Podcasts about Pain management

The final instalment of our series “Perioperative Pain Management” is a panel discussion where we answer the question: What are the various challenges and strategies in managing perioperative pain, particularly with regard to opioid use? The discussion covers the complexities of opioid de-escalation in preoperative periods, the benefits and risks of opioid-free anesthesia, and the use of multimodal approaches. We also touch on the coordination of patient care across multiple specialties and the impact of intraoperative practices on postoperative pain management and long-term opioid use. The session emphasizes the importance of patient education, consistent communication, and empowered collaboration among healthcare providers. The speakers on the panel are; Tim Miller, Professor of Anesthesiology at Duke University Medical Center, Fauzia Hasnie, Consultant Lead, Opioid Multidisciplinary Pain Management Clinic, Joint Lead, Combined Sickle-Opioid Virtual Multidisciplinary Clinic Guy's & St Thomas' NHS Foundation Trust, and Esteban Salas Rezola, Specialist in Anaesthesiology, Resuscitation and Pain Therapy at Hospital General Alicante. Chaired by John Whittle, Clinical Academic working in Perioperative Translational Medicine at UCL and Honorary Consultant in Perioperative Medicine, Anaesthesia and Critical Care at University College Hospitals London. The three presentations which accompany this piece are here: https://topmedtalk.libsyn.com/perioperative-pain-management-the-opioid-epidemic-and-opioid-reduction-strategies https://topmedtalk.libsyn.com/perioperative-pain-management-opioid-reduction-service https://topmedtalk.libsyn.com/perioperative-pain-management-opioid-sparing-analgesia-strategies-guided-by-nol-index

Episode 80: Balancing Relief and Risk: Pain Management and Opioid Prescribing in Children and Adolescents   Evaluation and Credit:  https://www.surveymonkey.com/r/medchat80 Target Audience             This activity is targeted toward primary care physicians and advanced providers. Statement of Need This podcast will address effective pain management in adolescents and teens and the utilization of opioids and risk reduction. Pediatricians may not have up-to-date knowledge and skills to effectively balance pain management with opioid safety in children and adolescents. Current practice often reflects underuse of multimodal pain strategies, inconsistent application of opioid prescribing guidelines, and limited screening for substance use disorders (SUDs) in youth. This educational activity addresses the gap between current and optimal practice by enhancing pediatricians' competence in evidence-based opioid prescribing and their performance in implementing risk mitigation strategies in clinical settings. Objectives Describe evidence-based guidelines for prescribing opioids in a manner that optimizes both pain treatment and safety for children and adolescents (“youth”). Discuss evidence-based strategies for the prevention, screening, and treatment for substance use disorders in youth. ModeratorMark McDonald, M.D., MHA, CPE System Vice President Pediatric Medical Affairs Medical Director, Norton Children's Louisville, Kentucky SpeakerScott E. Hadland, M.D., MPH, MS Associate Professor of Pediatrics Chief, Division of Adolescent and Young Adult Medicin Mass General Hospital for Children / Harvard Medical School Boston, MA Moderator, Speaker and Planner Disclosures  The planners, moderator and speaker of this activity do not have any relevant financial relationships with ineligible companies to disclose.   Commercial Support  There was no commercial support for this activity.    Physician Credits Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians. Designation Norton Healthcare designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. HB1This program has been approved for .75 HB1 credit hours by the Kentucky Board of Medical Licensure, ID# 037-H.75 NHC3A. Nursing Credits Norton Healthcare Institute for Education and Development is approved as a provider of nursing continuing professional development by the South Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. This continuing professional development activity has been approved for 0.75 ANCC CE contact hours.  In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance.  For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org.   Resources for Additional Study/References Screening to Brief Intervention (S2BI) https://nida.nih.gov/s2bi Brief Screener to Tabacco, Alcohol, and other Drugs https://nida.nih.gov/bstad/ Crafft Screening Tools https://crafft.org/ Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings: Clinical Practice Guideline https://publications.aap.org/pediatrics/article/154/5/e2024068752/199482/Opioid-Prescribing-for-Acute-Pain-Management-in?autologincheck=redirected Find Treatment Website https://findtreatment.gov/   Date of Original Release | July 2025; Information is current as of the time of recording. Course Termination Date | July 2028 Contact Information | Center for Continuing Medical Education; (502) 446-5955 or cme@nortonhealthcare.org Also listen to Norton Healthcare's podcast Stronger After Stroke. This podcast, produced by the Norton Neuroscience Institute, discusses difficult topics, answers frequently asked questions and provides survivor stories that provide hope. Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. More information about Norton Healthcare is available at NortonHealthcare.com.    

157 Understanding Hospice Care with Hospital Chaplain Janice Willett Part 2 In this episode of 'Hospice Explained,' host Marie Betcher RN, a former hospice nurse, interviews Janice Willett, a hospital spiritual care chaplain and author of several inspirational books. Janice shares her experiences and insights into end-of-life care, discussing her books 'Affairs of the Heart,' 'Dying Without Crying,' and 'Bye-Bye Butterfly.' These books offer guidance and support for patients, caregivers, and children dealing with grief and loss. The episode also touches on the importance of comfort, boundaries, and forgiveness in hospice care, as well as the vital role of chaplains in providing emotional and spiritual support. 00:00 Introduction to Hospice Explained 00:49 Understanding Pressure Injuries and Cloud 9 Care System 01:25 Introducing Janice Willett and Her Work 02:04 Discussing Fear of Death and Pain Management 04:43 Exploring Janice's Book: Dying Without Crying 07:36 Communicating Grief to Children: Bye-Bye Butterfly 17:03 The Role of a Chaplain in Hospice Care 19:18 Janice's Spiritual Journey and Her Book: Affairs of the Heart 25:17 Conclusion and Contact Information   https://jiwillett.com/meet-j-i-willett/   Hospice Explained Affiliates & Contact Information Buying from these Affilite links will help support this Podcast.  Maire introduces a partnership with Suzanne Mayer RN inventor of the  cloud9caresystem.com,  When patients remain in the same position for extended periods, they are at high risk of developing pressure injuries, commonly known as bedsores. One of the biggest challenges caregivers face is the tendency for pillows and repositioning inserts to easily dislodge during care.(Suzanne is a former guest on Episode #119) When you order with Cloud 9 care system, please tell them you heard about them from Hospice Explained.(Thank You)  If you would, you can donate to help support Hospice Explained at the Buy me a Coffee link  https://www.buymeacoffee.com/Hospice Marie's Contact Marie@HospiceExplained.com www.HospiceExplained.com   Finding a Hospice Agency 1. You can use Medicare.gov to help find a hospice agency, 2. choose Find provider 3. Choose Hospice 4. then add your zip code This should be a list of Hospice Agencies local to you or your loved one.

This series of talks hits upon one of the longstanding themes of TopMedTalk, opioids and opioid reduction in a perioperative setting. We discuss the opioid epidemic, the issue of persistent opioid use after surgery, and strategies for opioid reduction. Topics include historical usage, the dangers of high-dose opioids, and alternative pain management techniques such as opioid-free anesthesia and multimodal analgesia. The discussion also highlights the importance of ongoing research, patient education, and evidence-based practices to minimize the side effects of opioids while ensuring effective pain management. Presented by Tim Miller, Professor of Anesthesiology at Duke University Medical Center. Tim completed his training in Nottingham, UK followed by a fellowship in cardiothoracic anaesthesia at Glenfield Hospital, Leicester, UK. He is a fellow of the Royal College of Anaesthetists.

In this episode of The Matt Feret Show I interview pain management pioneer Dr. Mitchell Yass. Dr. Yass is a physical therapist with over thirty years of experience treating individuals with chronic and episodic pain. Dr. Yass shares how he became disillusioned with traditional methods of treating chronic pain through his experience as a physical therapist and why he decided to develop his unique approach to pain management. He also shares expert advice and guidance to those questioning their experience with chronic pain treatment. Watch this episode on YouTube.Introduction to Dr. Mitchell Yass with Matt Feret [1:09]Dr. Mitchell Yass' Tumor and Recovery [05:41]Dr. Mitchell Yass' Perspective on the Root of Chronic Pain [13:23]The Yass Method of Pain Management with Dr. Mitchell Yass [28:07]Conclusion and Final Message with Matt Feret and Dr. Mitchell Yass [59:03]Connect with me via the podcast website, LinkedIn, Facebook, and Instagram.Check out Dr. Yass' YouTube, LinkedIn, Amazon bookstore, and The Yass Method website. Hosted on Acast. See acast.com/privacy for more information.

Michael Huot, M.D., Director of Pain Management, Pain Specialist, Anesthesiologist and Chief of Staff of Rapid City Hospital reveals the responsibilities of a hospital Chief of Staff. Referencing Rapid City Hospital's vast improvement in safety ratings, Dr. Huot provides insight on his approach to leadership and reflects on how he has made an impact during his tenure. He also gives historical details and legal reasons for why the position of Chief of Staff came to be important, how the position is chosen at Monument Health and the learning curve that comes along with accepting the role. Hosted on Acast. See acast.com/privacy for more information.

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In this episode, I sat down with Katie Dabrowski to explore the relationship between neuroscience, psychology, and injury rehab. We discussed how pain is not just a physical sensation but a complex experience influenced by emotional states, past experiences, and neuroplasticity. We also touched on the importance of movement, progressive overload, and understanding the psychological aspects of pain management. We closed out the episode with a discussion about the future of training as healthcare and the need for a holistic approach to rehab that goes beyond just addressing pain.TakeawaysNeuroscience and psychology are crucial in understanding rehab.Pain is a complex experience influenced by many factors.Neuroplasticity allows the brain to adapt and recover from injuries.Experiences shape our pain perception and responses.Understanding pain can reduce anxiety and improve outcomes.Movement is essential in managing pain and building resilience.Progressive overload applies to both physical and emotional challenges.Fear of pain can lead to avoidance and further issues.Building confidence through manageable challenges is key.The future of rehab should focus on holistic health, not just pain.Get In Touch With Katie: https://www.instagram.com/ktdabrowski/Old Bull Athletics: https://www.instagram.com/oldbullathletics/Get 4 FREE Weeks of Hybrid Training: https://assembleperformance.com/4-week-training-plan-page Contact Me IG: https://www.instagram.com/justinsjones/ Email: justin@assembleperformance.com Website: https://assembleperformance.com/ Youtube: https://www.youtube.com/@justinjonesfitness

Where does cryoneurolysis fit in contemporary pain management? In this episode of Backtable MSK, host Jacob Fleming is joined by Dr. Alexa Levey to discuss the role of cryoneurolysis in various pain presentations, covering indications, anatomical targets, and techniques in different clinical scenarios. --- SYNPOSIS This episode offers practical guidance on how to take a detailed patient history, how to use cryoneurolysis for pain management, and the significance of multidisciplinary collaboration. The conversation also highlights the importance of setting proper patient expectations, understanding different types of pain, and the need for standardizing cryoneurolysis procedures through structured research and education.Dr. Levey also shares her recent career move to Yale, her passion for research, and the challenges she faced returning to academia from private practice. --- TIMESTAMPS 00:00 - Introduction03:49 - Discussion of Dr. Levey's Recent Research Paper09:35 - The Fine Details of Pain and Pain Management 18:42 - Patient Quality of Life Assessment in Regards to Pain Management28:28 - Game Plan for Managing Neuritis37:19 - Collaboration Between Different Specialists40:16 - Offering Patient Education and Support 42:31 - Final Reflections and Gratitude --- RESOURCES Dr. Alexa Leveyhttps://medicine.yale.edu/profile/alexa-levey/ Common Cryoneurolysis Targets in Pain Management: Indications, Critical Anatomy, and Potential Complicationshttps://pubmed.ncbi.nlm.nih.gov/40376212/

In this piece we look at the opioid crisis in the UK and how it has translated into clinical practice. Hear about the history and data behind opioid prescription trends, specifically highlighting the high-risk patient demographics and mortality figures associated with opioid use. Learn how a multidisciplinary approach, taken by the opioid reduction service at Guy's & St. Thomas', helps showcase early outcome data and the strategies employed in opioid weaning. Emphasizing the importance of patient engagement and personalized care we detail the clinic's processes, preparations, and long-term strategies for opioid tapering. The episode concludes with a compelling patient testimonial video reflecting the positive outcomes of the service. Fauzia Hasnie, Consultant Lead, Opioid Multidisciplinary Pain Management Clinic, Joint Lead, Combined Sickle-Opioid Virtual Multidisciplinary Clinic Guy's & St Thomas' NHS Foundation Trust. Resources: UK National Institute for Health Care Excellence (NICE) guidelines: Overview | Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults | Guidance | NICE US Centers for Disease Control and Prevention (CDC): Guideline Recommendations and Guiding Principles | Overdose Prevention | CDC

Listen to this next: Most Back Pain Advice Fails For High Achievers - Here's Why Something changed with my dog recently, and it caught me off guard. The way her body started to break down felt familiar, almost like I'd seen it before. And I had… just not in dogs. What I learned from helping her has completely changed how I think about injury, pain, and staying strong as we age. If you've been dealing with back pain or just feel like your body isn't what it used to be, this might shift how you see everything. Book a call with us: Click Here Watch This Video To Understand My Process:  Back Pain Fix I Wish I Knew Earlier (My Story) Music: Dean Kenny

On this special episode of the Architect of Resilience Podcast, host Chris Duffin welcomes back Dr. Rahul Desai, a regenerative musculoskeletal radiologist and expert in innovative therapies for joint and spine health. Originally recorded during a private member community session, this conversation dives deep into the cutting-edge world of red and near-infrared light therapy—otherwise known as photobiomodulation. Dr. Desai shares his extensive experience using platelet-rich plasma (PRP), bone marrow, and fat-derived treatments to help patients heal without surgery, and he unpacks the science and safety of red light therapy for tissue regeneration, pain relief, and overall wellness. The discussion is packed with direct audience questions, revealing practical insights on treatment timing, optimal dosing, systemic versus local effects, and the latest research on using light therapy for everything from injury recovery to anti-aging and sleep.   This episode of the ARCHITECT of RESILIENCE podcast is available on Apple, Spotify & YouTube, and is sponsored by  @marekhealth : Performance. Longevity. Optimization.

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What happens when you're already drowning in chronic pain—and then life throws drywall, sawdust, and emotional chaos on top of it? In this episode, Lyndsay Soprano gets real about the mess behind the scenes: home renovation hell, relentless exhaustion, and the kind of stress that clings to your skin.This isn't a glamorized version of pushing through. It's about those moments when everything feels too loud, too heavy, too much. Lyndsay opens up about the toll that physical pain takes when you're not numbing it, and how hard it can be to walk away from things—even when they're clearly not serving you. She shares what it's like to live in a body that feels like a battleground, and how something as simple as a swim can feel like coming home.More than anything, she talks about finding purpose inside the pain. The power of community. The reminder that you are not your diagnosis. And the importance of setting boundaries that protect your peace—especially when life feels like a construction zone.This one's for anyone who feels like their body is breaking and their life is a little too chaotic to keep pretending everything's fine.Tune in if you're craving honesty, connection, and a little more room to breathe.Find The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastEpisode Highlights:(00:00) Introduction to Chronic Pain and Trauma(02:38) Living with Chronic Pain: Personal Struggles(10:54) Coping Mechanisms and Strategies(16:57) Conclusion and Community Engagement

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.

In this conversation, Dr. Ashley and Dr. Lizellen LaFollette, MD discuss the various stages of pregnancy, focusing on pain management, physical changes, and the importance of support systems. They explore the first, second, and third trimesters, addressing common aches and pains, as well as the postpartum recovery phase. The discussion emphasizes the need for communication with healthcare providers, the role of physical therapy, and the long-term health considerations for women, including menopause.You can reach out to Dr. LaFollette directly here: Check out our favorite products! (affiliate page): https://ifixyoursciatica.gymleadmachine.co/favorite_productsDid you know that our YouTube channel has a growing number of videos including this podcast? Give us a follow here- https://youtube.com/@fixyoursciatica?si=1svrz6M7RsnFaswNAre you looking for a more affordable way to manage your pain? Check out the patient advocate program here: ptpatientadvocate.comHere's the self cheat sheet for symptom management: https://ifixyoursciatica.gymleadmachine.co/self-treatment-cheat-sheet-8707Book a free strategy call: https://msgsndr.com/widget/appointment/ifixyoursciatica/strategy-callSupport this podcast at — https://redcircle.com/fix-your-sciatica-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

This piece focuses on strategies for opioid-sparing anesthesia guided by the NOL Index, emphasizing the variability in patient responses to opioids. The importance of monitoring nociception, using advanced devices and techniques to customize opioid dosing, reduce side effects, and confirm the effectiveness of regional anesthesia. Our presenter shares personal experiences from their professional life and case studies, illustrating the benefits and challenges of implementing multimodal and opioid-free anesthesia approaches. The talk highlights the need for individualized treatment strategies in critical care and anesthesia. Presented by Esteban Salas Rezola, Specialist in Anaesthesiology, Resuscitation and Pain Therapy at Hospital General Alicante.

Southern Remedy Healthy and Fit is hosted by Josie Bidwell, Professor of Preventive Medicine and Nurse Practitioner at UMMC. If you have a question for Josie, you can email fit@mpbonline.org. It this episode, Josie talks about pain management with Dr. Kevin Vance, Medical Director of the Comprehensive Pain Management Center of Mississippi. Hosted on Acast. See acast.com/privacy for more information.

Dr. Ankeet Choxi is an interventional pain management physician focused on treating the root cause of pain, not just masking it. During his anesthesiology residency, he discovered his passion for helping people heal through less invasive, regenerative techniques.Rather than relying on medications, Dr. Choxi takes a multimodal approach using targeted injections, PRP, stem cells, and exosomes to reduce inflammation and promote tissue repair. He often combines these with physical therapy, shockwave, or hyperbaric oxygen to speed recovery and improve outcomes.Patients travel from around the world to his South Florida clinic, where collaboration is at the heart of care. He works alongside Dr. Jarred Mait, who brings a background in integrative and functional medicine, to offer a truly root-cause, whole-body approach to pain management.To learn more about South Florida Pain and Regenerative Specialist Dr. Ankeet Choxi Learn more about Stems Health Regenerative MedicineFollow Dr. Choxi on Instagram @achoxiFollow Dr. Choxi's practice on Instagram @stemshealthABOUT MEET THE DOCTOR The purpose of the Meet the Doctor podcast is simple.  We want you to get to know your doctor before meeting them in person because you're making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you're interested in. There's no substitute for an in-person appointment, but we hope this comes close.Meet The Doctor is a production of The Axis. Made with love in Austin, Texas.Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast?  Book a free 30 minute recording session at meetthedoctorpodcast.com.Host: Eva Sheie Assistant Producers: Mary Ellen Clarkson & Hannah BurkhartEngineering: Ian PowellTheme music: A Grace Sufficient by JOYSPRING

Send us a textHillary Kallenberger is a dedicated yoga teacher based on the west coast of Florida, known for her transformative approach to body movement and mindfulness. With a rich background in high-level dance performance in New York, Hillary transitioned into yoga and bodywork, combining her passion for movement with a keen understanding of the human body. Previously a licensed counselor, Hilary has excelled in betterment coaching, helping clients achieve holistic wellness. Her recent journey through hip replacement surgery has further deepened her personal insights, enhancing her empathetic and therapeutic approach to teaching yoga and assisting others.Visit Hillary: https://www.currentmanifestationssrq.com/Key Takeaways:Embracing modern medicine alongside natural healing can be an essential part of recovery, even for those committed to holistic practices.Experiencing acute pain can lead to unexpected personal growth and a deeper connection with one's body.Self-compassion and asking for help are vital components of healing and personal well-being.Practicing gratitude and presence can transform one's relationship with their body and promote holistic healing.Thanks for listening to this episode. Check out:

Common issues like sleep problems or chronic pain can keep you from living your best life. Delivra Health Brands (TSXV: DHB | OTCQB: DHBUF) is helping people reclaim mobility through clinically proven solutions.President & CEO Gord Davey shares what makes the company stand out in the health and wellness space—from formulations developed by Dr. Joseph Gabriele to real customer feedback and upcoming innovations aimed at enhancing their proprietary products, Dream Water® and LivRelief™.Watch the full interview and discover why consumers in over 20 countries choose Delivra Health Brands for trusted wellness solutions.Explore how Delivra Health Brands can help with sleeplessness and pain management: https://www.delivrahealthbrands.com/    Watch the full YouTube interview here: https://youtu.be/K34GBeMJPik?si=X8CS2iazZR_zrz39  And follow us to stay updated: https://www.youtube.com/@GlobalOneMedia?sub_confirmation=1

This week, Carl is excited to welcome Dr. David Bass, a renowned chiropractic therapist, acupuncturist, and inventor. As the founder of the Neck & Back Pain Institute of Coral Springs, a treatment and training facility centered around the Antalgic-Trak®, Dr. Bass is transforming the path to pain relief. In this chat, Carl and David discuss Dr. Bass's unique journey from being one of the most successful chiropractic practitioners in the Northeast to relocating to Florida, where he developed the innovative Antalgic-Trak®. This groundbreaking piece of medical equipment has revolutionized spine pain management, providing relief to countless patients worldwide. Dr. Bass shares the inspiration behind the device, the challenges he faced during its development, and the eventual global success of his incredible invention. Carl also shares his personal testimony of overcoming chronic back pain through Dr. Bass's treatments, underscoring the device's effectiveness and Dr. Bass's compassionate approach to health care, pain management, and recovery.   Connect with Dr. David and The Neck & Back Pain Institute: Website LinkedIn Facebook    Connect with Carl: Instagram Facebook LinkedIn YouTube Website   Produced by: Social Chameleon

Each month, the VA Office of Inspector General publishes highlights of our oversight reports, congressional testimony, and investigative work. In May 2025, the VA OIG published 11 reports that included 54 recommendations. Report topics varied from an audit of the VHA's Pain Management, Opioid Safety, and Prescription Drug Monitoring Program to a healthcare inspection to assess allegations of deficiencies in the emergency department care provided to a patient at the Martinsburg VA Medical Center in West Virginia.  On Capitol Hill, Deputy Assistant IG Brent Arronte, in the Office of Audits and Evaluations, testified on May 14 before the House Veterans' Affairs' Subcommittee on Disability Assistance and Memorial Affairs. His testimony focused on the OIG's independent oversight of VA's compensation and benefits programs, specifically how inadequate staff training combined with often unclear and inadequate guidance contribute to incorrect payments being made to veterans.  VA OIG investigative efforts resulted in the sentencing of four defendants for their roles in an $110 million healthcare kickback scheme. Meanwhile, a former nurse at the Michael E. DeBakey VA Medical Center in Houston was indicted for falsely claiming she had checked on a patient who ultimately died. Read the full monthly highlights at: https://www.vaoig.gov/report/monthly-highlights  Related Reports: Better Communication and Oversight Could Improve How the Pain Management, Opioid Safety, and Prescription Drug Monitoring Program Manages Funds Failure to Flag Fiduciaries Who Were Removed Results in Risk to Vulnerable Beneficiaries Deficiencies in Emergency Care for a Female Veteran at Martinsburg VA Medical Center in West Virginia

Want to know if PEMF therapy could be the non-invasive, drug-free pain management solution you've been searching for? Read PEMFPod's guide to find out! Go to https://pemfpod.com/pemf-vs-fsm-vs-tens-differences-comparisons/ for more details. PEMFPod City: Clackamas Address: 10117 Southeast Sunnyside Road Ste F40 Website: https://pemfpod.com/

How to identify different types of pain, treatment options, and information about when you should be seeking help from a professional and what you can do at home. Brian Kvamme, CRNA and Prairie Doc Andrew Ellsworth answer our medical questions. prairi

We're diving into a question I get all the time as a coach, trainer, and someone who's worked with thousands of people in pain:"Should I stop doing this exercise if it hurts?"We talk pain, movement, injuries, mindset, posture, programming, tendons, recovery—you name it. And most importantly, we challenge the way most people think about pain.You'll hear stories from my personal journey of healing from ruptured tendons, broken bones, and all kinds of setbacks. You'll also learn about the 7 fundamental human movements every single person should be able to do—and what to do if pain is keeping you from doing them.This episode is about ownership. About reclaiming your power and rebuilding confidence in your body, one rep at a time. Because pain doesn't mean you're broken. It might actually be your body asking for your attention.Pain is not the end of the story. It's the beginning of your comeback.So whether you're a fitness newbie, a weekend warrior, or someone who's been struggling with chronic pain for years—this episode is a must-listen.Let's roll it back to one of the most important conversations we've ever had on this show. Here's your Throwback Thursday: “Should You Avoid Exercises If They Hurt? An Overview of Pain” — let's dive in.Resources:Brain.fm App(First month Free, then 20% off subscription)Discount Code: coachdamiensdCaldera Lab Skin Carewww.calderalab.comDiscount Code: CoachDLinks:IG:@coachdamien_sd@damienrayevans@livinthedream_podcast YouTube:https://www.youtube.com/channel/UCS6VuPgtVsdBpDj5oN3YQTgFB:https://www.facebook.com/coachdamienSD/

In this episode of The Healers Café, Manon Bolliger, FCAH, RBHT (facilitator and retired naturopath with 30+ years of practice) speaks to Dr. Mala who describes her recovery program, which integrated Western psychological theories with Eastern holistic approaches like yoga and meditation.   For the transcript and full story go to: https://www.drmanonbolliger.com/dr-mala     Highlights from today's episode include: Dr. Malasri Chaudhery-Malgeri shares her experiences working with the military, focusing on pain management, PTSD, and TBI, and the challenges of providing long-term care in a return-to-duty culture. Dr. Malasri Chaudhery-Malgeri explains that pain is a survival skill and that treating pain requires addressing the underlying causes, whether physical or emotional. She emphasizes the need for providers and patients to engage in a process of "why" to uncover the root causes of pain and trauma.  Manon Bolliger reflects on the importance of honoring one's true nature and using creative and holistic expressions to heal from trauma, emphasizing the role of the body in soul expression.   ABOUT DR MALA: Dr. Malasri Chaudhery-Malgeri brings both professional expertise and personal understanding to her work with trauma survivors. As a trauma survivor herself, her approach is deeply informed by lived experience, creating a unique bridge between clinical knowledge and authentic empathy. A respected authority in Traumatic Brain Injury, TBI, PTSD, and Military Psychology, Dr. Mala has pioneered integrative treatment approaches that address the complex interplay between physical trauma and psychological healing. Her multidisciplinary background spans Rehabilitative Therapy, Marriage & Family Psychology, and Industrial/Organizational Psychology, allowing her to create holistic recovery pathways for diverse populations. Dr. Mala's practice transcends traditional boundaries, serving military personnel, executives, political figures, rural communities, native populations, LGBTQ+ individuals, professional athletes, and families in crisis. Through her powerful speaking engagements, she transforms personal triumph over trauma into inspiration for others on their healing journey. Recovery.com | TheSynergyCentre.net | Facebook | Instagram | TikTok | LinkedIn    ABOUT MANON BOLLIGER, FCAH, RBHT  As a de-registered (2021) board-certified naturopathic physician & in practice since 1992, I've seen an average of 150 patients per week and have helped people ranging from rural farmers in Nova Scotia to stressed out CEOs in Toronto to tri-athletes here in Vancouver.  My resolve to educate, empower and engage people to take charge of their own health is evident in my best-selling books:  'What Patients Don't Say if Doctors Don't Ask: The Mindful Patient-Doctor Relationship' and 'A Healer in Every Household: Simple Solutions for Stress'.  I also teach BowenFirst™ Therapy through and hold transformational workshops to achieve these goals. So, when I share with you that LISTENING to Your body is a game changer in the healing process, I am speaking from expertise and direct experience". Manon's Mission: A Healer in Every Household!  For more great information to go to her weekly blog:  http://bowencollege.com/blog.  For tips on health & healing go to: https://www.drmanonbolliger.com/tips  Follow Manon on Social – Facebook | Instagram | LinkedIn | YouTube | Twitter | Linktr.ee | Rumble   ABOUT THE HEALERS CAFÉ:  Manon's show is the #1 show for medical practitioners and holistic healers to have heart to heart conversations about their day to day lives.  Subscribe and review on your favourite platform: iTunes | Google Play | Spotify | Libsyn | iHeartRadio | Gaana | The Healers Cafe | Radio.com | Medioq |   Follow The Healers Café on FB: https://www.facebook.com/thehealerscafe   Remember to subscribe if you like our videos. Click the bell if you want to be one of the first people notified of a new release.   * De-Registered, revoked & retired naturopathic physician after 30 years of practice in healthcare. Now resourceful & resolved to share with you all the tools to take care of your health & vitality!

Two-time Emmy and Three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald interviewed Shiloh Bigles. A certified functional nutrition counselor and founder of Level Minds CBD Health Club, joins Money Making Conversations Masterclass to discuss how CBD, functional nutrition, and holistic wellness help individuals manage pain, anxiety, and autoimmune disorders. She shares her personal experience overcoming lupus and Crohn’s disease through natural remedies.

Two-time Emmy and Three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald interviewed Shiloh Bigles. A certified functional nutrition counselor and founder of Level Minds CBD Health Club, joins Money Making Conversations Masterclass to discuss how CBD, functional nutrition, and holistic wellness help individuals manage pain, anxiety, and autoimmune disorders. She shares her personal experience overcoming lupus and Crohn’s disease through natural remedies.

  Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113

KARE is an Ayurvedic and Yoga Center located in the outskirts of Pune, India and focusing on Ayurveda, Iyengar Medical Yoga, nutrition and meditation. 

Welcome to Pain-Bytes, a bite-sized extension of The Pain Game Podcast! Hosted by our wild and crazy, Lyndsay Soprano, these drop every Friday and serve up small but mighty dose of real talk. Whether it's chronic pain, emotional chaos, unexpected wins, or everything in between—this is the space to say it out loud and be heard. Each Pain-Byte lets you in on a moment (or meltdown) from your week—because pain “bytes” but also…life bites back.  Lyndsay is also calling on YOU—our VIPs—to submit your wins, losses, struggles, celebrations, and everything in between. Whether it's a DM, email, or voice memo, let's share the load and spread some light. Because here, you are seen, heard, and held—even if it's just for a byte.

Send us a textIf you think joint pain is just part of getting older… think again. In this episode, I sit down with Jeff Bailey - founder of Avita Yoga and author of the upcoming book Mobility for Life: Healthy Joints, Strong Bones, and a Peaceful Mind - to talk about a radically different approach to joint health, healing, and pain relief after 50. After a devastating ski accident at 50 left Jeff with a wrecked hip and grim medical predictions, Jeff turned his pain into purpose by developing a practice that helps restore mobility and joint function - without surgery, without extreme stretching, and without feeling like a pretzel in spandex. We cover everything from why stretching isn't the answer, to how compression actually heals your joints, to what you should be doing right now to bulletproof your hips, shoulders, knees, and spine for the long haul. Whether you're dealing with joint pain, facing a possible replacement, or just want to stay strong, mobile, and independent for decades to come - this one's for you. 

This PER® featured podcast includes a discussion with 3 experts on best practices for integrating opioid-sparing strategies into the treatment paradigm along with updates including the 2025 NOPAIN Act. The panel includes members of the care team including the surgical oncologist and anesthesiologist. This program is designed to help clinicians recognize the impact and potential harm of widespread opioid use for pain management following breast cancer surgeries and identify and understand strategies that can be implemented to mitigate the use of opioids to improve patient outcomes.

Managing pain in pediatric patients is a critical aspect of prehospital care. Yet, this remains a challenging area for many EMS providers.   A new study out called “Barriers and Enablers in Prehospital Pediatric Analgesia” sheds light on the complexities of assessing and treating pain in children during ambulance rides. Led by Dr. Hoi See Tsao, Assistant Professor in the Department of Pediatrics at UT Southwestern Medical Center, the research identifies key hurdles EMS workers face and suggests actionable solutions to improve care.   Dr. Tsao, a specialist in pediatric emergency medicine with a passion for prehospital care, shared her insights and findings during a recent interview. “When pain in kids is not treated, it can lead to adverse effects such as increased anxiety, decreased pain tolerance, and fear of future healthcare encounters,” she pointed out. The stakes are high, and the study highlights both challenges and opportunities for EMS professionals.

Two-time Emmy and Three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald interviewed Shiloh Bigles. A certified functional nutrition counselor and founder of Level Minds CBD Health Club, joins Money Making Conversations Masterclass to discuss how CBD, functional nutrition, and holistic wellness help individuals manage pain, anxiety, and autoimmune disorders. She shares her personal experience overcoming lupus and Crohn’s disease through natural remedies.

Watch this next -> https://youtu.be/_t2RjDfxiQY?si=5E82eScf7qLHkw2e In this episode we look at what is wrong with the way people are treating back pain. We also assess why you get stuck in loops as well as what is never considered in treatment. This actually could be having the biggest impact on your pain. Learn more about our programs: Back Pain Back To Exercise Music: Dean Kenny

In this conversation, Dr. Ashley interviews Dr. Isabel Amigues, a rheumatologist, about her journey in the field of rheumatology, the importance of pain management, and the challenges patients face in accessing care. Dr. Amigues shares her personal experiences with cancer and how it transformed her approach to patient care, emphasizing the need for a collaborative and holistic approach to treatment. The discussion also covers the significance of early diagnosis, the concept of remission, and practical steps patients can take to manage their conditions effectively. Dr. Amigues highlights her commitment to education and patient empowerment through her practice and online platforms.You can find here at https://www.unabridgedmd.com/ and her Youtube channel: https://www.youtube.com/channel/UC-f7bKlYsfOLQ1UulyzMprACheck out our favorite products! (affiliate page): https://ifixyoursciatica.gymleadmachine.co/favorite_productsDid you know that our YouTube channel has a growing number of videos including this podcast? Give us a follow here- https://youtube.com/@fixyoursciatica?si=1svrz6M7RsnFaswNAre you looking for a more affordable way to manage your pain? Check out the patient advocate program here: ptpatientadvocate.comHere's the self cheat sheet for symptom management: https://ifixyoursciatica.gymleadmachine.co/self-treatment-cheat-sheet-8707Book a free strategy call: https://msgsndr.com/widget/appointment/ifixyoursciatica/strategy-callSupport this podcast at — https://redcircle.com/fix-your-sciatica-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

⚠️ Content Warning: This episode contains a discussion around suicidal thoughts. Please take care while listening and seek support if you need it.Living with Complex Regional Pain Syndrome (CRPS) isn't just painful—it's punishing. It hijacks your body, messes with your mind, and turns everyday tasks into uphill battles. In this episode, Lyndsay Soprano sits down with Jeannette Tashjian for a brutally honest conversation about what it really means to live with relentless, unpredictable pain.They talk about the parts most people don't see: the mental spiral, the isolation, the weight of explaining yourself over and over, and the moments when giving up feels like the only option. But they also talk about what keeps them going—connection, infrared sauna therapy, self-advocacy, and the power of simply being heard.This episode doesn't sugarcoat anything. From navigating life with a disability to confronting the stigma around suicidal thoughts, Jeannette and Lyndsay lay it all out. They speak from the gut—about grief, about resilience, and about finding pieces of joy in a body that feels like it's working against you.If you've ever felt like no one understands what you're going through—or if you love someone who lives with chronic pain—this conversation will hit home.Tune in for the truth behind CRPS, and the reminder that you're not alone in this fight.Find Jeanette Tashjian Online Here:Website: www.burbankinfraredsauna.comInstagram: @burbankinfraredsaunaPast Guest Episode 6: The Pain Game Podcast Episode 6Find The Pain Game Podcast Online Here:Website: thepaingamepodcast.comInstagram: @thepaingamepodcastFacebook: The Pain Game PodcastLinkedIn: Lyndsay SopranoYouTube: The Pain Game PodcastIF YOU'RE IN CRISIS:USA – Call or text 988 (24/7)Canada – Call: 1-833-456-4566 (24/7) | Text: 45645 (4 PM–12 AM EST)Episode Highlights:(00:00) Introduction to Chronic Pain and Trauma(03:12) Understanding Complex Regional Pain Syndrome (CRPS)(06:01) Personal Stories of Pain and Trauma(08:52) The Role of Infrared Sauna in Pain Management(12:11) Navigating Life with CRPS(14:58) Acceptance and Coping Mechanisms(18:07) The Importance of Community and Support(23:42) Finding Freedom in Acceptance(30:43) Navigating the Pain Journey(31:12) Addressing Suicidal Thoughts(43:45) The Importance of Hope and Support

Ever wonder how chronic pain impacts not just your body, but your mindset and life? This week I'm joined by Dr. Amber Johnston, a leading Clinical Psychologist and Neuropsychologist, to unpack the science behind pain. We talk about breaking the cycle of fear and avoidance, how stress amplifies pain, and practical steps to reclaim your life. Whether you're battling pain or supporting someone who is, you'll gain actionable strategies to feel empowered and hopeful again. Listen in and discover how changing your relationship with pain can change everything.Highlights include:04:13 Acute vs. Chronic Pain08:26 Chronic Pain's Impact on Social Plans11:36 Subjectivity of Pain Perception15:49 Brain's Complex Pain Processing18:59 Perception's Role in Chronic Pain22:10 Understanding Fear Avoidance Cycle25:21 Rethinking Pain Signals30:18 Impact of Lifestyle on HealthWant more?Head over to Hello Therapy's Substack for an EXCLUSIVE mini interview where I ask Dr Amber why she specialised in pain and what her personal, go-to pain management strategy is. Watch HERE.This week's guest:Dr Amber Johnston, a practicing clinician specialising in Clinical, Health, Pain Management, and Neuropsychology, offers her expertise to individuals facing a broad spectrum of challenges - from those with mild stress looking to build healthier emotional tools, to those with more significant clinical diagnoses that need formal, specialised treatment. Amber also works with individuals who do not meet clear psychological or medical diagnosis, those requiring cognitive assessment or emotional support following a neurological injury or stroke, those with complex chronic medical conditions, and those with medically unexplained symptoms/Functional Neurological Disorder including health anxiety. In her capacity as the founder and director of Healthy Mind Psychology, Amber leads a team of over 26 doctoral-level Psychologists. Her mission is to expand understanding of the mind/body connection and emphasise the important message that psychological understanding is important for everybody.Follow Amber:@healthymindpsychologyukLinkedInBE PART OF OUR GROWING SUBSTACK COMMUNITY FOR FREE - Join now****************For private psychology services and therapy in person (London/Hertfordshire) or online, please visit Harley Clinical Psychology.*****************Subscribe to Dr Liz's YouTube channelFollow Harley Clinical on InstagramFollow Dr Liz White on TikTok*****************DISCLAIMER - The Hello Therapy podcast and the information provided by Dr Liz White (DClinPsy, CPsychol, AFBPsS, CSci, HCPC reg.), is solely intended for informational and educational purposes and does not constitute personalised advice. Please reach out to your GP or a mental health professional if you need support.

The TopMedTalk team takes you to Euroanaesthesia 2025: The European Society of Anaesthesiology and Intensive Care annual meeting in Lisbon, Portugal. The Society is dedicated to supporting professionals in anaesthesiology and intensive care by serving as the hub for development and dissemination of valuable educational, scientific, research, and networking resources. This year we're bringing you interviews with some of the key players and speakers from the conference presented by our very own Professor Kate Leslie, Head of Research in the Department of Anaesthesia and Pain Management at Royal Melbourne Hospital.

  In this Q&A episode, Dr. Rebecca Dekker answers questions submitted by EBB Pro Members—each exploring a different facet of evidence-based maternity care.   First, she explores the latest evidence on early induction for gestational hypertension, including findings from the WILL trial and other recent studies. What are the real risks and benefits of inducing labor at 37 or 38 weeks for gestational hypertension? And how should families weigh these decisions with their providers?   Next, Dr. Dekker shares new insights into the effectiveness of acupuncture and acupressure for labor pain, anxiety, and Cesarean recovery. From systematic reviews to randomized trials, the data is growing!   Finally, she looks into the evidence on interpregnancy intervals. What does the research say about the risks associated with short or long gaps between pregnancies? And how might this information apply to those who are pregnant again after a five-year or more break?   (00:00) Intro to Mini Q&A and EBB Pro Membership (02:17) Early Induction for Gestational Hypertension – What the Research Says (06:20) WILL Trial Findings and Recommendations from ACOG and NICE (08:23) Outcomes at 37 vs. 38 Weeks – Cesareans, NICU, and Respiratory Distress (10:15) Balancing Induction Timing and Risks of Continuing Pregnancy (11:03) Acupuncture and Acupressure – New Research and Applications (12:41) Studies on Pain, Anxiety, and Nausea During Labor and Cesareans (14:46) Acupuncture and Cesarean Recovery – Mobility and Pain Management (16:54) Interpregnancy Intervals – Definitions and Research Challenges (19:39) Risks of Short and Long Pregnancy Spacing (23:22) Global Perspectives and Meta-Analysis on Birth Outcomes (26:49) Public Health Implications and Final Thoughts   View the full list of resources and references on ebbirth.com.   For more information about Evidence Based Birth® and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.

What if surgery isn't the only answer to pelvic pain? In this episode of the BackTable podcast, host Dr. Mark Hoffman and co-host Dr. Amy Park welcome Dr. Frank Tu, Vice Chair for Quality at Endeavor Health and Director of the Division of Gynecological Pain and Minimally Invasive Surgery. The episode explores the complexity of chronic pelvic pain, emphasizing its multifactorial origins and individualized treatment approaches.---SYNPOSISDr. Tu shares insights into the persistence and treatment of chronic pelvic pain, the role of trauma, and the evolving understanding of endometriosis and other gynecological conditions. The discussion covers patient treatment modalities, the potential of artificial intelligence in medical diagnostics, and the significant role of non-surgical interventions like physical therapy. Dr. Tu's reflections on interdisciplinary collaborations, preventative approaches, and the future directions of gynecologic pain management provide a comprehensive overview of this complex field.---TIMESTAMPS00:00 - Introduction05:21 - Mentorship and Influences07:01 - Research and Innovations in Pelvic Pain09:21 - Preventative Approaches to Chronic Pain14:15 - Exploring Pain Mechanisms and Treatments26:32 - The Role of Sensory Reintroduction30:20 - The Importance of Mental Health30:49 - Challenges in Treating Chronic Pelvic Pain31:24 - The Role of Surgery and Mental Health in Pain Management34:00 - Barriers to Effective Pelvic Floor Physical Therapy35:40 - The Complexity of Treating Dysmenorrhea44:11 - Exploring Personalized Medicine and AI in Pain Management51:22 - The Future of Pain Management and AI54:25 - The Role of Big Data and AI in Medical Research59:25 - Final Thoughts

In August 2024, the CDC updated its MEC. This included a recommendation for local anesthesia for IUD/S placement and also had guidance regarding misoprostol for that procedure. Coming up in July 2025, the ACOG will officially release a new clinical consensus on “Pain Management for In-Office Uterine and Cervical Procedures”. Are these recommendations similar to the CDC's? What about misoprostol? Was the non-use of local anesthesia for these office-based procedures rooted in racism and sexism? Listen in for details.

Orgasmic Birth Story Series   Ep 149 Description:  “The way to start to feel comfortable with it in birth is to become comfortable with the vibrator before your birth.” —Molly Moon  For too long, vibrators have been shrouded in shame and stigma, viewed solely as sexual devices. But the truth is, these powerful tools have the potential to transform the birthing experience.   Molly Moon is a yoga teacher, doula, and sacred songstress who brings the timeless wisdom of the feminine into her work. Her passion for guiding spiritual awakening has been reignited by the birth of her own child, inspiring her to explore nature-based education Tune in as Debra and Molly share how self-pleasure can be used as a powerful pain management tool, how it helps increase oxytocin—the essential hormone of labor, and how we can normalize vibrators as a shame-free support tool for birth preparation and beyond.     Connect with Debra! Website: https://www.orgasmicbirth.com  Instagram: https://www.instagram.com/orgasmicbirth X: https://twitter.com/OrgasmicBirth  YouTube https://www.youtube.com/c/OrgasmicBirth1  Tik Tok https://www.tiktok.com/@orgasmicbirth  Linkedin: https://www.linkedin.com/in/debra-pascali-bonaro-1093471      Episode Highlights: 02:43 Meet Molly: Incorporating Pleasure Into Birth 09:39 Molly's Birth Experience 14:14 Vibrator for Pain Management   21:28 Addressing Shame and Normalizing Vibrators  23:26 Postpartum Benefits of Vibrators  27:39 Tips for Birth Prep      Resources: 

-CHAPTERS-00:00 Introduction to Resilience10:59 Overcoming Low Self-Worth11:48 The Turning Point: A Moment of Crisis16:45 Military Journey Begins24:52 The Marine Experience and Identity36:35 The Desire for Deployment37:39 Experiences in Korea and the Reality of Combat38:48 The Harsh Realities of Haiti41:00 The Smell of War and Its Impact42:58 The Challenges of Deployment44:40 The Complexity of Hearts and Minds53:02 Trust Issues in Combat54:27 The Bonds Formed in War56:46 Transitioning to Training01:02:27 The Impact of Bullying on Resilience01:04:29 Pushing Through Pain in SEAL Training01:06:06 Facing Fears and Overcoming Pain01:09:45 The Sense of Accomplishment01:11:47 The Hunt vs. The Prize01:15:48 Proving Worth to God01:16:45 Lessons from the SEALs01:18:37 First Impressions in Combat01:24:57 Understanding the Enemy01:30:43 Adapting to New Tactics01:35:51 The Simplicity of War01:37:55 Mental Fitness in Combat01:41:40 The Journey of Fatherhood and Personal Growth01:42:59 Struggles with Pain Management and Substance Use01:45:03 The Impact of Physical and Mental Trauma01:50:00 Transforming Pain into Strength through Bodybuilding01:52:06 Mental Resilience and Overcoming Adversity01:53:14 Facing Life-Altering Health Challenges01:56:53 Finding Strength in Faith and Purpose02:02:56 Legacy, Forgiveness, and Moving Forward02:05:23 Balancing Warrior Mentality with Spiritual Healing02:06:58 Empowering Others through Training and Leadership-SUMMARY-In this conversation, Tommy Richardson shares his incredible journey from a troubled childhood marked by bullying to becoming a Marine and Navy SEAL. He discusses the evolution of his understanding of resilience and overcoming challenges, the impact of childhood relationships on self-worth, and the importance of mentorship. Tommy reflects on his military experiences, the camaraderie built in combat, and the lessons learned from both bullying and mentorship. He emphasizes the significance of facing crises and how they can lead to profound personal change, ultimately shaping his unbreakable spirit. In this conversation, Tommy Richardson shares his journey through adversity, resilience, and personal growth as a former Navy SEAL. He discusses the challenges faced during training, the importance of mental toughness, and the lessons learned from combat experiences. Tommy reflects on his physical and mental health struggles, including a significant health scare involving a brain tumor, and emphasizes the importance of finding purpose and fulfillment in life. He also highlights the value of sharing knowledge and experiences to help others grow and succeed.

Chapters 00:00 The Journey of a Dunker: Early Years and Injuries 03:02 Understanding Knee Pain: Causes and Solutions 06:09 Training Techniques: Isometrics and Warm-ups 09:00 Diet and Its Impact on Performance 12:00 Adapting to Age: Training Adjustments Over Time 15:05 The Mechanics of Jumping: Techniques and Styles 17:58 Warm-up and Cool-down: Importance in Training 20:52 Managing Volume and Intensity in Training 24:10 The Role of Recovery: Isometrics and Pain Management 26:51 Final Thoughts: The Future of Dunking and Training 33:07 Exploring Conservative Management Techniques 36:09 Plyometrics: Finding the Balance 39:30 Lifting Strategies for Injury Management 42:01 Understanding Muscle Imbalances 43:48 The Impact of Footwear on Knee Health 45:36 Managing Pain During Training 48:20 Common Tendon Issues in Dunkers 51:16 The Role of Weight Training in Dunking 53:12 Dealing with Tendon Blow-Ups 54:52 Preventing Tendon Injuries in Dunking 01:06:39 Final Advice for Dunkers with Knee Pain Takeaways Jordan Kilganon shares his journey as a professional dunker. Knee pain can be managed with proper training and techniques. Isometric exercises play a crucial role in injury prevention. Diet can significantly impact tendon health and performance. As athletes age, training methods must adapt to prevent injuries. Different jumping techniques can affect knee stress differently. Warm-ups are essential to prevent injuries, especially as one ages. Cool-downs can aid recovery and reduce next-day soreness. Managing jump volume and intensity is key to longevity in the sport. Listening to one's body is crucial for effective training. Jordan has never used injections or stem cells for recovery. He emphasizes conservative management and load management for knee issues. Plyometrics should be approached with caution, focusing on depth jumps and seated jumps. Single effort jumps are preferred over multi-effort jumps to avoid knee strain. Lifting techniques should be adjusted based on individual comfort and pain levels. Muscle imbalances should be addressed by strengthening weaker muscles rather than focusing solely on balance. Footwear can significantly impact knee health; personal preference varies. Pain management during training can involve isometric exercises and adjustments in technique. Common tendon issues arise from excessive jumping without proper recovery and management. Weight training is essential for dunkers to prevent injuries and improve performance. Jordan on Instagram: https://www.instagram.com/jordankilganon/?hl=en Jump Master: https://my.playbookapp.io/jordan-kilganon Jump Master X: https://www.jumpmasterx.com/home-copy Jordan on YouTube: https://www.youtube.com/@killerjunior23 Notes: https://jackedathlete.com/podcast-149-patellar-tendons-with-jordan-kilganon/

Send us a textIn this episode, Dr. Jade Teta interviews Dr. Andrew Bloch, who discusses the intersection of quantum biology, fascia, and pain management. Dr. Bloch emphasizes the importance of understanding pain as a protective mechanism and introduces his unique approach to resetting the nervous system through breathwork. He explains how breath can be a powerful tool in managing pain and highlights the interconnectedness of the body's systems. The conversation delves into the philosophy of treatment, the role of observation in healing, and practical steps for both practitioners and clients to enhance their understanding and management of pain.Contact Dr Bloch:Instagram: @ihatepain.ahpsGet Book: https://a.co/d/ja7zo1CChapters:00:00:00 Episode Introduction and Guest Overview00:04:00 The Light Bulb vs. Switch Paradigm00:08:45 The Journey Beyond Traditional Medicine00:16:05 Pain as Protection: Rethinking Root Causes00:31:30 True Breath: Accessing the Automatic System00:44:30 Reflexive Point Therapy and Practical Application00:58:20 Final Takeaways and Contact Information Looking for a Next Level Human Coach? Get on the waitlist and get access to the brand-new science of quantum metabolism and identity restructuring with Dr Jade and the team.http://nextlevelhuman.com/human-coaching Want to become a Next Level Human Coach? Get on the waitlist. Go to: http://www.nextlevelhuman.com/human-coach Connect with Next Level HumanWebsite: www.nextlevelhuman.comsupport@nextlevelhuman.comConnect with Dr. Jade TetaWebsite: www.jadeteta.comInstagram: @jadeteta