Birthday Massacre, “All of You” Matthew Nowhere, “Love is Only What We Are” Cylix, “As If I Had Your Wings” Vampyros Lesbos, “Angemessen” Sjöblom, “Weirdo (Universe mix)” Plague Garden, “Blood Debt” Autumn – U.S., “Catacombs” DJ CYPHER'S DARK NATION RADIO—24 years strong! **Live Sundays @ 9 PM Eastern US on Spirit of Resistance Radio sorradio.org **Recorded @ http://www.mixcloud.com/cypheractive **Downloadable @ http://www.hearthis.at/cypheractive **Questions and material for airplay consideration to darknationradio[at] gmail[dot]com **Facebook @ http://www.facebook.com/groups/darknationradio

Dr Jen. Wolkin is a neuropsychologist, writer, speaker and professor. She has not only a clinical but a holistic approach to trauma and care. This is what makes her unique with her practice. In this episode, we talk about how the brain is affected by trauma, the brains amazing ability to change via Neural plasticity, how the brain is affected by childhood trauma and how burn out affects the brain. This episode was insightful, informative and mind blowing! To follow Dr. Jen on Instagram:https://instagram.com/drjenwolkin?igshid=YmMyMTA2M2Y=Dr. Jen's website:https://braincurves.comAbout the Host:Keresse Thompson is a Licensed Clinical Social Worker, intuitive empath, and professional Tarot reader. Through the Diary of an Empath podcast, she explores topics like mental health, spirituality, and personal development, aiming to guide listeners on their healing and growth journeys. Stay Connected: • Website: therapeutichealingbyreese.com • Instagram: @keresse • Facebook: Therapeutic Healing by Reese • TikTok: @DiaryofanEmpathPodcastIf you like this podcast please leave me a review and rate!For more info on my services such as Therapy, Tarot readings or coaching; please visit my website at www.therapeutichealingbyreese.com

Here Dr Thomas Levy talks about the amazing power of Vitamin C as an antioxidant with amazing beneficial capabilities. We also discuss the other supplements in his Top 8 for cellular and mitochondrial health

First Baptist Church Broken Arrow is located at 100 W. Albany in Broken Arrow, Oklahoma. We would love to connect with you online and in-person! We would love to connect with you on Facebook: https://www.facebook.com/fbcbrokenarrow​ You can also check out our website: https://www.fbcba.org​

Christopher is the founder of Recovery Health Coaching. He helps clients recover from chronic illness, improve chronic pain, and deal with the limitations of their conditions. He does so with principles from neuroscience, behavior management, and personalized lifestyle and supplement approaches from a Functional Health perspective. He developed this system while reversing his 35 years of autoimmunity and severe neuropathic pain and successfully working in intensive one-on-one sessions with over 100 clients. Christopher's personal journey includes conquering numerous conditions that plagued him for over 30 years, including interstitial cystitis, fibromyalgia, irritable bowel syndrome, chronic headaches, and severe neuropathy in 85% of his body. At his worst, the pain was so severe that he would stay awake for over 30 hours per wakeful cycle and relied on numerous medications including max-dose morphine and multiple muscle relaxers for nearly 10 years. His recovery approach has been primarily meat-based for over 7 years, beginning with the Autoimmune Protocol (AIP) in 2017 and then transitioning to a Keto diet. His comprehensive recovery also incorporated about 30 other interventions including lifestyle changes, mindset work, neuroscience techniques learned from former Mayo Clinic doctor Jim Lemons, and Functional Medicine principles. Today, Christopher is medication-free and physically active, lifting weights 4-6 days per week, running sprints, and going bouldering regularly. He has restored his testosterone to optimal functional ranges after measuring below 200, lost significant weight (from 242 pounds to 160 pounds), and regained his former height after postural issues had left him three inches shorter during his 15 years of disability. Christopher is currently developing two online courses focused on nervous system health and universal health principles, co-hosting the upcoming weekly podcast "Recover Your Health," and writing a book with Dr. Jim Lemons about using integrated principles to achieve optimal results with chronic health problems. Instagram: https://www.instagram.com/christopher_blakeslee/ YouTube: https://www.youtube.com/@christopherblakesleeRHC Website: recoverfromchronicillness.com/ Timestamps: 00:00 Trailer 01:22 Introduction 06:15 Living with limitations and allergies 07:56 Chronic illness journey: high school struggles 13:18 Chronic pain and failed treatment 14:13 Chronic pain: surgery, diet, relapse 19:27 Chronic pain and medication struggles 23:44 Three years of endless struggle 24:38 Terrifying health crisis moment 30:29 Mindset shift: embracing movement 31:12 Celebrating small achievements 36:11 Neuroscience: the essential body manual 39:43 Rebuilding health through minimal movement 42:48 Muscle building and fasting benefits 44:02 Happiness and health transformation 48:07 Preventing pain flare-ups tips 50:22 Optimizing health through routine 53:48 Where to find Christopher Join Revero now to regain your health: https://revero.com/YT Revero.com is an online medical clinic for treating chronic diseases with this root-cause approach of nutrition therapy. You can get access to medical providers, personalized nutrition therapy, biomarker tracking, lab testing, ongoing clinical care, and daily coaching. You will also learn everything you need with educational videos, hundreds of recipes, and articles to make this easy for you. Join the Revero team (medical providers, etc): https://revero.com/jobs ‪#Revero #ReveroHealth #shawnbaker  #Carnivorediet #MeatHeals #AnimalBased #ZeroCarb #DietCoach  #FatAdapted #Carnivore #sugarfree Disclaimer: The content on this channel is not medical advice. Please consult your healthcare provider.

In this captivating episode of the Meditative Prayers podcast, Dr. Tim Clinton takes the helm, guiding us through a profound exploration of life's spiritual dimensions—an endeavor that deeply resonates within our Christian community. Throughout our spiritual journey, there are moments when navigating the complexities of life and finding meaning becomes a paramount desire. These moments not only enrich our faith but also invigorate our relationships, propelling us toward the fulfillment of our individual dreams. The reassuring truth remains constant: with the Lord as our steadfast guide, we possess the innate ability to navigate life's challenges, discovering renewed hope and purpose in our journey. Drawing deep inspiration from sacred scriptures, we embark on an exploration of this transformative human experience. For those who seek guidance in navigating life's spiritual dimensions along their path of faith, we extend a heartfelt invitation to explore the Pray.com app. By simply downloading it today, you can embark on a transformative journey of faith and resilience, deeply rooted in the unwavering presence of the Divine. Together, let us wholeheartedly embrace the incredible potential for life within us, finding boundless inspiration and strength during our shared spiritual pilgrimage. We invite you to join us in this enlightening episode as we venture toward a profound understanding of life's spiritual dimensions and discover the extraordinary sense of fulfillment that resides within each one of us. Embracing the practice of praying before slumber is more than just a routine; it's an avenue to recenter your heart, aligning it with God's purpose. Let Pray.com’s Meditative Prayer be a nightly companion, deepening your bond with the Almighty and settling your spirit for a serene night's rest.Dr. Clinton is from the American Association of Christian Counselors, for more information please visit: https://aacc.net/See omnystudio.com/listener for privacy information.

In this episode, I'm joined by Dr. Jocelyn Wittstein—orthopedic surgeon, sports medicine expert, and Associate Professor at Duke University—for a powerful and practical conversation about bone and joint health across the lifespan. From the challenges of frozen shoulder and arthritis to the truth about running and menopause hormone therapy, this episode is your definitive guide to staying strong, mobile, and pain-free well into your 40s, 50s, and beyond.We cover:Why your joints and bones start changing after 30—and what to do about itThe difference between male and female aging (and why 50 hits women harder)The role of estrogen in health, inflammation, muscle mass, and osteoporosisThe truth about running and arthritis: myth vs. realityHow to actually build stronger bones: plyometrics, impact, and intensityWhy frozen shoulder happens and how to treat it earlyThe supplements Dr. Wittstein actually recommends (and which ones she used to dismiss)What we're learning about GLP-1 medications and their surprising effect on bone and joint healthWhether you're an athlete, a parent, or entering perimenopause, this conversation is a masterclass in movement longevity and joint and bone preservation.Who is Dr. Jocelyn Wittstein?Dr. Jocelyn Wittstein is an Associate Professor of Orthopedic Surgery at Duke University specializing in sports medicine and women's joint health. As a leading researcher and clinician, she's pioneered work on arthritis, adhesive capsulitis, and the role of hormones in bone and joint aging. She is also co-author of the upcoming book The Complete Bone and Joint Health Plan (May 2025), a practical guide for women who want to move well and stay strong at every stage of life.This episode is brought to you by:Puori – Code DRLYON for 20% off sitewide! → puori.com/DRLYONNeeded – Code DRLYON for 20% off your first order → thisisneeded.comBON CHARGE – Code DRLYON for 15% off! → boncharge.com/DRLYONDivi – Get 20% off your first order → diviofficial.com/DRLYONFind Dr. Jocelyn Wittstein at: Duke Health: https://www.dukehealth.org/find-doctors-physicians/jocelyn-ross-wittstein-md Instagram: @jocelyn_wittstein_mdThe Complete Bone and Joint Health Plan: Amazon and Barnes & Noble Find me at:Instagram: @drgabriellelyonTikTok: @drgabriellelyonFacebook: facebook.com/doctorgabriellelyonYouTube:youtube.com/@DrGabrielleLyonX (Twitter):

In this episode, you'll learn how to let go of regret, overcome regret, let go of past mistakes, and step into a powerful new chapter. Today, Mel is joined by one of the most powerful and honest voices of our time: Charlamagne Tha God. He's a Radio Hall of Famer, a three-time New York Times bestselling author, an Emmy-winning producer, and co-host of The Breakfast Club, one of the biggest radio shows in the world, among many accolades. But none of that is why this episode matters. This is a raw, inspiring, and deeply personal conversation about redemption, reinvention, letting go of mistakes, and becoming a better version of yourself.  Charlamagne opens up about childhood trauma, addiction and the moment he finally chose to change his life. He shares how he became a better father, how he broke toxic cycles, and why grace is the key to growth.  You'll learn: – How one simple decision can set you free – How to stop punishing yourself for who you used to be – A simple practice to help you find peace, even when life feels heavy By the end of this episode, you'll know that no matter where you come from or what you've done, you can reinvent yourself. You can change yourself. Starting today.  For more resources, click here for the podcast episode. Note: this episode includes open conversation around mental health, including anxiety, depression, and suicidal thoughts. Please take care while listening.If you liked this episode, and want to know more about how to become a happier, healthier you, listen to this next: Why You Feel Lost in Life: Dr. Gabor Maté on Trauma & How to HealConnect with Mel:  Get Mel's #1 bestselling book, The Let Them TheoryWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel's personal letter Subscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer

Dr Ellen J. Langer is Professor of Psychology at Harvard University, and many consider her to be the ‘mother of mindfulness'.  Today on the show, we discuss: why life is so stressful right now, how to reframe the way you see adversity, why you don't have to meditate to practice mindfulness, how to improve the way you speak to yourself, how your perception shapes the way you live your life, how to cultivate self-awareness and live a more mindful life, and much more. Thanks to this episode's sponsor: Timeline Nutrition Upgrade your mitochondrial health with Mitopure. Timeline is offering 10% off your first order of Mitopure. Go to https://www.timelinenutrition.com/doug and use code DOUG to get 10% off your order. ⚠ WELLNESS DISCLAIMER ⚠ Please be advised; the topics related to mental health in my content are for informational, discussion, and entertainment purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your mental health professional or other qualified health provider with any questions you may have regarding your current condition. Never disregard professional advice or delay in seeking it because of something you have heard from your favorite creator, on social media, or shared within content you've consumed. If you are in crisis or you think you may have an emergency, call your doctor or 911 immediately. If you do not have a health professional who is able to assist you, use these resources to find help: Emergency Medical Services—911 If the situation is potentially life-threatening, get immediate emergency assistance by calling 911, available 24 hours a day. National Suicide Prevention Lifeline, 1-800-273-TALK (8255) or https://suicidepreventionlifeline.org.  SAMHSA addiction and mental health treatment Referral Helpline, 1-877-SAMHSA7 (1-877-726-4727) and https://www.samhsa.gov Learn more about your ad choices. Visit megaphone.fm/adchoices

Jeff Gross sits down with Dr. Grant Elliott, founder of Rehab Fix, to talk about chronic back pain, movement, and how he's helping people ditch surgery through simple, effective rehab. Whether you're a poker pro hunched over for 12-hour sessions, a new parent carrying toddlers all day, or just someone who's tired of nagging back pain—this episode is packed with actionable insights.

Seeking deeper connection and guidance? In today's message, Dr. Melodye Hilton unpacks the transformative power of "surrender." Explore how letting go isn't a one-time event, but a continuous journey that reshapes us and becomes our heartfelt offering to God. Discover the freedom that comes when we open ourselves to His divine direction.Notes & Scriptures for this message are available in the Notes section of the Giving Light App.Visit our website at www.givinglight.org.Download the Giving Light App available for free on iOS and Android.

Dr. Joe Dispenza is a renowned author, speaker, and educator in the fields of neuroscience, epigenetics, and quantum physics. He has spent over three decades studying the mind-body connection and the ways in which we can harness our thoughts and emotions to create positive change in our lives.Take action and strengthen your mind with The Resilient Mind Journal. Get your free digital copy today: ⁠⁠⁠⁠⁠https://bit.ly/Download_JournalSubscribe to Steven Bartlett for more inspiring videos: https://www.youtube.com/c/TheDiaryOfACEO Hosted on Acast. See acast.com/privacy for more information.

If you feel lost or stuck in life, today's episode will help you understand the root cause of trauma and how childhood experiences shape you throughout your life. Understanding your trauma is the key to healing. Your past doesn't define you—but it does shape you. And today, world-renowned physician and bestselling author Dr. Gabor Maté is here to break it all down. Dr. Maté, a leading expert on trauma, shares insights on this topic unlike anything you have heard before. In this powerful conversation, he reveals how childhood experiences—whether you realize it or not—impact your relationships, self-worth, and the way you navigate life. You'll learn why trauma, stress, addiction, and people-pleasing aren't just personality traits but survival patterns formed in your early years. And most importantly, you'll discover that while what happened to you isn't your fault, healing is your responsibility. This conversation will challenge the way you see yourself—and give you the tools to take control of your future. For more resources, click here for the podcast episode page. If you enjoyed this episode with Dr. Gabor Maté, listen to his first appearance, where he dives deep into the connection between trauma, ADHD, and autoimmune disease: Dr. Gabor Maté: The Shocking Link Between ADHD, Addiction, Autoimmune Diseases, & TraumaConnect with Mel:  Get Mel's #1 bestselling book, The Let Them TheoryWatch the episodes on YouTubeFollow Mel on Instagram The Mel Robbins Podcast InstagramMel's TikTok Sign up for Mel's personal letter Subscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer

Dr. Steve Heine, cultural psychologist and author of Start Making Sense, joins us to explore the psychology of meaning. We discuss the four essential connections that shape a fulfilling life, why existential anxiety is on the rise, and how nostalgic reflection and storytelling help us make sense of our experiences. Plus, we dive into his “meaning audit” tool—a practical way to strengthen purpose and connection. Topics [0:00] Intro - Did Kurt take a psychology class? [5:24] Speed Round with Dr. Steve Heine [8:54] Was Sisyphus actually happy? [10:37] The importance of process over destination [19:48] Cultural differences in meaning-making [25:10] Why we rationalize our life choices [31:17] How storytelling shapes our identity [42:46] Practical tips for building a meaningful life [48:42] Grooving session: Building community and connecting with each other ©2025 Behavioral Grooves Links Start Making Sense by Dr. Steve Heine More about Dr. Steve Heine Joseph Campbell's The Hero's Journey Join the Behavioral Grooves community Subscribe to Behavioral Grooves on YouTube Music Links Talking Heads - Once in a Lifetime  The Beatles - Don't Let Me Down

Dr. Allan Bacon holds a Doctorate in Dental Surgery from the University of Maryland. He is a certified personal trainer through the National Academy of Sports Medicine, a certified physique & bodybuilding coach, a certified nutritionist (x2), a certified coach for USA Powerlifting, and has formulated professionally for industry-leading dietary supplement companies since 2009. Today on the show we discuss: how to overcome mental barriers that block you from achieving results, how to get back into the best shape of your life if you haven't worked out for a long time, why strength training must be prioritized and how to do it effectively, popular health and wellness trends that you are wasting your time on, how to optimize your nutrition to crush your goals, how to stick to your plan longterm and much more. Thanks to this episode's sponsor: Timeline Nutrition Upgrade your mitochondrial health with Mitopure. Timeline is offering 10% off your first order of Mitopure. Go to timelinenutrition.com/doug and use code DOUG to get 10% off your order. ⚠ WELLNESS DISCLAIMER ⚠ Please be advised; the topics related to health and mental health in my content are for informational, discussion, and entertainment purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your health or mental health professional or other qualified health provider with any questions you may have regarding your current condition. Never disregard professional advice or delay in seeking it because of something you have heard from your favorite creator, on social media, or shared within content you've consumed. If you are in crisis or you think you may have an emergency, call your doctor or 911 immediately. If you do not have a health professional who is able to assist you, use these resources to find help: Emergency Medical Services—911 If the situation is potentially life-threatening, get immediate emergency assistance by calling 911, available 24 hours a day. National Suicide Prevention Lifeline, 1-800-273-TALK (8255) or https://suicidepreventionlifeline.org. SAMHSA addiction and mental health treatment Referral Helpline, 1-877-SAMHSA7 (1-877-726-4727) and https://www.samhsa.gov Learn more about your ad choices. Visit megaphone.fm/adchoices

Your inner voice can be your greatest weapon—or your worst enemy. So… which one is yours? Psychologist and bestselling author Ethan Kross joins the boys to unpack the science of self-talk, emotional control, and mental resilience. Why do some people crack under pressure while others thrive? What separates high performers from those who let emotions run their lives? And most importantly, how can you take control of your mind before it controls you? Ethan takes Jer and Bri on a dive deep into his latest book SHIFT to unpack elite psychological strategies used by Navy SEALs, healthcare workers, and top performers to master their emotions. Learn how to shift your perspective, silence negative self-talk, and use your inner voice as a tool—not a weapon. You're already talking to yourself. It's time to start listening the right way.Be sure to catch the full video version of this episode on YouTube. Follow Sickboy on Instagram, TikTok and Discord!

We all know sleep is important, but most of us don't realize just how much it shapes our health—from metabolism and heart function to emotional well-being and even social connections. In this episode of The Dr. Hyman Show, I sit down with world-renowned sleep expert Matthew Walker, PhD, to uncover the science behind why sleep is one of the most powerful (and overlooked) tools for longevity. In this fascinating conversation, we discuss: Why Dr. Walker sees sleep as the foundation of good health and how it enhances the benefits of diet and exercise. The dramatic effects of even mild sleep deprivation on cognitive function and emotional health. How poor sleep can disrupt blood sugar regulation and increase the risk of chronic disease. The science behind deep sleep and its role in memory, learning, and brain detoxification. Simple, science-backed strategies to improve your sleep quality starting tonight. If you've ever struggled with sleep—or just want to optimize your health—this is an episode you won't want to miss. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman's Weekly Longevity Journal This episode is brought to you by Seed, PerfectAmino, Sunlighten, and AirDoctor. Seed is offering my community 25% off to try DS-01® for themselves. Visit seed.com/hyman and use code 25HYMAN for 25% off your first month of Seed's DS-01® Daily Synbiotic. Get pure essential amino acids today. Go to bodyhealth.com and use HYMAN20 to get 20% off your first order. Visit sunlighten.com/ and save up to $1400 on your purchase with code HYMAN. Get cleaner air. Right now, you can get up to $300 off at airdoctorpro.com/drhyman.