Podcasts about nrs

“If you're not moving forward, you're moving backwards,” says Elie Katz, CEO of National Retail Solutions. In this Telecom Reseller podcast, Doug Green speaks with Katz about National Retail Solutions, its relationship with IDT, and the continuing opportunity for telecom resellers, MSPs and channel partners to serve independent retailers. Katz explains that National Retail Solutions was built to help independent merchants gain access to the tools they need to compete, including point-of-sale systems, credit card processing, cash advance, payroll and related business services. The company now serves more than 35,000 locations. Katz says NRS grew out of IDT's long-standing relationship with independent retailers, many of which were already selling telecom products. That connection helped NRS recognize that small merchants needed practical, easy-to-use technology to remain competitive as e-commerce, delivery, AI and digital payments reshape retail. The discussion also looks at the importance of local stores in their communities. Katz says independent retailers often have close relationships with their customers, giving them a level of service and flexibility that larger chains may not offer. For telecom resellers and channel partners, Katz says the retail community remains a strong opportunity. Many already have relationships with small businesses and can add value by bringing them technology and services that help them operate more efficiently. Katz also discusses NRS retailer networking meetups, which bring merchants and business partners together to share ideas, learn from one another and identify new opportunities. Learn more at NRSplus.com.  

Seu SESMT opera com a agilidade que a segurança do trabalho exige ou está engessado pelas burocracias de um sistema genérico? Neste episódio, analisamos por que os módulos de SST integrados aos grandes ERPs costumam gerar retrabalho em campo e como um software especializado, desenhado sob a rotina das NRs e com funcionamento 100% offline, revoluciona a rotina técnica. Descubra o verdadeiro impacto da tecnologia dedicada na produtividade da sua equipe.

Cobra Oar Locks & Undercut Rocks | Gear Garage Live Show This podcast is the audio version of the Gear Garage live show, where Zach covers whitewater rafting, river safety, gear, and answers viewer questions. In this episode, Zach discusses the dangers of undercut rocks and addresses a question about a 14-foot Star raft and calculating oar length. Episode Summary Zach begins the show by highlighting that this episode will focus on answering user questions and revisiting a video from Bedrock on the Grand Canyon. The main technical segment covers a question regarding undercut rocks and what happens when a swimmer encounters them. He notes that hazards like nasty ledge holes, weirs, trees, and sieves are also major concerns. To look at specific statistics, Zach pulls up the American Whitewater accident database to review trends regarding fatalities, highlighting that "flush drowning" represents about 19% of recorded fatalities. The second user question comes from a viewer who purchased a 14-foot PVC Star raft from NRS for $600 and wants to know if they wasted their money, alongside asking for the best oar length for a 66-inch wide boat. Zach reassures the viewer that $600 is an incredible price for a raft, making it a very smart financial choice even though PVC boats might not have the absolute best performance or last forever. Regarding oar length, Zach reiterates his standard formula: measure the exact distance between the oar locks and multiply by 1.63. Boaters can then add or subtract half a foot depending on personal preferences like tube size, height, or shoulder width. Key Questions and Discussion Points Topic: Undercut Rocks. What exactly happens when a person swims into an undercut rock, and can they get pinned like a boat? Topic: Boat Value. Is buying a $600 PVC Star raft directly from NRS a waste of money? Topic: Sizing Math. Does the overall width of a raft dictate your oar length, or does it strictly depend on the distance between the oar locks? Connect with Zach Instagram YouTube Zach Collier is the owner of Northwest Rafting Company and an International Rafting Federation Rafting Instructor. He has decades of river guiding and expedition experience across the American West and internationally, specializing in technical rowing and professional guide training.

Ann Gillard saw a gap in the paddling community and did what any good river person would do: she gathered her crew and got on the water to build a space where people can actually show up as themselves. Ann is an ACA Level 4 whitewater kayak instructor, NRS ambassador, and founder of Pride Day on the River, a volunteer-led event on the Deerfield River in Massachusetts dedicated to LGBTQ+ visibility and participation in paddle sports. It draws over 150 people for a community paddle, beginner clinics, affinity group paddling, and one of the most joyful after-parties on the river. In this episode, Anna and Ann explore: The discomfort zone continuum — how Ann uses body cues to distinguish her comfort zone, panic zone, and the growth space in between The 51% rule — Ann's personal metric for deciding when a rapid is worth running, and why purpose matters more than peer pressure Ego and the river — when ego is a useful push, when it gets in the way, and how to tell the difference Building genuinely inclusive spaces — what it actually looks like to create a container where people can show up as themselves, not as who the sport expects them to be Ann's favorite river metaphor — she shares one in rapid fire that will make you see rivers and community completely differently Cleaning up your mistakes — the courage it takes to own an error in front of a group, and why that moment of accountability can build more trust than getting it right the first time If any of this is resonating — hit play. This one stays with you.

Loralee Ward is a true fan of the sport and has dedicated her life to learning the ins-and-outs and studying the greats. She has advanced through the ranks from youth rodeos to WPRA and in 2025 won the WPRA Tour to give herself an opportunity at limited rodeos. We saw her get a victory lap this year at San Antonio and win the wild card round at Houston taking full advantage of those chances, and we loved hearing about her insight on getting to this point in her career! This is a great episode for everyone to listen to - from youth contestants to seasoned veterans! This week's episode is brought to you by NRS - from boots, hats, and apparel, to bits, spurs, saddles, and more - NRS has you covered! Shop all things Western in-store on online at NRSworld.com

Episode Summary Zach opens the show with a discussion on River Hardware, expressing his frustration with boaters who purchase substandard gear—often simply because they don't know better options exist. He explains that while high-quality gear may cost slightly more, it is significantly better in terms of performance and safety. The conversation highlights several items Zach has personally vetted and imported for his store, including WWTC throw bags from Hungary and Maurice Equipment throw bags from Chile. Zach also dives into the technical superiority of Rock Exotica pulleys, noting that many other "swiftwater" pulleys fail to effectively mind prusiks, especially when used with standard throw bag ropes. A major highlight of the episode is Zach's advice on oar locks. He strongly advises against using NRS oar locks, arguing that their rigidity causes oars to snap. Instead, he recommends bronze oar locks from Sawyer, which provide enough "give" to allow an oar to pop out rather than break under extreme pressure. Topics and links that Zach talked about in this episode Gear Spotlight: Rock Exotica pulleys and their technical advantages. Rescue Equipment: WWTC and Maurice Equipment throw bags. Technical Setup: Why Sawyer bronze oar locks are superior for protecting your oars. Key Questions and Discussion Points Topic: Gear Quality. Why is so much "standard" river gear considered substandard by professionals? Topic: Pulleys. What makes a pulley truly "prusik-minding" for river rescue? Topic: Oar Maintenance. Should you cut down oar shafts that are too long for your frame? Topic: PFD Accessories. The pros and cons of externally mounted knives vs. pocket folders. Connect with Zach Instagram YouTube Zach Collier is the owner of Northwest Rafting Company and an International Rafting Federation Rafting Instructor. He has decades of river guiding and expedition experience across the American West and internationally, specializing in technical rowing and professional guide training.

Elie Y. Katz, President and CEO of National Retail Solutions, joined Doug Green, Publisher of Technology Reseller News, to discuss how NRS is transforming independent retail with enterprise-grade technology, integrated services, and new approaches to security and growth. Katz described NRS as the leading point-of-sale (POS) platform for independent retailers—including convenience stores, liquor stores, and bodegas—while also delivering a broader suite of services such as payments, cash advances, and payroll. The company's mission is to bring big retail capabilities to small businesses that lack the time and resources to source and integrate these tools on their own. “We look at it as if we're the back office for these small businesses… we bring them the best tools so they can focus on running their business,” Katz said. A major focus of the discussion was store security, a growing concern as theft and shrinkage increasingly impact small retailers. NRS has embedded multiple security features directly into its POS platform, including panic alarms, real-time alerts for suspicious activity, and integrated camera systems that align transactions with video footage. These tools help merchants detect both internal and external risks while maintaining operational efficiency. Importantly, Katz emphasized that these solutions are designed with affordability in mind, ensuring that even the smallest retailers can access advanced protection without compromising margins. Beyond security, NRS is enabling independent retailers to compete more effectively through digital transformation. With tools like e-commerce integration, delivery platform connectivity, loyalty programs, and rewards systems, small stores can expand beyond their immediate neighborhood and reach a broader customer base. Katz also shared current retail trends, noting softness in certain sectors like liquor sales, while convenience stores remain relatively stable. In this environment, technology becomes a key differentiator—helping merchants maintain revenue and improve customer engagement. With a network of over 35,000 locations, NRS is effectively creating a collective ecosystem of independent retailers, giving them scale, tools, and services typically reserved for large chains. For channel partners, MSPs, and service providers, Katz highlighted a significant opportunity: leveraging existing customer relationships to introduce additional services and generate new revenue streams. Learn more: https://nrsplus.com/

Empowering Small Retailers: NRS Plus Revolutionizes Independent Store Success https://NRSplus.com/ About the Guest(s): Elie Katz is the President and CEO of National Retail Solutions (NRS), a company dedicated to empowering independent convenience stores, liquor stores, tobacco shops, and gas stations across the U.S. With extensive experience as an executive in diverse industries, Ellie utilizes his strong leadership and organizational skills to drive NRS since its inception, under the subsidiary of IDT. NRS provides an advanced point of sale, network, and credit card processing ecosystem servicing over 35,000 retail locations. Elie Katz is also involved in managing real estate and food establishments, showcasing his deep understanding of business growth and investment. Episode Summary: In this episode of the Chris Voss Show, Chris hosts Elie Katz, President and CEO of National Retail Solutions. Elie Katz’s journey in establishing NRS as a beacon for small retailers is explored in depth, alongside discussions on how NRS provides advanced solutions to help independent retailers compete effectively. From revolutionary point of sale systems to integrations with platforms like DoorDash and Uber Eats, Elie Katz outlines how his organization facilitates digital transformation for small businesses in an increasingly competitive market. Listeners are offered a firsthand understanding of how NRS’s tailored solutions are leveling the playing field for independent retailers across the United States. Elie Katz elaborates on NRS’s latest initiatives, including the expansion of premium features and AI product recommendations that streamline operations and enhance consumer engagement. The discussion also dives into security innovations like the company’s patented panic alarm and strategies for digital transformation, which are not just theoretical but ingrained into the ethos at NRS. Elie Katz’s insights into focus and execution in leadership highlight pivotal lessons that are not only applicable to existing retailers but inspiring to aspiring entrepreneurs as well. Discover the evolving dynamics in retail and learn how to remain relevant and successful through adaptive strategies in this engaging episode. Key Takeaways: NRS empowers over 35,000 independent retailers across the U.S. with state-of-the-art POS systems and service integrations. Elie Katz’s leadership philosophy emphasizes understanding pain points, focus, and execution to drive company growth and customer satisfaction. NRS’s AI product recommendations help retailers optimize inventory and pricing, vital in today’s economy. Partnerships with major companies like DoorDash and GrubHub expand customer reach for neighborhood retailers. Innovations like the panic alarm showcase NRS’s commitment to retailer security and business continuity. Notable Quotes: “Small retailers have to stay in the game, especially in today’s economy.” “Focus and get it done. You can’t pay your bills with excuses.” “We’ve got to keep up with the AI transformation, or you risk being left behind.” “Digital transformation isn’t just necessary—it’s vital for survival in today’s competitive market landscape.” “Every feature we add aims at one goal: helping small businesses become more efficient.”

Today on the Advancing Nitrogen Smart podcast we speak in-depth about the recently-revised Minnesota Nutrient Reduction Strategy with Matt Drewitz from the Minnesota Pollution Control Agency. What are the goals of the MN Nutrient Reduction Strategy, and how are they being addressed specifically? Are we on track to meet our objectives? How have environmental changes over the years affected our progress? How have wastewater treatment plants contributed to the effort, and what have we learned from them? What kinds of other practices can be leveraged to meet the goals of the NRS, and how should farmers approach these ideas? Who's a farmer's point of contact with questions about adopting these practices? All of this on today's episode, recorded on the road from the recently held Nutrient Management Conference in Mankato, MN.Guests:Brad Carlson, Extension educator (Mankato)Matt Drewitz Minnesota Pollution Control Agency, (St. Paul)Additional resources:Minnesota Nutrient Reduction StrategyOne Watershed, One PlanAddressing nitrate in southeastern MinnesotaThe state of Minnesota's soil health: How many farmers are doing no-till, cover crops, and moreEdge of field N and P reduction strategies: What to know about conservation drainage practicesVideos of the 2026 Nutrient Management and Nitrogen Conference presentations are now available---For the latest nutrient management information, subscribe to the Nutrient Management Podcast. And don't forget to subscribe to the Minnesota Crop News daily or weekly email newsletter, subscribe to our YouTube channel, like UMN Extension Nutrient Management on Facebook, follow us on X (formerly twitter), and visit our website.If you have questions or comments, please email us at nutmgmt@umn.edu.Advancing Nitrogen Smart is proud to be supported by the farm families of Minnesota and their corn check-off investment through Minnesota Corn.

This podcast is the audio version of the Gear Garage Live Show, where Zach answers submitted questions and talks all things whitewater. In this episode, Zach discusses new one-day safety clinics, dives into the "horrible" customer service at River Hardware, and analyzes whether a 13'9" raft is suitable for multi-day trips. Episode Summary Zach starts the show by introducing a new concept: "a la carte" rescue instruction through Northwest Rafting Company. These one-day clinics allow boaters to focus on specific skills, like throw bags and mechanical advantage, without the time commitment of a full three-day course. He explains that building skills incrementally every year is often more effective than trying to cram everything into one long session. A significant portion of the show is dedicated to a very honest look at his side project, River Hardware. Zach explains that because he is so busy running his main outfitting business, River Hardware offers no customer service. He addresses a viewer's frustration regarding blower adapters for Craftsman tools, explaining the challenges of designing custom parts for every brand and suggesting that those who want traditional support should shop at larger retailers like NRS. The technical discussion shifts to raft design when a viewer asks about using a 13'9" Wing Raft for overnight trips. Zach, who has designed many boats for Wing, explains that while he loves rowing the boat for light trips, its high rocker and smaller tube size make it a poor choice for heavy multi-day loads. He offers advice on better alternatives for those looking to carry a kitchen, groover, and multiple passengers. Topics and links that Zach talked about in this episode Training: One-day Safety Clinics at Northwest Rafting Company. Gear: Blower adapters for DeWalt, Milwaukee, and Makita tools. Raft Design: Wing rafts. Some of the Questions that Zach covered in the Q&A section of this episode Topic: Blower Adapters. "Does the DeWalt adapter work on a Craftsman blower?" Topic: Boat Selection. "Is a thirteen foot nine raft big enough for a multi-day trip with passengers and gear?" Topic: Customer Service. "Why is there no contact link for River Hardware?"

This podcast is the audio version of the Gear Garage Live Show, where Zach answers submitted questions and talks all things whitewater. In this episode, Zach dives deep into river safety "rants," analyzes rescue videos, and discusses the importance of professional training for both private boaters and aspiring guides. Zach begins the show by announcing new one-day rescue clinics offered by Northwest Rafting Company. These clinics are designed as a "palatable" way for private boaters to gain experience in specific areas like mechanical advantage and throw bags without committing to a full three-day course. He also shares a personal "safety rant," emphasizing that while some may call him a "safety squirrel," his access to non-public incident reports drives his passion for teaching rescue techniques. A significant portion of the episode is dedicated to video analysis. Zach reviews footage of a "pushing move" gone wrong, explaining why aggressive maneuvers can leave boaters exposed and sideways to obstacles. He suggests that many situations are better handled by pulling or using a "ferry" to maintain control. He also reviews a rescue scenario in flat water, cautioning against the reflexive use of throw ropes which can create dangerous tangles in the water. The discussion also touches on gear essentials, particularly PFD selection. Zach notes that while many kayakers prefer low-profile vests for agility, rafters—especially larger individuals—benefit from higher flotation models like the Astral Indus or specific NRS rescue vests. He concludes with a reminder that professional growth in the industry requires "time on the water," recommending programs like the Class III Rowing School for those looking to build a solid foundation. Topics and links that Zach talked about in this episode Training: Northwest Rafting Company Rescue Clinics and Class III Rowing School. Gear: PFD selection and the dangers of ropes in flat water rescues. Safety: Using your voice as a rescue tool (Speech, Reach, Throw, Row, Go).

Elie Y. Katz, Founder, President & CEO of National Retail Solutions (NRS), joined Doug Green, Publisher of Technology Reseller News, for a wide-ranging conversation about what's changing right now for independent convenience stores—and why technology partners should be paying attention. Katz opened with a candid, real-world story from home that set the tone for the episode: small-business life is relentless, unpredictable, and personal. “I'm here, ready to roll… and tell them about National Retail Solutions and how we could help them make more money and put more money in their pocket,” he said—framing NRS as both a technology provider and a support system for business owners who are often juggling everything themselves. NRS serves the “onesies, twosies” of retail: independent convenience stores, bodegas, and similar single-operator businesses. Katz said NRS has deployed more than 40,000 point-of-sale registers across the U.S., supporting stores that compete daily against national chains with far deeper resources. The discussion highlighted how these stores—often located at street level in dense neighborhoods—are increasingly becoming the preferred option for shoppers who want convenience, familiarity, and a sense of safety. A key theme was how consumer behavior shifts can quickly reshape revenue. Katz noted that many NRS-supported stores are seeing strong growth in e-commerce and delivery, enabled by POS integrations that connect store inventories to their own websites and to marketplaces like DoorDash and Grubhub. In his view, this is a repeatable pattern: during COVID, convenience stores went from shutdown panic to becoming essential community hubs, and those that embraced digital ordering surged. “The ones that were smart enough to be hooked into online ordering and the marketplaces… they thrived,” Katz said. Green and Katz also explored what Katz called a “quiet revolution” inside these neighborhood businesses—moving from cash-first operations to modern payment methods, loyalty programs, and digitally enabled workflows. Katz argued that the next generation of customers expects to order, pay, and interact through mobile experiences, and retailers that resist change risk getting left behind. “If you don't want to embrace the technology… you're going to wake up like Blockbuster, Kodak, Yahoo,” he warned. The conversation also covered safety and risk reduction, especially for stores operating in high-crime environments. Katz pointed to a patented feature built into NRS registers: a “panic alarm” workflow that can silently alert police in the event of a robbery while opening the cash drawer to comply with demands. “We have a patented alarm system embedded in our point of sale register… the drawer opens up and a silent alarm goes to the police department,” he said. Beyond POS, Katz positioned NRS as a broader financial and operational services provider for small businesses, including credit card processing, cash advance services to help with cash flow, and payroll services. His message to the channel was direct: technology resellers already have trusted relationships with Main Street businesses, and those relationships can translate into new revenue streams. “They're leaving money on the table by not taking advantage of the fact that they're trusted already by their customer,” Katz said. Finally, Katz emphasized that NRS wraps these capabilities with what he described as “white glove, back-of-house assistance,” helping store owners navigate programs, compliance issues, and operational setup—critical for owners who are often, as he put it, “the employee of the month, the pot washer, the HR person, head of legal, head of purchasing.” To learn more, visit https://nrsplus.com/. Katz also noted there is a “contact the CEO” option at the bottom of the site for direct outreach.

We're kicking off the New Year for Equine Affaire with a little visit on the Western Side of things! Today, we're chatting with Zoe Woodland, a cutting horse & cow work trainer, and Jason Brooks, vice president of marketing for National Roper's Supply. Zoe will be presenting as part of Cowtown in Cooper, sponsored by Western Life Today, and NRS will be exhibiting with us in the Bricker Building! Horses in the Morning Episode 3863 - Show Notes & Links: Hosts: Allison Rehnborg and Glenn the GeekTitle Sponsor: Equine AffaireGuest: Zoe Woodland of Zoe Woodland Performance Horses | FacebookGuest: Jason Brooks of NRS | FacebookTo subscribe, search Horses in the Morning OR Equine Affaire in your favorite podcast player!Equine Affaire on FacebookHorses In The Morning on FacebookTIMESTAMPS:12:40 - Zoe Woodland27:28 - Jason Brooks

We're kicking off the New Year for Equine Affaire with a little visit on the Western Side of things! Today, we're chatting with Zoe Woodland, a cutting horse & cow work trainer, and Jason Brooks, vice president of marketing for National Roper's Supply. Zoe will be presenting as part of Cowtown in Cooper, sponsored by Western Life Today, and NRS will be exhibiting with us in the Bricker Building! Horses in the Morning Episode 3863 - Show Notes & Links: Hosts: Allison Rehnborg and Glenn the GeekTitle Sponsor: Equine AffaireGuest: Zoe Woodland of Zoe Woodland Performance Horses | FacebookGuest: Jason Brooks of NRS | FacebookTo subscribe, search Horses in the Morning OR Equine Affaire in your favorite podcast player!Equine Affaire on FacebookHorses In The Morning on FacebookTIMESTAMPS:12:40 - Zoe Woodland27:28 - Jason Brooks

 Welcome to ROADSIDE presented by Zwift!    In today's episode, Tom and Jet catch up with Jayco AlUla climbing star, Ben O'Connor. The boys discuss Ben's World Tour career and the different hurdles that were presented to him along the way. Ben details the moment he knew he could be one of the best riders in the world and what goes through your mind when your about to win your first Tour de France stage. The boys also chat Netflix, NRS, Boxing Day Papas and the upcoming 2026 Aussie Summer.   Zwift Mailbag: Send in your questions, hypotheticals, takes and everything in between to jet@roadsidepod.com and we will read the best ones out in the next episode!   -  -    The Roadside Cycling Show is presented by Zwift   Need a trainer? Try the all-new Zwift Ride - zwiftinc.sjv.io/55gL11 Head to https://www.zwift.com/ to start your free 14-day trial today. The Roadside Cycling Show is also supported by FE Sports, the home of premier cycling brands and products such as Wahoo, Pirelli, 100%, Campagnolo and more. Check out their range now - https://www.fesports.com.au/Shop/c_230/Products 

Doug Green, Publisher of Technology Reseller News, sat down with Elie Y. Katz, Founder, President & CEO of National Retail Solutions (NRS), to discuss how payments, telecom, and point-of-sale technology are converging to reshape small and independent businesses. Katz explained how NRS, incubated within IDT, was created to give independent convenience stores and small merchants the same tools and insights long available to large national chains. At the center of NRS's success is its integrated point-of-sale platform, now deployed in more than 38,000 locations nationwide. Katz described how NRS combines POS, credit card processing, payroll, cash advance services, and telecom products into a single system. “We didn't just build a register,” Katz said. “We built a platform that lets independent merchants compete with corporate America.” The conversation highlighted the accelerating shift away from cash toward cards, mobile wallets, and peer-to-peer payment apps such as Venmo and Zelle—especially among younger consumers. Katz noted that safety, efficiency, and cost are driving merchants toward cashless or low-cash environments. “The phone has become the bank,” he said, pointing to how mobile payments are now central to everyday commerce. Katz also outlined the opportunity this shift creates for telecom channel partners, MSPs, and resellers. By leveraging existing customer relationships, partners can expand into POS, payment processing, payroll, and cash advance services through NRS. “If you didn't pivot, you went out of business,” Katz said. “Our platform gives channel partners a new stream of recurring revenue using relationships they already have.” Finally, Katz detailed NRS's growing ecosystem of integrations, including DoorDash, Grubhub, and NationsBenefits, which help independent merchants increase revenue and compete more effectively. With offerings like NRSPay and flexible, no-penalty credit card processing, NRS is positioning itself as a long-term partner for small businesses navigating the transition to a digital, cashless economy. For more information, visit https://nrsplus.com/.

Send us a textMikey sits down with Craig Caudill of Nature Reliance School live at the Georgia Bushcraft Fall Gathering and queries Craig about his childhood, the pillars of NRS and his catalog of work!https://www.naturereliance.org/https://ltwrightknives.com/https://www.woodsmonkey.com/Support the showSupport the show

“Hard to get a customer — but once you have that customer, sell them something else.” — Elie Y. Katz, Founder, President & CEO, National Retail Solutions (NRS) In this Technology Reseller News podcast, Doug Green, Publisher of TR Publications, speaks with Elie Y. Katz, CEO of National Retail Solutions (NRS), about how NRS is helping small businesses compete with national chains — and why telecom resellers and MSPs are perfectly positioned to benefit from a new wave of retail technology opportunities. NRS, a division of IDT, began as a mission to modernize small, independent convenience stores through affordable, easy-to-use point-of-sale (POS) systems. A decade later, NRS has more than 38,000 units deployed nationwide, helping merchants streamline sales, manage operations, and now — expand digitally through DoorDash and Grubhub integrations. What started as a POS platform has evolved into a full suite of business services — including NRSPay for transparent, no-contract credit card processing, NRS Purple Payroll for affordable payroll solutions, and cash advance programs that help small businesses stay liquid and grow. Katz is now calling on telecom resellers and channel partners to leverage their trusted customer relationships and add new, high-margin offerings. “Every one of your customers needs credit card processing, payroll, or better cash flow. We make it simple, transparent, and profitable — for you and them,” he explained. With NRS, partners can expand beyond telecom into broader small-business enablement — reaching industries from convenience stores and retailers to medical, dental, legal, and service-based businesses. “The hardest part of sales is building trust. Our resellers already have that trust — now it's time to build on it,” Katz added. To learn more about partnership opportunities, visit SellNRS.com or explore NRS solutions at NRSPlus.com. Software Mind Telco Days 2025: On-demand online conference Engaging Customers, Harnessing Data

"At RX, we celebrate failure, which is kind of a strange thing to say," said RX CEO Hugh Jones on the November 2025 edition of Trade Show Talk.  Why?   "Failure is actually a part of the executive process and making great choices," he said In this episode, Host Danica Tormohlen delves into this topic and more with Jones, who shares the company's recent growth and strategic bets in the trade show industry.   Jones discusses a broad range of topics, including RX's expansion into Saudi Arabia, digital product development, and the importance of celebrating failures to drive innovation and leadership.   For context: RX, a division of public company RELX and ranked No. 2 on the Stax Top 20 Exhibition Organizers List (by revenues), produced 282 face-to-face events in 25 countries in 2024, and these events served 41 industry sectors and attracted more than 6 million participants, according to its 2024 Annual Report. Some of RX's flagship events include New York ComicCon, JCK, ISC West, and FIBO Global Fitness. In its most recent earnings report in August, RX saw 8% growth year over year for the first half of 2025.  The episode also features interviews with Legends Global GM Rodney Falk on the Cincinnati convention center's reopening in January 2026 and Exhibitions and Conferences Alliance Executive VP Tommy Goodwin on the U.S. government shutdown's impact on the industry.  00:00 Introduction to Trade Show Talk  00:34 Meet Hugh Jones, CEO of RX  01:22 Sponsorship Message from Legends Global  02:08 Hugh Jones' Background and Philosophy  04:17 Interview with Hugh Jones Begins  04:24 The Importance of Taking Risks  07:16 RX's Expansion and Acquisitions  08:36 Digital Transformation at RX  11:39 Innovative Approaches in Trade Shows  15:16 Navigating the Pandemic and Strategic Changes  20:25 Value-Based Selling and Customer Focus  29:08 Advocacy, Sustainability, and Talent in the Trade Show Industry  37:40 The Importance of Standardization in Events  40:30 Digital Innovation and Future Trends  44:42 Real-Time Matchmaking and Industry Trends  46:08 AI in Trade Shows: Strategy and Implementation  49:41 Personal Insights: Monday Morning Routine  52:24 Upcoming Events and Travel Plans  54:35 Hobbies and Family Life  55:55 Worst Business Advice Ever Received  58:25 Cincinnati Convention Center Update  01:14:27 Advocacy Update with Tommy Goodwin  01:22:03 Conclusion and Upcoming Episodes    This episode is brought to you by Legends Global.   Legends Global is the premier partner to the world's greatest live events, venues, and brands. Legends Global delivers a fully integrated suite of premium services—from feasibility and consulting to venue management, sales, merchandise, hospitality, partnerships, content and booking. The company's white-label approach keeps partners front and center while leveraging the power of their global network with more than 450 venues, 20,000 events, and 165 million guests annually. Learn more at LegendsGlobal.com.     Guest bio: Hugh Jones   Chief Executive Officer   Every executive has to place bets in order for the value propositions to remain relevant to the customers, but not every bet has to work. Hugh believes that executives learn by both our successes and our failures. That philosophy has served Hugh well over the years since joining RELX in 2011, following the purchase of Accuity where he was Chief Executive Officer. In addition to leading Accuity to become one of the world's largest and most significant companies in the payment routing and Anti Money Laundering sectors, Hugh has also led Fircosoft, NRS, I.C.I.S, Estates Gazette (EG) and Cirium; and before joining RX he was Global Managing Director within the Risk and Business Analytics Division.   Hugh's philosophy has seen him lead large scale acquisitions and subsequent integrations of many companies that now reside and prosper within the RELX portfolio. Hugh joined RX as CEO at the start of 2020, bringing with him plenty of experience in public company protocol and all facets of business management including P&L oversight, talent development, forecasting, sales execution, technology innovation and product discovery, launch and growth.   Hugh's experience has been invaluable in navigating RX's response to challenges and his strategic understanding of technological innovation has accelerated the use of digital and data products and services across RX events, as an ongoing core component of RX face to face events. Passionate about building a culture of collaboration, exploring, risk taking, accountability and courage, Hugh champions the creation of a psychologically safe and inclusive workplace for all.  versed in public company protocol and all facets of firm management including P&L oversight, talent development, forecasting, sales, technology and product innovation, discovery, launch and growth.   A mélange of exceptional investment and overall management qualifications, combined with superior analytical leadership. Accustomed to and effective in high-profile executive roles, making high-stakes investment decisions with world-class clients and customers. Versed in leading investor forums at a publicly traded firm, commercializing data streams, contributing forward-thinking vision and overcoming complex business obstacles.   More than two decades of experience building corporate value by creating rich data streams that provide new solutions to difficult corporate challenges. Successful at developing and coaching top executive teams, leading sales efforts, and negotiating complicated corporate and functional business deals with financial institutions, corporations and governmental agencies.  • Member of the Young President's Organization (YPO) since 2009 • Served on numerous Boards for the benefit of Private Equity firms • Winner of the 2013 Ernst & Young Entrepreneur of the Year Award in Financial Services for the Midwest Region • Holds a BA in economics from Yale University cum laude and an MBA from the University of Michigan  Guest bio: Tommy Goodwin is Executive Vice President for the Exhibitions & Conferences Alliance (ECA), the advocacy association for the business events industry. In this role, he leads ECA's work on behalf of the interconnected ecosystem of exhibitors, event and meeting organizers, suppliers, venues, and destinations that comprise the global business events landscape.     Prior to joining ECA, Tommy spent more than 20 years leading social impact, member value, public affairs, and international engagement efforts for several globally recognized associations and corporations, including Oracle, AARP, and the Project Management Institute (PMI). Additionally, he was a research fellow at Harvard Business School focused on the international political and legal environment in which businesses and social enterprises operate.     Tommy has a B.B.A. from The George Washington University, an M.B.A. from Auburn University, and a Postgraduate Diploma in European Union Law from King's College London. He also holds several certifications including a Project Management Professional from PMI, a Certified Meeting Planner from the Events Industry Council, and a Certified Association Executive from the American Society of Association Executives (ASAE).     Recognized by The Hill in its list of association "Top Lobbyists" every year since 2020, Tommy was also named a "Leading Association Lobbyist" by CEO Update/Association TRENDS in 2023. He has also been elected as a Fellow by ASAE (2022), named an "Association Innovation Leader" by DCA Live (2022), received the "Industry Support Award" from Trade Show News Network (2022), and recognized as an events industry "Changemaker" by MeetingsNet (2022).     Tommy currently serves on the advisory boards of Factum Global and The Iceberg. He is also a past president of the National Institute of Lobbying & Ethics and a past chair of ASAE's Executive Management Professionals Advisory Council and Advocacy Council.    Host bio: Danica Tormohlen    Meet Danica Tormohlen, a dynamic force in the trade world who's been telling compelling stories for more than 30 years. As VP of Group Content at Informa, she's the mastermind behind Trade Show News Network, bringing the pulse of the industry to life. When she's not crafting engaging content, you'll find her behind the microphone hosting the Trade Show Talk podcast, where she chats with industry movers and shakers.    A proud Mizzou Journalism School grad (go Tigers!), Danica has left her mark across the events industry landscape, from SISO to Trade Show Executive. Her trophy shelf sparkles with journalism awards, but what really gets her excited is breaking new ground for women in the industry. As a founding member and current president of the Women in Exhibitions Network North America, she's passionate about lifting others up while climbing the ladder herself.    When she's not reporting on trade shows and events, you'll spot Danica pounding the pavement as an enthusiastic runner or rolling up her sleeves with the National Charity League, proving that giving back is always in style. Her secret sauce? A perfect blend of journalistic integrity, industry insight, and boundless energy.     Catch Danica's latest thoughts on LinkedIn and X, where she's always sharing industry insights with a personal twist.   

In paddling and in life, nothing is wasted — every stroke counts, and every experience is money in the bank moving you toward your goal. In this episode of The Discomfort Zone Podcast, Anna Levesque sits down with longtime paddler, coach, and storyteller Anna Bruno — a six-time member of the USA Freestyle Team and current Marketing Communications Manager at NRS. From pre-competition nerves that literally send her running for the bushes, to redefining her relationship with ego and identity in paddling, Anna Bruno shares the raw and relatable side of navigating discomfort. Together, Anna and Anna dive into:

Heidi Gunderson has had a whirlwind futurity year with Wonder If Im Lucky - starting with the BFA Juvenile World Championship. This isn't her first big time winner however, and we had the chance to talk to Heidi about the horses that have made her career. This year, Heidi took a leap of faith and retired from her 20+ year career as a teacher to train full time, and her story and mindset change about chasing your dreams can be an inspiration to all. A wife, a mom, a teacher, and now a full time futurity trainer, she has worn a lot of hats and we are thankful for the time she spent with us to share her story! This week's episode is brought to you by NRS. NRS has everything you need from boots, hats, apparel, bits and spurs, saddles, ropes, feed and more! NRSworld.com

Elie Y. Katz, President & CEO of National Retail Solutions (NRS) that operates the leading point-of-sale (POS) terminal-based platform and NRS Pay credit card processing … Read more The post NRS strives to present the most innovative technologies to help retailers survive and thrive appeared first on Top Entrepreneurs Podcast | Enterprise Podcast Network.

47 When evening came, the boat was out on the sea, and he was alone on the land. 48 When he saw that they were straining at the oars against an adverse wind, he came towards them early in the morning, walking on the sea. He intended to pass them by. 49 But when they saw him walking on the sea, they thought it was a ghost and cried out; 50 for they all saw him and were terrified. But immediately he spoke to them and said, "Take heart, it is I; do not be afraid."51 Then he got into the boat with them and the wind ceased. And they were utterly astounded, 52 for they did not understand about the loaves, but their hearts were hardened. (Mark 6:47-52 NRS)

47 When evening came, the boat was out on the sea, and he was alone on the land. 48 When he saw that they were straining at the oars against an adverse wind, he came towards them early in the morning, walking on the sea. He intended to pass them by. 49 But when they saw him walking on the sea, they thought it was a ghost and cried out; 50 for they all saw him and were terrified. But immediately he spoke to them and said, "Take heart, it is I; do not be afraid."51 Then he got into the boat with them and the wind ceased. And they were utterly astounded, 52 for they did not understand about the loaves, but their hearts were hardened. (Mark 6:47-52 NRS)

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

The results of the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure for lateral osteochondral lesions of the talus (OLTs) are unknown. Therefore, the present prospective study aims to assess the numeric rating scale (NRS) of pain during walking at 2-year follow-up. Secondarily, the aim is to assess other clinical, radiologic, and safety outcomes. In conclusion, in the first 7 prospectively followed patients who underwent the TOPIC procedure for large osteochondral lesions of the lateral talar dome, an improvement of the NRS of pain during walking from median 5 preoperatively to 1 at 2-year follow-up was observed. Click here to read the article.

43 After sternly warning him he sent him away at once, 44 saying to him, "See that you say nothing to anyone; but go, show yourself to the priest, and offer for your cleansing what Moses commanded, as a testimony to them."45 But he went out and began to proclaim it freely, and to spread the word, so that Jesus could no longer go into a town openly, but stayed out in the country; and people came to him from every quarter. (Mark 1:40-45 NRS)

43 After sternly warning him he sent him away at once, 44 saying to him, "See that you say nothing to anyone; but go, show yourself to the priest, and offer for your cleansing what Moses commanded, as a testimony to them."45 But he went out and began to proclaim it freely, and to spread the word, so that Jesus could no longer go into a town openly, but stayed out in the country; and people came to him from every quarter. (Mark 1:40-45 NRS)

Elie Y. Katz Talks NRS Innovations for Small Retail Success Nrsplus.com About the Guest(s): Elie Y. Katz is the President and CEO of National Retail Solutions (NRS). Seven years ago, Elie brought his extensive experience from various industries to establish NRS, focusing on empowering independent retailers with essential business tools. His past involvement includes managing multiple real estate investments and food establishments. Under his leadership, NRS has grown to service close to 30,000 independent retailers across the U.S. with a robust ecosystem of point-of-sale networks and credit card processing solutions. Elie's vision revolves around providing cutting-edge technology to small businesses to help them compete against larger corporate entities. Episode Summary: In this episode of The Chris Voss Show, host Chris Voss welcomes back Elie Y. Katz, the dynamic President and CEO of National Retail Solutions (NRS). They explore the transformative impact of technology on small businesses and how NRS is spearheading innovations for independent retailers. Elie shares insights from his vast experience in creating tools that allow small businesses to thrive in a competitive market dominated by major retailers. Together, Chris and Elie delve into NRS's mission to support these businesses with state-of-the-art solutions. This episode takes a deep dive into the world of retail solutions, highlighting how NRS's products and services are game-changers for small retailers. With a focus on enhancing efficiency and profitability, Elie discusses NRS's wide array of offerings, from point-of-sale systems tailored for various industries to innovative credit card processing services. The conversation also touches on the importance of adopting technology to meet modern business challenges, the role of AI in improving operational efficiency, and exciting future expansions. Chris and Elie make a compelling case for why technology is indispensable for the growth of small businesses in today's economy. Key Takeaways: Empowering Small Retailers: National Retail Solutions offers an extensive range of tools, including point-of-sale systems and credit card processing, aimed at enhancing the operational efficiencies of small, independent retailers. AI and Technology Integration: NRS is integrating AI to assist retailers with product pricing and inventory management, ensuring they remain competitive and informed. Safety and Security: NRS has developed a patented panic alarm feature in their POS systems, which can silently alert authorities during emergencies, thus improving store safety. Expansion and Growth: NRS plans to expand its offerings into the restaurant industry while also aiming at serving international markets, leveraging its technology-backed solutions. Community Impact: Elie Katz emphasizes NRS's commitment to helping small business owners succeed, highlighting the entrepreneurial spirit that fuels independent retailers. Notable Quotes: "Our point of sale register is the brain. It has all the items… and it's ready to go." "Technology rules the roost… if we don't embrace the technology change, then you better embrace the fact that you may be out of business soon." "With our point of sale register, you're standing there… and that's why these brands love us." "We are gonna be hot and heavy going into the restaurant point of sale register business." "I know the struggles… it makes me proud to help business owners be successful with their business."

We are always honored when we can sit down with a veterinarian to discuss their specialty and passion and that was just the case with Dr. John Janicek. Dr. Janicek specializes in wobbler surgery and neurological diseases as well as having a very long resume in orthopedic surgery, soft tissue surgery, and sports medicine. From the causes, how to diagnose, treatment, rehab, recovery, outcomes and more we really got the opportunity to learn about Wobblers disease and its impact in our industry. Knowledge is power when making the best decisions for your horses and early diagnosis of Wobblers leads to a better outcome - and we are thankful to have the chance to share this knowledge with our listeners! As always when we bring a veterinarian on the podcast, remember - there is no way to cover everything in an hour and an audio podcast does not replace a trip to your veterinarian. If you have concerns about your equine athlete, consult your personal veterinarian!This week's episode is brought to you by NRS. NRS has everything you need from boots, hats, apparel, bits and spurs, saddles, ropes, feed and more! NRSworld.com

Katie Veteto is a river guide with quiet calculated confidence and a sharp eye for water. Within a few years she was navigating one of the most difficult crafts on the river—the massive sweep boat. NRS's new film Driving Sweep, directed by River Radius Contributing Host Greg Cairns, follows her journey of learning, doubt, and determination as she takes on a role historically dominated by men. Through her story, the film offers a powerful reflection on resilience, mentorship, and making space in wild places.GUESTSKatie VetetoKatie Veteto was born in Southern Utah, raised in the Missoula Valley, and now spends her time in Missoula, MT and Salmon, ID. She grew up seeing the rivers of the West through the joyful lens of community and recreation and continues to guide on rivers in Montana and Idaho. Katie is an elementary school teacher. During Katies time off, you'll find her romping in the woods with her dog Tuck, swing dancing, knitting hats, writing, or bumping around on a bike. In the Summer you'll find her somewhere on the Middle Fork of the Salmon.Greg CairnsContributing Host & Film Creator SPONSORSNRS@nrsweb Valley Nissan@valley_nissan WATCH THE FILMYouTube linkRead about the film GIVEAWAYEnter Here@riverradiuspodcast  THE RIVER RADIUSWebsiteRunoff signup (episode newsletter)InstagramFacebookApple PodcastSpotifyLink Tree

Evo Japan announcements, Tekken DLC reception, and the NRS curse come for MK1.

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about in this episode Answer Questions Middle Fork Trip Planning Blog Some of the Questions that Zach covered in the Q&A section of this episode Topic: Oar Length (For a Specific Situation) What's the best oar length for running Class II rapids in a 15'6" long Stryker inflatable boat? The boat has a 60-inch span, a 6'2" wide beam, and a 160-pound outboard motor on the stern. I plan to use it occasionally as a drift boat. For longer, deeper, easy-going sections, I'll use the motor to go back upstream and re-fish, or to get through slow, deep, unfishable water. Thanks! Topic: IK for Extended Trips I've been using an Aquaglide touring IK for Class III/IV trips—our last was on the Lower Salmon—and after spending days sitting in water, I know it's time for an upgrade. I recently picked up a Star Outlaw II for my son, but so far it's only seen flatwater. We've got some whitewater trips planned for June and July, and I'd love some advice for my new IK. I'm super torn between a few options. In order of interest: Star Outlaw II — I like the 5 chambers, drop-stitch floor, and the price point, plus the reviews are solid. But I hate the lack of anchor points for gear—had to glue some on for my son. AIRE Outfitter II — Tons of great reviews, nice bow kick, and it has good gear loops. But it's pricey, and I'm worried I'll be sitting in water again with that floor. AIRE Lynx II — Same pros and cons as the Outfitter. Corran Tandem — I like that it handles big water, but I think I'd hate it on flatwater. RMR Taylor vs Animas — The price is right and what I've found so far is positive, but reviews are way fewer compared to NRS stuff. I'm 6'2”, around 300 lbs (currently cutting weight), and I need an IK that can support me on a 5-night trip. Also curious about the NRS Riffle—it looks durable and capable.

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about in this episode GoRafting.com Maps Answer Questions May 4th Illinois Trip Today's Questions: Topic: Raft Pressure I'd love to hear your thoughts on air pressure for rafts. How do you know when it's right? What do you think about those digital air pressure caps, like the TRiB brand ones NRS sells? I know you should let some air out when driving over mountain passes or when the boat's sitting in the sun to prevent blowouts. But other than that, how important is it to get the air pressure just right on the water? Thanks, and keep up the good work! Topic: Tech Support Hi Zach! Love the show, great content! I'm filming our Main Salmon trip this year with a GoPro. What do you use—or what have you heard of—to merge and edit GoPro clips into one seamless video with text and music? I need something old-guy friendly, since I'm not super tech-savvy. Got any tips or tricks you've learned from your own experience? Thanks! Topic: Dish Bucket Water Love the show, thank you for keeping this up. I always look forward to the Tuesday show and any other reviews, testing or other topics you cover. For getting rid of dish water, different rivers have different rules. My understanding is that for high-volume rivers, it's better to dispose of strained dishwater into the river. For smaller rivers (Smith, MFS), you're supposed to disperse the water above the high water line and away from camp. For low use camps, I guess this could make sense, that eventually the rain will do it's thing and it'll soak into the ground. For desert trips or popular camps, this just seems like a recipe for attracting pests. Even if you could strain every bit of food, there's still going to be oils and dissolved sugars which will get tossed on the ground. Maybe my concept of how much oil/sugar/small stuff gets left behind is wrong. I'm assuming these rules have science/research behind them. Any thoughts or ideas on this?

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Ask a question on the next live show Some of the Questions that Zach covered in the Q&A section of this episode Topic: 40k Rogue Hi, Zach. Hope things are well How was the Wind Race? Some AW staff and Board and families were planning to paddle the Rogue April 6-8 after the Board meeting. But it looks like the flow forecast shows 40k. Thoughts on the Rogue at high flows? Topic: High Float PFD Hope you are well. Not sure you remember me, I have done a Rogue rowing school and a regular Rogue trip with NWRC (though it was some time ago). You have also been kind enough to answer a couple of questions for me and I think my son, Nathan, has been in touch with you once or twice. I have another question, if I may. Many years ago you answered my question on a recommendation for a PFD, you recommended the Kokatat Maximus. I have had two of them and since I am typing this email they have both done their job perfectly! Sadly both the second Maximus and I are getting long in the tooth. I think it may be time to up my flotation. Doing a bit of looking, there seem to be two out there that have 22 lbs of floatation, NRS big Water Guide and the Astral Indus. I vaguely recall you were not a big fan of NRS PDF's (I could be 100% wrong on that and please feel free to correct me if I am) and I do seem to prefer the Astral. Though the rescue harness is a little unnecessary for me to have since I could not imagine any situation being improved by me being live bait. If you have any thoughts on these two or any others it would be greatly appreciated. Topic: Mustang Dry Suit I saw your video on dry suits and I'm curious what you think about Mustang's newish neoprene necked drysuit? They seem to claim that it's dry, I have issues with tight neck gaskets and am considering giving it a shot. Curious if you have tried it or have any thoughts. Topic: River Trip Roster One idea for a future YouTube segment: How to assemble the right crew for your next private river trip. Personalities, skills, chores, kids/no kids, shared goals, etc. I've been fortunate to be on some great Grand Canyon and Salmon trips and it's been thanks to strong vision and leadership from permit holders / trip leaders.

Welcome to episode 232 of the Women's Running podcast. I'm your host Esther Newman and she's your other host Holly Taylor. On this podcast we talk about health, politics, stuff on TV and what we ate last night. Occasionally, we talk about running.This episode is sponsored by Coopah, the running app. Use the code WOMENSRUNNING when you sign up for 2 free weeks and a further 20% off for a whole year.Marathon trainingWe're talking training, and we're talking pop psychology – two of our most favourite things. See if you can figure out what's going on with our deeply troubling psyches. Speaking of which, Holly tries to persuade me to watch The Traitors – if you also avoid reality TV, let us know if she manages to persuade you. We also talk about looking forward to going to the NRS this weekend – if you're coming along, do please pop by to our stand and say hi!Coopah supportWe have another Jordan segment this week, as she checks in to see how our training is going using the Coopah training app. She explains how our training is like a sandwich, and we're very keen to find out what constitutes the pickle. And we're also very keen to find out if anyone cheats the plan! Do let us know!Lovely extra bitsThis episode is sponsored by Coopah. Coopah are offering all pod squadders a 2-week free trial of their app and then giving 20% off their standard annual subscription price. Just download the Coopah app and use the code WOMENSRUNNING when you sign up. Or visit coopah.com/womensrunning where you can find all of these details.·      Subscribe to Women's Running – and you'll save 50%Setting up your own podcast? Try Zencastr – we've been using it for ages and LOVE ITDownload a FREE mini mag to help you run 5K! Go to womensrunning.co.uk/runBuy a Pod Squad t-shirt!Do join us on Patreon so you can come and chat in our new Pod Squad community on Discord! Go to patreon.co.uk/womensrunningEmail us at wrpodcast@anthem.co.uk with any questions or running stories Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

What if you could cheat aging, indulge in life's guilty pleasures, and still thrive? Dr. Sandra Kaufmann, a pioneering longevity expert and fearless explorer of the biochemical frontier, joins Dave to reveal how you can bend the rules of biology to live longer, smarter, and stronger. Forget perfection—Dr. Kaufmann's radically practical approach embraces the human side of longevity, showing you how to optimize your body while enjoying the ride. From downing Diet Cokes to defying traditional medical dogma, she's rewritten the playbook on anti-aging with her Seven Tenets of Aging. Together, she and Dave dive into everything from molecular hacks for outsmarting junk food to unlocking the secret power of your mitochondria, DNA, and circadian rhythms. This episode goes beyond the surface with mind-blowing insights, hilarious moments, and actionable steps to take your health (and your fun) to the next level. What You'll Learn: • The Seven Tenets of Aging and how they'll change your approach to health • Why indulging in “bad” habits doesn't have to sabotage your longevity • Biochemical secrets to combat oxidative stress, glycation, and cellular junk • The real story behind NAD, circadian rhythms, and the tools for better sleep • How to create a personalized health plan that's sustainable, effective—and fun Resources: • Supplement Protocol One-Sheet for this episode: https://www.instagram.com/dave.asprey/?hl=en• 2025 Biohacking Conference: https://biohackingconference.com/2025 • Kaufmann Protocol Website: https://kaufmannprotocol.com • Sandra Kaufmann's Book – Why We Age and How to Stop It: https://www.amazon.com/Kaufmann-Protocol-Why-Age-Stop/dp/0692089047 • Sandra Kaufmann's Instagram: https://www.instagram.com/kaufmannantiaging/?hl=en • Danger Coffee: https://dangercoffee.com • Dave Asprey's Website: https://daveasprey.com • Dave Asprey's Book – Smarter Not Harder: https://daveasprey.com/books • Dave Asprey's Linktree: https://linktr.ee/daveasprey • Upgrade Collective – Join The Human Upgrade Podcast Live: https://www.ourupgradecollective.com • Own an Upgrade Labs: https://ownanupgradelabs.com • Upgrade Labs: https://upgradelabs.com • 40 Years of Zen – Neurofeedback Training for Advanced Cognitive Enhancement: https://40yearsofzen.com SPONSORS: Leela Quantum | Head to https://leelaq.com/DAVE for 10% off. Timeline | Head to https://www.timeline.com/dave to get 10% off your first order. Timestamps: • 00:00 Trailer • 00:45 Guest Introduction • 02:30 Longevity Insights • 04:22 Personal Stories • 08:00 Pharmaceuticals • 12:26 Diet and Lifestyle • 18:19 Seven Tenets • 22:04 Sleep and Circadian Rhythms • 26:41 NAD and Supplements • 37:46 Blood Sugar and AGEs • 47:09 Microcirculation • 49:08 NRS and Imports • 49:18 Cellbex Medication • 50:03 Cellbex Benefits • 50:41 Alzheimer's and Cellbex • 51:28 Antioxidants • 54:26 Stem Cells and Exosomes • 58:03 Laser Skin Treatments • 01:07:34 Hormones and Longevity • 01:20:03 Lithium for Mood • 01:27:45 Gender and Longevity • 01:32:39 Final Thoughts See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

13 Who is wise and understanding among you? Show by your good life that your works are done with gentleness born of wisdom. 14 But if you have bitter envy and selfish ambition in your hearts, do not be boastful and false to the truth. 15 Such wisdom does not come down from above, but is earthly, unspiritual, devilish. 16 For where there is envy and selfish ambition, there will also be disorder and wickedness of every kind. 17 But the wisdom from above is first pure, then peaceable, gentle, willing to yield, full of mercy and good fruits, without a trace of partiality or hypocrisy. (James 3:13-17 NRS)

13 Who is wise and understanding among you? Show by your good life that your works are done with gentleness born of wisdom. 14 But if you have bitter envy and selfish ambition in your hearts, do not be boastful and false to the truth. 15 Such wisdom does not come down from above, but is earthly, unspiritual, devilish. 16 For where there is envy and selfish ambition, there will also be disorder and wickedness of every kind.17 But the wisdom from above is first pure, then peaceable, gentle, willing to yield, full of mercy and good fruits, without a trace of partiality or hypocrisy. (James 3:13-17 NRS)

Darby McAdams holds many places in the river world: kayaker, film maker & instructor of both kayaking and film work for young paddlers. In November of 2024 her new film NEAR THE RIVER went public. In this episode Darby moves through her kayak path, her film path and talks about NEAR THE RIVER and its story about the people of the Zambezi River in Africa. DARBY MCADAMSNear the River filmIGRiver Roots Film ProductionNRS Dirtbag Diaries:  “Darby McAdams & the Evolution of Passion” by Chandra BrownSPONSORSDenver Area Nissan Dealers@nissanusaOver It Raft Covers@overitraftcoverspromo code, free shipping: riverradius   THE RIVER RADIUSWebsiteInstagramFacebookApple PodcastSpotifyLink Tree

In this episode of The Discomfort Zone Podcast, I sit down with Danny Mongno, a true paddling industry veteran, as he opens up about his journey through the highs and lows of a career in paddle sports. From his passion for teaching to overcoming physical challenges like hip surgeries, Danny shares the resilience it takes to stay active in an ever-evolving outdoor industry. We delve into the impact of e-commerce on small retailers, the growing significance of fitness and personal connections, and how the paddling community is shifting focus toward athletes who lift others up. Discover how Danny, through his work at NRS, is supporting events that are reuniting paddlers, amplifying women's voices, and empowering athletes to make a lasting impact. This episode is a must-listen for anyone passionate about the outdoors, community, and the power of connection in sports.

12 Take care, brothers and sisters, that none of you may have an evil, unbelieving heart that turns away from the living God. 13 But exhort one another every day, as long as it is called "today," so that none of you may be hardened by the deceitfulness of sin.14 For we have become partners of Christ, if only we hold our first confidence firm to the end. (Heb 3:12-14 NRS)

Join me as I interview my friend and regular student at NRS, Mr. Jayberry Miller.  Jayberry is a young businessman who has an integrity that surpasses many in the industry. His gear is top notch, as well as his character.  Listen in as we discuss his business strategy, details of how he makes gear and much more.  The NRS Online Membership is THE best way to get the most up to date content for our followers: https://bit.ly/NRSONLINE Please check out our preferred gear provider, Tuff Possum Gear. Use code NATURERELIANCE for 10% off: https://tuffpossumgear.com/ Dont forget to go check out our NRS Online Membership for the best and most up-to-date content: https://bit.ly/NRSONLINEWild Times: Wildlife EducationWildlife mysteries, crazy news, and daring animal stories—listen now!Listen on: Apple Podcasts SpotifyThanks for listening! Follow us at Nature Reliance School.

The stolen documents case is back! Judge Aileen Cannon dismissed the charges against Trump and his goons in July on the theory that special counsels are illegal, and Monday Special Counsel Jack Smith filed his brief to the Eleventh Circuit explaining why she is very obviously wrong. Plus, RFK Jr. dropped out and endorsed Trump. Does that mean he's off the ballot everywhere? Links: Jack Smith 11th Cir Brief https://storage.courtlistener.com/recap/gov.uscourts.ca11.87822/gov.uscourts.ca11.87822.18.0_1.pdf   Trump v. US https://www.supremecourt.gov/opinions/23pdf/23-939_e2pg.pdf 18 USC 599 https://www.law.cornell.edu/uscode/text/18/599 ADLF Complaint re: Trump/Carson https://static.politico.com/83/4d/90f795464ab58210ca25aa3a1af7/adlf-complaint.pdf NRS 293.202 https://www.leg.state.nv.us/nrs/nrs-293.html New Yorker profile https://www.newyorker.com/magazine/2024/08/12/robert-f-kennedy-jr-profile-presidential-campaign Show Links: https://www.lawandchaospod.com/ BlueSky: @LawAndChaosPod Threads: @LawAndChaosPod Twitter: @LawAndChaosPod Patreon: patreon.com/LawAndChaosPod

Spyware is discovered on U.S. hotel check in systems. A Microsoft outage affects multiple services. Bitdefender uncovers Unfading Sea Haze. University of Maryland researchers find flaws in Apple's Wi-Fi positioning system. Scotland's NRS reveals a sensitive data leak. Rapid7 tracks the rise in zero-day exploits and mass compromise events. The SEC hits the operator of the New York Stock Exchange with a ten million dollar fine. Operation Diplomatic Specter targets political entities in the Middle East, Africa, and Asia. The FCC considers AI disclosure rules for political ads. N2K T-Minus Space Daily podcast host Maria Varmazis speaks with guests Brianna Bace and Unal Tatar PhD sharing their work on Legal Perspectives on Cyberattacks Targeting Space Systems. Tone-blasting underwater data centers.  Our 2024 N2K CyberWire Audience Survey is underway, make your voice heard and get in the running for a $100 Amazon gift card. Remember to leave us a 5-star rating and review in your favorite podcast app. Miss an episode? Sign-up for our daily intelligence roundup, Daily Briefing, and you'll never miss a beat. And be sure to follow CyberWire Daily on LinkedIn. CyberWire Guest N2K T-Minus Space Daily podcast host Maria Varmazis speaks with guests Brianna Bace and Unal Tatar PhD sharing their work on their paper: Law in Orbit: International Legal Perspectives on Cyberattacks Targeting Space Systems. You can learn more about their work in this post. Check out T-Minus Space Daily for your daily space intelligence.  Selected Reading Spyware found on US hotel check-in computers ( TechCrunch) Microsoft outage affects Bing, Copilot, DuckDuckGo and ChatGPT internet search (Bleeping Computer) Deep Dive Into Unfading Sea Haze: A New Threat Actor in the South China Sea (Bitdefender)  Apple's Wi-Fi Positioning Can Be System Abused To Track Users (GB Hackers)  National Records of Scotland Data Breached in NHS Cyber-Attack (Infosecurity Magazine) Zero-Day Attacks and Supply Chain Compromises Surge, MFA Remains Underutilized: Rapid7 Report (SecurityWeek) NYSE Operator Intercontinental Exchange Gets $10M SEC Fine Over 2021 Hack (SecurityWeek) Operation Diplomatic Specter: An Active Chinese Cyberespionage Campaign Leverages Rare Tool Set to Target Governmental Entities in the Middle East, Africa and Asia (Palo Alto Networks Unit 42 Intel) FCC chair proposes requirement for political ads to disclose when AI content is used (The Record) Acoustic attacks could be a serious threat to the future of underwater data centers (TechSpot) Share your feedback. We want to ensure that you are getting the most out of the podcast. Please take a few minutes to share your thoughts with us by completing our brief listener survey as we continually work to improve the show.  Want to hear your company in the show? You too can reach the most influential leaders and operators in the industry. Here's our media kit. Contact us at cyberwire@n2k.com to request more info. The CyberWire is a production of N2K Networks, your source for strategic workforce intelligence. © N2K Networks, Inc.