Podcasts about Neuropathic pain

Un nouvel épisode du Pharmascope est disponible! Dans ce 154e épisode à saveur psychoactive, Nicolas, Isabelle et Olivier reçoivent un nouvel invité pour discuter de cannabis. Cette première partie est consacrée à discuter des composantes du cannabis, des différents cannabinoïdes pharmaceutiques et de leur efficacité en douleur neuropathique.  Les objectifs pour cet épisode sont les suivants: Discuter des composantes du cannabis et des cannabinoïdes pharmaceutiques Discuter de l'efficacité des cannabinoïdes dans le traitement de la douleur neuropathique Comparer les données d'efficacité et d'innocuité des cannabinoïdes en douleur neuropathique Ressources pertinentes en lien avec l'épisode  Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018 Mar 7;3(3):CD012182. Hansen JS et coll. Cannabis-Based Medicine for Neuropathic Pain and Spasticity-A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial. Pharmaceuticals (Basel). 2023 Jul 28;16(8):1079. Ware MA, Fitzcharles MA, Joseph L, Shir Y. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg. 2010 Feb 1;110(2):604-10. Skrabek RQ, Galimova L, Ethans K, Perry D. Nabilone for the treatment of pain in fibromyalgia. J Pain. 2008 Feb;9(2):164-73. Bell AD et coll. Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions. Cannabis Cannabinoid Res. 2024 Apr;9(2):669-687. Busse JW et coll. Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BMJ. 2021 Sep 8;374:n2040. Wang L et coll. Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials. BMJ. 2021 Sep 8;374:n1034. Allan GM et coll. Simplified guideline for prescribing medical cannabinoids in primary care. Can Fam Physician. 2018 Feb;64(2):111-120. Allan GM et coll. Systematic review of systematic reviews for medical cannabinoids: Pain, nausea and vomiting, spasticity, and harms. Can Fam Physician. 2018 Feb;64(2):e78-e94.

The March 2025 replay features four previously released episodes focused on peripheral neuropathy and radiculopathy. The episode begins with Dr. Anne Oaklander discussing the association between long COVID and the development of polyneuropathy affecting small-fiber axons. This is followed by another interview with Dr. Oaklander, where she shares key takeaways for clinicians regarding the management of small-fiber neuropathy. The third segment features Drs. Raymond Price and Brian Callaghan discussing practice guidelines for painful diabetic neuropathy. The episode concludes with Dr. Carmel Armon addressing the efficacy of epidural steroid injections in treating cervical and lumbar spinal stenosis and radiculopathies. Podcast Links: Peripheral Neuropathy and Prolonged COVID  Relapsing-Remitting Immunotherapy Responsive SFN  Practice Guidelines for Painful Diabetic Neuropathy Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Article Links:  Peripheral Neuropathy Evaluations of Patients With Prolonged Long COVID  Relapsing-Remitting Immunotherapy Responsive Small-Fiber Neuropathy  Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary  Disclosures can be found at Neurology.org.

Episode Summary: In this episode of NRAP's PainExam Podcast, host David Rosenblum, MD, interviews Dr. Thomas Strouse about his extensive experience with Scrambler Therapy and the evidence supporting its use in treating chronic pain.   They delve into the intricacies of this innovative therapy, discussing treatment protocols, patient responses, and the overall effectiveness of Scrambler Therapy for various pain conditions.    Key Topics Discussed: - Overview of Scrambler Therapy and its analgesic response. - The importance of adjusting treatment intensity based on patient feedback. - Sensations experienced by patients during therapy (from burning to tapping). - Safety considerations for patients with pacemakers during treatment. - Insights into the effectiveness of Scrambler Therapy for conditions such as discogenic back pain and peripheral neuropathy. - Discussion on treatment costs for patients and providers. - Experiences with patients who have experienced pain recurrence after treatment. - The role of booster sessions in maintaining pain relief. -   Challenges faced by failed back surgery patients and the potential benefits of Scrambler Therapy. Resources Mentioned: -   Contact information for Stefan Erickson at  stefan@mail.scramblertherapy.com to integrate Scrambler therapy into your practice.   Links to additional resources and research on Scrambler Therapy. Info] Additional Information: - For more information about upcoming webinars, including the next session on cervical ultrasound, visit  www.NRAPpain.org   Thank you for tuning in to NRAP's PainExam Podcast! We hope you find the insights shared in this episode valuable in your journey toward understanding and managing chronic pain.   NY based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246   Creators Biography: David Rosenblum, MD, currently treats patients in Garden City and Brooklyn. He serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn , NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.    Dr. Rosenblum has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is working closely with the American Society of Interventional Pain Physicians (ASIPP), Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, and various state societies, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum is a co-founder of the International Pain Academy and created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Office based Pain Physicians, Physiatrists, Emergency Room Physicians, Anesthesiologists, Neurologists and Orthopedics who treat pain, utilize Neuromodulation and use PRP, Bone Marrow Aspirate or any other Biologics will benefit from this course. #longislandpaindoctor #interventionalpain #paindoctor #scrambler #scramblertherapy

Support this podcast at — https://redcircle.com/hypnosis-and-relaxation-sound-therapy9715/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dr. Claudine Courey is the founder of Eye Drop Shop, which has become one of the leading online retailers for eyecare products in Canada and the USA. She is also a clinical expert in specialty contact lens and dry eye.In this episode, we discuss what has changed in Claudine's professional and personal life in the past few years; how she balances family, clinic, and entrepreneurship; and some advanced clinical tips for fitting scleral lenses and treating complex dry eye cases.This episode was supported by Thea Pharma Canada and recorded at their headquarters in Toronto. A big thank you to Thea for their continued support of the podcast.Connect with Harbir:InstagramLinkedInYouTube

Join Dr. Mile Brujic on the OI Show as he delves into the intricate world of neuropathic ocular pain with expert guest, Dr. Kaleb Abbott. As an optometrist and assistant professor at the University of Colorado School of Medicine, Dr. Abbott specializes in complex ocular surface diseases. Together, they uncover the nuances of neuropathic dry eye, a condition challenging to diagnose and treat.Key Highlights:Understanding neuropathic ocular pain: When symptoms outweigh signs.Insights into diagnostic tools like in vivo confocal microscopy and the role of proparacaine testing.Practical approaches to differentiate peripheral and central neuropathic pain.Off-label treatments, including varenicline nasal spray and its potential in trigeminal nerve modulation.Strategies for co-managing patients with neurologists and pain specialists.Dr. Abbott shares actionable tips to help eye care professionals manage these complex cases, improve patient outcomes, and explore emerging therapies.Tune in to learn cutting-edge insights into managing neuropathic pain in practice! Subscribe to the OI Show for more expert-driven episodes, and don't forget to share this episode with colleagues passionate about advancing patient care.About Kaleb Abbott Is an optometrist and assistant professor of ophthalmology at the University of Colorado School of Medicine. He is faculty in both the Dry Eye Clinic and the Center for Ocular Inflammation where he specializes in complex ocular surface disease and participates in clinical trials/research pertaining to ocular surface disease. In addition to his clinical and research duties, he is on the board of directors for the Ocular Wellness and Nutrition Society; Vice Chair of the Nutrition, Disease Prevention, and Wellness SIG for AAO; on the advisory council for the Academic Medical Center Optometry AAO SIG; and on the editorial advisory board for Optometry360. He will be graduating from the AAO Flom Leadership Academy at AAO 2024. In 2024, he became host of the Dry Eye and Ocular Surface Disease section of the Clinical Podcast Series through the American Academy of Optometry Foundation. In 2019, Kaleb co-founded a start-up company called SunSnap Kids which took 1st place in the inaugural Bright Ideas Pitch Competition in 2022 and 3rd place in the Optometry Innovation Awards in 2023. Recently he sold the majority of this company to focus more on his clinical and research responsibilities at the University of Colorado. When not seeing patients, conducting research, or working on SunSnap Kids, Dr. Abbott lectures on ocular surface disease, writes articles, and is a medical reviewer for multiple medical journals including The Ocular Surface and Optometry and Vision Science. He resides in Denver, CO with his wife, daughter, and newborn twins. 

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.

Broadcast from KSQD, Santa Cruz on 10-31-2024: Dr. Dawn addresses a listener's question about PSA results, introducing the new ExoDX prostate score test as a less invasive screening option. Dr. Dawn provides a comprehensive overview of chronic pain types, including nociceptive, neuropathic, and nociplastic pain, affecting 30% of the global population. She explains the gate control theory of pain and how recent research suggests autoimmune components in conditions like fibromyalgia. A caller's description of intermittent, localized pain leads to discussion of food sensitivities, immune complexes, and elimination diet strategies. Dr. Dawn reveals exciting new research showing GLP-1 receptor agonists (like Ozempic) may effectively treat various types of pain. She concludes with practical advice for pain management, including nutritional support, hormone optimization, and medications to avoid.

In the patient populations treated by neurologists, central neuropathic pain develops most frequently following spinal cord injury, multiple sclerosis, or stroke. To optimize pain relief, neurologists should have a multimodal and individualized approach to manage central neuropathic pain. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Charles E. Argoff, MD, author of the article “Central Neuropathic Pain,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Argoff is a professor of neurology and vice chair of the department of neurology, director of the Comprehensive Pain Management Center, and director of the Pain Management Fellowship at Albany Medical College in Albany, New York. Additional Resources Read the article: Central Neuropathic Pain 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 Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Doctor 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 Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Charles Argoff, who recently authored an article on central neuropathic pain in the latest issue of Continuum covering pain management. Dr Argoff is a neurologist at Albany Medical College where he's a professor of Neurology, and he serves as vice chair of the Department of Neurology and program director of the Pain Medicine Fellowship Program there. Dr Argoff, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Argoff: I'm Charles Argoff. It's a pleasure to be here and thank you so much for that kind introduction. Dr Jones: I've read your article. Many of our listeners are going to read your article. Wonderful article, extremely helpful. Closes a lot of gaps, I think, that exist in our field about understanding central neuropathic pain, treating central neuropathic pain. You now, Doctor Argoff, you have the attention of a huge audience of mostly neurologists. What's the biggest point you would like to make to them, or the most important practice-changing advice that you would give to them? Dr Argoff: I think it's at least twofold. One is that central neuropathic pain is not as uncommon as you think it might be, and it occurs in a variety of settings that are near and dear to a neurologist's heart, so to speak. And secondly, although we live in an evidence-based world and we want to practice evidence-based medicine - and I'm proud to have formerly been a member of the Quality Standard subcommittee, which I think has changed its name over time. And so, I understand the importance of, you know, treatment based upon evidence - the true definition of evidence-based medicine is using the best available evidence in making decisions about individual patients. And so, I would urge those who are listening that, although there might not be as robust evidence currently as you'd like, please don't not take the time to try to treat the patient in front of you o r at least acknowledge the need for treatment and work with your colleagues to address the significant neuropathic pain associated with that central neurological disorder. Because it can be life-changing in a positive way to make even a dent and to really work with somebody, even though not clear-cut always what's going to work for an individual patient. Dr Jones: Well said. I'm glad you brought that up. So, to put it a different way, absence of evidence is not an excuse for absence of treatment. Right? Dr Argoff: Exactly. And I think that, I hope that we would agree that especially in neurology, what we do is about as far from, ‘Yep, you've got strep throat, here's that antibiotic that's going to work for you and all you have to do is take the medicine.' I mean, most of what we do is nowhere near that.  Dr Jones: It's complicated stuff. And this is a complicated topic. And I'll tell you, I learned a lot reading your article. I think most of us in neurology and medicine, when we hear the term neuropathic pain, it feels roughly synonymous with peripheral generators of that pain, such as diabetic neuropathy or posttraumatic neuralgia. But as you mentioned, there's central mechanisms for pain generation. How is it defined? What is central neuropathic pain? Dr Argoff: It's defined as pain caused by a lesion or disease of the central somatosensory system . Though neuropathic pain in general is pain associated with the lesion of the somatosensory system; and to your point, that can be peripheral, which of course is outside the spinal cord, or brain or central, which is within the spinal cord or brain. And central neuropathic pain is defined specifically as pain caused by a lesion or disease of the central somatosensory system. That's either brain or spinal cord. But there's an interesting follow-up, and I'm going to ask if you could remind me because I know we're talking about definitions now, but I'll just bring something up and we can come back to it. What's interesting about that is that my - whoever 's listening, that's not to say that they're not connected. And in fact, they are very much connected. And there's very new work, which I included in the article, down at Washington University in Saint Louis, that suggests you can actually affect central neuropathic pain by addressing peripheral input to the central nervous system. If you remember Ken Casey at the University of Michigan at the World Pain Congress in Vancouver, British Columbia many years ago, he ended his talk on pain with a limerick, of which the last line was, Remember, there ain't no such thing as pain without a brain. And so that kind of summarizes that. Dr Jones: Well, and it goes both ways too, right? We know that there's some central sensitization that can happen with peripheral generators, right? So we really have to think about the whole circuit. Dr Argoff: Yes. And that's been sometimes the bane of my existence as a colleague of others and a sometimes debater. Is the pain central? Is it peripheral? Well, it's everything. And it's important to know as many of the mechanisms and many of the targets that you could use for treatment so that you can affect the best outcome for your patients. Dr Jones: Yeah, so - and you mentioned in your article what some of the common causes of central neuropathic pain are. What are the big ones in your experience?  Dr Argoff: So, the biggest ones are spinal cord injury-related pain, MS-related pain - and I'd like to come back to a point and just if I do the third one - and central poststroke pain. And what struck me, I think Tim Vollmer published a survey about the incidence, the prevalence of ongoing pain in patients with multiple sclerosis. And it blew my mind several years ago because it was incredibly high. Like in this survey of MS patients who, you never hear about pain, you hear about these modifying treatments, all the wonderful expanses that have been made. I mean, like seventy something percent of people say they have moderate to severe pain. And when you think about how sensory processing occurs, it makes perfect sense that a demyelinating disorder is going to interrupt the flow of information for a person to feel normal.  Dr Jones: Yeah, I think it's a good example of, there are things that we tend to focus on as clinicians where we worry about deficit and function and capacity. But if we're patient-centered and we ask patients what they care about, pain usually moves up higher on the list. And so, I think that's why we, it's maybe underrecognized with some of those central disorders, right? Dr Argoff: I think so, and I and I think you hit the nail on the head that - and we're also trained that way. I tell this to my patients very often so that they are reassured when I examine them and I say, and I tell them that everything looked pretty OK. It's not a medical term, I understand that. Because what we do in a typical neurological exam, even if it's detailed, doesn't really address all the intricacies of the nervous system. So it's really a big picture and sensory processing and especially picking up sensory deficits; you know, we use quantitative sensory testing and research studies and things like that, but bedside testing may not reveal the subtle changes. And when we don't see overt changes, we often think - that can lead someone to think that everything is OK and it's not. Dr Jones: So, when you when you see a patient who you've diagnosed with a central mechanism, so central neuropathic pain, how do you approach the management of those patients, Dr Argoff? Dr Argoff: I always review what treatments and what approaches have been addressed already. And I see if - a handful of time, we actually just submitted a paper for publication regarding this in a group of patients with pelvic pain who had untreated, difficult-to-treat chronic pelvic pain, seen all the urological kinds, gynecological things. Look, we picked up two patients who had unknown MS. So, it's just interesting when it comes down to that level. And we also picked up some patients who had subacute combined degeneration. So that's another central kind of disorder as well. Again, the neurologist in us says to make sure that we have specific diagnosis that underlies the central neuropathic pain. And so interestingly, of course, for somebody with MS - or even though it's uncommon, it could be more than one. Somebody with MS might have a stroke, somebody with MS might have a cord injury due to cervical, you know, joint disc disease. Not to overcomplicate things. Know the lay of the land, know the conditions, know what you're battling and lay out so that you can treat the treatable; you want to treat whatever you can correct? So, for MS you simply want to have the best disease-modifying treatment on board, tolerable and appropriate for that person, and so on. And then you really want to take a history of past treatments - and your treatments can be everything and anything, including behavioral modification, physical rehabilitative approaches, as well as pharmacologic management. That's - as I think I put in my article, we concentrated in the article on pharmacologic management because honestly, that's what most patients are looking for, is ‘what can we, what can you do to help me now, in addition to what I can do myself.' And that's what we typically think of. There are also some more interventional approaches, invasive options, that have developed over time. And of course, those are the ones, some of them, especially in neuromodulation, that we have the least information about, but it appears somewhat promising.  Dr Jones: No, that's exactly what we need to hear. And you also mentioned something that I think is important. This is a common theme throughout the issue because I think it's true for the management of many different types of pain and interdisciplinary approach. In other words, not just honing in on pharmacotherapy or neuromodulation as a one-size-fits-all magic pill, right? So, that - tell us a little bit more about that interdisciplinary approach and how that's important for these patients. Dr Argoff: So, let me back up and give an example. Let's look at Botox for chronic migraine. So, the pre-M studies that led to the approval of Botox for chronic migraine: two treatment sessions versus two random, two placebo session in different patients. The mean headache frequency was, let's say, fifteen to twenty in each group. It was like seventeen, eighteen, something like that. But the mean pain headache day reduction was somewhere between four and five after two treatments compared to a lesser, a lower number in the placebo group. So, if you think about that, that means that you went from nineteen, let's say, to fourteen, thirteen, or twelve. Want to be generous, eleven or ten. But that means that person, everyone 's happy. We use treatment. We have better data than that because the longer you use it, the better it gets in general, but it means that people are still going to be symptomatic. So that drives home in a different painful disorder the importance of yes, treatment can be effective, but it's not the only treatment that a person is going to likely need. And so, I think that's what's so important about multidisciplinary approach. I- we may affect positive changes, reduction in pain intensity with a particular pharmacologic agent, but we don't anticipate it's like taking an antibiotic or a strep throat, not curative. And so, we want to, early on, to explain that logically, methodically, step by step. There are many options for you and we're going to, you know, systematically go through them. And I may need to call in some colleagues to help because I don't do everything. No one does everything, right? But don't feel as if there isn't any hope because there is. If we were to use intraspinal Baclofen for someone who has painful spasticity following a stroke or a spinal cord injury, combining that with physical therapy might give more effect, maybe synergistic. Some targeted muscles, some local muscles may not respond as well to the intraspinal Baclofen, so is that - what can we do? Well, we could use oral agents or we might be able to target that with botulinum toxin, and so on and so forth. So it's limitless, virtually, in what you can do. Dr Jones: There's kind of setting expectations and letting people know that you, you're going to need a lot of different approaches, right? To sort of get them the best possible outcome. Dr Argoff: Yeah, I think that's so important. And of course, no matter what we try to set out, there are going to be individuals - for those of you who are listening, we all know - who expect to be cured yesterday. That might be challenging for us not only to actually complete, but also, it's challenging for some individuals to appreciate that we're with them, we're going to work with them. It'll be a process, but we've got your back. Dr Jones: Great. And you know, this is a question that I get all the time from patients and from other clinicians is, you know, what about cannabinoids? What's the role of cannabinoids for the management of central neuropathic pain? Dr Argoff: First, I'll say that the short answer to that is we don't know. The second part of my response would be, there is new evidence that it might be helpful in the acute treatment of migraine. And I'm happy to say that the editor of this edition of Continuum is the person who developed that evidence, and it's been recently presented at the American Headache Society. But the challenge and the conundrum that we all face is, everywhere within our nervous system where there's pain being processed, there are endocannabinoid receptors. There also happen to be opioid receptors, but that's a separate issue. And the endocannabinoid system, the peripheral or central, you know, CB1, CB2, is very, very important, but we haven't figured out a way of harnessing that knowledge in developing an analgesic, an effective analgesic. And part of that is that there are so many chemical agents that have cannabinoid properties and there are different… the right balance has not yet been found. But even the legalization, the available of medical cannabis, hasn't led to a standardized approach to evaluating if a preparation does help. And that's part of the conundrum. It's like saying, ‘does medicine work?'Well, yeah, sometimes. But which medicine? Which receptor? How do you harness the right ratio between TBD, THC, other active agents, et cetera? And I think maybe as we go forward in the future, we'll be able to do that with - more precise. I mentioned Dr Schuster's study in which he had defined ratios of THC effect and CBD and was able to clearly show effect based upon that. But the average person going into a dispensary doesn't really get that. We don't get to study that. Each person's an NF1  and it's not very helpful to understand how to do that. I would say, as I'm sure you remember, there was a practice parameter that was published probably over a decade ago about using cannabis symptomatically in different neurological disorders. And I believe that it was what they studied or what they reviewed was helpful in MS-related urinary discomfort and spasticity, but not necessarily pain.  Dr Jones: And we're still in the early days of studying it, right? Dr Argoff: Yes.  Dr Jones: That's part of the point, as we got started late and we're still waiting for high-quality evidence. And I guess, if you look at the horizon, Dr Argoff, or the future of management of central neuropathic pain, what's going to be the next big thing?  Dr Argoff: One of the joys of being asked to get involved in a project like this is that inevitably we learn so many new things because, you know, that's when anyone says, oh, you must be an expert, I say, I don't know anything because I'm always learning something new. One of the reasons why I moved to Albany Medical College about seventeen years ago was to be able to further my interest in studying why people benefit from topical analgesics by working with a scientist at Albany Med who studied keratinocyte neurochemistry and its impact on pain transmission. And that's a separate issue, but it indicates my love for the peripheral nervous system. And one of my thoughts historically, that is, what the central nervous system processes is what it processes and it might get input, as you mentioned earlier, from the peripheral nervous system, so that topical agents could be dampening central mechanisms. And lo and behold, as I was doing research for this article, I learned that people doing peripheral nerve blocks - so blocking peripheral input at the into the spinal cord - at Washington University, Simon Guterian and colleagues, demonstrate that they could give prolonged benefit from central pain by blocking peripheral input. And that's wild because certainly the nervous system is a two-way street. It's an understatement. What I really found amazing was that, again, blocking input helped the injured central nervous system to behave better.  Dr Jones: That is kind of cool to think about. And I'll tell you, as editor of the journal, one of the funnest things is getting to learn all about neurology, including pain and including central neuropathic pain, when in the end you're doing all the work, I just get to sit here and enjoy it. And you're a program director of a pain fellowship. What's the pipeline look like? Are neurologists more interested in pain than they used to be?  Dr Argoff: I'm happy for this. We are seeing more and more applicants from neurology into our pain management programs. I would say… I was going to say tragically. If I say tragically, it's because what specialty better understands how to diagnose, figure out, assess, come to a conclusion? You can't have pain without your brain. It's always amazed me that more neurologists weren't interested, and I understand the background and such. Just like in migraine, it's only advances in understanding mechanisms of migraine that allow neuroscientific advances that are leading to great therapeutics - that's happening and increasing in ‘pain.' Today, as program director, we had our fellowship interviews earlier today and three of the nine applicants that we interviewed were neurologists. Last week, I think we interviewed two or three also. That would not have happened five years ago or six years ago. And if you think about it, we can not only diagnose, quote-unquote figure out what's happening, but we now, with pain management training, we can offer people a variety of both invasive and noninvasive options, all while understanding what we're doing with respect to the nervous system in a way that's different than the other specialties that typically go into pain med. And that's such - for me, it's a beautiful experience and something I really enjoy doing. There isn't a neurological condition in the most part that either doesn't have pain associated with it or doesn't have mechanisms that overlap. If you think about epilepsy, and please don't think I'm crazy, but epilepsy is associated with disinhibited hyper-excitatory behavior, just to put it loosely, among certain neurons. That's what pain and neuropathic pain is about too. And you, in fact, we know that several mechanisms since now what medicines are used for both. But what was interesting since, if I may just go back to another point, one of the advances since I brought up the migraine that's very exciting is the whole story about sodium channels. Dr Harouthounian at WashU and his group used lidocaine injection. Lidocaine's a more generalized sodium channel blocker, but some of the newest treatments for treating neuropathic pain. Our NAV specific sodium channel blocker's trying to match up mechanism to treatment. Not exactly the way that we do with migraine, but still a step forward to not just generally treat but really target different neuronal mechanisms. It's an exciting time.  Dr Jones: So, the pipeline is doing better because we're getting better understanding of disease, and hopefully that pulls in more interest because obviously there are big gaps in caring for patients with pain. And again, thank you, Dr Argoff, for an amazing article. Thank you for joining us and thank you for such a fascinating discussion. I enjoyed the article. I read the article, I learned from our conversation today. So, thank you for joining us to talk about central neuropathic pain. Dr Argoff: Thank you for having me. Dr Jones: Again, we've been speaking with Dr Charles Argoff, author of an article on central neuropathic pain in Continuum 's most recent issue on pain management. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Doctor 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 the 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.

In this captivating and thoroughly engaging episode of Join the Docs, our dynamic duo, Professor Jonathan Sackier and Doctor Nigel Guest, embark on an enlightening and comprehensive journey into the intricate labyrinth of the human brain and  nervous system. They unravel the tangled web of neurological diseases, with a special spotlight on multiple sclerosis (MS). This isn't just a superficial overview; The Docs delve deep into the brain's complex structure, its multifaceted functions, and the critical importance of the nervous system's intricate wiring. Imagine it as a high-stakes game of Operation, but with fewer buzzers and a lot more brain power. The Docs also explore the fascinating realms of cranial nerves and proprioception, which might sound like a fancy term for knowing where your nose is without looking, but it's so much more. With The Docs guiding the way, you'll get an inside look into why your body ‘nose' what it's doing - even when you don't!Who better to shed light on the rollercoaster ride of living with MS than Montel Williams? He rolls in to share his deeply personal journey, complete with all the twists, turns, and loop-de-loops that come with it. The Docs dive into his initial symptoms, which were more confusing than a plot twist in a soap opera, and the myriad challenges he faced in getting a diagnosis. Montel's story is not just about the physical and emotional struggles but also about the resilience and determination required to navigate life with MS. He also passionately advocates for cannabis as a treatment for neuropathic pain, making a compelling case that might just leave you reefer-ing to it in a new light.What's the takeaway from this brainy banter? The conversation underscores the paramount importance of awareness, early diagnosis, and resilience in managing neurological conditions. It's a powerful reminder that when it comes to your health, the best approach is to always have the heads up.So, tune in, get your neurons firing, and remember: knowledge is brain power! This episode of Join the Docs is not just an educational experience but also an inspiring call to action for anyone dealing with neurological conditions or simply interested in the wonders of the human brain. So, give your brain a stem cell-bration!!—--DISCLAIMER: The views and opinions expressed on Join the Docs are those of Dr. Nigel Guest, Jonathan Sackier and other people on our show. Be aware that Join the Docs is not intended to be medical advice, it is for information and entertainment purposes only - please, always take any health concerns to your doctor or other healthcare provider. We respect the privacy of patients and never identify individuals unless they have consented. We may change details, dates, place names and so on to protect privacy. Listening to Join the Docs, interacting on our social media, emailing or writing to us does not establish a doctor patient relationship.To Contact Us: For a deeper dive on this episode's issue, merchandise and exclusive content, head to www.jointhedocs.comFollow us on youtube.com/JoinTheDocs Follow us on instgram.com/JoinTheDocsFollow us on tiktok.com/JoinTheDocsFollow us on: facebok.com/JoinTheDocsFollow us on: x.com/JoinTheDocs

Peripheral neuropathic pain is primarily influenced by the biology and pathophysiology of the underlying structures, peripheral sensory nerves, and their central pathways. In this episode, Kait Nevel, MD speaks with Miroslav Bačkonja, MD, an author of the article “Peripheral Neuropathic Pain,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Bačkonja is the clinical director in the Division of Intramural Research at the National Institutes of Health in Bethesda, Maryland. Additional Resources Read the article: Peripheral Neuropathic Pain 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: @IUneurodocmom 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 Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Miroslav Backonja about his article on peripheral neuropathic pain, which appears in the October 2024 Continuum issue on pain management and neurology. Welcome to the podcast.  Dr Backonja: Thank you.  Dr Nevel: Misha, can you please introduce yourself to the audience? Dr Backonja: Yes, I'm Miroslav Backonja, but everybody calls me Misha. So everybody knows me by that. I'm a training neurologist, and I also have training as well as certification in pain management. And most of my practice has been where neurology meets the pain, which is neuropathic pain. I spend some time basic science lab and then transition into clinical research. And I was in academia for a couple of decades and was most recently recruited by NCCIH National Center for Complementary and Integrated Health and have been there for two and a half years now.  Dr Nevel: That's wonderful. I would love to hear more about your career at the NCCIH, a little bit and what you do in your role now, and how that came to be. Dr Backonja: Yeah, I was recruited to help and provide clinical support to efforts at NCCIH in the phenotyping of pain and neurologists who've done research in quantitative sensory assessment and other quantitative means of assessment of pain. Coming to NIH was very rewarding and quite of a learning experience. After six months being there, I've discovered that NIH is the biggest secret in plain sight. They say in the plain sight because it's public institution and everything is open to public and it's a secret because we don't think about it. This is in particular in reference to biomedical research training, including clinical trainings. So, I would encourage everybody to think of NIH as a place to spend some time and learn. There are wonderful research opportunities as well as educational opportunities. Vast library of presentations, green rounds and different other types of courses - some of them open to public, and some of them are up to FAS, which is a foundation of advances in science education by discovering. I feel like being back in school and having fun.  Dr Nevel: That's wonderful. Can you share with us a little bit about how you became interested in peripheral neuropathy and pain management of peripheral neuropathic pain?  Dr Backonja: It actually goes back to my residency and fellowship. And actually, you know, I had the luck of being exposed to a couple of clinicians who actually became my mentors. First was Jose Ochoa, who was one of the first people to quote from a small fiber, C fiber specifically, and he also was pioneered in quantitative sensory testing. And the other one was Charles Cleland, who was a psychologist and who pioneered assessment of patient symptoms, developing the Brief Pain Inventory is one of the tools. That actually peaked my interest in the topic of pain and once when I started learning about pain, what is the kind of mysterious experience of humans' pain, turns out that we have learned a lot of science about the pain and can make the pain very accessible. And I hope some of this will come to the chapter that we've provided.  Dr Nevel: Thank you for sharing that. I think of peripheral neuropathy and I think most neurologists think of peripheral neuropathy as one of the bread-and-butter diagnosis within our field. For the practicing neurologist out there who might be listening, what do you think is the most important takeaway from your article that maybe they don't already know about peripheral neuropathic pain? Dr Backonja: When it comes to peripheral neuropathy and peripheral neuropathic pain, it goes back to my early experience and still holds the truth. Neuropathies don't kill people, they just maim them. They create- cause lots of disability and if you add a pain to it, it can be quite disabling. In some regards, it has been neglected the area of development in neurology in terms of scientific discoveries, although things are changing quite rapidly as of recently. Main take home messages, and especially when it comes to a sensory neuropathies and painful neuropathies, is that it's one of the skills that has not been well researched and then not well communicated to the vaccine neurologist in terms of what to do with it. But most neurologist sensory symptoms are just like a noise because, especially when it comes to pain and prosthesias and allodynia and hyperalgesias, like, what is that like? It's just not knowing what to make of it. Frequently associated also with emotional components in terms of the people are either depressed because of persistence of pain or anxious, not knowing what's going on. And that really can create quite a bit of a challenge in terms of what to do with it. But once anybody who's interested learns the fact that sensory neuropathies and fever neuropathies as well could be as well and is easily diagnosed by a neurologist who pays a little bit of attention and gains some skills in assessing not only negative sensory phenomena, because that's what he as a neurologist get trained to detect and quantify sensory deficits as well as motor deficits and loss reflexes. Also, if you pay attention to positive sensory phenomena, which is part of the repertoire of symptoms that patients with neuropathic pain experience, it's not whether patients would have either positive sensory phenomena like prosthesia and pain or negative sensory phenomena. Actually, they have all of them. And that's kind of puzzling for many patients. And lots of times, very patients say, like, how can I hurt when I don't feel like, let's say, like most commonly it's lower extremities. Like I don't feel my feet, but it hurts. I mean, how come? Oh, that's a cardinal feature of neuropathic pain, neuropathic painful neuropathy. Dr Nevel: Yeah, thanks for that. You know, I really thought that your Table 3-1 was really nice. It kind of lists through the common causes of peripheral neuropathic pain and just demonstrates the diversity of the different etiologies or other conditions that can cause neuropathic pain. And so, I encourage the listeners to review that table. But, on that topic, can you share with us what you think are the most important components of evaluating patients with neuropathic pain to maybe come to a diagnosis, to find what the underlying etiology or driver is?  Dr Backonja: When it comes to painful neuropathies, there are actually two problems you have to solve. So, don't forget that part. The first one is finding a pathological theology. Why a person has a neuropathy, what kind of neuropathy. And then second is, what's the nature of the sensory problems? What's the nature of the sensory symptoms, specifically pain, levodenia and hypogesia. So, figuring out the theology of the B12 deficiency or diabetic painful neuropathy, you can relatively quickly or hopefully one would relatively quickly come to that at theological diagnosis. But then the second part is the diagnosis of symptoms. What's the underlying metaphysiology of that. And again, just reminding colleagues that the specific sensory phenomena such as thermal hyperalgesia is now well established to be due to what's called peripheral sensitization of C fibers, which are the small unmyelinated fibers, expressed TP 1 receptors. So, patients who will report that taking a hot shower is very painful. An example of that or when conducting sensory exam and applying if you come to the point of examining the perception of warm and hot and patient affords the pain. That's just the hallmark of the C hurtful sensitizations to C fibrous sensitization. On the other hand, if somebody has mechanical ordinia like putting the shirt on hurts, putting the socks hurts. Well, that's evident to central sensitization. These are the simple, relatively simple but symptoms or signs that could have implication if those patients with central sensitization are more than likely to benefit from medications that restore descending inhibition, such as tricyclic antidepressants or SNRI's. And so just paying attention to that, it gives a clinician being a clinician or a neurologist, like, let me consider prescribing medication that have central A acting properties. Or if it's purpose sensitization, something we have like a sodium channel blocking property, things of that sort. Actually, there are some other strategies such as antagonist TRPV1receptors, the capsaicin base. Those are the kind of things that can help a neurologist kind of take the evaluation of painful neuropathies to the next level. Dr Nevel: Yeah, the- by getting a careful history and exam, that can influence what treatment you prescribe to patients. Understanding whether it's central or peripheral. On the topic of treating patients and talking with patients and evaluating them, what do you think is most important to counsel our patients about who we are treating for neuropathic pain? Dr Backonja: Number one: by getting good history and exam. Well, really in the coming to specific diagnosis is huge relief to the patients who thinks many themselves that they're just going nuts are crazy because nobody else understands these symptoms. So, validation in terms they have a real problem. Second important step is that for the most patients, there is probably reasonable degree of therapeutic interventions that can lead to relief of pain. And also, with applying the integrative approaches with complementary medicine is that patients are given tools to deal with what is otherwise underlying problem. Those two steps make a huge difference.  Dr Nevel: Absolutely. What's the most challenging aspect about managing patients with peripheral neuropathic pain? Dr Backonja: Actually, there are a couple. Number one thus far: we do not have a cure for any other neuropathies or painful neuropathies. So that's one of the big disappointing things one would need to communicate to the patient. The second challenge is actually the therapies that actually for neuropathic pain. There's a half a dozen- yeah, half a dozen FDA approved treatment. One thing that's interesting characteristic that all of them prove proven efficacy in clinical trials. If you scratch the surface, you find out that only 40% of patients obtain 30% pain relief. So, it's a rare patient that gets 100% pain relief, and even those, too, get what we call clinically significant, and then in studies, basically significant benefit. It's only partial penalty. But for the most those who do get the benefit, pain goes down probably enough for them to get some a semblance of normality in terms of having some control over the symptoms and their function. It's then the third challenge is really working through those available therapies to find what works for individual patients because we're not at the point yet where for example, other fields like oncology, you can quickly through the means of biomedical and other evaluation come to the patient specific therapy. So, at this point in time you're far from that. What we end up doing with when it comes to management for painful neuropathies is a trial. Sometimes patients say, well, trial and error. I would say, well, it's a treatment trials. We try one thing at a time, assess the risks and benefits and then there was many treatments that carry the benefit. If you carry it on when once, when they don't or if there's adverse events, side effects, we discontinue them. And then most of the patients end up with a combination of pharmacological and now pharmacological treatments and most of them can get some semblance of symptoms control. Dr Nevel: I really appreciate your point on preparing our patients and you know, expectations and things like that and working with them and looking for things that may help. But also having an understanding that the likelihood of complete pain relief is maybe not a super high chance of complete pain relief.  Dr Backonja: But if you're going back to the kind of preparing patients, it's a good to acknowledge or give a chance to express themselves because many times they patients are confused because they have symptoms that are confusing to them. And so just to have them express it. And for example, my alma mater, we developed the color paint drawing where the different sensory qualities are presented by different colors. And then on the body diagram, patients draw where they have symptoms. And this is probably one of the rare examples where you can literally see a pain because these neurologists can recognize the patterns. You can see the pattern of the motor, right, is multiplex or radiculopathy or the list goes on and on. So, this is one of the kind of tools that's very simple, but gives the patients another way to communicate because lots of times they really have difficulties expressing themselves. Dr Nevel: Right. So, the opposite of the most challenging, can you share with the listeners what you find the most rewarding about taking care of patients with peripheral neuropathic pain? Dr Backonja: What is rewarding is that with some work- and again, it's not easy work because it does require multiple visits and multiple assessments and the reassessments, most patients can get control over their symptoms to the point of coming to beginning some of the functional improvement and aspects of quality of life like sleep and work, they are definitely rewarding and most of the time it's fairly obvious. And again, pain management is definitely a team sport where really, it's important to gauge colleagues. Most of the places don't have what I have had when I was in academic institutions, easy access to health psychologist or physical therapist. Most communities do have those specialties. And many patients actually benefit from things that are what's considered a complementary medicine, such as Tai chi or yoga. And actually, in my practice, Tai chi was probably most common prescription for my patients because, as I tell them, there are multiple benefits. Number one: one of the risks of patients, especially prophyl neuropathies and lower extremities, is a loss of proprioception. Again, even those who have a reasonable preserved proprioception over welding, noise of pain actually makes the problem walking the at risk of falling. Actually, Tai chi one gets improvement in balance. There's also medicating component to it. So, mindfulness medication is kind of built in it and that all kind of gives the patients a better control of symptoms. So, some of those interventions are easily accessible in community. So, it's, again, it's a patient education that really takes important part. Dr Nevel: Yeah. And that Tai chi is maybe one of the answers to the next question that I have for you. But as the clinical director of the Division of Intramural Research at the National Center for Complementary and Integrative Health, I have to ask you, Misha, what sort of integrative and complementary type interventions do you counsel your patients about, maybe beyond Tai chi, and which ones do you think are the most helpful? Dr Backonja: To clarify, the NIH patients I see are all admitted per protocol. Actually, NIH has the largest research hospitals called clinical NIH Clinical Centre, which has a hospital and clinics. All the patients that come to our program, they come per protocol for the most part. They come for specific investigations. At the moment, we do not have intramural treatment protocols, although in near future one of my goals is to establish that. The NIH funds- 90% of funding from NIH goes extramurally to academic institutions and other healthcare organizations and so on, and only 10% goes for intermural research. So, what we do is much smaller in scope, much more focused. So, what do we support NCCIH actually support extramurally full range of anything from probiotics, research in microbiome related to health and pain all the way to interventions such as mindfulness meditation? Intramurally, once when patients come for protocol, we evaluated and it's unavoidable to be a question. So, what do we do now? What recommendations do we make? Again, we don't- with the present time, we have treatment protocols and then, most of the time, what I can do is provide recommendations to the patients when they go back to the treating community, to the treating providers. It's usually a fairly comprehensive list including pharmacological and non-pharmacological accommodations for those who have had experience with pharmacology. Sometimes I can just say yes, continue or change or whatever. But then when it comes to additional complementary accommodations, they always provide information. For example, why do I recommend Tai chi? Or, what's the benefit of yoga and why would one want to try to learn trying to behavioral therapy or mindfulness meditation? What's the benefit of turmeric and some other components of what's called anti-inflammatory diet and what's the rationale behind all of that? So rather than just giving a list of recommendations and leaving it that, I try to engage patients in terms of having to understand why something is recommended, whether the fits with their expectations and what fits with their lifestyle and so on. Dr Nevel: Yeah. So, what's coming up, what's next in painful peripheral neuropathy? What do you think is exciting? Where do you foresee some breakthroughs in this field? Dr Backonja: Probably what will make the most difference is application of some of the really molecular biology tools that are being applied to peripheral neuropathy. So hopefully one of these days you'll have a cure for neuropathy and pain and anything would come to that will be probably interaction between a nervous system and an immune system, in particular neuroinflammation. That's kind of my bias. They're probably that's- well, the answer will be, but many painful neuropathies - actually every painful neuropathy, because they come from, as a result, specific pathologies - are different in a sense of trajectory natural course that will have to be first addressed. And again, depending on the underlying disease and molecular biology of that and genetics of it will determine that. But on the other hand, there are some common denominators, as we talked, when it comes to painful neuropathies, which is drivers of peripheral and central sensitization. And maybe one of these days, we'll find what are those drivers and how to change the system so it does not produce pain and other associated symptoms. Dr Nevel: So once again, today I've been interviewing Dr Miroslav Misha Backonja, whose article on peripheral neuropathic pain 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 to our listeners for joining us today. And thank you, Misha, so much for talking with me today about your article. I encourage all of the listeners to read it. It was very comprehensive and just really wonderful to read. Dr Backonja: Thank you. Enjoyed it. 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.

In this episode of the Crazy Wisdom Podcast, host Stewart Alsop welcomes Jonathan Dickinson, a specialist in Ibogaine treatment and co-founder/CEO of Ambio Life Sciences and Teregnosis. They discuss the history and therapeutic uses of Iboga and Ibogaine, focusing on its effects in treating heroin addiction, traumatic brain injury, and chronic pain. Jonathan also shares insights into the cultural origins of Iboga, its use in traditional Bwiti ceremonies, and how modern approaches, particularly his work with veterans, expand its applications. More information about Jonathan's work can be found at Ambio Life.Check out this GPT we trained on the conversation!Timestamps00:00 Introduction to the Crazy Wisdom Podcast00:21 Understanding Ibogaine and Its Uses02:00 Ibogaine's Impact on Veterans and Brain Injuries03:57 Psycho-Spiritual and Medical Benefits of Ibogaine07:12 Scientific Studies and Misconceptions18:50 Legalization and Research Challenges25:05 Ibogaine Sourcing and Sustainability31:43 Ibogaine Smuggling and Export Practices32:10 Pharmaceutical Grade Iboga Extract33:36 Challenges of Growing Iboga33:53 Traditional Growth Methods and Cultural Attitudes37:04 Global Cultivation Efforts38:05 Access and Benefit Sharing Agreements38:54 Traditional Knowledge and Bwiti Culture39:40 Historical Context of Iboga Use40:44 Bantu and Pygmy Cultural Exchange42:31 Bwiti Rituals and Practices46:23 Learning from Traditional Practices48:19 Western and Traditional Knowledge Integration55:58 Future of Iboga and Ibogaine59:22 Connecting with AmbioKey InsightsIboga and Ibogaine as Addiction Treatments: Ibogaine is primarily known for its effectiveness in treating heroin addiction. It interrupts the addiction cycle through a powerful psychoactive experience lasting 12-24 hours, which helps individuals detox from drugs like heroin and opioids. After the session, many report being free of withdrawal symptoms and cravings for months, providing a unique pathway out of addiction.Use in Treating Traumatic Brain Injuries (TBI): Jonathan has worked extensively with veterans, especially Navy SEALs, using Ibogaine to address TBIs. These injuries, often from combat-related concussive forces, lead to symptoms that mirror PTSD. Ibogaine appears to regenerate brain function, as seen in a study conducted with Stanford University, where veterans exhibited significant brain activity improvement following treatment.Cultural Roots in Bwiti and African Traditions: Iboga has deep cultural significance in Gabon, particularly in Bwiti spiritual practices, which have been influenced by both indigenous Pygmy traditions and Bantu peoples. Bwiti uses Iboga in ceremonies for psycho-spiritual exploration, healing, and connection to ancestors, a tradition that has persisted for centuries and possibly millennia.Misunderstandings About Noribogaine: Many believe that noribogaine, a metabolite of Ibogaine, remains in the body for up to eight months, contributing to long-lasting effects. However, Jonathan clarifies that noribogaine remains in the system for only a few days or a week. The extended feeling of ease or afterglow people experience may be due to neurotrophic factors like GDNF, which stimulate brain healing and regeneration over time.Emerging Scientific Understanding of Ibogaine: Research into Ibogaine's mechanisms is still developing. It acts on many receptors in the brain, including the Sigma 2 receptor, which has been linked to pain relief and neuroprotective effects. There's also growing interest in its potential role in intracellular processes and energy metabolism, where it appears to improve cellular efficiency, possibly explaining its long-term regenerative effects on brain function.Decentralized Knowledge and Treatment Communities: Unlike tightly regulated pharmaceutical models, Ibogaine treatment has grown in a decentralized, community-driven way, with providers sharing their experiences and knowledge. This echoes the traditions of Bwiti and emphasizes the importance of communal support around Ibogaine therapy, where the intensity of the experience requires a supportive environment and a collective sharing of insights.Sustainability and Ethical Sourcing of Iboga: Jonathan is actively involved in ensuring the sustainable and ethical sourcing of Iboga through his company, Teregnosis. Working with Gabonese communities, Teregnosis follows the Nagoya Protocol to ensure that the benefits of Iboga's growing global interest are shared with the traditional communities that have long relied on this plant, protecting both the ecosystem and cultural heritage.

Dr. Rosenblum reviews the benefits of Scrambler Therapy for CRPS and Neuropathic Pain State.  What is Scrambler Therapy? Efficacy of Scrambler Therapy for Neuropathic Pain  Mechanism of action of Scrambler Therapy Regenerative Pain Management Course PainExam Board Prep NRAP Academy Private Tutorials for Ultrasound Guidance and Regenerative Medicine ST was introduced as a chronic pain relief method in 2003. That same year, Giuseppe Marineo published findings from a small clinical trial involving 11 terminal cancer patients suffering from drug-resistant chronic visceral pain, with all participants showing positive responses and significant reductions in pain scores. In a subsequent trial involving 226 patients with neuropathic pain, 80% reported a 50% reduction in pain. Since then, numerous case reports and studies have documented the use of ST for various pain types. Evidence from these reports suggests that ST is effective for managing both acute and chronic pain from different causes. For instance, a child with acute mixed pain, resistant to pharmacological treatment, experienced significant relief after four ST sessions, with pain levels dropping from 5/10 to 0/10. Additionally, a 52-year-old woman with burning pain from her foot to knee, stemming from a right medullary acute hemorrhage and suffering for 12 years, reported immediate relief after ST. Her pain score decreased from 9/10 to 3/10 on the first day, and to 0/10 by the second day, remaining below 1 on the Visual Analog Scale (VAS) throughout the 10-day treatment period. In terms of chronic pain, literature includes a case where a patient with shoulder joint pain and limited range of motion saw significant pain reduction and increased mobility after 10 sessions of ST. ST has shown considerable promise in treating severe pain conditions that are typically difficult to manage, such as complex regional pain syndrome and pain related to HIV. Despite the encouraging results from these case studies, higher-quality evidence is necessary to establish the efficacy of ST, which could be obtained through extensive clinical trials, particularly focusing on chronic pain. Besides the aforementioned studies by Marineo and Sabato et al, additional trials have indicated that ST is an effective treatment for various chronic pain conditions, including low back pain, postherpetic pain, and neuropathic pain. For instance, a prospective study on chronic low back pain patients showed a significant decrease in VAS scores from 8.12 to 3.63 after six treatment days. Another trial involving 10 patients with postherpetic pain reported a drop in the average Numeric Rating Scale (NRS-11) score from 7.64 to 1.46 at baseline and 0.42 to 0.89 after one month, with benefits persisting at two and three months. ST has also demonstrated significant potential in treating neuropathic pain. In a prospective study of 45 patients with neuropathic pain lasting over three months, 28 experienced a decrease in Douleur Neuropathique en 4 questions (DN4) pain scores, with four patients stopping treatment early due to complete pain resolution. The mean baseline DN4 score dropped from 5.67 to 2.82 by the end of treatment. A pilot randomized trial involving 52 patients found that 21 out of 26 in the intervention group achieved complete pain relief. While the findings from these studies, along with others that have been systematically analyzed, suggest strong evidence for the efficacy of ST, a definitive conclusion regarding its effectiveness has not yet been reached. A systematic review by Majithia et al concluded that while studies generally indicate ST results in pain reduction with lasting benefits, there are still gaps in the evidence. This article aims to evaluate the research needs surrounding ST for cancer pain management. While Majithia et al focused on chronic pain across various conditions and noted specific evidence limitations, this study will concentrate on the effectiveness of ST for cancer-related pain. The objective is to identify gaps in the existing literature and provide recommendations for future research through a systematic review. We will specifically analyze the types and levels of evidence supporting the use of ST in managing cancer pain and determine what studies are necessary to enhance the evidence base. References  Majithia, N., Smith, T.J., Coyne, P.J. et al. Scrambler Therapy for the management of chronic pain. Support Care Cancer 24, 2807–2814 (2016). https://doi.org/10.1007/s00520-016-3177-3 Mohamed, Mohamed S. I.1; Alkahlout, Lama1; Elgamal, Salma1; Mohiuddin, Amna1; Al-sayed, Talal1; Al-Marri, Hamad1; Zahid, Fatima1; Martínez-Magallanes, Daniela2; Fregni, Felipe2; Doi, Suhail A. R.1; Abdallah, Abdallah M.3; Musa, Omran A.H.1,4; Khan, Muhammad Naseem1; Babu, Giridhara R.1,*. Efficacy of scrambler therapy in chronic neuropathic pain: pairwise and dose-response meta-analysis. Brain Network and Modulation 3(3):p 63-70, Jul–Sep 2024. | DOI: 10.4103/BNM.BNM_20_24 Kashyap, Komal, and Sushma Bhatnagar. "Evidence for the efficacy of scrambler therapy for cancer pain: a systematic review." Pain Physician 23.4 (2020): 349.

Dr. Rosenblum reviews the benefits of Scrambler Therapy for CRPS and Neuropathic Pain State.  What is Scrambler Therapy? Efficacy of Scrambler Therapy for Neuropathic Pain  Mechanism of action of Scrambler Therapy Regenerative Pain Management Course PainExam Board Prep NRAP Academy Private Tutorials for Ultrasound Guidance and Regenerative Medicine ST was introduced as a chronic pain relief method in 2003. That same year, Giuseppe Marineo published findings from a small clinical trial involving 11 terminal cancer patients suffering from drug-resistant chronic visceral pain, with all participants showing positive responses and significant reductions in pain scores. In a subsequent trial involving 226 patients with neuropathic pain, 80% reported a 50% reduction in pain. Since then, numerous case reports and studies have documented the use of ST for various pain types. Evidence from these reports suggests that ST is effective for managing both acute and chronic pain from different causes. For instance, a child with acute mixed pain, resistant to pharmacological treatment, experienced significant relief after four ST sessions, with pain levels dropping from 5/10 to 0/10. Additionally, a 52-year-old woman with burning pain from her foot to knee, stemming from a right medullary acute hemorrhage and suffering for 12 years, reported immediate relief after ST. Her pain score decreased from 9/10 to 3/10 on the first day, and to 0/10 by the second day, remaining below 1 on the Visual Analog Scale (VAS) throughout the 10-day treatment period. In terms of chronic pain, literature includes a case where a patient with shoulder joint pain and limited range of motion saw significant pain reduction and increased mobility after 10 sessions of ST. ST has shown considerable promise in treating severe pain conditions that are typically difficult to manage, such as complex regional pain syndrome and pain related to HIV. Despite the encouraging results from these case studies, higher-quality evidence is necessary to establish the efficacy of ST, which could be obtained through extensive clinical trials, particularly focusing on chronic pain. Besides the aforementioned studies by Marineo and Sabato et al, additional trials have indicated that ST is an effective treatment for various chronic pain conditions, including low back pain, postherpetic pain, and neuropathic pain. For instance, a prospective study on chronic low back pain patients showed a significant decrease in VAS scores from 8.12 to 3.63 after six treatment days. Another trial involving 10 patients with postherpetic pain reported a drop in the average Numeric Rating Scale (NRS-11) score from 7.64 to 1.46 at baseline and 0.42 to 0.89 after one month, with benefits persisting at two and three months. ST has also demonstrated significant potential in treating neuropathic pain. In a prospective study of 45 patients with neuropathic pain lasting over three months, 28 experienced a decrease in Douleur Neuropathique en 4 questions (DN4) pain scores, with four patients stopping treatment early due to complete pain resolution. The mean baseline DN4 score dropped from 5.67 to 2.82 by the end of treatment. A pilot randomized trial involving 52 patients found that 21 out of 26 in the intervention group achieved complete pain relief. While the findings from these studies, along with others that have been systematically analyzed, suggest strong evidence for the efficacy of ST, a definitive conclusion regarding its effectiveness has not yet been reached. A systematic review by Majithia et al concluded that while studies generally indicate ST results in pain reduction with lasting benefits, there are still gaps in the evidence. This article aims to evaluate the research needs surrounding ST for cancer pain management. While Majithia et al focused on chronic pain across various conditions and noted specific evidence limitations, this study will concentrate on the effectiveness of ST for cancer-related pain. The objective is to identify gaps in the existing literature and provide recommendations for future research through a systematic review. We will specifically analyze the types and levels of evidence supporting the use of ST in managing cancer pain and determine what studies are necessary to enhance the evidence base. References  Majithia, N., Smith, T.J., Coyne, P.J. et al. Scrambler Therapy for the management of chronic pain. Support Care Cancer 24, 2807–2814 (2016). https://doi.org/10.1007/s00520-016-3177-3 Mohamed, Mohamed S. I.1; Alkahlout, Lama1; Elgamal, Salma1; Mohiuddin, Amna1; Al-sayed, Talal1; Al-Marri, Hamad1; Zahid, Fatima1; Martínez-Magallanes, Daniela2; Fregni, Felipe2; Doi, Suhail A. R.1; Abdallah, Abdallah M.3; Musa, Omran A.H.1,4; Khan, Muhammad Naseem1; Babu, Giridhara R.1,*. Efficacy of scrambler therapy in chronic neuropathic pain: pairwise and dose-response meta-analysis. Brain Network and Modulation 3(3):p 63-70, Jul–Sep 2024. | DOI: 10.4103/BNM.BNM_20_24 Kashyap, Komal, and Sushma Bhatnagar. "Evidence for the efficacy of scrambler therapy for cancer pain: a systematic review." Pain Physician 23.4 (2020): 349.

Chronic pain is pain that lasts for more than 3 months, and it can be primary (with no underlying cause identified) or secondary (with an underlying cause identified). In this episode, the MIMS Learning editors look at the diagnosis and management of chronic pain in primary care. They review what NICE says about assessing chronic pain, the possible causes of chronic pain, and management options. Educational objectivesAfter listening to this podcast, healthcare professionals should be more aware of:The definition of chronic primary pain and when to consider it as a diagnosis The different types of neuropathic pain, including postherpetic neuralgia Non-pharmacological and pharmacological options for managing chronic painThe relationship between chronic pain and mental healthYou can access the website version of this podcast on MIMS Learning to make notes for your appraisal. MIMS Learning offers hundreds of hours of CPD for healthcare professionals, along with a handy CPD organiser.Please note: this podcast is presented by medical editors and discusses educational content written or presented by doctors, nurses and other healthcare professionals on the MIMS Learning website and at live events.Useful linksGuidance update: NICE guidelines on chronic pain in over 16sBest use of neuropathic pain medicationUnderstanding painful diabetic neuropathyDepression and anxiety in people with chronic painPost-herpetic neuralgia and herpes zoster vaccinesAcute pelvic pain - red flag symptomsRegister for a free MIMS Learning healthcare professional accountwww.mimslearning.co.uk/register Hosted on Acast. See acast.com/privacy for more information.

OKYO Pharma Ltd CEO Gary Jacobs joined Steve Darling from Proactive to share additional key findings from the Phase 2 clinical trial evaluating the safety and efficacy of OK-101 (0.05%) ophthalmic solution in patients with dry eye disease (DED). This trial involved 240 patients in a randomized, double-masked, placebo-controlled study. OK-101, developed using a membrane-anchored-peptide technology, is a novel long-acting drug candidate designed to treat dry eye disease. It has shown anti-inflammatory and pain-reducing efficacy in mouse models of dry eye disease and corneal neuropathic pain. Jacobs highlighted that the findings include a statistically significant and durable reduction in ocular pain and a statistically significant improvement in Tear Film Break-Up Time throughout the study, which is a clinically important endpoint. Additionally, multiple symptomatic improvements were observed through both data obtained from patient clinic visits and daily symptom diaries. Jacob explained that OK-101 targets a receptor called Chemerin 23, present on both immune and nerve cells, including those in the spinal cord and ocular nerves. Preclinical animal studies indicated that OK-101 could reduce neuropathic pain, which can be particularly severe and debilitating in affected patients. The company is preparing to launch a Phase II trial for OK-101 specifically targeting neuropathic corneal pain. This trial will be a placebo-controlled, randomized study involving 48 patients diagnosed with ocular nerve damage through confocal microscopy, with top-line data anticipated by mid-2025.The significance of this development is underscored by the lack of FDA-approved treatments for neuropathic corneal pain, a condition recognised by the National Organization of Rare Diseases. The upcoming trial aims to fill this therapeutic gap, potentially offering relief to patients suffering from this excruciating condition. #proactieinvestors #okyopharmalimited #nasdaq #okyo #GaryJacob, #DryEyeDisease, #OK101, #ClinicalTrials, #NeuropathicPain, #OcularHealth, #PharmaceuticalResearch, #FDAApproval, #MedicalInnovation, #HealthUpdates, #BiotechNews, #PatientCare, #PhaseIITrail, #TopLineData, #Chemerin23, #NerveDamage, #RareDiseases, #PlaceboControlled, #EyeResearch#invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

In this episode of The Healers Café, Manon Bolliger, FCAH, RBHT (facilitator and retired naturopath with 30+ years of practice) speaks with Deana Tsiapalis about her experience in training people's bodies to feel safe and relive pain.   For the transcript and full story go to: https://www.drmanonbolliger.com/deana-tsiapalis       Highlights from today's episode include:   Deana Tsiapalis  02:48 There's a real disbelief when they see someone who's smiling and, you know, carrying on with life doing their best to carry on with life, that they're fine, that they can get up and walk and why do they need that handicap parking spot? You know, there is that real uneducatedness about our society or unawareness from our society around chronic pain.   Deana Tsiapalis  Or is it because we now know that perhaps you experienced acute trauma or chronic trauma, when you were a child. Perhaps there is a lot of stress in your life currently, that is leading to more pain, perhaps you're in a relationship that's not as secure, perhaps, you know, financially, you're struggling. I mean, there's everything matters when it comes to chronic pain.   Manon Bolliger  11:31 If you start working as if the trauma wasn't there, their body is not ready for it. You have to have therapies that address actually the trauma.     ABOUT DEANA TSIAPALIS:   Deana studied both Physical health, education and lifestyle management at the University of Toronto and George Brown College. She is also a certified  Wellness coach through the American College Of Sports Medicine. Deana is the founder, the head pain coach, and chief curator at Pain 2 Possibilities and the Change Pain Academy. She also is the host of The Chronic Pain Experience; podcast that focuses on conversations about chronic pain management, the chronic pain experience and interviews with experts to inspire, motivate and improve your lived experience with pain. After watching her mothers lived experience with undiagnosed ADHD, post polio syndrome and celiacs disease & which resulted in an early death; along with her husbands experience of living much of his early years with an undiagnosed rare metabolic disorder Deana grew to understand the challenges of those who live with invisible chronic conditions….being misunderstood, not believed, labelled as slow or lazy, being told that everything ‘looks fine' after testing….that what they experience on a daily basis must all be in their head. As a pain coach,  Deana along with the chronic pain community, witness first hand how chronic pain care is truly broken. Through all of this Deana has learned that all chronic health, all chronic pain is indeed biological, psychological and social in nature and this is just not being shared with the chronic pain community….even though there is 12 years of solid research to back it up. So she got to work and created a unique space exclusively for the chronic pain community to bridge the gap between physician care and the pain warrior with self care management through pain education, coaching, community and peer mentorship. Exactly the sort of model she wished she could find when her parents and husband needed guidance. Core purpose/passion: My mission is to help those who suffer with chronic pain learn to manage pain beyond the procedures and medications. I provide coaching, support and mentorship as well as teaching advanced self-care management techniques to help the chronic pain community regain control and improve their quality of life. Website | Facebook | LinkedIn | YouTube |   ABOUT MANON BOLLIGER, FCAH, RBHT  As a de-registered (2021) board-certified naturopathic physician & in practice since 1992, I've seen an average of 150 patients per week and have helped people ranging from rural farmers in Nova Scotia to stressed out CEOs in Toronto to tri-athletes here in Vancouver.  My resolve to educate, empower and engage people to take charge of their own health is evident in my best-selling books:  'What Patients Don't Say if Doctors Don't Ask: The Mindful Patient-Doctor Relationship' and 'A Healer in Every Household: Simple Solutions for Stress'.  I also teach BowenFirst™ Therapy through and hold transformational workshops to achieve these goals. So, when I share with you that LISTENING to Your body is a game changer in the healing process, I am speaking from expertise and direct experience". Manon's Mission: A Healer in Every Household!  For more great information to go to her weekly blog:  http://bowencollege.com/blog.  For tips on health & healing go to: https://www.drmanonbolliger.com/tips   Follow Manon on Social – Facebook | Instagram | LinkedIn | YouTube | Twitter | Linktr.ee | Rumble   ABOUT THE HEALERS CAFÉ:  Manon's show is the #1 show for medical practitioners and holistic healers to have heart to heart conversations about their day to day lives.  Subscribe and review on your favourite platform:  iTunes | Google Play | Spotify | Libsyn | iHeartRadio | Gaana | The Healers Cafe | Radio.com | Medioq |   Follow The Healers Café on FB: https://www.facebook.com/thehealerscafe     Remember to subscribe if you like our videos. Click the bell if you want to be one of the first people notified of a new release.   * De-Registered, revoked & retired naturopathic physician after 30 years of practice in healthcare. Now resourceful & resolved to share with you all the tools to take care of your health & vitality!

RespireRx Pharmaceuticals Inc CEO Arnold Lippa joined Steve Darling from Proactive to unveil exciting developments within the company. Lippa shared the groundbreaking news that RespireRx's lead GABAA receptor potentiator, KRM-II-81, has ascended to the next phase of evaluation within the esteemed NIH HEAL Initiative® Preclinical Screening Platform for Pain program. The NIH HEAL Initiative, an integral component in combatting the national opioid public health crisis, stands as a collaborative and resolute effort aimed at accelerating scientific solutions. Launched in April 2018, this initiative is dedicated to advancing prevention and treatment strategies for opioid misuse and addiction, while concurrently enhancing pain management protocols. Lippa elaborated on the significant progress made with KRM-II-81, citing emerging data that showcased its efficacy in mitigating pain-like behaviors in rats. Remarkably, these effects were observed at doses demonstrating minimal or no detectable side effects, underscoring the compound's potential for therapeutic success. These promising results were witnessed across both male and female rats, across two distinct measures, including models of post-incision pain and spinal nerve ligation-induced persistent neuropathic pain. This latest research builds upon prior observations made by RespireRx Pharmaceuticals Inc and other laboratories, affirming KRM-II-81's effectiveness in alleviating acute, chronic, and neuropathic pain across various experimental models. Importantly, these benefits were achieved without the development of tolerance or sedation, highlighting the compound's favorable safety profile and therapeutic potential. As a result of these compelling findings, KRM-II-81 has progressed within the NIH PSPP program, where it will undergo further evaluation across additional disease-specific pain models. With promising clinical validation on the horizon, RespireRx Pharmaceuticals Inc firmly believes that KRM-II-81 holds the potential to emerge as a groundbreaking medication not only for pain management but also for the treatment of epilepsy and other neuropsychiatric disorders. This remarkable advancement underscores the company's commitment to pioneering innovative solutions that address critical medical needs and improve patient outcomes. #proactiveinvestors #respirerxpharmaceuticalsinc #otc #rspi #CAREM281, #Analgesic, #NonAddictive, #OpioidAlternative, #PainReliefInnovation, #GABAAgonist, #PharmaNews, #DrugDevelopment, #HEALInitiative, #NeurologicalDisorders, #MedicalBreakthrough, #AddictionFree, #ChronicPainSolution, #NeuropathicPain, #AcutePain, #OpioidEpidemicSolution, #HealthcareInnovation, #Pharmaceuticals, #ClinicalResearch, #PainManagement, #ScienceNews, #Biotech, #MedicalResearch, #PharmaTech #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

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

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

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

In this conversation with Dr. Vanessa Milanese, we cover the importance of anatomy in neurosurgery and explore her intriguing work in both fields – and how they cross-informed one another. Vanessa is a functional neurosurgeon at A Beneficencia Portuguesa Hospital in São Paulo, Brazil and holds an adjunct assistant professorship of neurosurgery at Mayo Clinic in Jacksonville, Florida. We talk about her stellar work in combining her neurosurgical activity with anatomical work – which involves dissections of the white matter of postmortem brains using the Klingler's method. We will talk about the rare community of neurosurgeons involved in similar activities, world-wide and the big influence Dr. Al Rhoton had on the field and on Vanessa's career. We thoroughly enjoyed this conversation and learned a lot – and we hope you will enjoy it as much as we did! Thank you so much for tuning in! References we talked about in the episode: Holanda, Vanessa M., Michael S. Okun, Erik H. Middlebrooks, Abuzer Gungor, Margaret E. Barry, John Forder, and Kelly D. Foote. 2020. “Postmortem Dissections of Common Targets for Lesion and Deep Brain Stimulation Surgeries.” Neurosurgery 86 (6): 860–72.  https://journals.lww.com/neurosurgery/abstract/2020/06000/postmortem_dissections_of_common_targets_for.14.aspx Holanda, Vanessa Milanesi, Maria Cristina Chavantes, Xingjia Wu, and Juanita J. Anders. 2017. “The Mechanistic Basis for Photobiomodulation Therapy of Neuropathic Pain by near Infrared Laser Light.” Lasers in Surgery and Medicine 49 (5): 516–24.  https://www.thieme-connect.de/products/ejournals/pdf/10.1002/lsm.22628.pdf Middlebrooks, Erik H., Ibrahim S. Tuna, Leonardo Almeida, Sanjeet S. Grewal, Joshua Wong, Michael G. Heckman, Elizabeth R. Lesser, et al. 2018. “Structural Connectivity-Based Segmentation of the Thalamus and Prediction of Tremor Improvement Following Thalamic Deep Brain Stimulation of the Ventral Intermediate Nucleus.” NeuroImage. Clinical 20 (October): 1266–73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308387/ Middlebrooks, Erik H., Sanjeet S. Grewal, and Vanessa M. Holanda. 2019. “Complexities of Connectivity-Based DBS Targeting: Rebirth of the Debate on Thalamic and Subthalamic Treatment of Tremor.” NeuroImage. Clinical. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543122/ Ferreira, Tancredo Alcântara, Jr, Erik H. Middlebrooks, Wen Hung Tzu, Mateus Reghin Neto, and Vanessa Milanesi Holanda. 2020. “Postmortem Dissections of the Papez Circuit and Nonmotor Targets for Functional Neurosurgery.” World Neurosurgery 144 (December): e866–75. https://www.sciencedirect.com/science/article/abs/pii/S1878875020320969?via%3Dihub Additional Resources we talked about: Mayo Functional Neuro Course 2024:  https://ce.mayo.edu/functionalneuro2024 Scaniverse app for 3D brain reconstruction: https://apps.apple.com/br/app/scaniverse-3d-scanner/id1541433223?l=en-GB Rhoton's book: https://shop.lww.com/Rhoton-Cranial-Anatomy-and-Surgical-Approaches/p/9781975226879 Stênio Holanda Filho Q&A book: https://www.dilivros.com.br/livro-neuroanatomia-pratica-e-ilustrada-questoes--e-respostas--3d-9788580531527,h18213.html Deep Brain Stimulation: A case-based approach https://academic.oup.com/book/29505

Gabapentin is widely used, often for pain, but it is often not used skillfully. This can result in patients getting inadequate symptom relief or stopping the drug unnecessarily because they mistakenly think that they can't tolerate it.Using gabapentin skillfully is worth learning!Listen and learn the 8 things that you should know about gabapentin. Your patients will be happier and you'll be happier.Happy learning!Dr. Chiaramontewww.integrativepalliative.com/training Helping you to find joy in your work as you help your seriously ill patients to thrive. Free Guide for Clinicians:Adding Integrative Medicine To Your Practicehttps://trainings.integrativepalliative.com/pl/2147657852Free Guide for You if Your Loved One Is Ill:The 10 Best Ways to Help When Your Loved One Has A Serious Illnesshttps://trainings.integrativepalliative.com/pl/2147661904 Please review this podcast wherever you listen and forward your favorite episode to a friend! Thanks for helping me spread the word about heart-centered care for people with complex and serious illness, using all the tools that work.I'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

Dr. Deb Johnston answers questions about neuropathic pain.

Welcome to the 11th episode of The Brain Podcast - the official podcast of the journals Brain and Brain Communications.  In this episode we speak with Ted Price, senior author of the article entitled: RNA profiling of human dorsal root ganglia (DRG) reveals sex differences in mechanisms promoting neuropathic pain This article explores exciting findings around differences in the DRG transcriptome which were only apparent when stratifying participants by sex and how these differences may inform mechanistic targets for neuropathic pain. Check out the full article on the Brain website: https://doi.org/10.1093/brain/awac266 This episode was co-hosted by Andreas Thermistocleous and Debra Ehrlich, edited and produced by Xin You Tai; co-produced by Antonia Johnston and David Michael; original music by Ammar Al-Chalabi.

  David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy's Continuing Medical Education Programs discusses Central post-stroke pain (CPSP).   Central Post Stroke Pain is a debilitating condition that affects a significant number of stroke survivors. It is characterized by persistent neuropathic pain, often described as burning, shooting, or electric shock-like sensations, in the areas of the body affected by the stroke. CPSP can significantly impact a patient's quality of life and functional recovery, making it crucial for physicians to have a comprehensive understanding of its pathophysiology. Earn CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HQ69sg Ultrasound Workshops and Courses Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR For  up to date Calendar, Click Here! Neuropathic Pain and Central Sensitization:CPSP is classified as a neuropathic pain syndrome, which means it arises from a dysfunction or damage to the nervous system. The exact pathophysiology of CPSP is complex and multifactorial, but it often involves the phenomenon of central sensitization. Central sensitization refers to the increased excitability and responsiveness of neurons within the central nervous system (CNS) in response to peripheral input. Cortical Reorganization and Plasticity: One key aspect of CPSP pathophysiology is cortical reorganization and plasticity. Following a stroke, the brain undergoes structural and functional changes as a result of the injury. This neuroplasticity, particularly in the somatosensory cortex, can contribute to the development of CPSP. Maladaptive plasticity may occur, leading to abnormal sensory processing and the generation of pain signals in response to non-painful stimuli. Disrupted Pain Modulation Pathways:The pain perception and modulation pathways in the CNS play a crucial role in regulating pain signals. In CPSP, these pathways can be disrupted, leading to abnormal pain processing. Alterations in the descending inhibitory pathways, such as reduced inhibitory neurotransmitter release or impaired endogenous opioid system function, can result in increased pain sensitivity and the persistence of pain signals even after the resolution of the initial injury. Inflammatory Processes and Neurotransmitter Imbalances:Inflammation within the CNS and imbalances in neurotransmitter systems also contribute to CPSP. Following a stroke, there is an inflammatory response that involves the release of pro-inflammatory cytokines and activation of immune cells. This inflammation can lead to sensitization of nociceptive neurons and exacerbate pain signaling. Additionally, imbalances in neurotransmitters, such as glutamate, serotonin, and norepinephrine, may disrupt the normal pain processing pathways, further amplifying pain perception. Peripheral and Central Lesions:CPSP can arise from both peripheral and central lesions. Peripheral lesions, such as damage to the spinothalamic tract or thalamus, can directly affect the transmission of pain signals. Central lesions, on the other hand, involve damage to the somatosensory cortex, thalamus, or other brain regions involved in pain processing. Both types of lesions can contribute to the development of CPSP through various mechanisms, including altered neuronal activity, disrupted connectivity, and aberrant sensory processing.  The complex interplay of cortical reorganization, disrupted pain modulation pathways, inflammatory processes, and peripheral and central lesions contribute to the development and persistence of CPSP. Further research is needed to unravel the intricacies of CPSP's pathophysiology, leading to the development of targeted therapies to alleviate the burden of this debilitating condition. References Liampas, A., Velidakis, N., Georgiou, T. et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 37, 3278–3291 (2020). https://doi.org/10.1007/s12325-020-01388-w SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.678198

  David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy's Continuing Medical Education Programs discusses Central post-stroke pain (CPSP).   Central Post Stroke Pain is a debilitating condition that affects a significant number of stroke survivors. It is characterized by persistent neuropathic pain, often described as burning, shooting, or electric shock-like sensations, in the areas of the body affected by the stroke. CPSP can significantly impact a patient's quality of life and functional recovery, making it crucial for physicians to have a comprehensive understanding of its pathophysiology. Earn CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HQ69sg Ultrasound Workshops and Courses Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR For  up to date Calendar, Click Here! Neuropathic Pain and Central Sensitization:CPSP is classified as a neuropathic pain syndrome, which means it arises from a dysfunction or damage to the nervous system. The exact pathophysiology of CPSP is complex and multifactorial, but it often involves the phenomenon of central sensitization. Central sensitization refers to the increased excitability and responsiveness of neurons within the central nervous system (CNS) in response to peripheral input. Cortical Reorganization and Plasticity: One key aspect of CPSP pathophysiology is cortical reorganization and plasticity. Following a stroke, the brain undergoes structural and functional changes as a result of the injury. This neuroplasticity, particularly in the somatosensory cortex, can contribute to the development of CPSP. Maladaptive plasticity may occur, leading to abnormal sensory processing and the generation of pain signals in response to non-painful stimuli. Disrupted Pain Modulation Pathways:The pain perception and modulation pathways in the CNS play a crucial role in regulating pain signals. In CPSP, these pathways can be disrupted, leading to abnormal pain processing. Alterations in the descending inhibitory pathways, such as reduced inhibitory neurotransmitter release or impaired endogenous opioid system function, can result in increased pain sensitivity and the persistence of pain signals even after the resolution of the initial injury. Inflammatory Processes and Neurotransmitter Imbalances:Inflammation within the CNS and imbalances in neurotransmitter systems also contribute to CPSP. Following a stroke, there is an inflammatory response that involves the release of pro-inflammatory cytokines and activation of immune cells. This inflammation can lead to sensitization of nociceptive neurons and exacerbate pain signaling. Additionally, imbalances in neurotransmitters, such as glutamate, serotonin, and norepinephrine, may disrupt the normal pain processing pathways, further amplifying pain perception. Peripheral and Central Lesions:CPSP can arise from both peripheral and central lesions. Peripheral lesions, such as damage to the spinothalamic tract or thalamus, can directly affect the transmission of pain signals. Central lesions, on the other hand, involve damage to the somatosensory cortex, thalamus, or other brain regions involved in pain processing. Both types of lesions can contribute to the development of CPSP through various mechanisms, including altered neuronal activity, disrupted connectivity, and aberrant sensory processing.  The complex interplay of cortical reorganization, disrupted pain modulation pathways, inflammatory processes, and peripheral and central lesions contribute to the development and persistence of CPSP. Further research is needed to unravel the intricacies of CPSP's pathophysiology, leading to the development of targeted therapies to alleviate the burden of this debilitating condition. References Liampas, A., Velidakis, N., Georgiou, T. et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 37, 3278–3291 (2020). https://doi.org/10.1007/s12325-020-01388-w SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.678198

  Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ATmqM6     David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, Board Review and NRAP Academy's Continuing Medical Education Programs, discusses Ketamine infusions, optimal infusion protocols and the evidence or lack of to support them.    Ketamine infusions have been used for chronic neuropathic pain, CRPS and depression. Dr. Rosenblum is accepting new patients and consultations could be scheduled by visiting www.AABPPain.com or calling 718 436 7246 or 516 482 7246.   Pain Management Board Prep Anesthesiology Board Prep    Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR For  up to date Calendar, Click Here! References  Maher, Dermot P MD, MS; Chen, Lucy MD; Mao, Jianren MD, PhD. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesthesia & Analgesia 124(2):p 661-674, February 2017. | DOI: 10.1213/ANE.0000000000001787 

  Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ATmqM6     David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, Board Review and NRAP Academy's Continuing Medical Education Programs, discusses Ketamine infusions, optimal infusion protocols and the evidence or lack of to support them.    Ketamine infusions have been used for chronic neuropathic pain, CRPS and depression. Dr. Rosenblum is accepting new patients and consultations could be scheduled by visiting www.AABPPain.com or calling 718 436 7246 or 516 482 7246.   Pain Management Board Prep Anesthesiology Board Prep    Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR For  up to date Calendar, Click Here! References  Maher, Dermot P MD, MS; Chen, Lucy MD; Mao, Jianren MD, PhD. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesthesia & Analgesia 124(2):p 661-674, February 2017. | DOI: 10.1213/ANE.0000000000001787 

Imagine living with excruciating pain that prevents you from walking or doing the things most of us take for granted. We all experience pain, and 50 million people cope with chronic, debilitating pain. The market for pain therapies is estimated at $74 billion. And yet, investment in new pain and addiction treatments is falling short of what is needed, according to a new BIO report, which shows a 44% decrease in clinical drug programs for pain over the past five years. Our guests on this episode talk about the challenges of living with and treating pain, as well as research and development on new, non-addictive and safer pain therapies. 

Support this podcast at — https://redcircle.com/hypnosis-and-relaxation-sound-therapy9715/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Diagnosis and Management of Neuropathic Pain, with David Simpson, MD by PMReport

Imagine living with excruciating pain that prevents you from walking or doing the things most of us take for granted. We all experience pain, and 50 million people cope with chronic, debilitating pain. The market for pain therapies is estimated at $74 billion. And yet, investment in new pain and addiction treatments is falling short of what is needed, according to a new BIO report, which shows a 44% decrease in clinical drug programs for pain over the past five years. Our guests on this episode talk about the challenges of living with and treating pain, as well as research and development on new, non-addictive and safer pain therapies. 

Today, I'd like to tell you about some opportunities for you to participate in lipedema research. I've had numerous communications from people who would like to help further our knowledge about lipedema, so here are some studies that you may be able to either participate in yourself, or you may know someone who would be able to.These studies are all what is called asynchronous, meaning that participants can start and end at all different times, as long as they have completed their participation by the time the study ends. Some of the studies are testing an intervention and some are just collecting data.A Novel Approach to Examine the Adipose Cellular Kinetics of Lipedemahttps://clinicaltrials.gov/ct2/show/NCT05394467The Norwegian LIPODIET Study: Effect of Ketosis on Pain and Quality of Life in Patients With Lipedemahttps://clinicaltrials.gov/ct2/show/NCT04632810Effect of Weight Loss on Body Composition and Metabolic Function in Women With Lipedemahttps://clinicaltrials.gov/ct2/show/NCT03271034Evaluation of Neuropathic Pain in Lipedemahttps://clinicaltrials.gov/ct2/show/NCT05329324

Divabetic Mysteries: "Tomorrow Is Not On The Menu" is packed with diabetes information and self-care tips in a cozy mystery. Brief Synopsis: The happy healthcare host, Mr. Divabetic, lands his to-die-for job as a caterer for the nation's hottest health guru, Wendy Wattage's Wellness Retreat on the Jersey Shore. Everything seems low pressure and low calorie until the body of the nasty food critic, Marilyn Macaroni, is found stabbed to death with one of Max's new chef knives. Now he's the prime suspect in a big, fat murder investigation! Can he and his team of friends, diabetes educators, and his nosey Italian mother, Mama Rose Marie, find the killer before the police arrive? Or will he be trading his fruit suit for coveralls with stripes? Weight loss murder never tasted so good. Starring Mr. Divabetic, Best-Selling Author Tonya Kappes, Mama Rose Marie, Patricia Addie-Gentle RN, CDCES, Maryann Horst Nicolay MEd, NTDR, Kathie Dolgin aka 'High Voltage,' Seveda Williams, Catherine Schuller, Dave Jones, and Lorraine Brooks. Produced by Leisa Chester Weir. Special thanks to our colleague, the multi-talented Wendy Radford.

Neuropathic Pain | On Call with the Prairie Doc® | Dec. 29, 2022, Prairie Doc® host Deb Johnston, MD, with guests Dr. Cristina Sanders, Dr. Tyler Ptacek, and Dr. Matt Simmons answer viewer questions about Neuropathic Pain.

In this episode of Exploration Science, Professor David Craik talks about the discovery of the cyclotides and their potential to transform medicine and agriculture. References and links: Database of Cyclic Proteins https://www.cybase.org.au/ Biosynthesis and insecticidal properties of plant cyclotides: The cyclic knotted proteins from Oldenlandia affinis https://doi.org/10.1073/pnas.191366898) Trends in Cyclotide Research https://doi.org/10.1039/9781788010153-00302) Discovery, structure, function, and applications of cyclotides: circular proteins from plants https://doi.org/10.1093/jxb/erw210) T20K: An Immunomodulatory Cyclotide on Its Way to the Clinic https://doi.org/10.1007/s10989-018-9701-1 Synthesis of Proteins by Native Chemical Ligation https://doi.org/10.1126/science.7973629 Elucidation of the Primary and Three-Dimensional Structure of the Uterotonic Polypeptide Kalata B1 https://doi.org/10.1021/bi00013a002 Plant cyclotides: A unique family of cyclic and knotted proteins that defines the cyclic cystine knot structural motif https://doi.org/10.1006/jmbi.1999.3383 Evaluation of the in Vivo Aphrodisiac Activity of a Cyclotide Extract from Hybanthus enneaspermus https://doi.org/10.1021/acs.jnatprod.0c01045) Anthelmintic activity of cyclotides: In vitro studies with canine and human hookworms https://doi.org/10.1016/j.actatropica.2008.11.003 The Engineering of an Orally Active Conotoxin for the Treatment of Neuropathic Pain https://doi.org/10.1002/anie.201000620) Racemic and Quasi-Racemic X-ray Structures of Cyclic Disulfide-Rich Peptide Drug Scaffolds https://doi.org/10.1002/anie.201406563 Is the Mirror Image a True Reflection? Intrinsic Membrane Chirality Modulates Peptide Binding https://doi.org/10.1021/jacs.9b11194 Cyclotides: From Structure to Function https://doi.org/10.1021/acs.chemrev.9b00402) Discovery of Cyclotides from Australasian Plants https://doi.org/10.1071/CH19658)

In this episode of the Award-winning PRS Journal Club Podcast, 2022 Resident Ambassadors to the PRS Editorial Board – Saïd Azoury, Emily Long, and Ronnie Shammas- and special guest Kyle Eberlin, MD, discuss the following articles from the August 2022 issue: “Factors Related to Neuropathic Pain following Lower Extremity Amputation” by Lans, Groot, Hazewinkle, et al. Read the article for FREE: https://bit.ly/NeuropathicPainLowerExt Special guest Kyle Eberlin, MD, from Massachusetts General Hospital and the Harvard Plastic Surgery Residency Program. Dr. Eberlin has an extensive body of work encompassing the total spectrum of Peripheral Nerve and Extremity Surgery and Reconstruction and is internationally renowned for his expertise in the field. He serves as a Section Editor for Peripheral Nerve in PRS Global Open and serves as a Section Editor of Hand and Peripheral Nerve for PRS Journal. He currently serves as the Program Director of the Harvard Plastic Surgery Residency Program and the Associate Director of the MGH Hand Surgery Fellowship.  READ the articles discussed in this podcast as well as free related content from the archives: https://bit.ly/PRSAug22Collection

Ruth Fisher, PhD - Author of The Medical Cannabis Primer is an economist and models system dynamics to understand how environments shape outcomes. More specifically, for a given market system, social system, technology system, etc. She determines: * Which factors are important for shaping outcomes * How the system will likely evolve in the current environment* How to change the environment to get a desired outcome

Fast Takes - Ep39 Read the transcript at https://kesslerfoundation.org/sites/default/files/2022-05/Researching%20novel%20approaches%20for%20treating%20neuropathic%20pain%20and%20chronic%20fatigue%20-%20Ep39-TRANSCRIPT.pdf Historically, it was believed that the brain stopped growing after childhood. We now know the contrary to be true. Neuroscience has confirmed that our brains change throughout our lives, from birth to death. The brain's ability to rewire its circuitry and make adaptive changes, known as neuroplasticity, is why recovery after injury is possible. But much about neuroplasticity is not well understood. Our researchers are using functional magnetic resonance imaging (fMRI) and real-time neurofeedback capabilities to conduct several novel pilot studies. Their goal is to correlate changes in the brain to changes in behavior and function. In this episode, Joan Banks-Smith, Creative Producer for Kessler Foundation, spoke with three researchers about their latest studies (see specific list below): Olga Boukrina, PhD, senior research scientist in the Center for Stroke Rehabilitation Research; Jeanne Zanca, PhD, senior research scientist in the Centers for Spinal Cord Injury and Outcomes and Assessment Research; and Glenn Wylie, DPhil, director of the Rocco Ortenzio Center for Neuroimaging at Kessler Foundation. Funding sources: David F. Bolger Trust and Craig H. Neilsen Foundation Learn more about: Dr. Olga Boukrina, https://kesslerfoundation.org/aboutus/Olga%20Boukrina Dr. Glenn Wylie, https://kesslerfoundation.org/aboutus/Glenn%20Wylie Dr. Jeanne Zanca, https://kesslerfoundation.org/aboutus/Jeanne-Zanca Center for Outcomes and Assessment Research, https://kesslerfoundation.org/research/center-outcomes-and-assessments-research Center for Spinal Cord Injury Research, https://kesslerfoundation.org/research/center-spinal-cord-injury-research Center for Stroke Research, https://kesslerfoundation.org/research/stroke/rehabilitation Rocco Ortenzio Neuroimaging Center at Kessler Foundation, https://kesslerfoundation.org/research/mri/rocco-ortenzio-neuroimaging-center Interested in joining a study mentioned in this podcast? Strategies for Stroke Rehabilitation: fMRI Neurofeedback and Motor Imagery, PI: Olga Boukrina, PhD, https://kesslerfoundation.org/research/studies/reading-impairments-following-left-sided-stroke Assessment of Cognitive Fatigue in the Aging, PI: Glenn Wylie, DPhil, https://kesslerfoundation.org/research/studies/assessment-cognitive-fatigue-agedInvestigating Mental Fatigue among Individuals with Stroke, PI: Glenn Wylie, DPhil, https://kesslerfoundation.org/research/studies/investigating-mental-fatigue-among-individuals-stroke Brain Activity in People with Chronic Neuropathic Pain and SCI, PI: Jeanne Zanca, PhD, https://kesslerfoundation.org/research/studies/brain-activity-people-chronic-neuropathic-pain-and-sci Interested in joining a study, https://kesslerfoundation.org/join-our-research-studies ============================================== Tuned in to our podcast series lately? Join our listeners in 90 countries who enjoy learning about the work of Kessler Foundation. Be sure to subscribe to our SoundCloud channel “KesslerFoundation” for more research updates. Follow us on Facebook, Twitter, and Instagram. Listen to us on Apple Podcasts, Spotify, SoundCloud, or wherever you get your podcasts. This podcast was recorded remotely on May 16, 2022, and was edited and produced by Joan Banks-Smith, Creative Producer for Kessler Foundation.

If someone said to you, "I bet your peripheral neuropathy prescription meds have some wicked side effects!" he wouldn't exactly be going out on a limb, would he?! Ditch the drugs and call Dr. Barry Marks Chiropractor (714-938-0575) today! Check it out at https://drmarks.com/peripheral-neuropathy (https://drmarks.com/peripheral-neuropathy)

Knowing how to properly apply photobiomodulation is critical to get the results your patients need. Various irradiances of near infrared light have been shown to be beneficial for the treatment of neuropathic pain. Today Dr. Rountree and Kristi discuss a study on the mechanistic basis for beneficial outcomes regarding laser therapy by near infrared light on neuropathic pain. Follow along as they discuss why a combination of high irradiance and low irradiance treatments can be used to not only block pain signals, but to also alter the nerve's pathology and inflammation to stimulate repair. We have begun live-streaming this podcast. Watch the next episode LIVE in two weeks on Facebook!Studies mentioned in this episodeThe Mechanistic Basis for Photobiomodulation Therapy of Neuropathic Pain by Near Infrared Laser LightYouTube ChannelLaser Therapy InstituteFurther Resources:Success with Laser Therapy Flowchart & Checklist InfographicCheck out these FREE Provider ResourcesRead about laser research on the LTI BlogLearn more about what we offer on the LTI websiteFind out how you can Customize your LTI experienceRelated Podcast for PatientsHealing at the Speed of Light

Charles Miller, a certified registered nurse anesthetist, founded Scenic City Neurotherapy after discovering the brain healing benefits of neuroregenerative treatments such as minimally stimulated ketamine infusion therapy and TMS. Research has demonstrated significant benefits for individuals with treatment resistant depression, suicidality, anxiety, and various other medical conditions including dementia and chronic pain. In this episode, Charles explains how the use of a dissociative anesthetic facilitates neuronal growth and antidepressant effects. Beth asks him to use the analogy of a tree to explain how a brain looks pre-and post- infusions . The Scenic City Neurotherapy website explains: “Charles' knowledge and understanding of the process by which Ketamine facilitates changes on a measurable, demonstrable, and biological scale took years of experience and literature review to develop.” Find out more at https://www.sceniccityneurotherapy.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Seddon HJ. Three types of nerve injury. Brain. 1943;66(4):237-88.Ward KL. Rodriguez-Collazo ER. Surgical Treatment Protocol for Peripheral Nerve Dysfunction of the Lower. Orthoplastic techniques for lower extremity reconstruction–Part II, An Issue of Clinics in Podiatric Medicine and Surgery, E-Book. 2020 Nov 30;38(1):73-82.Chhabra A, Ahlawat S, Belzberg A, Andreseik G. Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications. The Indian journal of radiology & imaging. 2014 Jul;24(3):217.Ducic I, Fu R, Iorio ML. Innovative treatment of peripheral nerve injuries: combined reconstructive concepts. Annals of Plastic Surgery. 2012 Feb 1;68(2):180-7.Bibbo C, Rodrigues-Colazzo E, Finzen AG. Superficial peroneal nerve to deep peroneal nerve transfer with allograft conduit for neuroma in continuity. The Journal of Foot and Ankle Surgery. 2018 May 1;57(3):514-7.Bibbo C, Rodrigues-Colazzo E. Nerve transfer with entubulated nerve allograft transfers to treat recalcitrant lower extremity neuromas. The Journal of Foot and Ankle Surgery. 2017 Jan 1;56(1):82-6.Rodriguez-Collazo E, Jean CM, Leotaud GA. New Surgical Approach to Common Digital Neuroma with Combined Technique of Nerve Decompression, Dorsal Nerve Transposition and Nerve Wrap in the Foot. Orthopedics and Rheumatology Open Access Journals. 2017;7(1):5-8.Eberlin KR, Ducic I. Surgical algorithm for neuroma management: a changing treatment paradigm. Plastic and Reconstructive Surgery Global Open. 2018 Oct;6(10).Ward KL, Rodriguez-Collazo E. Peroneal and Sural Nerve Transfer for the Treatment of Intractable Lower Extremity Pain Following Trauma. Submitted to Plastic and Reconstructive Surgery, pending publication.Chang BL, Mondshine J, Attinger CE, Kleiber GM. Targeted Muscle Reinnervation Improves Pain and Ambulation Outcomes in Highly Comorbid Amputees. Plastic and reconstructive surgery. 2021 Jun 15;148(2):376-86.Valerio I, Schulz SA, West J, Westenberg RF, Eberlin KR. Targeted muscle reinnervation combined with a vascularized pedicled regenerative peripheral nerve interface. Plastic and Reconstructive Surgery Global Open. 2020 Mar;8(3).Agrawal NA, Gfrerer L, Heng M, Valerio IL, Eberlin KR. The Use of Peripheral Nerve Stimulation in Conjunction with TMR for Neuropathic Pain. Plastic and Reconstructive Surgery–Global Open. 2021 Jun 1;9(6):e3655.Eberlin KR, Pickrell BB, Hamaguchi R, Hagan RR. Reset Neurectomy for Cutaneous Nerve Injuries. Plastic and Reconstructive Surgery Global Open. 2021 Feb;9(2).Ducic I, Dellon AL, Graw KS. The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid-third of the lateral leg. Annals of plastic surgery. 2006 Jun 1;56(6):635-8.Khan AA, Rodriguez-Collazo ER, Lo E, Raja A, Yu S, Khan HA. Evaluation and treatment of foot drop using nerve transfer techniques. Clinics in Podiatric Medicine and Surgery. 2021 Jan 1;38(1):83-98.Oexeman S, Rodriguez-Collazo E. Utilization of Intraoperative Biphasic Waveform Nerve Stimulator for Performing Nerve Transfer for the Treatment of Drop Foot: Addendum to Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques. Clinics in Podiatric Medicine and Surgery. 2021 Jun 16.Miller TJ, Rodriguez-Collazo E, Frania SJ, Thione A. Regenerative surgery & intra-operative protocols utilizing bone marrow aspirate concentrate in microsurgical & limb reconstruction. International Journal of Orthoplastic Surgery. 2019 Apr 26;2(2).

Richard Mangan, OD, FAAO, begins the episode by addressing physician burnout and its implications (0:50), after which Scott Hauswirth, OD, FAAO, offers tips for identifying and managing neuropathic pain in patients with dry eye (10:32). Moving things to a lighter note, Justin Bazan, OD, shares his story on how he made his way from student to employee and then on to OD owner (31:50). Last, but not least, hear what inspired Damon Dierker, OD, FAAO, to pursue a career in optometry and what makes up a typical day for him (41:06).

Dr. Michelle Sexton, ND, began her career as a midwife and herbalist. Michelle is a veteran cannabis clinician. In this episode, she talks to us about neuropathic pain, minor cannabinoids, and transition times in women's health. Dr. Sexton's clinical practice, research, and teaching focus on the endocannabinoid system and roles for integrative medicine, including cannabis, to treat various conditions across the lifespan.Dr. Sexton is an Assistant Adjunct Professor at UCSD in the Department of Anesthesiology. She graduated from Bastyr University in 2008 and then completed a postdoctoral fellowship at the University of Washington, where she formally studied the endocannabinoid system for six years. Her NIH-funded pre-doctoral and postdoctoral research on cannabinoids and their roles in neuroinflammation and neurodegeneration investigated cannabis use and its impact on inflammatory markers. She has continued her research into the health effects of cannabis at UCSD. Before medical school, she was a midwife and herbalist for 15 years. Dr. Sexton has presented her research internationally and published 18 papers in peer-reviewed journals. She is a member of the International Cannabinoid Research Society, the International Association of Cannabinoid Medicine, the American Association of Naturopathic Doctors, and the Society of Cannabis Clinicians. She maintains a medical practice in the Pacific Beach neighborhood of San Diego, CA. When not caring for patients or pursuing research activities, you can find her in the garden, playing music, playing with grandchildren, swimming, or riding her bike to the beach for a surf session! Useful linksecsdoctor.comhttps://www.paintraumainstitute.com/resourcesTo learn more about plants & your health from Colleen at LabAroma check out this informative PDF: https://mailchi.mp/2fe0e426b244/osw1lg2dkhDisclaimer: The information presented in this podcast is for educational purposes only and is not intended to replace professional medical advice. Please consult your doctor if you are in need of medical care, and before making any changes to your health routine.

Kami Schaal is a career RN. She spent over a decade working in an ICU, in a level 1 trauma center in Philadelphia. She's seen it all. She transitioned to home care/hospice case management and says the transition wasn't difficult. She came to the use of essential oils with her family. Her academic background helps her understand them and confidently share them with others. Listen today to hear about: neuropathic pain How it is (and is not) treated Why you might want to learn more about the use of essential oils Who can benefit from their use and a bonus discussion about vaccines and things you may (or may not) know about them Hear more from Kami on her new podcast: The Imperfect Adventure And find her here: Her website: Family Wellness Warriors or on Facebook

In this episode I cover neuropathic pain.If you want to follow along with written notes on neuropathic pain go to https://zerotofinals.com/medicine/neurology/neuropathicpain/ or the neurology section in the Zero to Finals medicine book.This episode covers presentation, diagnosis and management of neuropathic pain. I also discuss complex regional pain syndrome.The audio in the episode was expertly edited by Harry Watchman.