Podcasts about Methadone

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/medicine

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/biography

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/public-policy

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/drugs-addiction-and-recovery

Dr. Melody Glenn was a burned-out emergency physician who had grown to resent the large population of opioid dependent patients passing through her ER. While working at a methadone clinic, she realized how effective harm reduction treatments could be and set out to discover why they weren't used more broadly. That's when she found Dr. Marie Nyswander.In the 1960s, Nyswander defied the DEA and medical establishment to co-develop methadone maintenance as a treatment for heroin addiction. According to some addiction specialists, its discovery could be considered as monumental as the discovery of penicillin. Yet, it still carries a stigma today.Deftly weaving together interviews, media coverage, and historical documents, Glenn recovers Nyswander's important legacy and reveals how the forces of racism, fearmongering politicians, and misinformation colluded to set us back decades in our understandings of opioids.With Nyswander as her guide, Glenn also shares her journey through addiction medicine as she confronts her own personal and philosophical quandaries around bias, ambition, and saviorism in the medical field.As the US continues to struggle with opioid and fentanyl use in communities, Mother of Methadone is a powerful reminder of the ways biases have prevented doctors from saving countless lives. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her second book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in 2026. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, we explore how to choose between methadone, buprenorphine, and naltrexone for opioid use disorder treatment. With over 100,000 overdose deaths annually, how do we match the right medication to save each patient's life? Faculty: Smita Das, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Pharmacologic Management of Opioid Use Disorder Tailored Patient Assessment: A Key to Effective OUD Treatment  

In this episode, we explore methadone maintenance therapy for opioid use disorder, covering dosing strategies, recent regulatory changes, and safety considerations. Why do so many patients fail on methadone despite its proven effectiveness, and how can proper dosing make the difference between recovery and relapse? Faculty: Smita Das, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Pharmacologic Management of Opioid Use Disorder Methadone for Managing OUD

The Springfied Development Review Board denied a permit application from Acadia Healthcare to open a methadone clinic in a building downtown that houses family medical practices.

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.

 Dopeywood!Note about ToddA  voicemail from a listener in Mexico: “¿Qué pasó David?”Email about a guy sober off weed and a listener who relapsed on shrooms and weed.Dave reflects on the cyclical pain of relapse in the Dopey Nation.Jessie G Segment“I formed like a make-believe relationship with him [Chris].”Jessie first listened to Dopey while working hotel jobs in 2018.“Early recovery sucks no matter which way you cut it.”“I was doing kratom and still eating acid in sober living.”She felt totally alone — “My roommates were gone, I was just in my house.”“I had to threaten suicide one night to get help.”“I think I would make a fine crackhead.”“I was just in my room with my foils.”“I was on probation… and doing really well… but using at the same time.”“I ended up getting arrested in Scranton.”“The methadone detox was the easiest of my life.”“I got a new number and was like, perfect.”“I was living a double life — one part spiritual, one part crazy.”“I was like, just give me a fucking bag.”Describes traveling while using: “I could see in my mind's eye the hotel we were in.”“COVID made it easy to disappear.”“Kensington was a wake-up call.”“I want a real life.”Todd Curry Tribute with DK“He was just a spark, man… I love Todd a lot and I miss him.”“He personified fun. If fun was a person, it was Todd on drugs.”“Do you think I beat a dead horse with Todd? I just can't stop honoring him.”Dave introduces the term “Todd Shot” — Dopey Nation's version of a “God Shot.”DK agrees to come back next year with stories of getting high with Todd.Dave invites listeners to submit Todd memories or tributes.OutroReflections on the importance of recovery: “It's the greatest thing I have in my life.”Outro song: “One More” by Rocker T“Stay strong Dopey Nation and fucking toodles for Chris.” 

Memory function in patients with opioid dependence treated with buprenorphine and methadone in comparison with healthy persons  Scientific Reports This study compared memory performance in patients treated with methadone or buprenorphine for drug abuse to healthy controls using the Wechsler Memory Scale. Healthy controls performed better than both treatment groups in mental control. Methadone patients scored higher than controls in personal and general information, while buprenorphine patients scored lower in associate learning. Longer buprenorphine treatment was linked to better overall memory scores, and patients on methadone for over two years showed better awareness of place and time compared to long-term buprenorphine users. Overall, neither medication showed major negative effects on memory except for mental control, which was impaired in both groups. Buprenorphine appeared to better preserve memory function over time than methadone.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Fentanyl vs. Heroin: "Trash high"—no legs, not the same rush, felt grateful when heroin disappearedFirst Shot: A friend made him do it for free—"Misery loves company"—then couldn't stopOD Stories: OD'd twice in one day—once behind the wheel on FDR, once after snorting Bronx bags, woke up in hospital, ripped tubes out, lied about asthmaMom's Heart Attack: 4 days after OD, mom has a heart attack from stressHustles: Selling weed, flipping Suboxone, scamming friends, "like a credit card"—balances, fronts, jugglingJam Band Scene: Heavy on acid, ketamine, nitrous, Calvin Klein (coke + K), LSD handling mishap at Camp Bisco led to paranoia for a weekMethadone Clinic Madness: Working in the clinic, finding crack pipes, wild characters, hustles in the waiting roomRecovery Pivot: Got clean after the ferry breakup, went to White Deer Run, cut methadone taper on day 3, Old Testament-level detox, started working the 12 steps, counselor Heath changed his lifeWorking in Treatment: From the methadone clinic to Ascendant, saw the whole spectrumWriting: Wrote Slingshot Diaries in Maryland, self-published hundreds of copies, found purposeReflection: Raw honesty, doesn't glorify but doesn't hide it either—“thank God for grace and mercy”

Note from Jeannine: Christina's story is one of my favorite all time episodes of the show. Just an incredible story of strength and resilience. This is an encore run of her episode, new episodes return next week after my TedX Talk! Thank you for being patient with me, I love you guys!TRIGGER WARNING******sex trafficking, domestic abuse, assault, SA and pregnancy termination My conversation today with Christina Garofalo will have you both laughing and crying. Christina is a survivor in the truest form of the word. I was blown away by her vulnerability, authenticity and the strength she has shown in escaping the world she was trapped in, making it back to her hometown and family in San Diego AND tapering down from an incredibly high dose of methadone (170 mL). Christina now has a sponsor, works steps, goes on twelve step retreats and does EMDR therapy - she has worked so hard to find healing, peace and safety and I am personally so proud of her.Connect with Christina on ⁠Instagram⁠Connect with Christina on ⁠TikTok⁠DM me on ⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠Message me on ⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠Listen AD FREE & workout with me on ⁠⁠⁠⁠⁠⁠⁠⁠Patreon⁠⁠⁠⁠⁠⁠⁠⁠ Connect with me on ⁠⁠⁠⁠⁠⁠⁠⁠TikTok⁠⁠⁠⁠⁠⁠⁠⁠Email me chasingheroine@gmail.comSee you next week!

In this episode of EM Pulse, Dr. Daniel Hernandez, an emergency medicine and addiction specialist at UC Davis, joins the team to spotlight methadone—one of the original and still powerful tools for treating opioid use disorder (OUD). While newer medications like buprenorphine often steal the spotlight, methadone remains a critical option, especially in the era of fentanyl. Tune in for a practical conversation on when and how to initiate methadone in the ED, navigating regulatory barriers, arranging follow-up at opioid treatment programs, and managing pain in patients already on methadone. Whether you're new to methadone or looking to sharpen your approach, this episode offers real-world insights and actionable pearls  Have you started methadone from the ED? Share your experience with us on social media @empulsepodcast or connect with us on ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Dr. Daniel Hernandez, Assistant Professor of Emergency Medicine and Assistant Director of the Addiction Medicine Fellowship at UC Davis Resources: CA Bridge ACEP/CA Bridge - Methadone Hospital Quick Start Liberate Methadone: An Introduction for the Emergency Medicine Physician By Terence M. Hughes, MD; Joan Chen, MD; and Utsha G. Khatri, MD, MSHP | on April 14, 2025 *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Listen in as our expert panel discusses medications for management of opioid use disorder. They'll review strategies to optimize buprenorphine use and clarify the role of methadone and naltrexone.Special guest:Tyler J. Varisco, PharmD, PhDUniversity of Houston College of Pharmacy Assistant Professor, Department of Pharmaceutical Health Outcomes and PolicyAssistant Director, The PREMIER CenterYou'll also hear practical advice from panelists on TRC's Editorial Advisory Board:Stephen Carek, MD, CAQSM, DipABLM, Clinical Associate Professor of Family Medicine for the Prisma Health/USC School of Medicine Greenville Family Medicine Residency Program at the University of South Carolina School of Medicine, GreenvilleCraig D. Williams, PharmD, FNLA, BCPS, Clinical Professor of Pharmacy Practice at the Oregon Health and Science UniversityFor the purposes of disclosure, Dr. Varisco reports a financial relationship [cardiology, inflammatory bowel disease] with HEALIX Infusion Therapy (research consultant).The other speakers have nothing to disclose.  All relevant financial relationships have been mitigated.This podcast is an excerpt from one of TRC's monthly live CE webinars, the full webinar originally aired in March 2025.TRC Healthcare offers CE credit for this podcast. Log in to your Pharmacist's Letter, Pharmacy Technician's Letter,or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.Claim CreditThe clinical resources mentioned during the podcast are part of a subscription to Pharmacist's Letter, Pharmacy Technician's Letter, and Prescriber Insights: FAQ: Management of Opioid Use DisorderChart: Treatment of Opioid WithdrawalFAQ: Treatment of Acute Pain in Opioid Use DisorderFAQ: Meds for Opioid OverdoseSend us a textIf you're not yet a subscriber, find out more about our product offerings at trchealthcare.com. Follow, rate, and review this show in your favorite podcast app. Find the show on YouTube by searching for ‘TRC Healthcare' or clicking here. You can also reach out to provide feedback or make suggestions by emailing us at ContactUs@trchealthcare.com.

https://x.com/annielcrawford/status/1916992027771998322 Ethan Caughey https://youtu.be/qq75FCWLoUU?si=kZtaWz0pTErmRYBj  https://roddreher.substack.com/p/we-have-to-be-truthful-about-this  https://roddreher.substack.com/p/trump-saves-canada-liberals-from  https://www.maryharrington.co.uk/p/the-industrialisation-of-thought   ⁨@WhiteStoneName⁩  Salvation and Will (and Time) https://www.youtube.com/live/b3TPm2FfT7c?si=dgBwd2Gwjmy5jLj2  Matt C's randos https://youtu.be/KmcbNIDKzoM    Paul Vander Klay clips channel https://www.youtube.com/channel/UCX0jIcadtoxELSwehCh5QTg Midwestuary Conference August 22-24 in Chicago https://www.midwestuary.com/ https://www.meetup.com/sacramento-estuary/ My Substack https://paulvanderklay.substack.com/ Estuary Hub Link https://www.estuaryhub.com/ If you want to schedule a one-on-one conversation check here. https://calendly.com/paulvanderklay/one2one There is a video version of this podcast on YouTube at http://www.youtube.com/paulvanderklay To listen to this on ITunes https://itunes.apple.com/us/podcast/paul-vanderklays-podcast/id1394314333  If you need the RSS feed for your podcast player https://paulvanderklay.podbean.com/feed/  All Amazon links here are part of the Amazon Affiliate Program. Amazon pays me a small commission at no additional cost to you if you buy through one of the product links here. This is is one (free to you) way to support my videos.  https://paypal.me/paulvanderklay Blockchain backup on Lbry https://odysee.com/@paulvanderklay https://www.patreon.com/paulvanderklay Paul's Church Content at Living Stones Channel https://www.youtube.com/channel/UCh7bdktIALZ9Nq41oVCvW-A To support Paul's work by supporting his church give here. https://tithe.ly/give?c=2160640 https://www.livingstonescrc.com/give

What caused the Delta flight to flip upside down in Toronto, and are drones to blame for other recent crashes?Was the new Captain America movie worth the hype, or did "Heart Eyes" miss the mark? Find out which movies to skip and which ones are surprisingly funny.A woman named Missy is married but is still looking for love. She wants KiddChris to help her out! Country Feff wants to make a cooking show! KiddChris wants to go on ‘Shark Tank' to pitch “Country Jeff's Prison Hooch”What's the craziest thing you've ever seen in a public restroom? One caller shares a shocking story about a dead body!!!!!!  

Alan delves into a thought-provoking ethical dilemma presented in the Very Clinical Facebook group regarding pain management for a patient in recovery. Pain Management Dilemma: A detailed discussion of a Facebook post in "Very Clinical" about a patient in recovery on methadone who initially refused narcotics but later requested stronger pain medication after a procedure. Alan's Perspective on Recovery and Pain: Alan shares personal anecdotes about his own recovery journey and experiences with pain management, including his thoughts on harm reduction and the importance of personal responsibility in recovery. Ethical Considerations: The complexities of prescribing narcotics to a patient in recovery, the importance of open communication, and the value of consulting with other healthcare professionals (like the patient's pain management MD in this case). Alternative Pain Management: Discussion of alternative pain management strategies, such as injectable or oral steroids (dexamethasone). Join the Very Dental Facebook group using the password "Timmerman," Hornbrook" or "McWethy," "Papa Randy" or "Lipscomb!" The Very Dental Podcast network is and will remain free to download. If you'd like to support the shows you love at Very Dental then show a little love to the people that support us! -- Crazy Dental has everything you need from cotton rolls to equipment and everything in between and the best prices you'll find anywhere! If you head over to verydentalpodcast.com/crazy and use coupon code “VERYDENTAL10” you'll get another 10% off your order! Go save yourself some money and support the show all at the same time! -- The Wonderist Agency is basically a one stop shop for marketing your practice and your brand. From logo redesign to a full service marketing plan, the folks at Wonderist have you covered! Go check them out at verydentalpodcast.com/wonderist! -- Enova Illumination makes the very best in loupes and headlights, including their new ergonomic angled prism loupes! They also distribute loupe mounted cameras and even the amazing line of Zumax microscopes! If you want to help out the podcast while upping your magnification and headlight game, you need to head over to verydentalpodcast.com/enova to see their whole line of products! -- CAD-Ray offers the best service on a wide variety of digital scanners, printers, mills and even  their very own browser based design software, Clinux! CAD-Ray has been a huge supporter of the Very Dental Podcast Network and I can tell you that you'll get no better service on everything digital dentistry than the folks from CAD-Ray. Go check them out at verydentalpodcast.com/CADRay!

Fiona Kanter's journey from heart-wrenching grief to a source of hope and support for others is a testament to the resilience of the human spirit. She joins us to share the painful loss of her daughter, Lee Gabriella, and how this tragedy has become a catalyst for her advocacy work in trauma and bereavement. Our conversation oscillates between poignant memories of our daughters' miraculous beginnings and the stark realities of their premature departures, highlighting how these experiences have irrevocably shaped our lives and missions.Parenting is never a straightforward endeavor, especially when raising exceptionally gifted children or spirited teenagers. Through the story of Lee, we explore the unique challenges and joys of nurturing a precocious child who excels in everything from languages to music. However, simultaneously, Fiona reveals the complexities of balancing Lee's intellectual gifts with her emotional development, as well as the profound impact Lee's short life left on those around her. These narratives underscore the delicate balance parents must strike in guiding and protecting their children as they navigate the world.Humor and giving back can be powerful tools in healing, as evidenced by the various initiatives we've embraced following personal loss. From supporting at-risk youth in Jerusalem to equine-assisted psychotherapy and aiding lone soldiers in Israel, our efforts reflect a commitment to community and resilience. Laughter, even amidst sorrow, emerges as a critical component of healing, offering moments of lightness and connection. Our episode promises insights into the transformative journey from grief to action, with the hope of inspiring others who find themselves on similar paths.Become a supporter of this podcast: https://www.spreaker.com/podcast/bereaved-but-still-me--2108929/support.

The amount of overdose deaths in the U.S. is staggering. And while addiction is a disease, there's no specific medical treatment or cure for it. Our guest this week points out that weight loss drugs and GLP-1s, or glucagon-like peptide-1s, which are used to treat type 2 diabetes and obesity, can be effective for helping people reduce cravings and consumption of drugs, alcohol and compulsive behaviors like gambling. Nick Reville is the cofounder and executive director of the Center for Addiction Science, Policy, and Research (CASPR). He joins WITHpod to discuss how he found his way into this research area, lessons learned from other health crises, innovations geared towards eliminating addictions at a widescale level and more. 

In episode 53 we discuss an article comparing treatment retention and mortality in patients who are prescribed methadone vs. buprenorphine/naloxone for treatment of opioid use disorder.    Nosyk B, Et al. Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. 2024 Oct 17.     We also discuss the Modernizing Opioid Treatment Access Act, engaging non-abstinent patients in treatment, and hostility to medications with the recovery community.    Modernizing Opioid Treatment Access Act (MOTAA) (H.R.1359 / S. 644)  ASAM: Engagement and Retention of Nonabstinent Patients in Substance Use Treatment  STAT News: The recovery community says it offers refuge from opioid addiction. But it's still hostile to lifesaving addiction medications  ---  This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go to this link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, visit MI CARES.  CME: https://micaresed.org/courses/podcast-addiction-medicine-journal-club/   ---  Original theme music: composed and performed by Benjamin Kennedy  Audio editing: Michael Bonanno  Executive producer: Dr. Patrick Beeman  A podcast from Ars Longa Media  ---  This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice.     The best part of any journal club is the conversation. Send us your comments on social media or join our Facebook group.  Email: addictionmedicinejournalclub@gmail.com   Facebook: @AddictionMedJC  Facebook Group: Addiction Medicine Journal Club  Instagram: @AddictionMedJC   Threads: @AddictionMedJC  YouTube: addictionmedicinejournalclub   Twitter/X: @AddictionMedJC   Addiction Medicine Journal Club is intended for educational purposes only and should not be considered medical advice. The views expressed here are our own and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities. 

While the numbers are finally starting to decline, more than 74,000 Americans are still dying every year from opioid overdoses. Despite that, very few people who are struggling with addiction get treatment. William Brangham looks at the renewed focus on methadone, one of the oldest and most effective medications in this fight. PBS News is supported by - https://www.pbs.org/newshour/about/funders

While the numbers are finally starting to decline, more than 74,000 Americans are still dying every year from opioid overdoses. Despite that, very few people who are struggling with addiction get treatment. William Brangham looks at the renewed focus on methadone, one of the oldest and most effective medications in this fight. PBS News is supported by - https://www.pbs.org/newshour/about/funders

Acadia Healthcare runs methadone clinics around the country and the clinics bring in millions of dollars in annual revenue. A New York Times investigation found that the for-profit company is accused of failing to provide counseling, falsifying records and enrolling patients who aren’t addicted to opioids. The company already faces federal investigations over practices at its psychiatric hospitals. Jessica Silver-Greenberg is a business investigations reporter for The New York Times. She reported on Acadia Healthcare with Katie Thomas, an investigative health care reporter for the news outlet. Silver-Greenberg joins us with more on the reporting. 

Tom was reasonably academic, enjoyed music and was quite competitive in his youth but always felt a bit different, like a square peg in a round hole.  He had depressive episodes early on which were evidence of sub-clinical mental illness that would affect him later in his teenage years.Tom was curious about drugs in his early teens and joined in with a drug culture at his school, using mainly marijuana. He stopped using drugs to improve his studies but experienced a mental breakdown and was placed on anti-psychosis drugs. Tom took a while off school and during that time he experienced heroin, which led him to his first rehab. He has since been in many rehabs and detox centres, where he was exposed to the 12th Step recovery program of Narcotics Anonymous. Tom has also been in long-term rehab, on Methadone treatment and attended Smart Recovery program to address his combination of needing to treat his mental illness and stay clean.  Today, his life is manageable, but depression still poses the greatest risk to him staying drug free.If you would like to find out more about Narcotics Anonymous or need to talk to somebody, then please call 1300 652 820 at any time or go online at www.navic.net.au.Show your support to the Living Free show and keep us on air by:subscribing to 3CR https://www.3cr.org.au/subscribeand/or donating to 3CR https://www.3cr.org.au/donateMusic played in this episode was provided by the artists, via Australian Music Radio Airplay Project (https://amrap.org.au/):Daniel J Farthing - Run Neddy Run [https://amrap.org.au/release/daniel-j-farthing-run-neddy-run] @16:34Byrd of Paradyse - Karma (Ft Uncle Kev Starkey) [https://amrap.org.au/release/byrd-of-paradyse-karma-ft-uncle-kev-starkey] @32:20Mainline – Kara's song [https://soundcloud.com/revampd/karas-song] @54:50

This week on the teaser! We lost someone in our recovery meeting - it shook me to the core. Then we read a note from a Dopey Zoomer - then we get a crazy voicemail from Mick Popham about SMASH & GRAB Danny! Then we get to Doug!  Patreon: https://www.patreon.com/dopeypodcast DOPEY WEST! https://buytickets.at/thedopeyfoundation/1484803 Here is what AI Says: Notes for Dopey Podcast Patreon Teaser Episode

Recovery Matters Podcast Episode 161 | Rich St. Pierre recounts his challenging upbringing, the impact of family dynamics, and his turbulent years of substance use. He discusses the pivotal moments that led him to recovery, including his experiences with various treatment programs and his ultimate decision to turn his life around. Rich highlights the importance of having a support system, finding new identities and passions, and maintaining accountability in recovery. He also delves into how martial arts and fitness played crucial roles in his sobriety and how he integrates these into his current life. Through his candid narration, Rich's story offers inspiration and valuable insights for anyone seeking or maintaining recovery. 00:00 Introduction and Host Background00:29 Early Life and Family Struggles03:20 High School and Descent into Addiction06:09 Attempts at Recovery and Setbacks08:36 Turning Point and Path to Recovery18:16 Rebuilding Life and Finding Purpose22:33 Coping with Loss in Recovery23:27 The Importance of Therapy24:58 Finding New Passions26:42 Identity Beyond Addiction29:42 The Role of Support Systems32:37 The Power of Practice39:03 Commitment to 12-Step Recovery41:11 Incorporating Recovery into Daily Life42:28 Conclusion and Final Thoughts ----Across the Web----

A new federal rule change has made methadone more accessible than ever, but many advocates and patients say it should be much easier for patients to receive. Those running the methadone clinics are not so sure.

Just John and Brooks hanging out trying to avoid the outside world. Might just go hang out in the woods for awhile. Thanks for being awesome. If you want to reach brooks either text him or email here. basementbuddiespod@gmail.com  Sorry, Stan for putting you on blast but I really dont think you'll hear this.  

Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder JAMA Network This population-based retrospective cohort study assessed whether the use of buprenorphine/naloxone is associated with lower risk of treatment discontinuation and mortality compared with methadone. It included 30,891 individuals initiating treatment for the first time during the study period and found that  the risk of treatment discontinuation was higher among recipients of buprenorphine/naloxone compared with methadone (88.8% vs 81.5% within 24 months). The risk of mortality was low while in either form of treatment (0.08% vs 0.13%).  Individuals receiving methadone had a lower risk of treatment discontinuation compared with those who received buprenorphine/naloxone. The risk of mortality while receiving treatment was similar between medications.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

Dr. Kelly S. Ramsey, an Addiction Medicine and Harm Reduction Consultant, discusses a Q&A she wrote for Johns Hopkins about the expansion of methadone treatment access; Matta Sannoh, ASTHO Chronic Disease Risk Factors Senior Analyst, tells us about ASTHO's Menthol Capacity Building web page; and an ASTHO blog article details how Washington State continues to improve emergency preparedness. Johns Hopkins Bloomberg School of Public Health Web Page: Expanding Access to Methadone Treatment for Opioid Use Disorder in Carceral Settings LinkedIn Web Page: Kelly S. Ramsey ASTHO Blog Article: Menthol Capacity Building ASTHO Blog Article: How Washington State Leverages Data to Improve Emergency Preparedness  

Brian, a person in long-term recovery, shares struggles with substance use that began in his teenage years, his journey through various treatments, and the pivotal moments that led him to seek a different path. Brian discusses his experiences with methadone and Suboxone, his involvement with the Connecticut Community for Addiction Recovery (CCAR), and how he now gives back as a volunteer manager supporting others in their recovery journeys. His story is one of resilience, transformation, and the importance of community and hope in recovery. 00:00 Introduction and Personal Recovery Stories 02:34 Early Life and Struggles 04:29 Descent into Addiction 06:26 Realization and Attempts at Recovery 13:37 Overcoming Addiction and Finding Recovery 17:29 Life in Recovery and Giving Back 29:58 Advice for Those Struggling

Moderator: BobbieJean Sweitzer, M.D. Participants: Lisa M. Einhorn, M.D. and Charles B. Berde, M.D., Ph.D. Articles Discussed: Single-Dose Intraoperative Methadone for Pain Management in Pediatric Tonsillectomy: A Randomized Double Blind Clinical Trial Improving Pain Management After Tonsillectomy Transcript

Two-time Emmy and three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald, interviewed Dr. Michael Giles. Our Virtual Dosing Window™ allows patients to record their take-homes by using a phone or computer to scan the QR code on their methadone bottles and then recording a video of themselves dosing for their care team to review. This patented solution helps build trust between OTP patients and their care teams, empowering clinics with real-time insights to make informed treatment decisions. Sonara also increases patients' likelihood of earning more take homes, which in turn improves program retention rates. Since starting Sonara in 2020, Dr. Giles has expanded the solution to a network of modernized, tech-enabled clinics in 11 states that provide accessible, patient-centered care for individuals struggling with OUD. Sonara® is on a mission to support OTP patients, with a remote dosing solution that makes it easier for people with opioid use disorder to commit to their methadone treatment programs, so they can get their lives back. Sonara provides OTPs with the confidence they need to approve more take-home doses responsibly, to improve the quality of life for patients and expand treatment accessibility for those who live farther away from clinics. Notable investors in Sonara include Mark Cuban and First Trust Capital. With Sonara, OTP patients can achieve their treatment goals without putting their lives on hold. To learn more about partnering with Sonara or bringing the Virtual Dosing Window to your OTP, visit sonarahealth.com/contact-us to get in touch. #STRAW #SHMS  Support the show: https://www.steveharveyfm.com/See omnystudio.com/listener for privacy information.

Two-time Emmy and three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald, interviewed Dr. Michael Giles. Our Virtual Dosing Window™ allows patients to record their take-homes by using a phone or computer to scan the QR code on their methadone bottles and then recording a video of themselves dosing for their care team to review. This patented solution helps build trust between OTP patients and their care teams, empowering clinics with real-time insights to make informed treatment decisions. Sonara also increases patients' likelihood of earning more take homes, which in turn improves program retention rates. Since starting Sonara in 2020, Dr. Giles has expanded the solution to a network of modernized, tech-enabled clinics in 11 states that provide accessible, patient-centered care for individuals struggling with OUD. Sonara® is on a mission to support OTP patients, with a remote dosing solution that makes it easier for people with opioid use disorder to commit to their methadone treatment programs, so they can get their lives back. Sonara provides OTPs with the confidence they need to approve more take-home doses responsibly, to improve the quality of life for patients and expand treatment accessibility for those who live farther away from clinics. Notable investors in Sonara include Mark Cuban and First Trust Capital. With Sonara, OTP patients can achieve their treatment goals without putting their lives on hold. To learn more about partnering with Sonara or bringing the Virtual Dosing Window to your OTP, visit sonarahealth.com/contact-us to get in touch. #STRAW #SHMS  See omnystudio.com/listener for privacy information.

This Week on a super new bonus Dopey Tuesday! We are joined by filmmaker and recovering addict John Comerford! We hear all about his super psychedelic path of addiction and recovery! John tells about his unsupervised nyc youth- we learn the secrets of old New York's music scene and Grateful Dead culture and much more on this super duper bonus episode of that good old Dopey Show!   PLUS SHOOTING METHADONE VOICEMAIL!!!!! and MORE! Emilia's Notes:  - brothers intervention - realizing his mom was taking percs his whole childhood - lsd at red rocks - mdma sale arrest - bill w and huxley - bill w and belladonna - brother's death AI NOTES: In this part of the conversation, David Manheim discusses the purpose of the Dopey podcast and emphasizes the importance of real recovery work. He also shares personal experiences, including being alone in his house for the first time, dealing with a hernia, and celebrating his nine years of sobriety. The conversation then transitions to a voicemail from a listener who shares his experience of shooting methadone and being prescribed benzos at a methadone clinic. The episode concludes with an interview with John Comerford, a film producer and music presenter, where they discuss their love for jazz and their experiences with alcohol and drugs. David Manheim reflects on his early experiences with music and drugs, including attending jazz shows and experimenting with acid at a young age. He discusses his identity formation and the role of feeling and experience in his life. He shares stories of his tumultuous family life and the impact of addiction on his brother. David also talks about his introduction to the Grateful Dead and the transformative power of their music. He delves into his own struggles with alcoholism and drug addiction, including selling ecstasy and his eventual decision to get sober. In this final part of the conversation, David and John discuss their experiences with addiction and recovery. They share personal stories of their struggles with drugs and alcohol, including John's time in jail and David's journey to sobriety. They also talk about the importance of community and support in the recovery process. David shares some of the projects he is currently working on, including a documentary about General Yamashita's gold and a character study of Sarah Jane Moore, the woman who attempted to assassinate President Ford. keywords: Dopey podcast, recovery work, personal experiences, hernia, sobriety, methadone, benzos, film producer, jazz, alcohol, drugs, music, drugs, jazz, acid, identity, addiction, family, Grateful Dead, alcoholism, sobriety, addiction, recovery, jail, sobriety, community, support, documentary, General Yamashita's gold, Sarah Jane Moore takeaways The Dopey podcast is meant to be supplemental to someone with a recovery program and is not a substitute for real recovery work. Personal experiences, such as being alone in the house, dealing with a hernia, and celebrating sobriety milestones, can be shared openly to reduce shame and judgment. The listener's voicemail highlights the dangers of shooting methadone and the inappropriate prescribing of benzos at a methadone clinic. The interview with John Comerford explores their love for jazz and their experiences with alcohol and drugs. Music, such as jazz, can have a profound impact on emotions and enhance the experience of substances like cannabis and alcohol. Early experiences with music and drugs can shape one's identity and worldview. Addiction can have a profound impact on individuals and their families. The transformative power of music can provide solace and inspiration. Recovery from addiction requires a shift in focus from the problem to the solution. Addiction can lead to serious consequences, including jail time and death. Recovery requires a commitment to change and a willingness to seek help and support. Community and connection are essential in the recovery process. Sobriety opens up new opportunities for personal growth and fulfillment. Projects like More Than Music Foundation aim to foster wellness and educational opportunities for musicians and audiences. titles The Importance of Real Recovery Work Listener Voicemail: Shooting Methadone and Prescribed Benzos Finding Sobriety and a New Path The Impact of Addiction on Family The Power of Community in Recovery Finding Purpose and Fulfillment in Sobriety Sound Bites "Good morning, Dopey. Good morning, Dopey. Ay -ay -ay." "This Friday is Dopey Day, AKA Christmas in August." "I'm on the methadone program here in my state, in my home state, and I've been on it since 2013." "What these guys are putting out there has magnitude, and it has power." "I didn't really develop an intellectual life until I was like in my mid-late 30s." "That's why she's an hour late all the time. That's why she doesn't know why I'm at Irving Plaza at 13." "I mean, you jails, institutions and death is where we're headed. If we don't change it" "I reapplied to Boulder. I got in because I told them the story of what happened." "It's completely life-changing because I mean, Tommy had been my friend for a long time and was involved with the fellowship and always talked about how he wouldn't give up his sobriety for anything." Chapters 00:00Introduction and Overview 01:15The Importance of Real Recovery Work 03:41Personal Experiences: Alone in the House and Dealing with a Hernia 09:09Listener Voicemail: Shooting Methadone and Prescribed Benzos 18:58Interview with John Comerford: Love for Jazz and Experiences with Alcohol and Drugs 36:04Early Experiences with Music and Drugs 39:01Family Dynamics and Addiction 44:12The Transformative Power of Music 46:04Navigating Addiction 57:45Selling Drugs and Consequences 01:08:13Finding Sobriety 01:11:01From Jail to Filmmaking 01:18:08The Power of Community in Recovery 01:21:00Uncovering Hidden Stories 01:27:19Finding Purpose and Fulfillment in Sobriety 01:34:15More Than Music: Fostering Wellness and Education

In this episode, Liz Rohr interviews Shelby Pope, DNP, APRN, FNP-BC, they discuss the stigma around addiction, the importance of supporting patients with opiate use disorder while exploring Shelby's journey into addiction medicine and impacts of this field. This episode includes discussion of various treatment options for opiate use disorder, including naltrexone and buprenorphine, including the importance of medication-assisted treatment (MAT) for opioid use disorder, while emphasizing the effectiveness of methadone and buprenorphine in reducing the risk of overdose and mortality. Liz and Shelby explore the process of induction and the importance of assessing withdrawal symptoms, ongoing monitoring and support for patients on MAT, including addressing cravings and harm reduction strategies. Key takeaways: Exploring the stigma around addiction, and the importance of supporting patients with opiate use disorder.Addiction medicine is a beautiful and impactful field that can be accessible in primary care.Naltrexone and buprenorphine are two treatment options for opiate use disorder.Open conversations with patients and providing support and resources are crucial in primary care.Methadone may be necessary for some patients with extreme cases of opiate use disorder. Medication-assisted treatment (MAT) with methadone and buprenorphine is highly effective in reducing the risk of overdose and mortality in individuals with opioid use disorder.Assessing withdrawal symptoms is crucial before starting buprenorphine to avoid precipitated withdrawal.Ongoing monitoring and support are essential for patients on MAT, including addressing cravings and providing harm reduction strategies.Tapering off medication should be done slowly and on an individualized basis, considering the patient's stability and goals.Individualized care and empathetic communication are key in building trust and supporting patients on their recovery journey.For a full transcript and conversation chapters, visit the blog: https://realworldnp.com/blog/opiate-use-disorder. ______________________________© 2024 Real World NP. For educational and informational purposes only, see https://realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

OTP yea you know me Make methadone a part of your practice. Learn how the methadone system in the US works and how you can play an active role in improving care for people with opioid use disorder treated with methadone. We're joined by Dr. Ruth Potee @DrRuthPotee (website) and Dr. David Frank @highway_dave  Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and  completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | CurbsidersAddictionMed@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio 5:00 Guest one-liner 10:25 Case from Kashlak; Definitions 11:19 Methadone pharmacology and evidence 17:08 What an OTP feels like 20:25 OTP intake 24:45 Talking through methadone with a patient 28:15 Personal impact of methadone 30:20 Requirements at an OTP 33:43 What your patient needs to access an OTP 37:25 The line 39:06 Dosing/Take homes 44:48 Loss of take homes 48:39 How to interact with an OTP as a PCP 52:50 Methadone at STRs 57:03 How to clinicians use their voice to improve things 1:00:45 Take home points 1:03:00 Plugs 1:04:24 Outro Credits Producer, Writer, Show Notes, Infographic, Cover Art: Shawn Cohen MD  Hosts: Carolyn Chan, MD. MHS and Shawn Cohen MD Reviewer: Payel Jhoom Roy MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest:  Ruth Potee MD, David Frank PhD

Contributor: Taylor Lynch, MD Educational Pearls: Opioid Epidemic- quick facts Drug overdoses, primarily driven by opioids, have become the leading cause of accidental death in the U.S. for individuals aged 18-45. In 2021, opioids were involved in nearly 75% of all drug overdose deaths The rise of synthetic opioids like fentanyl, which is much more potent than heroin or prescription opioids, has played a major role in the increase in overdose deaths What is Narcan AKA Naloxone? Competitive opioid antagonist. It sits on the receptor but doesn't activate it. When do we give Narcan? Respiratory rate less than 8-10 breaths per minute Should you check the pupils? An opioid overdose classically presents with pinpoint pupils BUT… Hypercapnia from bradypnea can normalize the pupils Taking other drugs at the same time like cocaine or meth can counteract the pupillary effects Basilar stroke could also cause small pupils, so don't anchor on an opioid overdose How does Narcan affect the body? Relatively safe even if the patient is not experiencing an opioid overdose. So when in doubt, give the Narcan. What if the patient is opioid naive and overdosing? Use a large dose given that this patient is unlikely to withdraw 0.4-2 mg every 3-5 minutes What if the patient is a chronic opioid user Use a smaller dose such as 0.04-0.4 mg to avoid precipitated withdrawal How fast does Narcan work? Given intravenously (IV), onset is 1-2 min Given intranasal (IN), onset is 3-4 min Given intramuscularly (IM), onset is ~6 min Duration of action is 60 mins, with a range of 20-90 minutes How does that compare to the duration of action of common opioids? Heroine lasts 60 min Fentanyl lasts 30-60 min, depending on route Carfentanyl lasts ~5 hrs Methadone lasts 12-24 hrs So we really need to be conscious about redosing How do you monitor someone treated with Narcan? Pay close attention to the end-tidal CO2 to ensure that are ventilating appropriately Be cautious with giving O2 as it might mask hypoventilation Watch the respiratory rate Give Narcan as needed Observe for at least 2-4 hours after the last Narcan dose Larger the dose, longer the observation period Who gets a drip? If they have gotten ~3 doses, time to start the drip Start at 2/3rds last effective wake-up dose Complications Flash pulm edema 0.2-3.6% complication rate Might be from the catecholamine surge from abrupt wake-up Might also be from large inspiratory effort against a partially closed glottis which creates too much negative pressure Treat with BIPAP if awake and intubation if not awake Should you give Narcan in cardiac arrest? Short answer no. During ACLS you take over breathing for the patient and that is pretty much the only way that Narcan can help Just focus on high quality CPR References https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#:~:text=Drug%20overdose%20deaths%20involving%20prescription,of%20deaths%20declined%20to%2014%2C716. Elkattawy, S., Alyacoub, R., Ejikeme, C., Noori, M. A. M., & Remolina, C. (2021). Naloxone induced pulmonary edema. Journal of community hospital internal medicine perspectives, 11(1), 139–142. https://doi.org/10.1080/20009666.2020.1854417 van Lemmen, M., Florian, J., Li, Z., van Velzen, M., van Dorp, E., Niesters, M., Sarton, E., Olofsen, E., van der Schrier, R., Strauss, D. G., & Dahan, A. (2023). Opioid Overdose: Limitations in Naloxone Reversal of Respiratory Depression and Prevention of Cardiac Arrest. Anesthesiology, 139(3), 342–353. https://doi.org/10.1097/ALN.0000000000004622 Yousefifard, M., Vazirizadeh-Mahabadi, M. H., Neishaboori, A. M., Alavi, S. N. R., Amiri, M., Baratloo, A., & Saberian, P. (2019). Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis. Advanced journal of emergency medicine, 4(2), e27. https://doi.org/10.22114/ajem.v0i0.279 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII

NC S2 Ep4 TikTok @trashtalkpodcasts YOUTUBE: www.youtube.com/c/TrashTalkPodcasts Bonus Patreon.com/TrashTalkPodcast Traceycarnazzo.com Tracey Carnazzo @trixietuzzini Noelle Winters @noeygirl_ IG @TeenMomTrashTalk Twitter @TeenMomPodcast tropicalsmoothiecafe.com

This morning on the radio I talked about the importance of zooming out when you are feeling anxious or overwhelmed or in despair. Zoom out to find perspective and peace. But it was William, at the end of the show, while telling us the story of how he was withdrawing from Methadone, who properly finished the process. You have to zoom out, but then, don't forget to zoom back in. Learn more about your ad choices. Visit megaphone.fm/adchoices

This morning on the radio I talked about the importance of zooming out when you are feeling anxious or overwhelmed or in despair. Zoom out to find perspective and peace. But it was William, at the end of the show, while telling us the story of how he was withdrawing from Methadone, who properly finished the process. You have to zoom out, but then, don't forget to zoom back in. Learn more about your ad choices. Visit megaphone.fm/adchoices

Methadone is a highly effective treatment for substance use disorder but strict regulations like daily clinic visits have led to its nickname, “liquid handcuffs.” Dr. Yngvild Olsen, director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services administration, talks with Lindsay Smith Rogers about new federal regulations that expand access to this life saving medication.  They talk about how the COVID era showed that changes can make methadone much easier to prescribe and access, and how these updates are part of a critical cultural shift towards making substance use treatment more reasonable, equitable, and compassionate. Resources for this episode: https://www.samhsa.gov/medications-substance-use-disorders/statutes-regulations-guidelines/methadone-guidance https://findtreatment.gov/

In this episode, my guest is Dr. Sean Mackey, M.D., Ph.D., Chief of the Division of Pain Medicine and Professor of Anesthesiology, Perioperative and Pain Medicine and Neurology at Stanford University School of Medicine. His clinical and research efforts focus on using advanced neurosciences, patient outcomes, biomarkers and informatics to treat pain. We discuss what pain is at the level of the body and mind, pain thresholds, and the various causes of pain. We also discuss effective protocols for controlling and reducing pain, including the use of heat and cold, acupuncture, chiropractic, physical therapy, nutrition, and supplementation. We also discuss how pain is influenced by our emotions, stress and memories, and practical tools to control one's psychological perception of pain. And we discuss pain medications, including the controversial use of opioids and the opioid crisis. This episode will help people understand, manage, and control their pain as well as the pain of others. For show notes, including referenced articles and additional resources, please visit hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman AeroPress: https://aeropress.com/huberman Levels: https://levels.link/huberman BetterHelp: https://betterhelp.com/huberman InsideTracker: https://insidetracker.com/huberman Momentous: https://livemomentous.com/huberman Timestamps (00:00:00) Dr. Sean Mackey (00:02:11) Sponsors: AeroPress, Levels & BetterHelp (00:06:13) Pain, Unique Experiences, Chronic Pain (00:13:05) Pain & the Brain (00:16:15) Treating Pain, Medications: NSAIDs & Analgesics (00:22:46) Inflammation, Pain & Recovery; Ibuprofen, Naprosyn & Aspirin (00:28:51) Sponsor: AG1 (00:30:19) Caffeine, NSAIDs, Tylenol (00:32:34) Pain & Touch, Gate Control Theory (00:38:56) Pain Threshold, Gender (00:44:53) Pain in Children, Pain Modulation (Pain Inhibits Pain) (00:53:20) Tool: Heat, Cold & Pain; Changing Pain Threshold (00:59:53) Sponsor: InsideTracker (01:00:54) Tools: Psychology, Mindfulness-Based Stress Reduction, Catastrophizing (01:08:29) Tool: Hurt vs. Harmed?, Chronic Pain (01:12:38) Emotional Pain, Anger, Medication (01:20:43) Tool: Nutrition & Pain; Food Sensitization & Elimination Diets (01:28:45) Visceral Pain; Back, Chest & Abdominal Pain (01:34:02) Referenced Pain, Neuropathic Pain; Stress, Memory & Psychological Pain (01:40:23) Romantic Love & Pain, Addiction (01:48:57) Endogenous & Exogenous Opioids, Morphine (01:53:17) Opioid Crisis, Prescribing Physicians (02:02:21) Opioids & Fentanyl; Morphine, Oxycontin, Methadone (02:07:44) Kratom, Cannabis, CBD & Pain; Drug Schedules (02:18:12) Pain Management Therapies, Acupuncture (02:22:19) Finding Reliable Physicians, Acupuncturist (02:26:36) Chiropractic & Pain Treatment; Chronic Pain & Activity (02:31:35) Physical Therapy & Chronic Pain; Tool: Pacing (02:36:35) Supplements: Acetyl-L-Carnitine, Alpha Lipoic Acid, Vitamin C, Creatine (02:42:25) Pain Management, Cognitive Behavioral Therapy (CBT), Biofeedback (02:48:32) National Pain Strategy, National Pain Care Act (02:54:05) Zero-Cost Support, Spotify & Apple Reviews, YouTube Feedback, Sponsors, Momentous, Social Media, Neural Network Newsletter Disclaimer