Podcasts about neuropathic

Neuropathyct.com1) Symptoms usually creep forward More numbness, burning, pins-and-needles, and sensitivity changes over time. (NINDS)2) Sleep gets hammered Neuropathic pain commonly disrupts sleep, which then worsens pain perception the next day. (ScienceDirect, PMC)3) Balance confidence drops; fall risk rises Loss of sensation and vibration sense increases falls and near-falls—especially in older adults. (PMC, PubMed, Frontiers)4) Foot problems can snowball (especially with diabetes) Delayed care → unnoticed injuries/ulcers → infection → higher chance of amputation if things progress. (NCBI, PMC)5) Daily function and quality of life shrink People report limits in walking, standing, hobbies, and overall well-being. Mood and anxiety often worsen. (Nature, PMC)6) Heavier reliance on pain meds without addressing nerve function Drugs like gabapentin/pregabalin/duloxetine may help pain for some, but results vary and they don't restore nerve function. (Patients should never change meds without their prescriber.) (ScienceDirect, Mayo Clinic Proceedings, PMC)7) Hidden injuries are easier to miss Reduced sensation means burns, cuts, or shoe-related wounds can go unnoticed and worsen. (This podcast welcomes your feedback here are several ways to reach out to me. If you have a topic you would like to hear about send me a message. I appreciate your listening. Dr. Brian Mc Kayhttps://twitter.com/DarienChiro/https://www.facebook.com/ChiropractorBrianMckayhttps://chiropractor-darien-dr-brian-mckay.business.sitehttps://podcasts.apple.com/us/podcast/not-just-chiropractor-for-stamford-darien-norwalk-new/id1503674397?uo=4Core Health Darien-Dr.Brian Mc Kay 551 Post RoadDarien CT 06820203-656-363641.0833695 -73.46652073GMP+87 Darien, Connecticuthttps://youtu.be/WpA__dDF0O041.0834196 -73.46423349999999https://darienchiropractor.comhttps://darienchiropractor.com/darien/darien-ct-understanding-pain/Find us on Social Mediahttps://chiropractor-darien-dr-brian-mckay.business.site https://www.youtube.com/channel/UCNHc0Hn85Iiet56oGUpX8rwhttps://docs.google.com/spreadsheets/d/1nJ9wlvg2Tne8257paDkkIBEyIz-oZZYy/edit#gid=517721981https://goo.gl/maps/js6hGWvcwHKBGCZ88https://www.youtube.com/my_videos?o=Uhttps://www.linkedin.com/in/darienchiropractorhttps://www.facebook.com/ChiropractorBrianMckayhttps://sites.google.com/view/corehealthdarien/https://sites.google.com/view/corehealthdarien/home

Neuropathic pain affects nearly 10% of the global population, yet effective treatments remain elusive. In this episode of Spark Time, we sit down with oncologists-turned-biotech-founders Christian Kersten and Marte Cameron of Akigai to hear the remarkable story of how a serendipitous clinical observation led to a new approach for treating chronic pain.From the first wheelchair-bound patient who walked again after EGFR inhibitor therapy, to the 100+ patients who have since experienced life-changing relief, Christian and Marte share the science and the vision behind Akigai's mission: to bring effective, non-opioid solutions to millions living with neuropathic pain. This is a story of discovery, persistence, and hope for one of medicine's most stubborn challenges.

OKYO Pharma CEO Gary Jacob joined Steve Darling from Proactive to share the top-line results from the recently completed Phase 2 trial of urcosimod, the company's drug candidate for the treatment of Neuropathic Corneal Pain (NCP). The 18-patient, randomized, double-masked, placebo-controlled study was conducted at Tufts Medical Center under the direction of Dr. Pedram Hamrah, a leading expert in NCP. Jacob noted that OKYO is the first company to conduct a clinical trial specifically targeting NCP, a serious and underserved condition with no approved treatments. The results showed that after 12 weeks of treatment, 75% of patients in the per-protocol group receiving 0.05% urcosimod experienced more than an 80% reduction in pain, as measured by the Visual Analogue Scale (VAS). Patients began to see meaningful improvement as early as Week 4, with effects sustained through the study's conclusion. The company also reported a statistically significant reduction in mean pain scores between the initial and final visits in the treatment group. All responders had entered the trial with moderate to severe pain despite previous use of maximum medical therapy. Importantly, no serious adverse events were reported among the 18 participants, underscoring the favorable safety profile of urcosimod. With Fast Track designation already granted by the FDA, OKYO Pharma plans to meet with the agency to discuss the next steps in urcosimod's regulatory pathway, potentially accelerating the development timeline for this novel treatment. #proactiveinvestors #okyopharmalimited #nasdaq #okyo #Urcosimod #NeuropathicCornealPain #BiotechNews #ClinicalTrials #FDAapproval #Ophthalmology #DrugDevelopment #CompassionateUse #EyeHealth

Viva StemYou meet a 60yo male for a laparoscopic cholecystectomy.PMx: IHD, T2DM, HTN. Neuropathic foot painMedications:MetoprololMetforminACEiStatinPregabalin---------Find us atInstagram: https://www.instagram.com/abcsofanaesthesia/Twitter: https://twitter.com/abcsofaWebsite: http://www.anaesthesiacollective.comPodcast: ABCs of AnaesthesiaPrimary Exam Podcast: Anaesthesia Coffee BreakFacebook Page: https://www.facebook.com/ABCsofAnaesthesiaFacebook Private Group: https://www.facebook.com/groups/2082807131964430---------Check out all of our online courses and zoom teaching sessions here!https://anaesthesia.thinkific.com/collectionshttps://www.anaesthesiacollective.com/courses/---------#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded ---------Please support me at my patreonhttps://www.patreon.com/ABCsofA---------Any questions please email abcsofanaesthesia@gmail.com---------Disclaimer: The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.

Podcast Show Notes: Peripheral Vascular Disease in PainManagement Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management Download the App Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence:   * 3-4% in 60-65 year olds   * Increases to 15-20% in 85-90 year olds   * Up to 50% of patients may progress to symptomatic stages 2. Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease 3. Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome 4. Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org Disclaimer: Always consult with a healthcare professional for personalized medical advice. Reference Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082, Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512 Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512  

Podcast Show Notes: Peripheral Vascular Disease in PainManagement Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management Download the App Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence:   * 3-4% in 60-65 year olds   * Increases to 15-20% in 85-90 year olds   * Up to 50% of patients may progress to symptomatic stages 2. Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease 3. Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome 4. Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org Disclaimer: Always consult with a healthcare professional for personalized medical advice. Reference Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082, Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512 Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512  

Podcast Show Notes: Peripheral Vascular Disease in PainManagement Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management Download the App Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence:   * 3-4% in 60-65 year olds   * Increases to 15-20% in 85-90 year olds   * Up to 50% of patients may progress to symptomatic stages 2. Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease 3. Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome 4. Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org Disclaimer: Always consult with a healthcare professional for personalized medical advice. Reference Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082, Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512 Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512  

In this piece we discuss pain medicine with Nadine Attal, a neurologist and pain medicine specialist from France, and Allen Finley, an anesthesiologist and pain medicine specialist from Canada. The episode delves into neuropathic pain and the need to personalize its management, and efforts to standardize the management of paediatric pain in Canada. We talk about the ICD-11 which recognizes chronic pain as a disease, and ChildKind.org which nurtures holistic and responsive support for children or all ages and abilities. Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guests, Professor Nadine Attal, Director for the Center of Evaluation and Treatment of Pain, Ambroise Paré Hospital, Paris, France, and Professor Allen Finley, Professor of Anesthesia and Psychology at Dalhousie University, and Medical Director of Pediatric Pain Management at IWK Health Centre in Halifax.

OKYO Pharma CEO Gary Jacob joined Steve Darling from Proactive to announce a strategic decision to accelerate the clinical development of urcosimod, its lead candidate for Neuropathic Corneal Pain. CEO Gary Jacob shared the update in an interview with Proactive, highlighting the company's decision to terminate its ongoing Phase 2 trial early in order to access and analyze masked trial data that could inform the next stage of clinical advancement. The Phase 2 trial, being conducted at Tufts Medical Center in Boston, MA, was initially designed as a single-site study to evaluate the safety and efficacy of urcosimod in patients suffering from NCP—a debilitating and poorly understood ocular condition. To date, 17 patients have successfully completed the trial. All of them were diagnosed with chronic, long-term NCP and had failed multiple prior therapies, positioning this cohort as a challenging yet highly relevant population for evaluating urcosimod's potential. According to Jacob, the trial has attracted significant attention from NCP sufferers, reinforcing the high unmet need in this patient population. NCP is characterized by severe ocular pain, light sensitivity, and discomfort that can radiate to the face or head. Its exact etiology remains uncertain but is believed to involve nerve damage and persistent inflammation of the cornea. Currently, no approved therapies exist specifically for NCP, and most patients rely on off-label or palliative treatments with limited success. OKYO's decision to close the trial early reflects a proactive strategic shift, allowing the company to refine its clinical development path and expedite next steps. The company is preparing to launch a multicenter trial, which will include multiple clinical sites and a broader patient population, enhancing the statistical robustness and generalizability of the data. As OKYO prepares for this next clinical phase, the company remains focused on its core mission of delivering innovative therapies for underserved ophthalmic conditions. The accelerated pathway for urcosimod underscores its potential to reshape the treatment landscape for neuropathic eye disorders. #proactiveinvestors #okyopharmalimited #nasdaq #okyo #Urcosimod #NeuropathicCornealPain #BiotechNews #ClinicalTrials #FDAapproval #Ophthalmology #DrugDevelopment #CompassionateUse #EyeHealth

For certain diagnoses and patients who meet clinical criteria, neuromodulation can provide profound, long-lasting relief that significantly improves quality of life. In this episode, Aaron Berkowitz, MD, PhD, FAAN speaks with Prasad Shirvalkar, MD, PhD, author of the article “Neuromodulation for Neuropathic Pain Syndromes,” in the Continuum® October 2024 Pain Management in Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology at the University of California San Francisco in the Department of Neurology and a neurohospitalist, general neurologist, and clinician educator at the San Francisco VA Medical Center at the San Francisco General Hospital in San Francisco, California. Dr. Shirvalkar is an associate professor in the Departments of Anesthesia and Perioperative Care, Neurological Surgery, and Neurology at Weill Institute for Neurosciences at the University of California, San Francisco in San Francisco, California. Additional Resources Read the article: Neuromodulation for Neuropathic Pain Syndromes Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Guest: @PrasadShirvalka Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor in Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors, who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Prasad Shirvalkar about his article on neuromodulation for painful neuropathic diseases, which appears in the October 2024 Continuum issue on pain management in neurology. Welcome to the podcast, and if you wouldn't mind, please introducing yourself to our listeners.  Dr Shirvalkar: Thanks, Aaron. Yes, of course. So, my name is Prasad Shirvalkar. I'm an associate professor in anesthesiology, neurology and neurological surgery at UCSF. I am one of those rare neurologists that's actually a pain physician.  Dr Berkowitz: Fantastic. And we're excited to have you here and talk to you more about being a neurologist in in the field of pain. So, you wrote a fascinating article here about current and emerging neuromodulation devices and techniques being used to treat chronic pain. And in our interview today, I'm hoping to learn and for our listeners to learn about these devices and techniques and how to determine which patients may benefit from them. But before we get into some of the clinical aspects here, can you first just give our listeners an overview of the basic principles of how neuromodulation of various regions of the nervous system is thought to reduce pain? Dr Shirvalkar: Yeah, I would love to try. But I will promise you that I will not succeed because I think to a large extent, we don't understand how neuromodulation works to treat pain, to describe or to define neuromodulation. Neuromodulation is often described as using electrical stimuli or a chemical stimuli to alter nervous system activity to really influence local activity, but also kind of distant network activity that might be producing pain. On one level, we don't fully understand how pain arises, specifically how chronic pain arises in the nervous system. It's a huge focus of study from the NIH Heal Initiative and many labs around the world. But acute pain, which is kind of when you stub your toe or you burn your finger, is thought to be quite different from the changes over time and the kind of plasticity that produces emotional, cognitive and sensory dimensions. Really what I think is its own disease, chronic pain, of which there are multiple syndromes when we use neuromodulation, either peripheral nerve stimulation or electrical spinal cord stimulation. One common or predominant theory actually comes from a paper in science from 1967 and people still use it, foundational theory and it's called the gate control theory. Two authors, Melzack and Wall, postulated that at the spinal level, there are, there's a local inhibitory circuit or, you know, there's a local circuit where if you provide input to either peripheral nerves or either spinal cord ascending fibers that to kind of summarize it, there's only so much bandwidth, you know, that nerves can carry. And so that if you literally pass through artificial signals electrically, that you will help gate out or block natural pathological but natural pain signals that might be arising from the periphery or spinal cord. So, you know, one idea is that you are kind of interfering with activity that's arising for chemical neuromodulation. The most common is something known as intrathecal drug infusion drug delivery ITTD for that we quite literally put a catheter in the spinal fluid, you know, at the level of the dorsal horn neurons that we think are responsible for perpetuating or creating the pain. Where's the pain generator? And you really, you can infuse local anesthetic, you can infuse opioids. And what's nice is you avoid a lot of systemic side effects and toxicity because it goes right to the spinal cord, you know, by infusing in the fluid. So there's a couple of modalities, but I will say just, like maybe all of our living experience, pain is in the brain. And so, we don't really understand, I would say, what neuromodulation is doing to the higher spinal or brain levels. Dr Berkowitz: Fascinating topic. And yeah, very interesting to hear both what our current understanding is that some of our current understanding is based on data that's 60 years old and that we're actually probably learning about pain by using these modulation techniques, even though we don't really understand how they might be working. So interesting feedback loop there as well as in as in the as in this land. So, your article very nicely organizes the neuromodulation techniques from peripheral to central. So, encourage our listeners to check out your article. And first before we get into some of the clinical applications, just to give the listeners the lay of the land, can you sort of lay out the devices and techniques available for treating pain at each level of the neuroaxis? We'll get into some of the indications in patient selection in a moment, but just sort of to lay out the landscape. What's available that you and your colleagues can use or implant at different levels when we're thinking of referring patients too? Dr Shirvalkar: Absolutely. So, starting from the least invasive or you know, over the counter patients can purchase themselves a TENS machine. Many folks listening to this have probably tried a TENS machine in the past. And the idea is that you put a couple of pads, at least two. So you have like a dipole or you have a positive and a negative lead and you basically inject some current. So, the pads are attached to a battery and you can put these pads over muscle. If you have areas where myofascial pain or sore muscles, you can put them, frankly, over nerves as well and stimulate nerves that are deeper. Most TENS machines kind of use electrical pulses that occur at different rates. You change the rates, you can change the amplitude and patient can kind of have control for what works best. Then getting slightly more invasive, we can often stimulate electrically peripheral nerves. To do this we implant through a needle, a small wire that consists of anywhere from one electrical contact to four or even eight electrical contact. What I think is particularly cool, like TENS, which is transcutaneous electrical nerve stimulation that goes through the skin. Peripheral nerve stimulation aims to stimulate nerves, but you don't have to be right up against the nerve. So, yeah. We typically do this under an ultrasound and you can visualize a nerve like the sciatic nerve, peroneal nerve, or you know, even if someone has an ulnar or a neuropathy, you know, that's the compression. There's a role obviously for surgery and release, but if they have predominantly pain, it's not related to a mechanical problem per se, you could prevent a wire from a peripheral nerve stimulator as far as one centimeter from a nerve and it'll actually stimulate that that modulated and then, you know, kind of progressing even more deeply. The spinal cord stimulation, SCS, it's probably the most ubiquitous or popular form of neuromodulation for pain. People use it for all kinds of diseases. But what it roughly involves is a trial period, which is a placement of either two cylindrical wires, not directly over the spinal cord, but actually in the epidural space, right? So, it's kind of like when you get an epidural injection or doing labor and delivery, when women get epidural catheters, placing spinal cord stimulator leads in that same potential space outside the dura, and you're stimulating through the dura to actually target the ascending dorsal column fibers. And so, you do a trial period or a test drive where the patients get these wires put in. They're coming out of the skin, they're connected to a battery, and they walk around at home for about a week, take careful notes, check in with them, and they keep a diary or a log about how much it helps. Separately. I will say it's hard to distinguish this, the placebo effect often, but you know, sometimes we want to use the placebo effect in clinical practice, but it is a concern, you know, with such invasive things. But you know, if the trial works well, right, you basically can either keep the leads where they are and place a battery internally. And it's for neurologists. You're familiar with deep brain stimulation. These devices are very similar to DVS devices, but they're specifically made for spinal cord stimulation. And there's now like seven companies that offer manufacturers that offer it, each with their own proprietary algorithm or workflow. But going yet more invasive, there is intrathecal drug delivery, which I mentioned, which involves placement of the spinal catheter and infusion of drug into spinal fluid. You could do a trial for that as well. Keep a patient in the hospital for a few days. You've all probably had experience with lumbar drains. It's something real similar. It just goes the other way. You know, you're infusing drugs, and it could also target peripheral nerves or nerve roots with catheters, and that's often done. And last but not least, there's brain stimulation. Right now, it's all experimental except for some forms of TMS or transcranial magnetic stimulation, which is FDA approved for migraine with aura. There are tens machine type devices, cutaneous like stimulators where you can wear on your head like a crown or with stickers for various sorts of migraines. I don't really talk about them too much in in the article, but if there's a fast field out there for adjunctive therapy as well,  Dr Berkowitz: Fantastic. That's a phenomenal overview. Just so we have the lay on the land of these devices. So, from peripheral essentially have peripheral nerve stimulators, spinal cord stimulators, intrathecal drug delivery devices and then techniques we use in other areas of neurology emerging for pain DBS deep brain stimulation and TMS transcranial magnetic stimulation. OK let's get into some clinical applications now. Let's start with spinal cord stimulators, which - correct me if I'm wrong - seem to be probably the most commonly seen in practice. Which patients can benefit from spinal cord stimulators? When should we think about referring a patient to you and your colleagues for consideration of implantation of one of these spinal cord stimulator devices?  Dr Shirvalkar: So, you know, it's a great question. I would say it's interesting how to define which patients or diagnosis might be appropriate. Technically, spinal cord stimulators are approved for the treatment of most recently diabetic peripheral neuropathy. And so, I think that's a really great category if you have patients who have been failed by more conservative treatments, physical therapy, etcetera, but more commonly even going back, neuropathic low back pain and neuropathic leg pain. And so, you think about it and it's like, how do you define neuropathic pain. Neuropathic pain is kind of broadly defined as any pain that's caused by injury or some kind of lesion in the somatosensory nervous system. We now broaden that to be more than just somatosensory nervous system, but still, what if you can't find a lesion, but the pain still feels or seems neuropathic. Clinically, if something is neuropathic, we often use certain qualitative descriptors to describe that type of pain burning, stabbing, electric light, shooting radiates. There's often hyperpathia, like it lingers and spreads in space and time as opposed to, you know, arthritis, throbbing dull pain or as opposed to muscle pain might be myofascial pain, but sometimes it's hard to tell. So, there aren't great decision tools, I would say to help decide. One of the most common syndromes that we use spinal cord stimulation for is what used to be called failed back surgery syndrome. We never like to, we now try to shy away from explicitly saying something is someone has failed in their clinical treatment. So, the euphemism is now, you know, post-laminectomy syndrome. But in any case, if someone has had back surgery and they still have a nervy or neuropathic type pain, either shooting down their legs and often there's no evidence on MRI or even EMG that that something is wrong, they might be a good candidate, especially if they're relying on long term medications that have side effects or things like full agonist opioids, you know that that might have side effects or contraindication. So, I would say one, it's not a first line treatment. It's usually after you've gone through physical therapy for sure. So, you've gone through tried some medications. Basically, if chronic pain is still impacting your life and your function in a meaningful way that's restricting the things you want to do, then it it's totally appropriate, I think, to think about spinal cord stimulation. And importantly, I will add a huge predictor of final court stimulation success is psychological composition, you know, making sure the person doesn't have any untreated psychological illness and, and actually making sure their expectations going in are realistic. You're not going to cure anyone's pain. You may and that's, you know, a win, but it's very unlikely. And so, give folks the expectation that we hope to reduce your pain by 50% or we want you to list personally, I like functional goals where you say what is your pain preventing you from doing? We want to see if you can do X,Y, and Z during the trial period. Pharmacostimulation right now. Yeah. Biggest indication low back leg pain, Diabetic peripheral neuropathy. There is also an indication for CRPS, complex regional pain syndrome, a lesser, I'd say less common but also very debilitating pain condition. For better or worse. Tertiary quaternary care centers. You often will see spinal cord stem used off label for neuropathic type pain syndromes that are not explicitly better. That may be for example, like a nerve injury that's peripheral, you know, it's not responding. A lot of this off label use is highly variable and, you know, on the whole at a population level not very successful. And so, I think there's been a lot of mixed evidence. So, it's something to be aware about.  Dr Berkowitz: That's a very helpful framework. So, thinking about referring patients to who have most commonly probably the patients with chronic low back pain have undergone surgery, have undergone physical therapy, are on medications, have undergone treatment for any potential psychological psychiatric comorbidities, and yet remain disabled by this pain and have a reasonable expectation and goals that you think would make them a good candidate for the procedure. Are those similar principles to peripheral nerve stimulation I wasn't familiar with that technique, I'm reading your article, so are the principles similar and if so, which particular conditions would potentially benefit from referral for a trial peripheral nerve stimulation as opposed to spinal cord stimulation?  Dr Shirvalkar: Yeah, the principles are similar overall. The peripheral nerve stimulation, you know, neuropathic pain with all the characteristics you listed. Interestingly enough, just like spinal cord stim, most insurances require a psychological evaluation for peripheral nerve stim as well. And we want to make sure again that their expectations are reside, they have good social support and they understand the kind of risks of an invasive device. But also, for peripheral nerve stem, specifically, if someone has a traumatic injury of an individual peripheral nerve, often we will consider it seeing kind of super scapular stimulation. Often with folks who've had shoulder injuries or even sciatic nerve stimulation. I have done a few peroneal nerve stimulations as well as occipital nerve stimulation from migraine, so oxygen nerve stimulation has been studied a lot. So, it's still somewhat controversial, but in the right patient it can actually be really helpful. Dr Berkowitz: Very helpful. So, these are patients who have neuropathic pain, but limited to one peripheral nerve distribution as opposed to the more widespread back associated pains, spine associated pains. Dr Shirvalkar: Yeah, Yeah, that's right. And maybe there's one exception actually to this, which is brachial plexopathy. So, you know, folks who've had something like a brachial plexus avulsion or some kind of traumatic injury to their plexus, there is I think good Class 2 evidence that peripheral nerve stem can work. It falls under the indication. No one is as far as to my knowledge, No one's done an explicit trial, you know PNS randomized controlled trial. Yeah, that's, you know, another area one area where PNS or peripheral nerve stems emerging is actually, believe it or not in myofascial low back pain to actually provide muscle stimulation. There are some, there's a company or two out there that seeks to alter the physiology of the multifidus muscle, one of your spinal stabilizer muscles to really see if that can help low back pain. And they've had some interesting results.  Dr Berkowitz: Very interesting. You mentioned TENS units earlier, transcutaneous electrical nerve stimulation as something a patient could get over the counter. When would you encourage a patient to try TENS and when would you consider TENS inadequate and really be thinking about a peripheral nerve stimulator?  Dr Shirvalkar: Yeah, you know TENS we think of as really appropriate for myofascial pain. Folks who have muscular pain, have clear trigger points or taught muscle bands can often get relief from TENS If you turn a TENS machine up too high, you'll actually see muscle infection. So, there's an optimal level where you actually can turn it up to induce, like, a gentle vibration. And so folks will feel paresthesia and vibrations, and that's kind of the sweet spot. However, I would say if folks have pain that's limited or temporary in time or after a particular activity, TENS can be really helpful. The unfortunate reality is TENS often has very time-limited benefits - just while you're wearing it, you know? So, it's often not enduring. And so that's one of the limitations. Dr Berkowitz: That's helpful to understand. We've talked about the present landscape in your article, also talk a little bit about the future and you alluded to this earlier. Tell us a little bit about some off label emerging techniques that we may see in future use. Who, which types of patients, which conditions might we be referring to you and your colleagues for deep brain stimulation or transcranial magnetic stimulation or motor cortex stimulation? What's coming down the pipeline here?  Dr Shirvalkar: That's a great question. You know, one of my favorite topics is deep brain stimulation. I run the laboratory that studies intracranial signals trying to understand how pain is processed in the brain. But, believe it or not, chronic pain is probably the oldest indication for which DBS has been studied. the first paper came out in 1960, I believe, in France. And you know, the, the original pivotal trials occurred even before the Parkinson's trial and so fell out of favor because in my opinion, I think it was just too hard or too difficult or a problem or too heterogeneous. You know, many things, but there are many central pain syndromes, you know, poststroke pains, there's often pains associated with Parkinson's disease, epilepsy, or other brain disorders for which we just don't have good circuit understanding or good targets. So, I think what's coming down the pipeline is a better personalized target identification, understanding where can we stimulate to actually alleviate pain. The other big trend I think in neuromodulation is using closed loop stimulation which means in contrast to traditional electrical stimulation which is on all the time, you know it's 24/7, set it and forget it. Actually, having stimulation respond or adapt to ongoing physiological signals. So that's something that we're seeing in spinal cord stem, but also trying to develop in deep brain stimulation and noninvasive stimulation. TMS is interestingly approved for neuropathic pain in Europe, but not approved by the FDA in the US. And so I think we may see that coming out of pipeline broader indication. And finally, MR guided focused ultrasound is, is a kind of a brand new technique now. You know, focused ultrasound lesions are being used for essential tremor without even making an incision in the skull or drilling in skull. But there are ways to modulate the brain without lesioning. And, you know, I think a lot of research will be emerging on that in the next five years for, for pain and many other neuronal disorders. Dr Berkowitz: That's fascinating. I didn't know that history that DBS was first studied for pain and now we think of it mostly for Parkinson's and other movement disorders. And now the cycle is coming back around to look at it for pain again. What are some of the targets that are being studied that are thought to have benefit or are being shown by your work and that of others to have benefit as far as DBS targets for, for chronic pain? Dr Shirvalkar: You know, that's a great question. And so, the hard part is finding one target that works for all patients. So, it may actually require personalization and actually understanding what brain circuit phenotypes do you have with regards to your chronic pain and then based on that, what target might we use? But I will say the older targets. Classical targets were periaqueductal gray, which is kind of the opioid center in your brain. You know, it's thought to just release large amounts of endogenous opioids when you stimulate there and then the ventral pusher thalamus, right. So, the sensory ascending system may be through gait control theory interferes with pain, but newer targets the answer singlet there's some interest in in stimulating there again, it doesn't work for everybody. We found some interesting findings with the medial thalamus as well as aspects of the caudate and other basal ganglion nuclei that we hopefully will be publishing soon in a data science paper.  Dr Berkowitz: Fantastic. That's exciting to hear and encourage all of our listeners to check out your article. That goes into a lot more depth than we had time to do in this short interview, both about the science and about the clinical indications, pros and cons, risks and benefits of some of these techniques. So again, today I've been interviewing Dr Prasad Shirvalkar, whose article on neuromodulation for painful neuropathic diseases appears in the most recent issue of Continuum on pain management in neurology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you again to our listeners for joining today.  Dr Shirvalkar: Thank you for having me. It was an honor. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

OKYO Pharma CEO Gary Jacob joined Steve Darling from Proactive to share news the company is reporting the first patient has been dosed in the Phase 2 trial of OK-101, a topical ocular treatment for neuropathic corneal pain (NCP). This double-masked, randomized, 12-week placebo-controlled trial will enroll 48 patients, all of whom will have their NCP disease confirmed via confocal microscopy. The trial is being conducted at a single center under the leadership of Dr. Pedram Hamrah from Tufts Medical Center, where he serves as Professor and Vice Chair of Research and Academic Programs, and Director of the Center for Translational Ocular Immunology. Dr. Hamrah's expertise will guide the study, which aims to evaluate the effectiveness of OK-101 in alleviating pain caused by corneal nerve damage—a condition with no current FDA-approved treatments. Jacob highlighted that OK-101 is a novel, non-opioid therapeutic specifically designed to target the severe and often debilitating pain associated with NCP. This condition can stem from various sources, including dry eye disease, surgery, or infections, and can significantly affect patients' quality of life. Presently, treatment options for NCP are limited to temporary pain relief strategies that often fall short of providing long-term relief. OKYO Pharma's development of OK-101 is a promising step toward addressing this unmet medical need, potentially offering patients a more effective solution to manage their corneal pain. #proactiveinvestors #okyopharmalimited #nasdaq #okyo #NeuropathicPain #OcularPain #OK101Trial #FDAApproval #Biotech #Pharmaceuticals #ClinicalTrial #DrugDevelopment #HealthInnovation#invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

“Why am I so itchy?” If you have itchy skin without rash, including issues like eczema, psoriasis, or chronic hives, you might have neuropathic itch.Though itch is caused primarily by inflammation, neuropathic itch is actually caused by dysfunction of your nervous system!Put simply, this type of itch has no primary skin rash, so you won't see inflamed dry patches or welts. You'll only feel itchy.It is often localized to certain areas of the body. For example, you could have an itchy scalp, back, or arms. The itchy skin can sometimes be mild, but is unfortunately usually quite intense, leading to scratching, which can damage the skin.And because there's no treatment for neuropathic itch, despite it being very common, you might start to feel like there's no hope. Yes, what's causing this is not yet well understood, but it sounds like experts are digging into this.Joining me to discuss neuropathic itch is returning guest Dr. Shawn Kwatra. He is the Chair of Dermatology at the University of Maryland School of Medicine. He specializes in medical dermatology areas of clinical expertise, including atopic dermatitis, psoriasis, chronic itch of unknown origin and dermatology for ethnic skin. Dr. Kwatra also runs a basic science laboratory and clinical trials unit and is funded by the National Institutes of Health and multiple foundations.He currently serves as the National Secretary/Treasurer of the Skin of Color Society. He is a member of the National Eczema Association's Scientific and Medical Advisory Council.Dr. Kwatra has been an author or co-author on over 200 publications and author of the book Living with Itch.In This Episode:What is neuropathic itch (aka. itchy skin without rash)?How could your brain cause itchy skin without rash?Itch intensity of different examples of neuropathic itchTreatment options for neuropathic itchWhich inflammatory cytokines are involved?Could Low Dose Naltrexone help itchy skin without rash?Alternative therapies for neuropathic itchQuotes“[Neuropathic itch is] initiated or caused by dysfunction of the nervous system…so it actually is caused by the nerves. And the core symptoms here are that you have normal skin, or skin only with some secondary skin changes or signs of scratching, excoriation, and it oftentimes favors a localized distribution. And so the scalp is actually a very common site where folks itch.”“Unfortunately, a lot of the medications we use to treat this condition are very sedating. They're drugs that are focusing on the transmission of itch in the central nervous system and spinal cord like gabapentin or anticonvulsants. So those are the type of drugs that we're giving for this condition.”LinksFind Dr. Shawn Kwatra online here and here | TwitterHealthy Skin Show ep. 275: Why You're So Itchy (HINT: It's Probably Not Histamine) w/ Dr. Shawn KwatraHealthy Skin Show ep. 302: What Is Prurigo Nodularis: Triggers, Body Connections + Crazy Itch w/ Dr. Shawn KwatraHealthy Skin Show ep. 331: Eczema Symptoms-Skin Color Connection: Why Skin Tone May Make Certain Symptoms WORSE w/ Dr. Shawn KwatraHealthy Skin Show ep. 03

This is a great episode I made last year that people got a lot of values from. I wanted to put this one back on just in case you have missed this.This was an amazing interview with one of my most ambitious clients, Larry, who suffered with neck pain that became so bad that he lost strengthen in his dominant arm.The neck has delicate relations to the nerves that go down the arm and control sensation and motor control. So when nerves are pinched acutely or chronically over time, it can lead to temporary but sometimes permanent weakness of your arm.This was Larry's fear, considering how often he used that arm for weight training, exercise, and being at the computer for his job.After weeks of working with him, we were able to eliminate majority of his neck pain, restore function in his arm, and get him back to a state of normalcy.I've been thankful to meet people like Larry who was ambitious enough but brave enough to seek out rehab and coaching outside of traditional means to get him to his health goals.Support the showIf you benefit from episodes like this, hit that ‘Follow' button, and leave a 5-star rating on Spotify or Apple. This would really help this podcast to grow and reach more people who could benefit from living a pain-free life. Interested in working with us? We're looking for healthcare workers, busy parents, and working professionals over 30 who want to eliminate chronic pain from their life so they can enjoy a more active life with their friends & family. We've helped over 550 people find long term success in becoming pain-free. Book a call here to speak with us: https://www.flexwithdoctorjay.co/book Here's a few other places to find me: Join my pain relief support group for busy parents to get weekly live trainings by me and access to my free 6 module pain relief course: http://www.flexwithdoctorjay.online/groupFollow on Instagram: https://instagram.com/flexwithdoctorjayFollow on Tiktok: http://tiktok.com/@flexwithdoctorjaySubscribe on Youtube: http://youtube.com/flexwithdoctorjayCase studies on Yelp: http://flexwithdoctorjay.online/yelpText me anything: 4159656580

In this episode, we review the high-yield topic of⁠ ⁠Neuropathic Charcot Arthropathy ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the MSK section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

This month Nathalie Dowgray is joined by Clare Rusbridge for part two of their conversation about neuropathic pain in cats. We then join Kelly St Denis and Julien Guillaumen as they discuss recent advances in feline aortic thromboembolism.Our episode begins with Professor Clare Rushbridge sharing her expertise on managing neuropathic pain in cats. We discuss the burdens that caregivers face as well as the various tools and medications that she has found to be helpful with her patients.Dr Kelly St Denis is then joined by Dr Julien Guillaumen to discuss his latest JFMS article ‘Feline Aortic Thromboembolism: Recent Advances and Future Prospects'. Guillaumen provides a historical overview of FATE research, dating back to 1953, and they discuss the delicate balance required in clinical management of these cases, especially concerning hydration and heart failure.For further reading material please visit:Neuropathic pain in cats: Mechanisms and multimodal managementAAFP and ISFM Feline Environmental Needs GuidelinesClare's Youtube ChannelFeline Aortic Thromboembolism: Recent Advances and Future ProspectsFor ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost:Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UKSpeakers:Clare Rusbridge, BVMS PhD DipECVN FRCVS, RCVS and European Specialist in Veterinary Neurology & JFMS AuthorKelly St Denis, MSc, DVM, DABVP (Feline), 2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines Co-Chair, St Denis Veterinary Professional Corporation, Powassan, Ontario, CanadaJulien Guillaumen, Doct Vet, DACVECC, DECVECC, Associate Professor of Emergency and Critical Care at Colorado State University and JFMS Author.

Airing Pain 144: Dilemmas in Pain Research  This episode of Airing Pain focuses on the challenges that researchers must overcome when researching pain and developing new treatment approaches. Many questions remain unanswered in the field of pain research. For example, we might know that a treatment works for some people living with pain, but we might not know how it works or why some people benefit and some do not.  So, there is a lot of research being done to try to better understand pain. This leads to another problem: how to cope with the amount of new information emerging from research and trials? It is important that new research data is made more accessible for clinicians, healthcare workers, patients, and researchers. Data is no use unless it can be assessed and summarized so that doctors can understand how to use it to benefit their patients.  Our contributors for this edition are leaders in this field and they discuss some of the issues they have encountered whilst conducting their research into pain and how to treat it.  The interviews were recorded at the British Pain Society's Annual Scientific Meeting, 2023.  Contributors:  Professor Robert Brownstone, Brain Research UK Chair of Neurosurgery, Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology.  Dr Neil O'Connell, Reader in Physiotherapy, Brunel University, Chair of the International Association for the Study of Pain (IASP) Methods, Evidence Synthesis and Implementation Special Interest Group. He is an advisor to Pain Concern.  Dr Kirsty Bannister, Neuroscientist and Associate Professor at King's College London.  Time Stamps:  1:22 Paul introduces Professor Robert Brownstone, Brain Research UK Chair of Neurosurgery at University College London.  1:32 Prof. Brownstone explains what a spinal cord stimulator is, the lack of progress made with this form of treatment, the varied results the treatment gets, and why some people experience long-term pain following back surgery.  7:40 Paul talks about Cochrane, a global independent network of health practitioners, researchers, and patient advocates who review research findings to provide a more precise estimate of the effects of a treatment.  7:54 Paul introduces Dr Neil O'Connell, a Reader at Brunel University who was the Co-ordinating editor of the Cochrane Pain, Palliative and Supportive Care (PaPaS) group.  8:35 Dr O'Connell discusses how Cochrane reviews research and clinical trials, and the complexities involved in gathering and interpreting evidence when developing interventions.  17:04 Paul introduces Dr Kirsty Bannister, a neuroscientist and Associate Professor at King's College London who specialises in neuropharmacology and runs a research group that uses animals to examine the mechanisms of pain processing.  17:22 Dr Bannister talks about why animal models are useful for researching the responses people may have to different pain processes and researching chronic pain by measuring neuronal responses to pain.  21:44 Paul and Dr Bannister discuss the limitations of using animals to research chronic pain.  23:48 Paul and Dr Bannister explore why looking at a patient's experience of pain first can better inform lab research on animal models for understanding and researching pain.  30:03 Prof. Brownstone gives some advice for those considering a spinal cord stimulator as an intervention they want to try.  Additional Resources:  Cochrane  Pain Matters 73: Neuropathic pain issue  Pain Matters 79: Navigating pathways to live well with pain  Pain Matters 80: What treatment really works  Neuropathic Pain  If you have any feedback about Airing Pain, you can leave us a review via our Airing Pain survey   ______________________________________________________________________________________________

This month our focus is on recognising feline pain. Yaiza Gomez-Meijas is joined by Beatriz Monteiro to discuss the feline grimace scale. Clare Rusbridge then joins Nathalie Dowgray to discuss neuropathic pain in cats.Our episode begins with Yaiza interviewing Beatriz about her findings from a large bilingual global survey assessing if cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale, an innovation that led to Monteiro winning the JFMS Best Resident Paper Award. The method allows both veterinarians and cat caregivers to evaluate pain based on facial expressions, aiming to bridge the gap between professionalveterinary assessments and at-home care for felines.Nathalie is then joined by Professor Clare Rusbridge who shares insights into her recent JFMS article on Neuropathic pain in cats: Mechanisms and multimodal management. She highlights the importance of distinguishing between nociception and pain perception and discusses diagnostic challenges and management strategies for conditions like osteoarthritis and feline hyperesthesia syndrome.For further reading material please visit:Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale?The Feline Grimace Scale WebsiteNeuropathic pain in cats: Mechanisms and multimodal managementAAFP and ISFM Feline Environmental Needs GuidelinesClare's Youtube ChannelFor ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.orgHost:Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UKSpeakers:Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal ClinicianBeatriz Monteiro, DVM, PhD, ISFMAdvCertFB, PgDip, Chair of the World Small Animal Veterinary Association Global Pain Council and Winner of the 2024 JFMS Resident Best Paper AwardClare Rusbridge, BVMS PhD DipECVN FRCVS, RCVS and European Specialist in Veterinary Neurology & JFMS Author

In today's episode, I cover the three primary types of musculoskeletal pain, which include mechanical (nociceptive) pain, neuropathic (nerve) pain and chronic or persistent pain. Understanding what type of pain you have helps determine the best path forward in terms of which treatment options to pursue. In future episodes, I will dive deeper into specific treatment interventions for each type of pain.  If you are suffering from pain or an injury, my book has comprehensive rehab programs for the 50 most common injuries and pain issues. Each program guides you through three phases of rehab and has pictures of me doing the exercises. The book is almost 500 pages in length and each body region has its own chapter. It is the type of reference that is intended to help you manage your own pains and injuries. Click the following Amazon LINK to learn more about my book. 

Visit nascentmc.com/podcast for full show notes [free course] ChatGPT4 in medical writing and editing at learnAMAstyle.com Nascentmc.com for medical writing assistance for your CME or Medical Communications company. Eplontersen for ATTR-CM Eplontersen received FDA Fast Track designation for treating transthyretin-mediated amyloid cardiomyopathy (ATTR-CM) in adults, aiming to inhibit TTR protein production. Nivolumab for NSCLC The FDA accepted supplemental applications for nivolumab in resectable stage 2A to 3B non-small cell lung cancer (NSCLC) based on the CheckMate-77T trial showing improved survival rates. RSV Vaccine for Adults Aged 50 to 59 The FDA prioritizes review of GSK's Arexvy vaccine for RSV in adults aged 50-59 at risk of complications, expanding from its existing approval for those 60 and older. Spinal Cord Stimulation System The FDA approved Boston Scientific's WaveWriter Spinal Cord Stimulation Systems for chronic low back and leg pain treatment in non-surgery patients, based on the SOLIS trial results. OK-101 for Neuropathic Corneal Pain The FDA approved an IND application for OK-101, a first for treating neuropathic corneal pain (NCP), an Orphan disease, developed by OKYO Pharma Limited. Viz ICH Plus for Brain Bleed The FDA cleared Viz ICH Plus, an AI algorithm by Viz.ai for automating the identification and quantification of brain bleeds and structures in NCCT images. Vepdegestrant for MBC Vepdegestrant received FDA Fast Track designation for treating ER-positive/HER2-negative advanced or metastatic breast cancer in patients previously treated with endocrine therapy. VerTouch Spinal Puncture Device The FDA cleared VerTouch, a handheld imaging tool by IntuiTap Medical, designed to improve the accuracy of spinal punctures by providing a 2D image of lumbar spinal anatomy.

In this Clinical Insight we take a shallow dive into the Radiculo-Neuropathic Myofascial Pain Model. This model was heavily influenced by Dr. Chan Gunn. It is a very solid model in the evaluation and treatment of chronic pain as it takes into consideration a lot of key components that play a role in the production of chronic pain. We talk through how the combination of Cannon's Law, denervation and other factors play a role in chronic pain based on how this model describes it. At the end we discuss what are some practical recommendations that you can try immediately to see if there is something you can do if you are dealing with chronic pain. Check it out, leave a comment and we will continue the discussion as well as we can to keep helping make the complicated simple. BOOK LINK: Treatment of Chronic Pain (https://amzn.to/3agkT3m) #Podcast #Clinically #Pressed #Wellness #Performance #Nutrition #ComplicatedSimple #Science #fitness #health #strength #athletics #medical #training #exercise #sportsscience #chiropractic #exercisescience #athletictraining #sports #pain #painrelief #weightloss #kettlebells #complicatedsimple #tpdn #rnmp #myofascial #myofascialpain #chronicpain #dryneedling --- Support this podcast: https://podcasters.spotify.com/pod/show/clinicallypressedco/support

Revolutionize your care at Budget Pharmacy (budgetpharmacytexas.com 713 694-3785) in Klein, TX for individuals with diabetes battling excruciating neuropathic nerve pain in their limbs. Focused on wound prevention, this cutting-edge service aims to eliminate the need for medical treatment and potential limb loss. Budget Pharmacy City: Spring Address: 19786 Interstate 45 Website https://www.budgetpharmacytexas.com Phone +1-713-694-3785 Email budgetphcy@gmail.com

Join us as we go through the JEADV Editor's Picks of January 2024: (1) A Treatment with Antineoplastic Potential in Squamous Cell Carcinoma (2) Describing Penile Cancer Carcinogenesis and The Role of HPV (3) Sensitive Skin may be Neuropathic in Nature (4) Urgency of Optimal Imaging in Toxic Epidermal Necrolysis   Read the Editor's Picks here: https://onlinelibrary.wiley.com/doi/10.1111/jdv.19624   Link to video version: https://www.youtube.com/playlist?list=PL2DbuyADMP5mFx4sZqS_vQtdTGOGIbwb1   You are invited to participate in our survey to improve the show. Your feedback is valued and appreciated to allow us to better serve our audience: https://eadv.org/eadv-podcast-survey/

Welcome to Season 3, Episode 40 of "Winning Isn't Easy"!

Burning Mouth Syndrome is not a strictly surgical topic, but it's something practitioners will often deal with. During this episode, Dr. Hayley Vatcher returns to the podcast to share her insights on this complex diagnosis and how best to treat it. Tune in as Dr. Vatcher draws on her years of experience to offer guidelines on identifying when patients are struggling with this condition and advising them on how to manage it. Starting with more conservative approaches, we explore different methods of dealing with Burning Mouth and reducing the symptoms, including nutritional and supplementary care, topical solutions, and more. Dr. Vatcher also breaks down key research into causes, management, and more. Thanks for listening in! Key Points From This Episode:Welcome to Oral Medicine Specialist, Dr. Hayley Vatcher.Defining Burning Mouth Syndrome, also referred to as Complex Oral Sensitivity Disorder (COSD).Neuropathic aspects of Burning Mouth Syndrome.How it is managed without surgery.Why Burning Mouth Syndrome is a diagnosis of exclusion.Ruling out the possibility of a vitamin deficiency instead of COSD.Why something that soothes an ordinary mouth will burn someone with COSD.The patient experiences of burning sensations elsewhere on the body or the skin.Treatment options for patients suffering with this condition.Why practitioners regularly start with a more conservative approach to treatment.Optimizing vitamin intake as a supplementary treatment. Noting that the symptoms are not visible to the eye within the mouth. Why the condition is most common in post-menopausal women. The possibility of whether other medicines can cause Burning Mouth. What has led to the lack of surgical intervention for this condition.Historical data that has shown a Vitamin B Complex to reduce symptoms.Research into different nutritional solutions. Why many of these patients have often already seen three to four other practitioners.Links Mentioned in Today's Episode:KLS Martin — https://www.klsmartin.com/en/KLS Martin Promo Code — StuckiFavsKLS Martin Email — usa@klsmartin.comDr. Hayley Vatcher on LinkedIn — https://www.linkedin.com/in/hvatcher/Dr. Hayley Vatcher Email — drvatcher@coafs.comAcademy of Orofacial Pain — https://aaop.org/Burning Mouth Syndrome: A Review and Update — https://onlinelibrary.wiley.com/doi/full/10.1111/jop.12101American Academy of Oral Medicine — https://www.aaom.com/Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

Welcome to Season 3, Episode 38 of "Winning Isn't Easy"!

Budget Pharmacy, Spring, TX (budgetpharmacytexas.com 713 694-3785) is offering a unique advisory service for those with nerve-related skin pain in their hands, arms, legs, and feet, especially diabetics. The goal is to prevent the development of active wounds that could potentially lead to amputation. Budget Pharmacy City: Spring Address: 19786 Interstate 45 Website https://www.budgetpharmacytexas.com Phone +1-713-694-3785 Email budgetphcy@gmail.com

In this episode, we review the high-yield topic of Neuropathic (Charcot) Joint of Shoulder⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠from the Shoulder & Elbow section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Orthobullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message

This was an amazing interview with one of my most ambitious clients, Larry, who suffered with neck pain that became so bad that he lost strengthen in his dominant arm.The neck has delicate relations to the nerves that go down the arm and control sensation and motor control. So when nerves are pinched acutely or chronically over time, it can lead to temporary but sometimes permanent weakness of your arm.This was Larry's fear, considering how often he used that arm for weight training, exercise, and being at the computer for his job.After weeks of working with him, we were able to eliminate majority of his neck pain, restore function in his arm, and get him back to a state of normalcy.I've been thankful to meet people like Larry who was ambitious enough but brave enough to seek out rehab and coaching outside of traditional means to get him to his health goals.Support the showIf you benefit from episodes like this, hit that ‘Follow' button, and leave a 5-star rating on Spotify or Apple. This would really help this podcast to grow and reach more people who could benefit from living a pain-free life. Interested in working with us? We're looking for healthcare workers, busy parents, and working professionals over 30 who want to eliminate chronic pain from their life so they can enjoy a more active life with their friends & family. We've helped over 550 people find long term success in becoming pain-free. Book a call here to speak with us: https://www.flexwithdoctorjay.co/book Here's a few other places to find me: Join my pain relief support group for busy parents to get weekly live trainings by me and access to my free 6 module pain relief course: http://www.flexwithdoctorjay.online/groupFollow on Instagram: https://instagram.com/flexwithdoctorjayFollow on Tiktok: http://tiktok.com/@flexwithdoctorjaySubscribe on Youtube: http://youtube.com/flexwithdoctorjayCase studies on Yelp: http://flexwithdoctorjay.online/yelpText me anything: 4159656580

In this episode of the Psychedelic Medicine Podcast, Dr. Michelle Weiner joins to discuss the research on ketamine assisted psychotherapy for chronic pain conditions. Dr. Weiner is Double board-certified in Interventional Pain Medicine, Physical Medicine and Rehabilitation and the Director of Integrative Pain Management at Spine and Wellness Centers of America. She uses a unique personalized approach to treat the root cause of one's pain using a biopsychosocial model including lifestyle and plant medicine to empower her patients to cultivate health, optimize quality of life and decrease pharmaceuticals. In this conversation, Dr. Weiner discusses her recent research into ketamine therapy for chronic pain and comorbid depression, which compared psychedelic and psycholytic doses of the dissociative. She emphasizes the importance of a biopsychosocial approach to pain treatment and sees the psychotherapy aspect of the ketamine treatments as crucial to their efficacy, as this approach allows doctors to have a better understanding of the complex etiology of the patients pain beyond just what shows up on imaging and empowers patients to actively take ownership of their pain management. While the results from Dr. Weiner's study were very encouraging, she mentions that ketamine therapies typically require maintenance and that more longitudinal research is needed to further understand how durable these changes are.    In this episode: The issue of central sensitization in chronic pain The difference between psychedelic and psycholytic doses  What led Dr. Weiner to study chronic pain and comorbid depression Neuropathic, nociceptive, and nociplastic forms of pain The influence of trauma and stress on chronic pain The intersection of pain and identity Dr. Weiner's biopsychosocial approach to pain treatment The differences between cannabis and ketamine as pain treatment medications   Quotes: “A lot of [patients'] pain is really similar to fear—fear in the brain—and… if we're not able to understand where this fear is coming from we're not able to extinguish their pain. So I really changed the way I practice and use ketamine because I started to think more about how the psychiatrists are using it, in terms of preparation and integration.” [6:59] “What I've seen is that ketamine does require maintenance in the sense that even if we do six sessions, a lot of patients do need to come back after a few weeks or a few months for maintenance treatment with ketamine as well as therapy.” [20:09] “Pain doctors [should try to] be a little bit more aware of the set, setting, and preparation and integration so that we don't need to use benzos and [patients] can actually have this dissociative experience to allow them to have hope or get out of that fight or flight.” [33:04]   Links: Dr. Weiner's study: Ketamine-assisted psychotherapy treatment of chronic pain and comorbid depression: a pilot study of two approaches Dr. Weiner's website Dr. Weiner on Instagram PMA webinar with Dr. Weiner: Treating Pain and Functional Neurologic Disorders with Psychedelics Spine and Wellness Centers of America  Psychedelic Medicine Association Porangui

This week, we take a look at the practical management of pain and the advancement of science regarding it, with our guest Dr. Dan Clauw. Co-author of the paper: “Identifying and Managing Nociplastic Pain in Individuals With Rheumatic Diseases: A Narrative Review”, Dr. Clauw joins us today to discuss the work to introduce the three types of pain classified by “The International Association for the Study of Pain” and the mechanisms that underlie pain, as it relates to the field of rheumatology.  

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.09.548214v1?rss=1 Authors: Crowther, A., Kashem, S., Jewell, M. E., Chang, H. L., Casillas, M. R., Midavaine, E., Rodriguez, S., Braz, J., Kania, A., Basbaum, A. Abstract: Mouse models that combine tetracycline-controlled gene expression systems and conditional genetic activation can tightly regulate transgene expression in discrete cell types and tissues. However, the commonly used Tet-Off variant, tetracycline transactivator (tTA), when overexpressed and fully active, can lead to developmental lethality, disease, or more subtle behavioral phenotypes. Here we describe a profound itch phenotype in mice expressing a genetically encoded tTA that is conditionally activated within the Phox2a lineage. Phox2a; tTA mice develop intense, localized scratching and regional skin lesions that can be controlled by the tTA inhibitor, doxycycline. As gabapentin, but not morphine, completely relieved the scratching, we consider this phenotype to result from chronic neuropathic itch, not pain. In contrast to the Phox2a lineage, mice with tTA activated within the Phox2b lineage, which has many similar areas of recombination within the nervous system, did not recapitulate the scratching phenotype. In Phox2a-Cre mice, but not Phox2b-Cre, intense Cre-dependent reporter expression was found in skin keratinocytes localized to the area of scratching-induced skin lesions. Most interestingly, topical application of the DREADD agonist, CNO, administered repeatedly over two months, which chronically induced Gi signaling in keratinocytes, completely reversed the localized scratching and skin lesions. Furthermore, ablation of TRPV1-expressing, primary afferent neurons reduced the scratching with a time course comparable to that produced by Gi-DREADD inhibition. These temporal properties suggest that the neuropathic itch condition arises not only from localized keratinocyte activation of peripheral nerves but also from a persistent, gabapentin-sensitive state of central sensitization. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.03.18.533004v1?rss=1 Authors: Raut, N. G., Maile, L. A., Oswalt, L. M., Mitxelena, I., Adlakha, A., Sprague, K. L., Rupert, A. R., Bokros, L., Hofmann, M. C., Patritti-Cram, J., Rizvi, T. A., Queme, L. F., Choi, K., Ratner, N., Jankowski, M. P. Abstract: Pain of unknown etiology is frequent in individuals with the tumor predisposition syndrome Neurofibromatosis 1 (NF1), even when tumors are absent. Schwann cells (SC) were recently shown to play roles in nociceptive processing, and we find that chemogenetic activation of SCs is sufficient to induce afferent and behavioral mechanical hypersensitivity in mice. In mouse models, animals show afferent and behavioral hypersensitivity when SC, but not neurons, lack Nf1. Importantly, hypersensitivity corresponds with SC-specific upregulation of mRNA encoding glial cell line derived neurotrophic factor (GDNF), independent of the presence of tumors. Neuropathic pain-like behaviors in the NF1 mice were inhibited by either chemogenetic silencing of SC calcium or by systemic delivery of GDNF targeting antibodies. Together, these findings suggest that Nf1 loss in SCs causes mechanical pain by influencing adjacent neurons and, data may identify cell-specific treatment strategies to ameliorate pain in individuals with NF1. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Dr. Amy Moore is a plastic surgeon at The Ohio State University Wexner Medical Center. She specializes in super microsurgery for peripheral nerve injuries and peripheral neuropathies including complex hand and trauma reconstructive surgery. She regularly performs procedures to reanimate limbs, relieve patients' debilitating pain, and restore sensation for those with nerve injuries.She is one of the few peripheral nerve surgeons in the world, and she has a focus on improving her patients' quality of life. Nerve growth is a years-long process, and she supports her patients the entire way through recuperating and regaining function after surgery.Her research is focused on developing treatments to make nerve regrowth more efficient and faster. She is also exploring strategies for rewiring nerves with the goal of preventing muscle atrophy, restoring motion and relieving pain. She has authored more than 100 peer-reviewed journal articles in addition to other publications.she also leads a federally funded translational scientific research investigation of advanced limb reconstruction.In addition to this she helps to train the next generation of physicians. She is a professor ands serve as the chair of the Department of Plastic and Reconstructive Surgery at The Ohio State University College of Medicine. She is on the scientific advisory board for the International Symposium of Neural Regeneration, the board of the American Association for Hand Surgery and the American Society for Peripheral Nerve.In this episode we discuss:What is a nerve? How does it function?Various ways nerves get damaged and try to heal themselves.The anatomy of nerve regrowth, for better or for worse.Nonsurgical options after nerve injury.Neuropathic pain descriptors.What is Wallerian degeneration? How does it influence timing of nerve testing?Surgical options after nerve injury.Common and uncommon examples.The growing & expanding field of peripheral nerve injury.The podcast episodes drop weekly on Mondays in seasonal chunks. Subscribe to stay up to date, and tune in when you can! Be sure to rate, review, and follow on your favorite podcast app and let me know what other brain & body things you'd like to hear about.For more information about me, check out my website, www.natashamehtamd.com.Follow me on Instagram, Twitter, or Tik Tok @drnatashamehta. Follow Dr.  Amy Moore on Instagram @amymooremd.This episode is not sponsored.

In this episode, we review the high-yield topic of Neuropathic (Charcot) Arthropathy from the Orthopedics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Episode 125: Non-opioid Chronic Pain Management Dr. Axelsson and Jesse explain how to treat chronic pain without opioids. Written by Anika Soleyn, MS4, Ross University School of Medicine. Edited by Jesse Lamb, MS3, American University of the Caribbean; Hector Arreaza, MD; and Fiona Axelsson, MD.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Axelsson:Welcome to the first episode of 2023, Happy new year! Today is January 10, 2023.What is chronic pain?According to the International Association for the Study of Pain, chronic pain is nonstop or reoccurring pain that lasts more than 3 months or beyond the expected clinical course of illness. Chronic pain can adversely affect well-being and quality of life. We used to think of pain as a response to tissue damage, and as the tissue heals, the pain dissipates, but chronic pain is much more complex than that because there may be no evidence of tissue damage, yet the nociceptors keep sending signals to the brain that there is damage.There are 3 options for the management of chronic pain: non-pharmacologic, nonopioid pharmacological and opioid management. CDC recommends a combination of nonpharmacological and non-opioid management for chronic pain. The 7 most common chronic pain conditions are neuropathic pain, fibromyalgia or chronic pain syndrome, osteoarthritis, inflammatory arthritis, low back pain, chronic headache, and sickle cell anemia.Opioids in long-term care facilities.The use of opioids for the treatment of pain is common in the post-acute and long-term care setting. From the AFP Journal, the Choosing Wisely Recommendation states: “Don't provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life.” The Society for Post-Acute and Long-Term Care Medicine published a statement in 2018 about the use of opioids. It states that the prescription of opioids should be based on an interprofessional assessment specifying why opioids are needed. When long-term opioids are not being used for cancer, palliative care, or end-of-life care in a long-term facility, a tapering plan must be “individualized and should minimize symptoms of opioid withdrawal while maximizing pain treatment with non-pharmacologic therapies and non-opioid medications”. Long-term opioid prescriptions should be reviewed regularly and take into consideration the potential harms of opioids. Clinicians are encouraged to offer alternatives such as behavioral therapy, non-opioid analgesics, and other non-pharmacologic treatments whenever available and appropriate.Initial assessment: Identify biopsychosocial factors and identify if the source is neuropathic, nociceptive, or central sensitization. This can be a challenging process and it may require several visits to determine the origin of pain. Neuropathic pain is due to nerve damage or irritation while nociceptive pain is due to tissue damage. Central sensitization is an abnormal response of the nociceptive system. There are changes in the nervous system that alter how it responds to sensory input that causes widespread pain with no apparent cause or in response to mild sensory input. Some examples include fibromyalgia, migraines in response to brushing hair, surgical scar pain, etc.Set goals and expectations: It is crucial to set up patient expectations if they have chronic pain. They should understand that pain can be improved to a manageable level but not always eliminated. Patients should have routine follow-up visits with education, and reassurance since they are shown to improve outcomes of pain management. Specific goals such as improved mobility and ability to do certain enjoyable tasks are more reasonable and specific goals than a goal of pain elimination. A good physician-patient relationship and clear communication are essential here. Patients could obviously become deeply upset at the prospect of pain that can't be eliminated, and those who have received opioids for their pain in the past could be even more distraught at the thought of not getting them now or needing to reduce their dose. The physician should be ready to have this discussion with their patients that have chronic pain and be ready to address their concerns appropriately. Reduce catastrophic thinking: Pain is an alarm system letting someone know there is some sort of damage. Because of this, it makes sense that a patient would respond to pain with anxious and catastrophic thinking. Patients who understand their own chronic diseases are more likely to be actively involved in their treatment, so understanding is crucial in the management of pain. Reducing fearful thoughts such as "there must be something wrong," and "hurt means harm'” is an important first step toward pain self-management and making sure the strategies attempted are effective.Rehabilitation: Focused pain clinics often include educational group classes for patients in distress. The programs include explanations for why pain might be present with no pathological factors. It also includes relaxation and mindfulness that help patients soothe themselves during attacks. The brain plays a big role in the experience of pain. Changing how your brain relates physical pain to stress and reducing those psychosocial barriers through self-care helps with pain management. Finding things that make you physically stronger like physical therapy or occupational therapy help, but also increasing mental strength by doing things that make you happy and having a quality social life is a strong determinant of how the brain perceives physical pain. Consistency is key in pain management even after the patient begins to feel better.Non-pharmacologic therapy – Most of what we will talk about today is non-pharmacological treatment. We will discuss the options and goals of different treatments. Chronic pain treatment should start with non-pharmacological approaches and then you can add medications if necessary. Again, these approaches aim to increase functionand reduce progression despite chronic pain. There should be a consistent non-pharmacological regimen, even if medications are added later. The three main approaches will be physical therapy, psychological therapy, and some integrative medicine methods.Physical therapy. The objective of physical therapy is to improve physical function. You should recommend programs that are specific for patients' limitations and the physical therapist should have trained specifically in chronic pain treatment. This ensures they do a proper initial evaluation and select appropriate therapeutic methods such as Therapeutic exercise: Sometimes patients can become so fearful of painful movement that they have deconditioned muscles. In the geriatric population, some patients are so afraid of falling, that they avoid any form of movement whatsoever, therefore almost certainly leading to falls due to deconditioning of those muscles. Adding small amounts of exercise as tolerated can begin to recondition patients and help them build strength. Patients with severe osteoarthritis are more likely to tolerate aquatic exercises. Therapeutic exercise programs may be available at the physical therapy facility or community centers. Patients can even find videos on the internet of tai chi, yoga classes, Pilates, and low-impact fitness programs. Exercise can certainly reduce pain and improve function, with few adverse effects but make sure patients tolerate the exercises and are not pushed beyond their limits. Stretching can also improve range of motion and strength, especially in chronic lower back pain patients. Psychological therapy:Cognitive-behavioral therapy. It is the most researched and recommended psychological treatment for chronic pain. It's normally recommended in conjunction with patient education, physical therapy, and exercise. CBT can be used after introducing meds and/or after surgery. There are 2 components to cognitive behavioral therapy: cognitions and behaviors. CBT addresses the way that patients' thoughts (cognitions) affect their actions and vice versa. This begins with helping patients identify situations and environments that trigger their pain and what they actually experience emotionally, behaviorally, and physically when they have pain.CBT addresses mental responses that may worsen pain, so patients learn to think about how they view their pain. To do this, they use a range of specific behavioral strategies such as relaxation and controlled-breathing exercises, activity pacing, pleasurable activities, improving their sleep, and cognitive reappraisal strategies, such as reframing negative situations to positive or practicing gratefulness.Complementary and integrative health therapies.-Mindfulness-based stress reduction. Mindfulness is the ability to be fully present where we are and what we're doing, and not be overly reactive or overwhelmed by what's going on around us.-Progressive muscle relaxation. For instance, tensing/relaxing muscles throughout the body along with positive imagery and meditation.-Biofeedback. During biofeedback, you're looking at biological signs, and feedback that is being correlated to physical sensations in your body to recognize the correlation between physical signs and symptoms of chronic pain. You're connected to monitors, such as electromyograms or electroencephalograms, to quantify muscle tension, brain waves, heart rate, and blood pressure to see how fluctuations and abnormal numbers physically feel in the body.-Massage therapy. It can relax painful muscles, tendons, and joints and relieve stress. The effect of pressure in certain areas that are tender causes relaxation and secretion of endorphins that can calm pains. That's why massage therapy can actually be addictive for some people, because of the endorphins. Another benefit of massage therapy is that it can help with improved absorption of medications due to improved circulation.There are many other integrative health therapies including Reiki, hypnosis, therapeutic touch, healing touch, and homeopathy. However, these are not well-researched and can't really be endorsed by evidence-based medicine.If patients are interested in trying complementary, integrative health therapy, you can guide them to practices that are at least safe. Some therapies can end up being harmful, such as herbal remedies or supplements with potential toxicities or known interactions with medications, so those should be taken cautiously. Make sure your med list while taking your history includes supplements and herbs patients might be trying. Shirodhara is an Ayurvedic approach to stress relief that involves having someone pour liquid — usually oil, milk, buttermilk, or water — onto your forehead.Herbal or plant-based treatments have also shown some efficacy in published studies. Ginger, turmeric, St John's Wort, and a handful of others seem like they could have some beneficial effects either on their own merit or as an adjunctive with other non-opioid therapies. Caution should be taken, though, as some of them, particularly St John's Wort, have been shown to have negative impacts on serum levels of opioids when used in combination with them due to their effects on the liver cytochrome system. Data is also rather mixed, with some studies showing reasonable efficacy and others showing almost none. If your patients want to take herbal supplements, it is essential to be diligent about checking their efficacy and interactions with other therapies to ensure safety. The physician should also be clear when discussing current medications to ask specifically if they take herbal supplements of any kind, as many patients don't consider these to be “medications” and will omit them during history. Of note, turmeric has to be taken with black pepper for better GI absorption.Weight reduction: A healthy diet and fitness are always recommended. Online guidelines are helpful on topics such as healthy fats, vegetables, avoiding refined sugar, and more. Obesity is a pro-inflammatory state, but it is important not to blame chronic pain problems solely on obesity since patients may still have pain after losing weight. Weight reduction can be a part of that plan, but we should not promise a cure for chronic pain after a patient reaches an ideal weight. Sleep disturbances: Ironically, sleep improves pain, but pain makes sleep more difficult. If patients complain of sleep disturbances, start with behavioral changes, including improved sleep hygiene (keep a regular sleep schedule, exercise regularly, don't use caffeine and caffeinated beverages, don't eat too late at night) and stimulus control (the bed should only be used for two things: sleep and sex, get out of bed if you can't sleep, wake up at the same time every day, and avoid bright screens before bedtime because they confuse your brain); cognitive behavioral therapy (deal with concerns or worries that may interfere with sleep). Treating sleep disturbance may have a positive effect on the treatment of chronic pain. Acupuncture: It involves the insertion of very thin needles through the skin at specific points on the body. Acupuncture is a key component of traditional Chinese medicine and can be considered in patients with chronic pain. There are significant difficulties in studying acupuncture, but randomized trials suggest that acupuncture and placebo may have similar efficacy, and both are superior to no treatment. Pharmacologic therapy – For patients with inadequate analgesia despite nonpharmacologic therapies, we add carefully selected multi-targeted pharmacological therapies based on the type of pain (i.e., nociceptive, neuropathic, central sensitization) For nociceptive pain, start with non-steroidal anti-inflammatory drugs (NSAIDs) while continuing non-pharmacologic treatments. If that doesn't work add a topical agent such as lidocaine, capsaicin, or topical NSAIDs. Consider opioid treatment if neither of those works. For neuropathic pain, start with antidepressants or antiepileptic drugs: tricyclic antidepressants, SNRIs, pregabalin, gabapentin, or carbamazepine in addition to non-pharmacologic therapy. If those medications do not provide relief of pain, then you can consider adding topical agents and then opioids after weighing the risk and benefits. Side effects can be viewed as harmful, but we can use them for our benefit.Opioids are reserved for people with moderate to severe pain who cannot function. Once you identify a treatment that works for the patient, follow-up visits should be continued to promote behavioral changes, monitor therapeutic response, and treat side effects. A pain contract should also be signed.Follow-up visits – Schedule follow-up visits to continue educating patients and their families and caregivers, to continue motivational interviewing, and to monitor improvement. Refer patients who are not making enough progress, such as not reaching goals of function and quality of life, to comprehensive pain programs that can use additional modalities such as injections.Bottom line: Non-pharmacologic options should be considered in the management of all patients with chronic pain. The main non-pharmacologic strategies include physical therapy, psychological therapy, and complementary and integrative therapy. Remember to treat sleep disturbances and obesity as part of your plan. Add pharmacologic agents such as NSAIDs, antidepressants, and anticonvulsants when non-pharmacologic therapies do not help the patient reach their goals. Consider opioids only in moderate to severe pain with loss of function. Opioid prescription is a complex topic that was addressed in episode 31 of this podcast, more than 2 years ago, it is time for an update. Stay tuned, we will talk about opioids soon.____________________________Conclusion: Now we conclude episode number 125, “Non-opioid Chronic Pain Management.” Non-pharmacologic therapy is proven to be effective in the treatment of chronic pain, especially physical therapy, psychological therapy, and some complementary therapy. Medications can be added to non-pharmacologic therapy, mainly NSAIDs, antidepressants, antiepileptic medications, and more. Opioids can be added in disabling chronic pain, but prescription needs to be done cautiously and watchfully. The treatment of chronic pain may be challenging and daunting at times, but fortunately, we have science to back us up with effective ways to help our patients. So, don't be discouraged and trust science! This week we thank Fiona Axelsson, Jesse Lamb, and Hector Arreaza. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________Links:Tauben, David, Brett R Stacey, Approach to the management of chronic non-cancer pain in adults, UpToDate. Last updated on May 06, 2022. Accessed January 10, 2023. https://www.uptodate.com/contents/approach-to-the-management-of-chronic-non-cancer-pain-in-adults.Choosing Wisely Recommendations: Don't provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life, American Family Physician, Collections 460, American Academy of Family Physician. Link: https://www.aafp.org/pubs/afp/collections/choosing-wisely/460.html.What is Mindfulness? Mindful.org. https://www.mindful.org/what-is-mindfulness/.Jahromi B, Pirvulescu I, Candido KD, Knezevic NN. Herbal Medicine for Pain Management: Efficacy and Drug Interactions. Pharmaceutics. 2021; 13(2):251. https://doi.org/10.3390/pharmaceutics13020251.Royalty-free music used for this episode: “Good Vibes - Fashionista." Downloaded on October 13, 2022, from https://www.videvo.net/

0:00 - Introduction5:32 - Importance of lower back pain. Statistics10:07 - What is lower back pain. Discussion around concepts of pain16:07 - What is nociception36:36 - Acute lower back pain57:10 - Manual therapy for acute pain1:10:20 - Recurrent/chronic lower back pain1:15:40 - Specific diagnosis1:17:40 - Neuropathic pain/referred pain1:24:10 - Non-musculoskeletal causes1:42:05 - Manual therapy for chronic pain1:45:15 - Posture1:51:57 - Types of exercise1:54:54 - Core stability2:04:40 - Strategies for decreasing LBP incidence2:06:43 - Lifting2:08:23 - Loaded lumbar flexion abdominal exercises2:18:10 - Spinal position for squat and deadlift2:26:00 - Living with chronic lower back pain2:33:37 - Closing

Neuropathy@CoreHealth551 Post Road Suite 1Darien CT 06820Here is a list of Questions I received recently about peripheral neuropathyis peripheral neuropathy curablecan peripheral neuropathy be reversedis peripheral neuropathy reversiblecan peripheral neuropathy be curedis peripheral neuropathy a disabilitywhat are the symptoms of peripheral neuropathydoes peripheral neuropathy come and gocan peripheral neuropathy go awayis peripheral neuropathy fatalwhat is peripheral neuropathy in diabeteshow long does peripheral neuropathy lastcan peripheral neuropathy kill youis peripheral neuropathy hereditaryis peripheral neuropathy permanentwhat does peripheral neuropathy meanis peripheral neuropathy dangerouscan peripheral neuropathy be caused by a bulging discwhat's peripheral neuropathywho treats peripheral neuropathycan peripheral neuropathy cause itchingcan peripheral neuropathy come and gowhat causes peripheral neuropathy other than diabetesis peripheral neuropathy painfulwhat does peripheral neuropathy feel like redditwhy does peripheral neuropathy cause fatigueperipheral neuropathy when to go to erwhere does neuropathy startwhich statins cause peripheral neuropathyis peripheral neuropathy progressivewhat causes peripheral neuropathy in diabeteswhat makes peripheral neuropathy worsecan peripheral neuropathy cause headachesis peripheral neuropathy seriouscan peripheral neuropathy cause dizzinesswhat helps peripheral neuropathy at nightwhat are the signs of peripheral neuropathyperipheral neuropathy is most likely to be manifested bywill peripheral neuropathy go awayhow does peripheral neuropathy progressdo symptoms of peripheral neuropathy come and gowhat triggers peripheral neuropathywhy peripheral neuropathy in diabeteswhy is peripheral neuropathy dangerouswhy does peripheral neuropathy come and gowhere does peripheral neuropathy starthow long peripheral neuropathy lastwhat are the first signs of peripheral neuropathyhow does peripheral neuropathy affect walkingis vitamin b12 good for peripheral neuropathywill peripheral neuropathy get betterwhy peripheral neuropathyhow peripheral neuropathyhow often peripheral neuropathywill peripheral neuropathy get worseis there a difference between neuropathy and peripheral neuropathyhow common peripheral neuropathywhen does peripheral neuropathy go awayhow can peripheral neuropathy be reversedwhy isoniazid causes peripheral neuropathyhow to get peripheral neuropathywhich cancers cause peripheral neuropathyhow much magnesium for peripheral neuropathyhow many peripheral neuropathy manifest in the patienthow peripheral neuropathy occurshow much alcohol can cause peripheral neuropathywhy does peripheral neuropathy get worsewhy peripheral neuropathy worse at nightwhich doctorThis podcast welcomes your feedback here are several ways to reach out to me. If you have a topic you would like to hear about send me a message. I appreciate your listening. Dr. Brian Mc Kayhttps://twitter.com/DarienChiro/https://www.facebook.com/ChiropractorBrianMckayhttps://chiropractor-darien-dr-brian-mckay.business.sitehttps://podcasts.apple.com/us/podcast/not-just-chiropractor-for-stamford-darien-norwalk-new/id1503674397?uo=4

Episode 184 hosts Dr Rungsima Wanitphakdeedecha, a dermatologist, laser and injectable expert based in Bangkok, Thailand.  Rungsima has a wealth of experience using toxins, has led research in the field and has published peer-reviewed journals on the topic. In this series of episodes called 'The Tox Talks', we feature expert injectors who have significant experience in using toxins. Each episode explores our guests experiences and we get special insights into the subtle nuances of getting the best results from toxin products. In Chapter 4 of 'The Tox Talks', we focus on a niche use of toxins most commonly referred to as 'microtoxin treatments'.  We explore: - What we mean by microtoxin treatments - Who started doing microtoxin treatments - Why microtoxin treatments are so popular in Asia - The proposed mechanisms by which microtoxin treatments work  - Which toxins seem to work best for microtoxin treatments - The main uses, techniques, doses/dilutions of microtoxin treatments including: Skin rejuventation 'Facial lifting' Sebum reduction/acne improvement rosacea Hyperhydrosis (excessive sweating) - Some more unusual uses of microtoxin including: Surgical scar prevention/improvement Hayfever symptom control Neuropathic pain reduction Retractile testicle pain   IA Patreons Dr Jake & David hugely appreciate our IA Patreons who have helped support and contribute to the day to day running of the podcast:  IA Supporters: Esther Hermann, Sue Arber, Mischell Christmas, Claire Waterworth, Gavin Scriven, Stephen Land, Estelle Kelly, Georgia Rappel, Camilla Phillips, Raquel Campos IA Fans: Ish Goonewardene, Steph Burrows, Zainab Al-Mukhtar, Monica Bahamon, Jacinta King, Hazel Salvedore, Skye Carter, Cathriona Sullivan, Jessica Halliday, Jane Conchie, Natalie Smith IA Super fans: Julie Ann Rogers, Tanya Khan, Martina Lavery, Matt Manton, Stephanie Sirillas, Alexandra Davies, Vanessa Anlezark IA Gold fans: Lori Robertson, Marrisa Dennis, Natasha Keeping, Karim Sayed, Sarah Mowby Want to be an IA Patreon too? You'll be invited into our IA Patreon whatsapp group, get injecting hints & tips, you can also watch our lockdown webinars and learn from injector colleagues aroud the world   Follow IA on Instagram Visit our website  Subscribe to IA on Apple Podcasts Subscribe to IA on Spotify Contact Dr Jake & David  More about Dr Jake Follow Dr Jake on Instagram Follow David on Instagram Follow Rungsima on Instagram  

In the second podcast of season 5, Dr. Nima Adimi, a pain and spine specialist at Ridgeview discusses many areas around pain management, including how we evaluate, manage and treat pain and spine patients, the multidisciplinary teamwork involved, current guidelines, new and contemporary management strategies, and what is in the pipeline for the future of pain medicine. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Describe the types of tools available for people suffering with chronic pain. Identify ways to get patients access for pain management. Differentiate the diverse and broad nature of treatments available to those suffering from chronic pain. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  Education@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES: *See the attachment for additional information.  In-take process:About 80% of patients referred to Ridgeview's pain center are LBP patients. The first conversation is the usual Goals of Care which are highly important in setting the expectations for the patient, including what type of testing or imaging the patient has received, what treatment modalities have they tried. Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscules and other parts of the body. The pain is usually described as a burning sensation and affected areas often sensitive to the touch.   Nociplastic pain (a type of pain caused by damage to body tissue. A pain that feels sharp, aching or throbbing) or a type of pain which is mechanically different from the normal nociceptive pain caused by inflammation and tissue damage or the neuropathic pain which results from nerve injury. It may occur in combination with the other types of pain or in isolation. Its location may be generalized or multifocal and it can be more intense than would be expected from associated physical causes. Its causes are not fully understood, but is thought to be a dysfunction of the central nervous system whose processing of pain signals may have become distorted or sensitised. This type of pain typically arises in some chronic pain conditions, with the archetypal condition being fibromyalgia. Opiod Induced HyperalgesiaWhich is a common diagnosis for Dr. Adimi. During this podcast, listeners learn the limitations for further interventions due to hyperalgesia. These interventions will often require opioid titration prior to implementing therapy. Multimodal Treatment Options:Include non-addictive strategies, such as physical therapy, chropractic, fucntional/personal trainer, behavioral health. Discussions continue regarding medications such as gabapentinoids and their side effects, NSAIDs, muscle relaxers, medical cannabis, low dose naltrexone, etc. Interventional StrategiesLeast invasive strategies are discussed, including: trigger point injectsions, epidural, radiofrequency ablation medial branch blocks, facet joint injections, occipital and trigeminal nerve blocks, spinal cord stimulators, peripheral nerve stimulators. During this section of the podcast, Dr. Adimi discusses how spinal cord stimulators are impacting pain with new and exciting modalities, intrathecal pain pumps and their limitations an dhow the use of narcotics, anesthetics and snal poison (ziconotide) are implemented. Dr. Adimi notes that SCS are not effective for mechanical back pain/arthritis patients. Vertiuflex for spinal stenosis patients is discussed, along with the "mild" procedure and minimally invasive lumbar decompression.      In wrapping up the podcast, Dr. Adimi discusses the future of pain and the new arena or space the pain specialist will be occupying. New research on SCS for Prakinson, movement disorders, dystonia as well as how it impacts select patient populations like Peripheral Diabetic Neuropathy Study.        Thanks for listening.Please check out the additonal show notes for additional resources.

How Peripheral Nerve Stimulation Controls Chronic Pain, With Dr Tim Feldheim On today's episode, Dr. Danko and Dr. Feldheim discuss the rapidly growing and emerging therapy in chronic pain, peripheral nerve stimulation. Dr. Felheim completed his training at The University of Florida and a fellowship at Case Western University. At The Premier Pain Institute they have had positive experiences with peripheral nerve stimulation that they are sharing with the listeners. Tune in for the details! Episode Highlights: Dr. Feldheim explains who peripheral nerve stimulation is good for. They most commonly see peripheral neuropathy characterized by inflammation of the nerves in the lower extremities but can affect the upper; it is usually accompanied by intense burning, numbness, tingling like feeling. What is Reflex Sympathetic Dystrophy (RSD)? Lumbar radiculitis is an extremely common cause of a diseased nerve pain state, a lot of people know this as sciatica. Dr. Feldheim reviews the list of other conditions that cause peripheral nerve pain and damage. Neuropathic pain can be caused by crushing of nerves, lacerations due to trauma or injury, surgical insults, stress injury, small fiber neuropathy and phantom limb pain post  amputation. What are the current treatments for peripheral nerve stimulation? Dr. Feldheim reviews the medications that are commonly prescribed as well as topical treatments and therapeutic modalities that may help. What is peripheral nerve stimulation? It does not include FieldSTEM. At PPT, one of their most common is the shoulder, they target the suprascapular nerve.  Peripheral nerve stimulation is a very safe and effective option. If you are very active,  need routine MRI, or for those who have not had success with spinal cord stimulation, this can have great benefits. Dr. Danko explains how there is a trial with peripheral nerve stimulation and why that is both exciting and important. Multiple imaging modalities can be used to target the nerves. Dr. Danko explains the setup of the devices and how they work.  A team of specialists work with the STIMwave technologies on insurance and things of that nature. Dr. Danko asks Dr. Feldheim to share other conditions that he has seen in regards to peripheral nerve stimulation. Are these procedures done in the office or the operating room? How long does the trial last?  Dr. Feldheim explains which patients would be best served with spinal cord stimulation and peripheral nerve stimulation. What about knee replacement issues?  Needing a battery versus not needing a battery: what are the pros and cons? Dr. Danko explains. How does stimulation compare to the TENS unit?  How long does the procedure take and what is the recovery period? 3 Key Points: There are many conditions that can cause issues in peripheral nerves. Dr. Danko and Dr. Feldheim are explaining the common causes and current treatments for this type of pain. The wearable device used for peripheral nerve stimulation is very durable and effective offering freedom to do daily activities and have better quality of life. What is the difference between spinal cord stimulation and peripheral nerve stimulation and what are indicators for one treatment over the other?    Resources Mentioned: https://premierpaintreatment.com/ https://www.facebook.com/PremierPainTreatment/ 513-454-7246 

On this episode of WOCTalk, we sit down with Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, WOCN Society Past President, and the Chair of the WOCN Wound Guidelines Task Force. Phyllis joins us to discuss the newest updated clinical guideline, Guideline for Management of Patients with Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease. Phyllis covers the 14-step process for revisions to the guideline, the updates the task force made to the guideline, and tips for implementing the Guideline for Management of Patients with Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease at your practice. The WOCN Society's Guideline for Management of Patients with Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease is the result of a systematic search, review, and synthesis of evidence from literature published from January 2014 through May 2018 with some relevant updates from 2019–2021 during the consensus review process. The target audience for the guideline includes wound, ostomy, and continence (WOC) specialty nurses and other healthcare professionals who specialize in, direct, or provide wound care for patients with/or at risk for lower-extremity (LE) wounds due to diabetes mellitus and/or neuropathic disease (DM/ND).Episode ResourcesClick here to purchase the Guideline for Management of Patients with Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic DiseaseClick here to purchase the mobile WOCN Clinical Practice Guideline Series.Click here to visit the WOCN BookstoreClick here to read the JWOCN article titled,2021 Guideline for Management of Patients With Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic Disease: An Executive SummaryClick here to view the WOCNext 2022 session titled, Update on the Guideline for Management of Patients with Lower-Extremity Wounds Due to Diabetes Mellitus and/or Neuropathic DiseaseClick here to view the Lower-Extremity Wounds due to Venous Disease, Arterial Disease, or Diabetes Mellitus and/or Neuropathic Disease: Clinical Resource Guide (2021)

In this episode, we review the high-yield topic of Neuropathic (Charcot) Joint of the Elbow from the Shoulder & Elbow section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://anchor.fm/orthobullets/message

How Peripheral Nerve Stimulation Controls Chronic Pain, With Dr Tim Feldheim On today's episode, Dr. Danko and Dr. Feldheim discuss the rapidly growing and emerging therapy in chronic pain, peripheral nerve stimulation. Dr. Felheim completed his training at The University of Florida and a fellowship at Case Western University. At The Premier Pain Institute they have had positive experiences with peripheral nerve stimulation that they are sharing with the listeners. Tune in for the details!   Episode Highlights: Dr. Feldheim explains who peripheral nerve stimulation is good for. They most commonly see peripheral neuropathy characterized by inflammation of the nerves in the lower extremities but can affect the upper; it is usually accompanied by intense burning, numbness, tingling like feeling. What is Reflex Sympathetic Dystrophy (RSD)? Lumbar radiculitis is an extremely common cause of a diseased nerve pain state, a lot of people know this as sciatica. Dr. Feldheim reviews the list of other conditions that cause peripheral nerve pain and damage. Neuropathic pain can be caused by crushing of nerves, lacerations due to trauma or injury, surgical insults, stress injury, small fiber neuropathy and phantom limb pain post  amputation. What are the current treatments for peripheral nerve stimulation? Dr. Feldheim reviews the medications that are commonly prescribed as well as topical treatments and therapeutic modalities that may help. What is peripheral nerve stimulation? It does not include FieldSTEM. At PPT, one of their most common is the shoulder, they target the suprascapular nerve.  Peripheral nerve stimulation is a very safe and effective option. If you are very active,  need routine MRI, or for those who have not had success with spinal cord stimulation, this can have great benefits. Dr. Danko explains how there is a trial with peripheral nerve stimulation and why that is both exciting and important. Multiple imaging modalities can be used to target the nerves. Dr. Danko explains the setup of the devices and how they work.  A team of specialists work with the STIMwave technologies on insurance and things of that nature. Dr. Danko asks Dr. Feldheim to share other conditions that he has seen in regards to peripheral nerve stimulation. Are these procedures done in the office or the operating room? How long does the trial last?  Dr. Feldheim explains which patients would be best served with spinal cord stimulation and peripheral nerve stimulation. What about knee replacement issues?  Needing a battery versus not needing a battery: what are the pros and cons? Dr. Danko explains. How does stimulation compare to the TENS unit?  How long does the procedure take and what is the recovery period?   3 Key Points: There are many conditions that can cause issues in peripheral nerves. Dr. Danko and Dr. Feldheim are explaining the common causes and current treatments for this type of pain. The wearable device used for peripheral nerve stimulation is very durable and effective offering freedom to do daily activities and have better quality of life. What is the difference between spinal cord stimulation and peripheral nerve stimulation and what are indicators for one treatment over the other?    Resources Mentioned: https://premierpaintreatment.com/ https://www.facebook.com/PremierPainTreatment/ 513-454-7246 

In this Clinical Insight we take a shallow dive into the Radiculo-Neuropathic Myofascial Pain Model. This model was heavily influenced by Dr. Chan Gunn. It is a very solid model in the evaluation and treatment of chronic pain as it takes into consideration a lot of key components that play a role in the production of chronic pain. We talk through how the combination of Cannon's Law, denervation and other factors play a role in chronic pain based on how this model describes it. At the end we discuss what are some practical recommendations that you can try immediately to see if there is something you can do if you are dealing with chronic pain. Check it out, leave a comment and we will continue the discussion as well as we can to keep helping make the complicated simple. BOOK LINK: Treatment of Chronic Pain (https://amzn.to/3agkT3m) #Podcast #Clinically #Pressed #Wellness #Performance #Nutrition #ComplicatedSimple #Science #fitness #health #strength #athletics #medical #training #exercise #sportsscience #chiropractic #exercisescience #athletictraining #sports #pain #painrelief #weightloss #kettlebells #complicatedsimple #tpdn #rnmp #myofascial #myofascialpain #chronicpain #dryneedling --- Support this podcast: https://anchor.fm/clinicallypressed/support

In this episode, we chat with Gary M. Heri, DMD. An internationally recognized expert in orofacial pain and temporomandibular disorders. He is the director of the Center for Temporomandibular Disorders and Orofacial Pain in the Department of Diagnostic Sciences at Rutgers School of Dental Medicine, which performs research and teaches this advanced field of dentistry focusing on the assessment, diagnosis and treatment of complex chronic orofacial pain disorders.  Gary Heir has recently been appointed to the Robert and Susan Carmel Chair in Algesiology at the Rutgers School of Dental Medicine. Over the past decade, Heir played a significant role alongside a committee of national orofacial pain program directors and the American Academy of Orofacial Pain to get orofacial pain recognized as the 12th specialty in dentistry by the American Dental Association in March 2020. He is also the signatory on the application to the National Commission on Recognition of Dental Specialties and Certifying Boards for recognition of the American Board of Orofacial Pain as the official certifying board for the specialty. Currently, Heir directs the center at the dental school, one of only 12 postgraduate orofacial pain programs in the country accredited by the Commission on Dental Accreditation (CODA). He stressed the need for more accredited programs, citing the millions of patients who require treatment but have difficulty finding specialists. In addition to his work at Rutgers, Heir is a highly sought-after lecturer, having delivered nearly 300 presentations on orofacial pain and related subjects in the region, in the country and throughout the world. He has served on the boards of many professional organizations, including as the president of the American Academy of Orofacial Pain and the American Board of Orofacial Pain and as a member of CODA and the Council on Dental Education and Licensure. He was appointed by three of New Jersey's governors for three consecutive terms as a member of New Jersey Governor's Lyme Disease Commission. Heir has published more than 100 peer-reviewed articles, chapters and abstracts on orofacial pain and TMJ disorders. He also serves as the section editor for Orofacial Pain Neuroscience of The Journal of the American Dental Association.  (Bio credit, Rutgers.edu)  Highlights of this podcast include: Orofacial Pain Musculoskeletal pain Neuropathic pain Neuralgia and palsy Nerve damage and neuropathy Trigeminal neuralgia Migraines Categories of Pain Fear and Pain - psychogenic  Placebo and nocebo effects Pain Management / Control Emotional component of pain Diagnosis And So Much More! To learn more about Dr. Heir, please visit rutgershealth.org. This episode is brought to you by Therasage. Use code: STOPCHASINGPAIN at checkout. 

What causes different types of face pain and what treatment is available? In this episode of Airing Pain we cover facial pain in its many forms, what treatments are available and how to cope better with your pain. Funded by The Hospital Saturday Fund. In collaboration with UCLH Royal National ENT & Eastman Dental Hospitals. The way our face feels and how we move it is a massive part of our identity. Feeling pain in the face, or not being able to use your face the way you want to, is not only a physical burden on the person suffering, but a heavy psychological load to cope with as well. Issues covered in this programme include: facial pain, unnecessary dental treatments, tooth ache, face and identity, management techniques, trigeminal neuralgia, neuropathic pain, carbamazepine, neurosurgery, pain management programmes, psychology and pain, temporomandibular disorder, burning mouth syndrome, persistent idiopathic facial pain, central sensitisation syndrome, physiotherapy, acceptance & commitment therapy Time Stamps: 01: 54 - Trigeminal neuralgia (TN): what is it and what does it feel like? Dr Joanna Zakrzewska explains. 06:27 - Dr Zakrzewska discusses what treatments are available for TN, including carbamazepine. 10:37 - How can neurosurgery help treat TN? 18:11 - Psychology Pain Management Programmes (PMPs) for sufferers of TN. 19:11 - Susie Holder on the psychological impact of face pain. 21:36 - Dr Roddy McMillan discusses temporomandibular disorder (TMD) as a source of face pain. 22:29 - Burning mouth syndrome and other types of face pain. 25:50 - Treatments available for other types of face pain. 28:30 - TMD and how it is different from other types of face pain (usually neuropathic in origin). 30:00 - What is central sensitisation syndrome? 32:21 - Pain management for chronic pain sufferers. 36:05 - Susie Holder explains what acceptance and commitment therapy (ACT) is. 44:07 - Obstacles to living well with pain, including the coronavirus pandemic. Contributors: Dr Joanna Zakrzewska, consultant in oral medicine specialising in trigeminal neuralgia at the Department or Oral Medicine and Facial Pain at the UCLH NHS Foundation Trust. Susie Holder, clinical psychologist on the facial pain team at the Royal ENT and Eastman Dental Hospitals, UCLH NHS Foundation Trust. Dr Roddy McMillan, consultant in oral medicine and facial pain at the Royal ENT and Eastman Dental Hospitals, UCLH NHS Foundation Trust. More Information: Pain Matters magazine issue 77: face the pain Airing Pain 12: Trigeminal Neuralgia, Pelvic Pain & Cannabis Airing Pain 115: Neuropathic pain 1 of 2, targeted Pain Management Programmes Airing Pain 116: Neuropathic pain 2 of 2, latest research My live well with pain Trigeminal Neuralgia Association UK

Researchers at the University of Maryland recently announced a potential breakthrough in the fight against "neuropathic" pain—that is, pain that results from malfunctioning or damaged nerves.Neuropathic pain afflicts 100 million Americans and costs the nation over half a trillion dollars every year. WIRED OPINION ABOUT KurtAmsler, Ph.D., is a professor of biomedical sciences at the New York Institute of Technology's College of Osteopathic Medicine.

This weeks Question & Answer Session with Christina Rendon interviewing Ronnie Landis involves topics Wild Food Nutrition, Investigating Natural Diets of Indigenous Cultures, Cardiovascular Disease & Heart Nutrients, Heavy Metal Cleansing, Detox Products, Elemental Nutrition involving Earth, Water, Air, Earth, Diabetes & Neuropathic Conditions, Calcification & Bio-Film Infections, And So Much More! Ronnie Landis: http://www.ronnie-landis.com The Holistic Health Mastery Program: http://www.holistichealthmastery.com