The PainExam podcast

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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.

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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

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PRP in the Epidural Space for Radiculopathy

Brooklyn Based Pain Physician, David Rosenblum, MD known for his work publishing and teaching Regenerative Pain Medicine and Ultrasound Guided Pain Procedures hosts this podcast covering the latest and most advanced concepts in Pain Medicine.

Summary Dr. David Rosenblum delivered a comprehensive lecture covering several key topics in pain management. He discussed his upcoming speaking engagements at PainWeek, ASPN and great upcoming meetings like the Latin American Pain Society, and other conferences. Dr. Rosenblum shared his extensive experience with PRP (Platelet-Rich Plasma) epidural injections, reviewing multiple research studies that support their efficacy. He highlighted three significant studies: a randomized control trial comparing PRP epidural injections to traditional treatments, a CT-guided epidural PRP study, and a 2025 meta-analysis comparing PRP to steroids. Dr. Rosenblum emphasized that PRP treatments are showing comparable or better results than traditional steroid injections, with potentially fewer required treatments and longer-lasting relief. He noted that while PRP is currently not covered by insurance, it represents a growing trend in 'natural' treatment approaches that patients increasingly prefer.

Chapters Introduction and Upcoming Events Dr. Rosenblum announced his upcoming lectures at Pain Week focusing on ultrasound and regenerative medicine, followed by presentations at the Latin American Pain Society in Chile and the New York, New Jersey Pain Conference. He mentioned the SoMeDocs online pain conference accessible through nrappain.org, and upcoming ultrasound training sessions in New York City.

PRP Epidural Research Review Dr. Rosenblum discussed a randomized control trial involving 30 patients receiving transforaminal epidural injections. The study showed that PRP patients demonstrated significant improvements in leg pain scores at 6, 12, and 24 weeks. He noted that while the study didn't use contrast, he personally prefers using contrast diluted with saline for better visualization.

CT-Guided Epidural Study Analysis Dr. Rosenblum reviewed a study comparing CT-guided epidural PRP versus steroid injections, questioning the necessity of CT guidance. The study included 60 patients and showed similar results between PRP and steroid groups at six weeks, though he criticized the short follow-up period, noting that PRP typically takes months to show full effects.

Meta-Analysis Discussion Dr. Rosenblum presented a 2025 meta-analysis comparing PRP to steroids in epidural injections. The analysis included 310 patients across five RCTs, demonstrating comparable efficacy between PRP and steroid injections without increased adverse events. He emphasized that his clinical experience shows patients typically require fewer PRP injections compared to steroid treatments.

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References

Wongjarupong, Asarn, et al. "“Platelet-Rich Plasma” epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial." BMC Musculoskeletal Disorders 24.1 (2023): 335.

Bise, Sylvain, et al. "Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain." European radiology 30 (2020): 3152-3160.

Muthu S, Viswanathan VK, Gangadaran P. Is platelet-rich plasma better than steroids as epidural drug of choice in lumbar disc disease with radiculopathy? Meta-analysis of randomized controlled trials. Exp Biol Med (Maywood). 2025 Feb 4;250:10390. doi: 10.3389/ebm.2025.10390. PMID: 39968415; PMCID: PMC11832311.

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Summary Dr. David Rosenblum delivered a comprehensive lecture on gender differences in opiate effects and prescribing practices. He discussed several key studies examining how opiates affect males and females differently, both in animal models and humans. Dr. Rosenblum shared findings showing that morphine has stronger analgesic effects in males, while females experience longer-lasting effects. He also addressed racial disparities in opiate prescribing, noting that white patients are more likely to receive opiates. From his personal clinical experience in Brooklyn, Dr. Rosenblum observed that certain populations tend to be at higher risk for opiate abuse. The lecture covered gender-specific risk factors for opiate misuse, with women tending toward emotional/psychological factors and men showing more behavioral issues.

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Chapters Introduction and Upcoming Conferences Dr. Rosenblum introduced himself as the host of the Pain Exam Podcast and announced several upcoming conferences including ASPN in July, PainWeek in September, and other events where he will be teaching ultrasound and regenerative medicine.

Board Preparation and Opiate Topics Dr. Rosenblum discussed his role in board preparation through painxam.com and nreppain.org. He emphasized that opiates are a frequently tested topic across different board examinations (FIP, ABPM, ABIP, ABA).

Gender Differences in Opiate Effects - Animal Studies Dr. Rosenblum presented research showing that in animal studies, morphine exhibited stronger analgesic effects in males, while females showed longer-lasting effects and could tolerate higher doses. He noted that physical dependence was more severe in male rats during spontaneous withdrawal.

Racial and Gender Disparities in Opiate Prescribing Dr. Rosenblum discussed a 2025 study revealing racial disparities in opiate prescribing, with white patients more likely to receive opiates. He shared his personal clinical experience in Brooklyn, noting that young white males were often higher-risk for abuse.

Gender-Specific Risk Factors for Opiate Misuse Dr. Rosenblum detailed how women tend to show emotional and psychological risk factors for opiate misuse, while men demonstrate more behavioral risk factors. Women were more likely to report distress and past trauma, while men showed higher rates of criminal behavior and substance abuse history.

References

Djurendic-Brenesel, Maja, et al. "Gender-related differences in the pharmacokinetics of opiates." Forensic science international 194.1-3 (2010): 28-33.

Kosten, Thomas R., Bruce J. Rounsaville, and Herbert D. Kleber. "Ethnic and gender differences among opiate addicts." International Journal of the Addictions 20.8 (1985): 1143-1162. Cicero, Theodore J., Shawn C. Aylward, and Edward R. Meyer. "Gender differences in the intravenous self-administration of mu opiate agonists." Pharmacology Biochemistry and Behavior 74.3 (2003): 541-549.

Jamison, Robert N., et al. "Gender differences in risk factors for aberrant prescription opioid use." The Journal of Pain 11.4 (2010): 312-320.

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Podcast Show Notes: Peripheral Vascular Disease in PainManagement

Episode Highlights: - Host: Dr. David Rosenblum - Podcast: Pain Exam Podcast - Focus: Peripheral Arterial Disease (PAD) in Pain Management

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Key Topics Covered: 1. Peripheral Arterial Disease (PAD) Overview - Definition: Arterial sclerosis condition developing over long term - WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9 - Prevalence: * 3-4% in 60-65 year olds * Increases to 15-20% in 85-90 year olds * Up to 50% of patients may progress to symptomatic stages

Diagnostic Considerations Diagnostic Tests: - Ankle Brachial Index (ABI) - Ultrasound - CT Angiography - Physical examination - Pulse volume recordings - Transcutaneous oximetry

ABI Interpretation: - 1.0-1.4: Normal - 0.9-1.0: Acceptable - 0.8-0.9: Some arterial disease - 0.5-0.8: Moderate arterial disease - < 0.5: Severe arterial disease

Pain Characteristics Types of Pain: - Intermittent claudication - Chronic limb ischemia - Nociceptive pain - Neuropathic pain - Mixed pain syndrome
Pain Management Strategies Pharmacological Approaches: - Mild Pain: Paracetamol, NSAIDs - Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine - Severe Pain: Morphine, fentanyl, ketamine

Non-Pharmacological Interventions: - Music therapy - Aromatherapy - Psychotherapy - Massage - Acupuncture - TENS - Intermittent pneumatic compression

Upcoming Conferences Mentioned: - ASPN - ASIPP - Pain Week - Latin American Pain Society

Additional Resources: - Pain Exam newsletter: painexam.com - Virtual pain fellowship at nrappain.org

Disclaimer: Always consult with a healthcare professional for personalized medical advice.

Reference

Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi, Peripheral Artery Disease: A Comprehensive Updated Review, Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082,

Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512

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Summary At some point this medication may show its face on the pain boards. Whether or not Suzetrigine will appear on the pain boards, all of us need to know about this new class of analgesic.

Brought to you by NRAP Academy, home of the PainExam Board Prep

Here, Dr. David Rosenblum delivered a comprehensive lecture about a new pain medication called Journavx (Suzetrigine). He discussed its mechanism of action as a NAV 1.8 receptor inhibitor, its clinical applications, contraindications, and dosing guidelines. Dr. Rosenblum emphasized that this non-opioid medication represents a new class of pain management drugs with no addiction potential. He also shared information about upcoming educational events, including ultrasound courses and various pain management conferences. The lecture included detailed information about drug interactions, safety considerations, and clinical trial results comparing Journavx to placebo and hydrocodone-acetaminophen combinations. Key findings from clinical trials showed that Jornavix achieved pain relief in 119 minutes compared to 480 minutes for placebo in abdominoplasty trials, and 240 minutes versus 480 minutes in bunionectomy trials. The recommended dosing is 50mg tablets twice daily, with an initial loading dose of 100mg. While the drug showed promising results for moderate to severe acute pain management, it did not demonstrate superiority over hydrocodone in clinical trials. Important contraindications include CYP3A inhibitors, and special considerations are needed for patients with hepatic impairment or those taking hormonal contraceptives. The medication should be taken on an empty stomach, either one hour before or two hours after food, and patients should avoid grapefruit juice while on this medication.

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Chapters Introduction and Upcoming Events Dr. Rosenblum announced several upcoming events, including an ultrasound course in New York City on May 17th, 2025. He mentioned offering ultrasound and IV training for healthcare professionals, particularly nurses, ICUs, PAs, and hospital doctors. He also highlighted upcoming conferences including ASPN, Pain Week, Latin American Pain Society, New York, New Jersey Pain Congress, ASIPP, and EPA.

Introduction to Journavx (Suzetrigine) Dr. Rosenblum introduced Suzetrigine (Journavx), a new 50mg tablet medication. He emphasized that this discussion was not sponsored by any pharmaceutical company but rather focused on educating about a new class of pain medication. He noted its potential importance as a future board examination topic.

Mechanism of Action Dr. Rosenblum explained that Jornavx works by inhibiting the NAV 1.8 receptor. He detailed how the drug blocks sodium ions from entering pain-sensing neurons, disrupting action potential initiation and propagation. He emphasized that the drug is highly selective, binding over 31,000 times more selectively to NAV 1.8 than other NAV subtypes.

Contraindications and Drug Interactions Dr. Rosenblum outlined various contraindications, particularly focusing on CYP3A inhibitors and inducers. He listed specific medications in each category and emphasized the importance of careful monitoring when prescribing Journavx alongside these medications.

Clinical Trial Results and Dosing Guidelines Dr. Rosenblum presented clinical trial results showing Journavx's effectiveness in treating moderate to severe acute pain. He detailed the dosing guidelines: 50mg tablets twice daily, with an initial loading dose of 100mg. He emphasized the importance of taking the medication on an empty stomach and avoiding grapefruit juice.

Q&A No Q&A session in this lecture

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Summary The video covers a conversation between Dr. David Rosenblum and Dr. Hamed Sadeghipour, discussing board preparation experiences and the current state of pain management practice. Dr. Rosenblum begins by announcing upcoming events, including a May 17th ultrasound course in New York City and his lectures at various conferences. He also mentions shadowing opportunities at his office. Dr. Sadeghipour shares his board preparation experience, discussing three main resources he used: Huntoon book (800 questions), Board Vitals (700 questions), and Pain Exam. He achieved notably high scores using these resources. Regarding his current practice, Dr. Sadeghipour describes working both in academic anesthesia (40-50% time) and private pain practice, managing four offices with four nurse practitioners. The discussion then shifts to the changing landscape of pain management, with both doctors noting concerning trends: increasing focus on surgery center procedures over office-based ones due to reimbursement differences, the challenge of maintaining competency in advanced procedures, and competition from non-specialists entering the field. They also discuss the future of the specialty, suggesting it's moving toward becoming a hybrid of neurosurgery and orthopedic surgery with traditional pain management procedures.

For pain medicine Board Prep go to NRAPpain.org

For ultraound training go to NRAP Academy

Highlights Introduction and Upcoming Events Dr. Rosenblum introduces the podcast and announces several upcoming events, including an ultrasound course in New York City on May 17th, appearances at ASPN and Pain Week conferences, and opportunities for shadowing at his practice.

Board Preparation Experience Discussion Dr. Sadeghipour details his board preparation strategy using three main resources: Huntoon book (800 questions), Board Vitals (700 questions), and Pain Exam(700 questions videos, lectures, ultrasound training, regenerative medicine training and more). He explains the strengths and limitations of each resource and mentions achieving exceptionally high scores.

Current Practice Structure Dr. Sadeghipour describes his dual practice model:

Evolution of Pain Management Practice Both doctors discuss the shifting landscape of pain management, noting increased focus on surgery center procedures, reimbursement challenges, and competition from non-specialists. They address concerns about fellowship training adequacy and the financial pressures affecting new practitioners.

Future of Pain Management Specialty The discussion concludes with perspectives on the specialty's future, suggesting it's evolving toward a combination of minimally invasive spine surgery and traditional pain management, with concerns about maintaining specialty integrity and the need for stronger regulatory oversight.

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Dr. Rosenblum Reviews Questions from my previous lecture, he gave at the trigeminal academy in Indonesia.

Dr. Rosenblum explores techniques for rich plasma injection and preparation. He discusses centrifuge settings with plasma volume and concentration as well as the addition of hyaluronic acid to platelet rich plasma.

Dr. Rosenb;um also received multiple comments on the recent video that he filmed on performing a cervical selective nerve root block under ultrasound.

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Disclaimer: This Podcast,video, website and any content from NRAP Academy otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

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

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Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM

Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively.

Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic.AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc.

Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.

Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.

Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles

Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources

Federation Pain Care Access Website:

https://www.painfed.org

# board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission.

Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.

Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.

Patients can schedule a consultation by going to

www.AABPpain.com or calling: Brooklyn Office 718 436 7246

Garden City Office 516 482 7246

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Unlock new, well-reimbursed services: Spravato, a needle-mover for pain practices. Discover how Spravato, an FDA-approved esketamine treatment for depression, can drive significant financial reimbursement for your practice while improving patient outcomes. Join me as I meet with Yakov Kagan, CEO and co-founder of Big Leap Health, as he highlights the clinical efficacy of Spravato, its comparison to ketamine, and its financial impact. Learn key considerations for launching—whether independently or via an MSO—and actionable steps to get started, from staff training to billing essentials. Yakov will also share insights into future developments like monotherapy developments, helping your practice stay ahead in this rapidly evolving field.

For more information and to integrate Spravato into your Pain Practice go to https://www.bigleaphealth.com

Host David Rosenblum, MD Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.

Patients can schedule a consultation by going to www.AABPpain.com or calling:

Brooklyn Office 718 436 7246

Garden City Office 516 482 7246

NRAP Academy also offers:

Board Review
Anesthesiology
Pain Management
Physical Medicine and Rehabilitation
Regenerative Medicine Training
Live Workshops
Online Training
The Virtual Pain Fellowship (online training program with discount to live workshops)

Regional Anesthesia & Pain Ultrasound Course

Private Training Available

Email Info@NRAPpain.org

Disclaimer: The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.

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Episode Title: Ketamine for Cancer and Pain Management - Journal Club

Host: David Rosenblum, MD

Upcoming Free Webinars: 1. Exploring Innovative Mental Health Treatments which are well reimbursed Discussing Spravato, Transmagnetic Stimulation, and Ketamine Infusion, sponsored by Big Leap Health. Register!

Understanding Scrambler Therapy Learn about this revolutionary approach to pain management. Register!
Cervical Ultrasound: Anatomy and Interventional Pain Targets Sponsored by Clarius, this session will explore advanced imaging techniques. Register!

Sign up for the webinars and check out our full calendar of events.

Join us for this insightful episode as we explore the potential of ketamine in transforming pain management practices!

Summary

In today's episode, we delve into the emerging role of ketamine in managing cancer and chronic pain. Our discussion is anchored around a comprehensive review article titled "Ketamine Use for Cancer and Chronic Pain Management," published in Frontiers in Pharmacology on February 1, 2021. This review, authored by Clayton Culp, Hee Kee Kim, and Salahadin Abdi, explores ketamine's potential as an analgesic in chronic pain conditions, particularly cancer-related neuropathic pain.

Key Points from the Review Article: - Mechanism of Action: Ketamine functions as an N-methyl-D-aspartate receptor antagonist, providing analgesic effects at sub-anesthetic doses. Its ability to counteract central nervous system sensitization makes it effective in opioid-induced hyperalgesia. - Clinical Efficacy: Recent studies highlight ketamine's potential to reduce pain scores and opioid consumption, offering a promising alternative for patients with refractory pain. - Safety Profile: At lower doses used for analgesia, ketamine's safety and adverse event profile are significantly improved compared to its use as an anesthetic. - Pharmacogenomics and Interactions: The article discusses how genetic variations can affect ketamine metabolism and highlights potential drug interactions that clinicians should be aware of.

Reference

Culp, Clayton, Hee Kee Kim, and Salahadin Abdi. "Ketamine use for cancer and chronic pain management." Frontiers in Pharmacology 11 (2021): 599721.

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Episode Title: Evidence-Based Regenerative Pain Medicine with Guilherme Ferreira Dos Santos, MD CIPS

Host: David Rosenblum Guest: Guilherme Ferreira Dos Santos, MD CIPS

Episode Overview: In this insightful episode of the PainExam Podcast, Dr. David Rosenblum sits down with Dr. Guilherme Ferreira Dos Santos, a distinguished expert in pain medicine who is well known for his research, educational endeavors and expertise in Regenerative Pain Medicine and Ultrasound-Guided interventions. Together, they delve into the evolving landscape of regenerative pain medicine, focusing on evidence-based practices and the standardization of Platelet-Rich Plasma (PRP) quality.

Key Topics Discussed:

Evidence-Based Regenerative Pain Medicine: An exploration of current research and practices that inform effective pain management strategies.
PRP Quality and Standardization: Discussion on the importance of PRP quality in treatment outcomes and the need for standardized protocols.
Ultrasound-Guided Spine Interventions: Insights into the benefits and techniques of ultrasound guidance in performing spinal interventions, including a conversation on avoiding cervical epidurals.
Access to Pain Care: A comparative analysis of the differences in access to pain care across Portugal, Spain, the USA, and Canada, highlighting challenges and opportunities in each region.
Pain Expo Dubai: An overview of the upcoming Pain Expo in Dubai, where both Dr. Rosenblum and Dr. Ferreira Dos Santos will be presenting, sharing their expertise with a global audience.

Guest Biography: Dr. Guilherme Ferreira Dos Santos is an Interventional Pain Medicine Specialist and Clinical Scientist with a career spanning Portugal, the United States, Canada, and Spain. He began his journey at the University of Lisbon, earning his Medical Degree in 2014, followed by a five-year residency program in Physical Medicine and Rehabilitation, which he completed in 2020. His fascination with Interventional Pain Medicine led him to the Department of Pain Medicine at Mayo Clinic, where he served as an Invited Clinical Research Scholar in 2018 and 2021 under the mentorship of Dr. Mark Friedrich Hurdle. At Mayo Clinic, he contributed to refining ultrasound-guided techniques for chronic spinal pain.

Dr. Ferreira dos Santos further advanced his expertise with a Clinical Fellowship in Chronic Pain Medicine at the University of Toronto in 2022, training under esteemed mentors such as Dr. Anuj Bhatia, Dr. Paul Tumber, and Dr. Philip Peng. In this role, he was instrumental in advancing education on ultrasound-guided techniques nationally and internationally, which deepened his clinical skills and passion for mentorship.

Currently based in Barcelona, Dr. Ferreira Dos Santos serves as the Senior Specialist and Responsible Clinical Lead for the Education and Training Excellence Center in Pain Medicine at Hospital Clínic de Barcelona. He is also the Director of the Clinical Fellowship Program in Interventional Pain Medicine. Throughout his career, he has lectured at international conferences in over 25 countries and authored more than 35 peer-reviewed Q1 articles. His contributions have earned him several accolades, including the 2018 Grant for Young Clinical Researcher of the Year in Pain Medicine from the Grünenthal Foundation, the 2020 Gofeld Academic Scholarship Award, and the 2022 Nikolai Bogduk Young Investigator Grant. His journey across four countries has shaped his approach to clinical care, research, and mentorship, fueling his mission to improve pain management globally.

Listen to the Episode: Tune in to gain valuable insights from Dr. Ferreira Dos Santos and learn more about the future of pain medicine. Available on all major podcast platforms.

Links and Resources: - NRAP Academy - Follow Dr. David Rosenblum on X and LinkedIn - Follow Dr. Guilherme Ferreira Dos Santos on LinkedIn

Join the Conversation: We encourage our listeners to reach out with their thoughts and questions! Use the hashtag #PainExamPodcast on social media to engage with us.

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Next Episode Preview: Stay tuned for our next episode, where we will continue to explore the latest advancements in pain management and treatment options.

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Painexam Podcast Episode Show Notes

Episode Title: Exploring Naturopathy in Pain Medicine with Dr. Sarah Trahan

Host: David Rosenblum, MD David Rosenblum is a dedicated pain management specialist with extensive experience in treating chronic pain conditions. He is passionate about integrating various approaches to improve patient outcomes and enhance quality of life. His expertise and commitment to patient-centered care make him a trusted voice in the field of pain medicine. His NY Practice is located in Brooklyn and Garden City and through his international educaitonal platform he has attracted physicians and pateints from all over the world to seek out consultation on the latest breakthroughs in interventional pain management.

Guest: Dr. Sarah Trahan Dr. Sarah Trahan is a licensed naturopathic physician with a focus on holistic approaches to pain management and regenerative therapies. With a background in both conventional and alternative medicine, Dr. Trahan is committed to empowering patients through education and personalized treatment plans that address the root causes of pain.

Episode Summary: In this episode, David Rosenblum, MD, interviews Dr. Sarah Trahan to explore the role of naturopathy in pain medicine and the potential of regenerative therapies. Dr. Trahan shares her insights on how naturopathic principles can complement traditional pain management approaches, offering a comprehensive view of patient care.

Key Discussion Points:

ntroduction to Naturopathy: Dr. Trahan explains the philosophy of naturopathic medicine and its emphasis on treating the whole person rather than just symptoms.
The Role of Naturopathy in Pain Management: The conversation delves into how naturopathy can be integrated into pain management strategies, including dietary changes, lifestyle modifications, and natural supplements.
Regenerative Therapies: Dr. Trahan discusses the latest advancements in regenerative therapies, focusing on how these approaches can be applied in the context of pain management without delving into stem cell treatments.
Patient-Centered Care: Emphasizing the importance of a collaborative approach, Dr. Trahan shares strategies for working with patients to develop tailored treatment plans that align with their individual needs and preferences.
Success Stories Dr. Trahan recounts some of her most impactful approaches and success stories, illustrating the benefits of combining naturopathic and conventional approaches to pain relief.
NRAP Academy Online Courses and Workshops: Dr. Trahan highlights the educational opportunities available through the NRAP Academy, which offers online courses and workshops aimed at healthcare professionals interested in enhancing their understanding of naturopathic principles in pain management. Private ultrasound training is also available for those seeking hands-on experience. For more information, visit NRAPpain.org

Resources

Pain Management CME Workshop Calendar

Pain Medicine CME Board Prep and Online Courses

Tune in to this insightful conversation to learn more about how naturopathy and regenerative therapies can play a vital role in managing pain and improving patient outcomes.

Stay connected with Painexam for more episodes on pain management and treatment innovations. Don't forget to subscribe and leave a review!

For questions or feedback, reach out to us at info@nrappain.org

This episode promises to provide valuable insights for healthcare professionals and patients alike, highlighting the importance of a holistic approach to pain management.

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PainExam Podcast Show

Episode Title: Exploring PRP and BMAC in Pain Managemen

Host: David Rosenblum, MD Release Date: November 27, 2024

Episode Overview: In this episode of the PainExam Podcast, Dr. David Rosenblum, a New York-based pain physician, examines the latest research surrounding Platelet-Rich Plasma (PRP) and Bone Marrow Aspirate Concentrate (BMAC) in pain management for the knee, shoulder, and spine. Dr. Rosenblum reviews several key studies, providing insights into the efficacy of these regenerative treatments and their implications for clinical practice.

Featured Studies:

A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis** - Authors: Seth J. Spicer, Sara Soliman, Robert Malek, Mitchell Kaplan, Jensen Clark, Nicholas Averell, Brandon Goodwin, Richard Jermyn - Published in: Cureus. 2024 Aug 23;16(8):e67594. doi: 10.7759/cureus.67594 - Summary: This systematic review evaluates the outcomes of rotator cuff repairs (RCR) using BMAC alone versus BMAC combined with PRP. The analysis included three studies and found no significant difference in functional outcomes between the two groups, suggesting that BMAC alone may be adequate, potentially reducing costs and resource use.
Bone Marrow Aspirate Concentrate Versus Platelet-Rich Plasma for Treating Knee Osteoarthritis: A One-Year Non-Randomized Retrospective Comparative Study - Authors: Abed El-Hakim El-Kadiry, Carlos Lumbao, Natasha Salame, Moutih Rafei, Riam Shammaa - Published in: BMC Musculoskeletal Disorders, 2022. - Summary: This study compared the effectiveness of intra-articular BMAC and PRP injections in patients with knee osteoarthritis (OA). Results indicated that patients receiving BMAC experienced significant improvements in pain and functionality scores over 12 months, while the PRP group showed nonsignificant improvements. BMAC was found to be more effective than PRP in managing knee OA symptoms.
Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis** - Authors: John W. Belk, Joseph J. Lim, Carson Keeter, Patrick C. McCulloch, Darby A. Houck, Eric C. McCarty, Rachel M. Frank, Matthew J. Kraeutler - Published in: World Journal of Stem Cells, 2021. - Summary: This systematic review assessed the efficacy of PRP and BMAC compared to hyaluronic acid (HA) injections for knee OA. The findings demonstrated that both PRP and BMAC led to significantly better patient-reported outcomes (PROs) compared to HA, with no significant differences between PRP and BMAC in terms of effectiveness.
Platelet-Rich Plasma vs Bone Marrow Aspirate Concentrate: An Overview of Mechanisms of Action and Orthobiologic Synergistic Effects - Authors: José Fábio Santos Duarte Lana, Lucas Furtado da Fonseca, Rafael da Rocha Macedo, Tomas Mosaner, William Murrell, Ashok Kumar, Joseph Purita, Marco Antonio Percope de Andrade - Published in: World Journal of Stem Cells, 2021. - Summary: This overview discusses the mechanisms of action for PRP and BMAC and their potential synergistic effects in musculoskeletal healing. The authors highlight that while both therapies show promise, further research is needed to standardize treatment protocols and fully understand their combined effects on healing processes.
PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers - Authors: Fabio S. M. Yamaguchi, Shahin Shams, Eduardo A. Silva, Roberta S. Stilhano - Published in:* International Journal of Molecular Sciences, 2019. - Summary: This review focuses on the use of biomaterial carriers in conjunction with PRP and BMAC to enhance regenerative processes for musculoskeletal injuries. The authors emphasize the growing interest in these therapies as alternatives for treating cartilage, muscle, and bone injuries, and discuss the various biomaterials used in clinical trials.

Key Takeaways: - The efficacy of BMAC compared to PRP in various orthopedic applications. - Insights into the mechanisms of action and potential synergistic effects of PRP and BMAC. - The importance of research in optimizing treatment protocols for knee osteoarthritis and other musculoskeletal conditions.

Upcoming Events: Visit NRAPpain.org to learn about the virtual pain fellowship and other educational resources. Additionally, check out our live courses designed for healthcare professionals looking to enhance their skills in pain management and regenerative therapies.

Listen to the Episode: Join Dr. Rosenblum as he provides expert analysis on these studies and discusses the implications for pain management and regenerative medicine.

Connect with Us: For more information, resources, and to access past episodes, visit our website or follow us on social media. Your feedback and questions are always welcome!

Disclaimer The content of this podcast is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for any medical concerns.

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Podcast Show Notes Episode Title: Optimizing Genicular Nerve Chemical Ablation: Insights from Dr. David Rosenblum Episode Summary: In this episode, we are joined by Dr. David Rosenblum, a New York-based interventional pain physician, who discusses optimizing genicular nerve chemical ablation. Dr. Rosenblum shares insights as well as his upcoming ultrasound course schedyke in New York City, focusing on regional anesthesia, interventional pain, and IV ultrasound placement. He emphasizes the significance of ultrasound in enhancing pain management procedures and the latest advancements in the field.

Key Topics Discussed: * Overview of Dr. Rosenblum's upcoming ultrasound courses in NYC, including regional anesthesia and IV ultrasound placement. More information can be found here or at NRAPpain.org. * The role of ultrasound in interventional pain management, specifically in optimizing genicular nerve chemical ablation. * Discussion on the recent study comparing genicular nerve phenol neurolysis and radiofrequency ablation. * Importance of updating anatomical targets for pain management. * Recommendations for expanding the number of targets in pain interventions. * Insights on the safety and efficacy of chemical neurolysis versus radiofrequency procedures. * Challenges and considerations in performing neurolytic blocks. * Future directions in personalized treatment for chronic pain patients.

Featured Article: Dr. Rosenblum references an article from The Korean Journal of Pain discussing the optimization of genicular nerve chemical ablation. Key takeaways include:

The evolution of anatomical understanding related to genicular nerves.
The recommendation to consider multiple targets for pain management instead of the traditional three.
The need for careful patient examination to map pain effectively before intervention.
Discussion on Knee Pain Management

• ArticlebyAndresRochaRomero: • Discussion on knee pain targeting genicular nerve ablation. • Co-authored by Tony Ng and King K Stanley Lam. • Published in Korean Journal of Pain. • Highlights differences in pain management practices outside the U.S.

Other Points on Genicular Nerve Chemical Ablation discussed

+ Phenol ablation being used more internationally vs. radiofrequency ablations.
+ Considerations for more extensive targeting of genicular nerves: • Importance of the median branch of the nerve to the vastus intermedius. • Expansion of targeting to include 6 nerves, not just 3. • Anatomical variations require different approaches.

 Recommendations and Observations

 • Importance of considering patient-specific anatomy and pain. • Repeat procedures and rehabilitation:

 • Concerns about bio intensity and fascia integrity. • Emphasizes muscle strengthening exercises to support knee.• CRPS Considerations: • Elderly patients may develop CRPS post-knee replacement. • Importance of lumbar sympathetic block in diagnosis and treatment.

Host Bio: Dr. David Rosenblum, MD is an interventional pain physician based in New York City. With extensive experience in pain management techniques, Dr. Rosenblum is dedicated to advancing the field through education and innovative practices. He is particularly focused on the integration of ultrasound technology into pain management procedures.

Course Information: Dr. Rosenblum's upcoming ultrasound courses are CME supported, monthly hands on workshops to give clinicians experience with ultrasound imaging to identify targets for nerve block joint injection, soft tissue injection and more..

• Monthly IV Ultrasound Course in Manhattan: • Ideal for nurses, PAs, anesthesiologists, ER docs. • Provides practice with phantoms, short lecture on IV ultrasound. • Offers CME credits.

• Ultrasound Courses: • Held one Saturday a month, mostly in New York, but travels if needed. • Upcoming dates: December 21st, January 11th in Manhattan.

• Presentation Invitation at Pain Expo in Dubai: April 26-27. •

• Next LAPS conference in September in Chile.

Call to Action: * Subscribe to our podcast for more episodes on advancements in pain management. * Follow us on social media for updates on upcoming courses and events. * Share this episode with colleagues who may benefit from learning about ultrasound techniques in pain management.

Upcoming Opportunities and Closing Remarks

Dr. Rosenblum encourages attending his ultrasound courses and conferences.
Mention of upcoming conferences in ASPN inMiami, Pain Expo in Dubai, and LAPS inChile.
Recommendations to subscribe to newsletters for updates and free info.
The podcast aims to support pain management professionals.

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Exploring the Efficacy of Autologous Platelet Leukocyte Rich Plasma Injections in Chronic Low Back Pain & Understanding Degenerative Lumbar Spinal Stenosis

Host David Rosenblum, MD

Episode Date: October 25, 2024

In this episode, Dr. David Rosenblum discusses two significant studies related to chronic low back pain and degenerative lumbar conditions. The first study focuses on the use of autologous platelet leukocyte rich plasma (PLRP) injections for treating atrophied lumbar multifidus muscles, while the second study investigates the correlation between muscle atrophy and the severity of degenerative lumbar spinal stenosis (DLSS).

Featured Article 1: - Effect of Autologous Platelet Leukocyte Rich Plasma Injections on Atrophied Lumbar Multifidus Muscle in Low Back Pain Patients with Monosegmental Degenerative Disc Disease - Authors: Mohamed Hussein, Tamer Hussein

Key Points Discussed 1. Background: Correlation between lumbar multifidus muscle dysfunction and chronic low back pain. 2. Study Overview: 115 patients treated with weekly PLRP injections for six weeks, followed for 24 months. 3. Outcome Measures: Significant improvements in NRS and ODI scores, with high patient satisfaction. 4. Conclusions: PLRP injections into the atrophied multifidus muscle are safe and effective for managing chronic low back pain.

Featured Article 2: - Degenerative Lumbar Spinal Stenosis Authors:* Gen Xia, Xueru Li, Yanbing Shang, Bin Fu, Feng Jiang, Huan Liu, Yongdong Qiao

Key Points Discussed 1. Background: DLSS is a common condition in older adults, often leading to muscle atrophy and disability. 2. Study Overview: A retrospective analysis involving 232 patients to investigate the correlation between muscle atrophy and spinal stenosis severity. 3. Results: - Significant differences in the ratio of fat-free multifidus muscle cross-sectional area between stenotic and non-stenotic segments. - A strong positive correlation was found between multifidus atrophy and the severity of spinal stenosis. - The atrophy was more pronounced on symptomatic sides of the spine compared to contralateral sides. 4. Conclusions: The findings suggest that more severe spinal stenosis is associated with greater muscle atrophy, emphasizing the importance of addressing muscle health in DLSS patients.

Discussion: Dr. Rosenblum provides insights into how these studies inform clinical practices for treating chronic low back pain and managing degenerative conditions. He emphasizes the need for comprehensive treatment strategies that consider both muscle health and spinal integrity which may be achieved via peripheral nerve stimulation of the medial branch nerve and multifidus muscle or PRP injection in to the multifidus muscle.

Closing Remarks: Listeners are encouraged to stay informed about innovative treatment options and the importance of muscle assessment in managing spinal disorders.

Follow Us: - Subscribe to the Painexam Podcast for more episodes discussing the latest in pain management research and treatments. - Connect with us on social media [insert social media links].

NRAP Academy also offers:

Board Review
Anesthesiology
Pain Management
Physical Medicine and Rehabilitation
Regenerative Medicine Training
Live Workshops
Online Training
The Virtual Pain Fellowship (online training program with discount to live workshops)

Regional Anesthesia & Pain Ultrasound Course

Private Training Available

Email Info@NRAPpain.org

Disclaimer: The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.

References

Xia, G., Li, X., Shang, Y. et al. Correlation between severity of spinal stenosis and multifidus atrophy in degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 22, 536 (2021). https://doi.org/10.1186/s12891-021-04411-5

Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016 Mar 22;2:12. doi: 10.1051/sicotj/2016002. PMID: 27163101; PMCID: PMC4849261.

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Dr. Rosenblum reviews the benefits of Scrambler Therapy for CRPS and Neuropathic Pain State.

What is Scrambler Therapy?
Efficacy of Scrambler Therapy for Neuropathic Pain
Mechanism of action of Scrambler Therapy
Regenerative Pain Management Course
PainExam Board Prep
NRAP Academy Private Tutorials for Ultrasound Guidance and Regenerative Medicine

ST was introduced as a chronic pain relief method in 2003. That same year, Giuseppe Marineo published findings from a small clinical trial involving 11 terminal cancer patients suffering from drug-resistant chronic visceral pain, with all participants showing positive responses and significant reductions in pain scores. In a subsequent trial involving 226 patients with neuropathic pain, 80% reported a 50% reduction in pain. Since then, numerous case reports and studies have documented the use of ST for various pain types.

Evidence from these reports suggests that ST is effective for managing both acute and chronic pain from different causes. For instance, a child with acute mixed pain, resistant to pharmacological treatment, experienced significant relief after four ST sessions, with pain levels dropping from 5/10 to 0/10. Additionally, a 52-year-old woman with burning pain from her foot to knee, stemming from a right medullary acute hemorrhage and suffering for 12 years, reported immediate relief after ST. Her pain score decreased from 9/10 to 3/10 on the first day, and to 0/10 by the second day, remaining below 1 on the Visual Analog Scale (VAS) throughout the 10-day treatment period.

In terms of chronic pain, literature includes a case where a patient with shoulder joint pain and limited range of motion saw significant pain reduction and increased mobility after 10 sessions of ST. ST has shown considerable promise in treating severe pain conditions that are typically difficult to manage, such as complex regional pain syndrome and pain related to HIV.

Despite the encouraging results from these case studies, higher-quality evidence is necessary to establish the efficacy of ST, which could be obtained through extensive clinical trials, particularly focusing on chronic pain. Besides the aforementioned studies by Marineo and Sabato et al, additional trials have indicated that ST is an effective treatment for various chronic pain conditions, including low back pain, postherpetic pain, and neuropathic pain. For instance, a prospective study on chronic low back pain patients showed a significant decrease in VAS scores from 8.12 to 3.63 after six treatment days. Another trial involving 10 patients with postherpetic pain reported a drop in the average Numeric Rating Scale (NRS-11) score from 7.64 to 1.46 at baseline and 0.42 to 0.89 after one month, with benefits persisting at two and three months.

ST has also demonstrated significant potential in treating neuropathic pain. In a prospective study of 45 patients with neuropathic pain lasting over three months, 28 experienced a decrease in Douleur Neuropathique en 4 questions (DN4) pain scores, with four patients stopping treatment early due to complete pain resolution. The mean baseline DN4 score dropped from 5.67 to 2.82 by the end of treatment. A pilot randomized trial involving 52 patients found that 21 out of 26 in the intervention group achieved complete pain relief.

While the findings from these studies, along with others that have been systematically analyzed, suggest strong evidence for the efficacy of ST, a definitive conclusion regarding its effectiveness has not yet been reached. A systematic review by Majithia et al concluded that while studies generally indicate ST results in pain reduction with lasting benefits, there are still gaps in the evidence.

This article aims to evaluate the research needs surrounding ST for cancer pain management. While Majithia et al focused on chronic pain across various conditions and noted specific evidence limitations, this study will concentrate on the effectiveness of ST for cancer-related pain. The objective is to identify gaps in the existing literature and provide recommendations for future research through a systematic review. We will specifically analyze the types and levels of evidence supporting the use of ST in managing cancer pain and determine what studies are necessary to enhance the evidence base.

References

Majithia, N., Smith, T.J., Coyne, P.J. et al. Scrambler Therapy for the management of chronic pain. Support Care Cancer 24, 2807–2814 (2016). https://doi.org/10.1007/s00520-016-3177-3

Mohamed, Mohamed S. I.1; Alkahlout, Lama1; Elgamal, Salma1; Mohiuddin, Amna1; Al-sayed, Talal1; Al-Marri, Hamad1; Zahid, Fatima1; Martínez-Magallanes, Daniela2; Fregni, Felipe2; Doi, Suhail A. R.1; Abdallah, Abdallah M.3; Musa, Omran A.H.1,4; Khan, Muhammad Naseem1; Babu, Giridhara R.1,*. Efficacy of scrambler therapy in chronic neuropathic pain: pairwise and dose-response meta-analysis. Brain Network and Modulation 3(3):p 63-70, Jul–Sep 2024. | DOI: 10.4103/BNM.BNM_20_24

Kashyap, Komal, and Sushma Bhatnagar. "Evidence for the efficacy of scrambler therapy for cancer pain: a systematic review." Pain Physician 23.4 (2020): 349.

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PainExam Podcast Episode: An In-Depth Look at Hydrogen-Rich Water for Chronic Inflammatory Pain In a recent episode of the PainExam podcast, Dr. David Rosenblum delves into an intriguing study published in the journal Antioxidants, exploring the therapeutic potential of hydrogen-rich water (HRW) in alleviating chronic inflammatory pain and associated mood disorders in mice. The study, conducted by Santiago Coral-Pérez and colleagues from the Institut d’Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, presents compelling evidence supporting the analgesic, antidepressant, and anxiolytic effects of HRW.

Study Overview The study investigates the efficacy of HRW in treating nociceptive responses and affective disorders associated with chronic inflammatory pain. Using a mouse model induced by the subplantar injection of complete Freund's adjuvant (CFA), the researchers evaluated the impact of HRW on several parameters:

Nociceptive Responses: Mechanical allodynia and thermal hyperalgesia.
Affective Disorders: Depressive-like behaviors (measured by Tail Suspension Test and Forced Swimming Test) and anxiety-like behaviors (assessed using Elevated Plus Maze and Open Field tests).
Biomarker Analysis: Levels of oxidative stress, inflammatory, and apoptotic markers in the paws and amygdala.

Key Findings 1. Analgesic Effects:

Mechanical Allodynia and Thermal Hyperalgesia: The study found that both intraperitoneal and subplantar administration of HRW significantly reduced mechanical allodynia and thermal hyperalgesia in CFA-injected mice. Remarkably, the local (subplantar) administration showed greater effectiveness, achieving complete inhibition of nociceptive responses with just one day of treatment.
Antidepressant and Anxiolytic Effects:
Depressive-like Behaviors: HRW treatment normalized the increased immobility times in both the Tail Suspension Test and Forced Swimming Test, indicating potent antidepressant properties.
Anxiety-like Behaviors: HRW also reversed the anxiety-like behaviors in the Elevated Plus Maze and Open Field tests, showcasing its anxiolytic effects without impairing motor function.
Biochemical Pathways:
The study highlighted the significant role of the Nrf2/HO-1-NQO1 pathway in mediating the analgesic effects of HRW. Inhibitors targeting this pathway reversed the pain-relieving actions of HRW, underscoring its pivotal role.
Oxidative Stress and Inflammation: HRW treatment reduced the expression of oxidative (4-HNE), inflammatory (p-IKBα), and apoptotic (BAX) markers in both the paw and amygdala tissues, demonstrating its broad-spectrum protective effects.

Implications for Clinical Practice Dr. Rosenblum emphasizes the potential of HRW as a novel therapeutic strategy for chronic inflammatory pain and its associated comorbidities. The study's findings suggest that HRW could offer a multifaceted approach, addressing both pain and mood disorders through its antioxidant, anti-inflammatory, and anti-apoptotic properties.

Conclusion The episode concludes with a discussion on the broader implications of these findings for pain management, particularly in conditions where chronic inflammatory pain is prevalent. Dr. Rosenblum highlights the need for further clinical trials to validate these promising preclinical results and explore the potential of HRW in human subjects.

For more detailed insights into this study, including potential applications and future research directions, tune into the PainExam podcast with Dr. David Rosenblum.

For more information go to:

https://molecularhydrogeninstitute.org/links-mhi/

Other Announcements from NRAP Academy: * PainExam App is ready for iphone * + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References

Coral-Pérez, S., Martínez-Martel, I., Martínez-Serrat, M., Batallé, G., Bai, X., Leite-Panissi, C. R., & Pol, O. (2022). Treatment with hydrogen-rich water improves the nociceptive and anxio-depressive-like behaviors associated with chronic inflammatory pain in mice. Antioxidants, 11(11), 2153.

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Dr. Rosenblum serves at AMETD's 2024 Conference as faculty and discusses the safe and accurate usage of Ultrasound to Guide PRP injecitons

Discussed in this lecure:

Knee, Hip, Shoudler, Ligament and Tendon Targets, the ultrasound technique, the evidence for PRP and controversy. Controversy with respect to the Achilles Tendon!

Other Announcements from NRAP Academy: * PainExam App is ready for iphone * + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdf

Disclaimer

Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

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Podcast Show Note Summary:

Episode Title: "New Guidelines for Corticosteroid Injections in Chronic Pain Management"

This podcast is a discussion about the recent review article

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

In this episode, we dive into the recently published guidelines on the use of corticosteroid injections for managing chronic pain, developed by the American Society of Regional Anesthesia and Pain Medicine, along with several other prominent pain societies. These guidelines address the safety and efficacy of corticosteroid injections for sympathetic and peripheral nerve blocks, as well as trigger point injections.

Key Discussion Points:

Background and Need for Guidelines:
- Overview of potential adverse events from corticosteroid injections, such as increased blood glucose levels, decreased bone mineral density, and suppression of the hypothalamic–pituitary axis.
- Importance of using lower doses of corticosteroids, which studies have found to be just as effective as higher doses.
- Development of the Guidelines:
- The guidelines were approved by multiple pain societies and structured into three categories: sympathetic and peripheral nerve blocks, joint injections, and neuraxial injections.
- Extensive literature review and consensus-building through a modified Delphi process.
- Key Recommendations:
- The addition of corticosteroids to local anesthetics is recommended for certain nerve blocks, such as the greater occipital nerve block for cluster headaches and ilioinguinal/iliohypogastric nerve blocks for post-herniorrhaphy pain.
- Corticosteroid addition is not recommended for sympathetic nerve blocks, greater occipital nerve blocks for migraines, and pudendal nerve blocks for pudendal neuralgia.
- Imaging guidance (ultrasound or fluoroscopy) improves the safety and accuracy of certain procedures.
- Efficacy and Safety:
- Detailed analysis of various studies on the effectiveness of corticosteroid injections for different types of chronic pain.
- Discussion on the minimal benefit of corticosteroids in trigger point injections and the potential risks associated with their use.
- Clinical Implications:
- How these guidelines can assist clinicians in making informed decisions regarding corticosteroid use in chronic pain management.
- Emphasis on the need for personalized treatment plans based on individual patient characteristics and clinical data.
- Future Directions:
- Identification of gaps in the current research and the need for well-designed studies to further assess the benefits and risks of corticosteroid injections.

Join us as we explore these comprehensive guidelines and their potential impact on improving chronic pain management practices.

Resources:

Link to the full guidelines: Journal Online

Other Announcements from NRAP Academy: * PainExam App is ready for iphone * + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdf

Disclaimer

Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

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PainExam Show Notes: Mandibular Division of the Trigeminal Nerve Block with Dr. David Rosenblum VIsit the NRAP Academy for the PainExam Board Prep!

Introduction * Host: Dr. David Rosenblum * Topic: Mandibular Division of the Trigeminal Nerve Block for Cancer Pain Management * Techniques: Ultrasound and Fluoroscopic Guidance

Overview * Purpose: Alleviate chronic facial pain, specifically in cancer patients suffering from trigeminal neuralgia or other related conditions. * Focus: Detailed discussion on the anatomy, clinical presentation, and procedural techniques for effective nerve block.

Anatomy of the Mandibular Nerve * Origin: Mandibular nerve is a branch of the trigeminal nerve (cranial nerve V). * Pathway: Exits the middle cranial fossa through the foramen ovale and descends between the lateral and medial pterygoid muscles. * Sensory Innervation: + Anterior two-thirds of the tongue + Teeth and mucosa of the mandible + Skin of the chin and lower lip + Skin over the mandible (excluding the mandibular angle) + Tragus and anterior part of the ear + Posterior part of the temporalis muscle up to the scalp

Ultrasound-Guided Technique 1. Patient Positioning: * Patient lies on their side with the affected side facing upward. 2. Transducer Selection: * Curvilinear transducer preferred for deeper structures. 3. Transducer Placement: * Place distal and parallel to the zygomatic arch to bridge the coronoid and condylar processes. 4. Anatomical Landmarks: * Identify the lateral pterygoid muscle and plate. * Use power Doppler to locate the sphenoid palatine artery. 5. Needle Trajectory: * Introduce the needle using an out-of-plane approach to target the pterygopalatine fossa (anterior to the lateral pterygoid plate). * For the mandibular nerve block, target the area posterior to the lateral pterygoid plate between the medial and lateral pterygoid muscles. 6. Electrostimulation (Optional): * Utilize a 22G, 10 cm insulated short beveled needle connected to a peripheral nerve simulator. * Position confirmed by motor response from the temporalis and masseter muscles.

Fluoroscopic-Guided Technique 1. Patient Positioning: * Similar to ultrasound guidance, patient lies on their side with the affected side facing upward. 2. C-arm Positioning: * Position the C-arm to visualize the foramen ovale. 3. Needle Insertion: * Insert the needle under fluoroscopic guidance towards the foramen ovale. 4. Contrast Injection: * Confirm needle placement with contrast injection. 5. Anesthetic Administration: * Administer local anesthetic and/or neurolytic agents.

Clinical Symptoms and Diagnosis * Symptoms: + Unilateral sharp, stabbing, or burning pain in the mandibular nerve distribution. + Pain triggered by activities such as eating, talking, washing the face, or cleaning the teeth. * Diagnostic Imaging: + MRI or CT scans to identify causes like vascular compression, mass lesions, or fractures.

Complications and Considerations * Potential Complications: + Bleeding, hematoma, infection, and hypersensitivity reaction to the injectate. + Serious complications from neurolytic agents like permanent sensory deficit and tissue necrosis. * Alternative Treatments: + PNS? Radiofrequency or cryoablation for recalcitrant cases.

Conclusion * Efficacy: Ultrasound and fluoroscopic guidance provide precise targeting of the affected nerves, minimizing collateral damage. * Safety: Routine use of power Doppler imaging to avoid injury to surrounding vessels. * Recommendation: Consider these techniques for patients unresponsive to oral medications or unsuitable for surgery.

These show notes provide a comprehensive overview of the discussion, highlighting key points on the anatomy, technique, and clinical considerations for mandibular nerve blocks in cancer patients.

Other Announcements from NRAP Academy: * PainExam App is ready for iphone * + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References

Nicholas A Telischak, Jeremy J Heit, Lucas W Campos, Omar A Choudhri, Huy M Do, Xiang Qian, Fluoroscopic C-Arm and CT-Guided Selective Radiofrequency Ablation for Trigeminal and Glossopharyngeal Facial Pain Syndromes, Pain Medicine, Volume 19, Issue 1, January 2018, Pages 130–141, https://doi.org/10.1093/pm/pnx088

Allam, Abdallah El-Sayed, et al. "Ultrasound‐Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques." Pain Research and Management 2018.1 (2018): 5480728.

isclaimer

Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

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Dr. Rosenblum addresses 2 Studies on this Pain Management Journal Club Podcast

Article 1:

The Treatment of Bone Marrow Lesions Associated with Advanced Knee Osteoarthritis: Comparing Intraosseous and Intraarticular Injections with Bone Marrow Concentrate and Platelet Products

Article 2:

Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: Aminimum of 2-year follow-up retrospective comparative study

Editorial:

Dr. Rosenblum poses some important questions:

Why are regenerative therapies not covered? Why is CMS limiting trigger point injections and not paying for certain peripheral nerve blocks? Who is making the decision? Do lobbying groups or big pharma have a role?

Other Announcements from NRAP Academy: * PainExam App is ready for iphone * + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References

Alessio-Mazzola M, Repetto I, Biti B, Trentini R, Formica M, Felli L. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study. Journal of Orthopaedic Surgery. 2018;26(1).

Centeno, Christopher, et al. "The treatment of bone marrow lesions associated with advanced knee osteoarthritis: comparing intraosseous and intraarticular injections with bone marrow concentrate and platelet products." Pain Physician24.3 (2021): E279.

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Join us on this episode of the PainExam Podcast where rising star, Christopher Robinson, MD PhD discusses his upcoming paper on exosomes featuring some of the largest names in pain managment. Dr. Rosenblum also alludes to degenerative disc disease being a partially infectious podcast.

Other topics discussed on this podcast:

The Anesthesiology Job Market

Pain Management Fellowship

Duration of Pain Management Fellowships

Should Pain Management be an Independent Residency?

Other Announcements from NRAP Academy: * PainExam App almost ready + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!

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Journal Club: Treating Degenerative Disc Disease with Leukocyte Rich PRP

Dr. Rosenblum discusses an article written by Dr. Gregory Lutz describing Leukocyte RIch PRP's role in treating Degenerative Disc Disease and the theory that there is an infectious disease component to disc injury.

Dr. Lutz describes multiple articles, as well as anectodal experience in which bacterial infectious was demonstrated in pathological discs, and PRP was successful in alleviating symptoms, modic changes and improved clinical as well as radiographic appearance.

Other Announcements from NRAP Academy: * PainExam App almost ready + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References

Lutz, Gregory E. "Intradiscal Leukocyte Rich Platelet Rich Plasma for Degenerative Disc Disease." Physical Medicine and Rehabilitation Clinics of North America 34.1 (2023): 117-133.https://www.binasss.sa.cr/bibliotecas/bhm/feb23/61.pdf

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Dr. Rosenblum reviews an article by Dr. Reuben Ingber regarding the use of iliopsoas trigger point dry needling and therapeutic stretching in the treatement of 6 consecutive patients wiht acute lumbar radiculitis and foot drop. Other Announcements from NRAP Academy: * PainExam App almost ready + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References

Reuben S. Ingber, Iliopsoas trigger point dry needling and therapeutic stretching in the treatment of a series of six consecutive patients presenting with acute lumbar radiculitis and foot drop, Journal of Bodywork and Movement Therapies, Volume 36, 2023, Pages 1-4, ISSN 1360-8592,

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57702#:~:text=No%20more%20than%203%20Trigger,group%20are%20not%20billed%20separately.

CMS National Coverage Policy

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Dr. Rosenblum describes a patient with chronic shoulder pain who failed shoulder replacement, steroid injections, nerve blocks, cryotherapy, and peripheral nerve stimulation of the axillary and suprascapular nerve block. In this podcast, he discusses his perfomance of Shoulder Radiofrequency Ablation targeting the articular branches of the suprascapular nerve, axillary nerve, nerve to subscapularis and lateral pectoral nerve. Reference: https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2020/11/01/how-i-do-it-shoulder-articular-nerve-blockade-and-radiofrequency-ablation Other Announcements from NRAP Academy: * PainExam App almost ready + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here!

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Advocating for Transparency and Oversight in Pain Management

Introduction:

Welcome back to Painexam, where we delve into the latest advancements and challenges in pain management.
Today's episode highlights a significant advocacy effort made by leading Interventional Pain Physicians and industry experts.

Summary of Lobbying Effort:

On March 20, 2024, a group of widely known and respected pain physicians and industry leaders, including Drs. Sean Li, Peter Staats, Mehul J. Desai, David Reece, Hemant Kalia, and David Rosenblum, alongside industry figures Mark Stultz, Christopher Conrad, and Cecelia Ruble, visited Capitol Hill to advocate for greater oversight and transparency in independent review organizations.
Despite their busy schedules, they recognized the critical need to address the 0% turnover rate in appeals for denied treatments, which disproportionately affects patients seeking alternatives to surgery and opioid medication.

Importance of Transparency:

The issue extends beyond pain management, impacting patients across various medical fields.
While opioid therapy may seem economically favorable initially, the long-term consequences, including delayed care and medication side effects, often outweigh the costs.
The group emphasized the importance of an unbiased review for accessible, cutting-edge treatments to improve patient outcomes and reduce overall healthcare expenses.

Purpose of the Lobbying Effort: Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes.

For Board Prep, Ultrasound Training and more, visit:

Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound-

guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain.

Conclusion and Actionable Steps:

To schedule a consultation with Dr. Rosenblum, patients can visit www.AABPpain.com or contact the Brooklyn Office at 718-436-7246 or the Garden City Office at 516-482-7246.
Stay tuned for more updates on advancements and advocacy efforts in pain management.

Outro:

Thank you for joining us on this episode of Painexam. Be sure to subscribe for future discussions on navigating the complexities of pain management.

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Dr. Rosenbum discusses Interventional Psychiatry, the role of Stellate Ganglion Blocks in PTSD, Ketamine Infusions for Depression, and the role of Magnesium as a co-factor in ketamine infusions. Other Announcements from NRAP Academy: * PainExam App almost ready + Pain Management Board Prep migrated to NRAPpain.org * AnesthesiaExam Board Prep migrated to NRAPpain.org * PMRExam Board Prep migrated to NRAPpain.org

Live Workshop Calendar Ultrasound Interventional Pain Course Registration For Anesthesia Board Prep Click Here! References https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full References Górska N, Cubała WJ, Słupski J, Wiglusz MS, Gałuszko-Węgielnik M, Kawka M, Grzegorzewska A. Magnesium in Ketamine Administration in Treatment-Resistant Depression. Pharmaceuticals (Basel). 2021 May 3;14(5):430. doi: 10.3390/ph14050430. PMID: 34063604; PMCID: PMC8147622. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.513068/full https://www.sutterhealth.org/services/behavioral-health/interventional-psychiatry Hanling SR, Hickey A, Lesnik I, et al Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial Regional Anesthesia & Pain Medicine 2016;41:494-500. https://www.psychiatrist.com/jcp/oral-ketamine-for-depression/

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Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course.

Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City.

After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360.

https://pain360.org https://www.malayilmd.com Ultrasound Interventional Pain Course Registration For Pain Management Board Prep Go to: References https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1293358/full

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In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain.

He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic.

The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches.

The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case.

Additionally, the show notes mention an events calendar located at this link: https://www.nrappain.org/pages/ultrasound-course-calendar.

Upcoming Course schedule for NRAP Academy includes the following events:

Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session.
MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management.
Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia.
Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia.
Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance.
Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques.

In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates.

Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information.

Reference

Fu E, Elsharkawy H #35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain Regional Anesthesia & Pain Medicine 2023;48:A193.

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Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves" Special Thanks to Robert Stall, MD

Introduction: * Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves.

Background: * The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons. * Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system.

Methods: * Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017. * The technique was applied to eight fresh cadavers before dissecting the median nerve. * Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens.

Results: * The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion. * Ventricular cannulation was performed successfully using specific coordinates. * Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma).

Conclusions: * Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves. * CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells. * Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons. * The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways.

Significance: * This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues. * Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves. * The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system.

Closing: * Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes!

Reference

Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.

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Exploring the Role of Ultrasound in Headache Evaluation and Treatment

A Journal Club based on Dr. Andrea Trescott's article:

Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.

Click Here to Claim CME for reflecting on content presented in this journal club.

David Rosenblum, MD

Accepting New Patients

Patients Interested in scheduling a consultation with Dr. David Rosenblum can call

516 482 7246 (Garden City) or 718 436 7246 (Brooklyn)

In this Podcast, Dr. Rosenblum discusses patient's in his practice who responsed to ultrasound guided nerve blocks in the treatment of headaches. He discusses the use of ultrasound injections as opposed to medication to manage the pain and references Dr. Trescott's comprehensive article on the various nerves and clinical presentations of headaches related to terminal nerve entrapment or irritation.

Dr. Rosenblum discusses

Supraorbital Neuralgia
Auriculotemproal Nerve
Anatomy
Clinical presentation
Interventional Pain Therapies

Summary of Dr. Trescott's Article and Key Points:

Headaches, affecting 28 million people in the US, pose a significant burden on society in terms of medical costs and lost labor. They are complex neurologic disorders with diverse origins and causes.
Headaches are often viewed as the primary pathology, but they are fundamentally a symptom. Understanding them is an evolving science, and their patterns can be recognized for effective diagnosis and treatment.
In 2003, Pareja et al proposed the term "epicrania" for headaches triggered by extracranial causes, suggesting a link between intracranial components and extracranial nerves.

Peripheral Triggers and Plastic Surgery:

Plastic surgeons noted relief of migraines through corrugator muscle resection and botulinum toxin injection, indicating peripheral headache triggers.
Severe migraines post-head or neck injury may have an extracranial origin, suggesting peripheral nerve irritation. Traditional migraine medications may offer modest relief.
Primary treatment involves inhibiting nerve irritation through interventional pain techniques, turning off the pain origin and associated migraine centers.

Ultrasound Advantages:

Evaluation and injection of nerves have traditionally used landmarks and fluoroscopic images, but ultrasound offers unique advantages.
Nerves often travel with arteries, potentially contributing to "throbbing" pain. Ultrasound provides a more precise and dynamic visualization of these structures.

Exploring Extracranial Causes:

The International Classification of Headache Disorders (ICHD) categorizes headaches as primary or secondary. While valuable, it broadly defines peripheral nerve contributions as "Other Terminal Branch Neuralgias."
The study of extracranial peripheral nerve entrapments and dysfunction reveals overlap between ICHD-defined headaches and potential nerve entrapments causing these pain patterns.
Collaboration with disciplines like pain management enriches the understanding and treatment options for headaches.

Conclusion:

Headaches, often seen as isolated intracranial phenomena, may have extracranial triggers. Understanding and treating these triggers, especially through ultrasound-guided techniques, present a promising avenue in headache management.

NRAP Academy also offers:

Board Review
Anesthesiology
Pain Management
Physical Medicine and Rehabilitation
Regenerative Medicine Training
Live Workshops
Online Training
The Virtual Pain Fellowship (online training program with discount to live workshops)

Private Ultrasound Training Available

Email Info@NRAPpain.org

Reference:

Trescot A. Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.

Publication Details:

Received: 15 Aug 2015, Reviewed: 2 Jun 2016, Accepted: 28 Jun 2016.

This podcast explores the dynamic relationship between intracranial and extracranial factors in headaches, shedding light on potential breakthroughs in their evaluation and treatment.

#interventionalpain #painboards #painfellowship #painexam #regionalanesthesia #ultrasoundguidedpain #ultrasoundpain #ultrasoundmsk #paincme #paincmecourse

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Phenol in the treatment of Hip Pain Bonus CME Available ($15 Processing Fee) The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wo9gDI Dr. Rosenblum discusses the use of phenol injected into the pericapsular nerve group, hip joint and outcome a isolated case reports. Also discussed, phenol, its mechanism of action and a refractory case of neuralgia paresthetica. Pain from hip cancer, pain from DVT and IPACK or articular branch of the tibial nerve block discussed for knee pain. Dr. Rosenblum discusses his ultrasound training programs, the migration of the PainExam platform to the new NRAPpain.org website and offers a testimonial from a previous ultrasound course from the student who inspired this podcast. Patients interested in scheduling a consultation with Dr. Rosenblum can call 516 482 7246 or 718 436 7246 For our Live Course Calendar, Click here Board Prep for PM&R, Pain and Anesthesiology Boards References

Monagle, John; Ee, Joanne1. Treatment of chronic hip osteoarthritic pain with intra-articular phenol. Indian Journal of Pain 27(1):p 41-43, Jan–Apr 2013. | DOI: 10.4103/0970-5333.114866 Marcio V. Pimenta, Amanda T. Nakamura, Hazem A. Ashmawi, Joaquim E. Vieira, Hermann dos Santos Fernandes, Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report, Brazilian Journal of Anesthesiology (English Edition), 2021, Rocha Romero, A., Carvajal Valdy, G. & Lemus, A.J. Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. Can J Anesth/J Can Anesth 66, 1270–1271 (2019). https://doi.org/10.1007/s12630-019-01448-y

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PainExam Podcast Show Notes: Exploring Traumeel as an Alternative for Back Pain Relief

Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HoEWFd Board Prep and Continuing Education

Introduction:

Today, Long Island Based Pain Physician David Rosenblum, MD delves into the latest advancements and alternative treatments for pain management.
In today's episode, we shine a spotlight on Traumeel®, a homeopathic alternative gaining traction for its anti-inflammatory properties, with fewer reported side effects compared to corticosteroids.

Understanding Traumeel:

Traumeel, a fixed combination of diluted plant and mineral extracts, has been available over-the-counter in Europe for over 60 years.
Contrary to corticosteroids, Traumeel's popularity has surged due to its limited side effect profile, with reported contraindications primarily linked to allergies [9].

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Scientific Insights:

A study by Lussignoli et al. demonstrated Traumeel's efficacy in decreasing systemic interleukin-6 production and reducing edema, countering an unregulated inflammatory response [10].
In vitro studies revealed Traumeel's inhibition of pro-inflammatory mediators (IL-1β, TNFα, IL-8) in immune cells, suggesting its potential in stabilizing the immune system [8].
Notably, Traumeel's effectiveness seems to surpass the sum of its individual components, indicating a synergistic interaction [9-10].

Clinical Applications:

Traumeel has shown efficacy comparable to nonsteroidal anti-inflammatory drugs (NSAIDs) in treating various inflammatory conditions.
It is available in oral, topical, and injectable preparations, making it a versatile option for pain relief [8-9].

Research Gaps and Potential:

Despite its established use, current research lacks information on Traumeel's efficacy in epidural injections for short-term back pain relief.
No studies have compared Traumeel to corticosteroid injections, although the TRARO study protocol proposes a potential avenue for comparison in rotator cuff syndrome patients [11].

Pain Management Board Prep

Clinical Cases:

Five patients seeking back pain relief opted for Traumeel injections due to either a contraindication to or a preference against steroids.
This real-world scenario lays the groundwork for further exploration into Traumeel's efficacy in epidural injections, providing additional pain-relieving options for patients unable to tolerate corticosteroid injections.

Conclusion:

Traumeel presents a promising alternative for pain management, particularly in cases where corticosteroids may be unsuitable, however the FDA has yet to approve it and therefore it has failed to gain traction in the US. [14]
As we wrap up, stay tuned for future developments in the research landscape surrounding Traumeel and its potential role in enhancing pain relief options.

Disclaimer:

Consult with a healthcare professional before considering any alternative treatments. The information provided in this podcast is for educational purposes only and does not replace medical advice.

David Rosenblum, MD President, NRAP Academy Clinical Assistant Professor Department of Anesthesiology SUNY Downstate Medical Center Director of Pain Management Maimonides Medical Center

References 1. Cassidy JD, Carroll LJ, Côté P: The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998, 23:1860-66. 10.1097/00007632-199809010-00012 2. Rudy TE, Weiner DK, Lieber SJ, Slaboda J, Boston JR: The impact of chronic low back pain on older adults: a comparative study of patients and controls. Pain. 2007, 131:293-301. 10.1016/j.pain.2007.01.012 3. Fyneface-Ogan S: Anatomy and Clinical Importance of the Epidural Space. Epidural Analgesia - Current Views and Approaches. IntechOpen. IntechOpen (ed): IntechOpen, Internet; 2012. 1-14. 10.5772/39091 4. Waldman SD: Complications of cervical epidural nerve blocks with steroids: a prospective study of 790 consecutive blocks. Reg Anesth. 1989, 14:149-51. 5. McGrath JM, Schaefer MP, Malkamaki DM: Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011, 12:726-31. 10.1111/j.1526-4637.2011.01077.x 6. Watters WC 3rd, Resnick DK, Eck JC, et al.: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. J Neurosurg Spine. 2014, 21:79-90. 10.3171/2014.4.SPINE14281 7. Understanding Potential Complications Of Epidural Steroid Injections . (2011). Accessed: October 1, 2019: https://www.practicalpainmanagement.com/treatments/interventional/injections/understanding-potentialcomplications-ep…. 8. Schneider C: Traumeel - an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. Int J Gen Med. 2011, 4:225-34. 10.2147/IJGM.S16709 9. Grech D, Velagala J, Dembek DJ, Tabaac B: Critical literature review of the homeopathic compound Traumeel for treatment of inflammation. Pharmacology & Pharmacy. 2018, 9:67-83. 10. Lussignoli S, Bertani S, Metelmann H, Bellavite P, Conforti A: Effect of Traumeel S®, a homeopathic formulation, on blood-induced inflammation in rats. Complement Ther Med. 1999, 7:225-30. 10.1016/S0965-2299(99)80006-5 11. Vanden Bossche L, Vanderstraeten G: A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome: the TRAumeel in ROtator cuff syndrome (TRARO) study protocol. BMC Musculoskelet Disord. 2015, 16:8. 10.1186/s12891- 015-0471-z 12. Birnesser H, Oberbaum M, Klein P, Weiser M: The homeopathic preparation Traumeel® S compared with NSAIDS for symptomatic treatment of epicondylitis 13. Ehlert, Dianna, and Ariel Majjhoo. "Traumeel® Epidural Injection: A Viable Alternative to Corticosteroids-A Five-Patient Case Study." Cureus 11.11 (2019) 14. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/medinatura-inc-596269-06112020

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Dr. Rosenblum reviews the anatomy of the ilioinguinal nerve and entrapment syndromes related to the nerve and its relationship to the iliohypogastric nerve. He describes cases in which patients have a tender spot (tinel’s) over the lateral iliac crest. Live Regenerative Medicine and Ultrasound Workshops For up to date Calendar, Click Here!

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References

https://assets.cureus.com/uploads/review_article/pdf/94743/20220610-32009-17da8fm.pdf https://www.bizwan.com/en/index.php?view=article&id=82:proximal-entrapments-of-the-lower-extremity&catid=86&start=1

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Hydroxyapatite Deposition Disease Dr. Rosenblum discusses shoulder pain, and the pathophysiology of Hydroxyapatite Deposition Disease. He discusses personal experience with infraspinatous tendon tear, and treatments such as NSAIDs, Lidocaine patch and steroid injections of the infraspinatous tendon. Dr. Rosenblum discusses his experience with a failed suprascapular nerve block as well as evidence to support PRP injections and ethical safe care. Dr. Rosenbum also is the NRAP Academy Course director for Ultrasound, Regenerative Pain Medicine and Regional Anesthesia CME Workshops and developed online PainExam, AnesthesiaExam and PMRExam Board Reviews Pain Management Board Review Upcoming Workshops and Events NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, December 16, 2023 7:30 AM NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, January 6, 2024 7:30 AM For up to date Calendar, Click Here! References

Valerio Sansone, Emanuele Maiorano, Alessandro Galluzzo & Valerio Pascale (2018) Calcific tendinopathy of the shoulder: clinical perspectives into the mechanisms, pathogenesis, and treatment, Orthopedic Research and Reviews, 10:, 63-72, DOI: 10.2147/ORR.S138225 Seijas R, Ares O, Alvarez P, Cusco X, Garcia-Balletbo M, Cugat R. Platelet-Rich Plasma for Calcific Tendinitis of the Shoulder: A Case Report. Journal of Orthopaedic Surgery. 2012;20(1):126-130. doi:10.1177/230949901202000128 Hegazi T. Hydroxyapatite Deposition Disease: A Comprehensive Review of Pathogenesis, Radiological Findings, and Treatment Strategies. Diagnostics (Basel). 2023 Aug 15;13(16):2678. doi: 10.3390/diagnostics13162678. PMID: 37627938; PMCID: PMC10453434.

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Dr. Rosenblum reviews an ASRA Newsletter article discussing the technique, relevant anatomy and more for performing Shoulder Articular Branch Radiofrequency ablation for chronic pain.

David Rosenblum, MD practices Interventional Pain Medicine in New York.

To schedule a conusultation call 718 436 7246 for Brooklyn and 516 482 7246 for Garden City locations or go to www.AABPpain.com

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Saturday, October 28, 2023 8:00 AM

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Saturday, November 11, 2023 8:00 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, December 16, 2023 7:30 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, January 6, 2024 7:30 AM

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Reference

https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2020/11/01/how-i-do-it-shoulder-articular-nerve-blockade-and-radiofrequency-ablation

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Dr. Rosenblum explores Peptides, the various types, usess and applications for health and wellness.

Upcoming Pain Management Conferences

Upcoming Workshops and Events

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, October 28, 2023 8:00 AM

Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop

Sunday, October 29, 2023 9:00 AM

NRAP Academy: Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, December 16, 2023 7:30 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, January 6, 2024 7:30 AM

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References

https://healthgains.com/wellness/peptide-therapy/#Selank

https://www.nature.com/articles/s41392-022-00904-4

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Dr. Rosenblum discusses his concerns over:

RFA of the Genicular Nerves being a non reimbursed service when the patient already had them in the past with excellent relief.

Plus a discussion on CMS policy toward Peripheral Nerve Block reimbursement limitations and documentation!

Pain Management, Anesthesiology, PMR Board Review

Upcoming Workshops and Events

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, October 28, 2023 8:00 AM

Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop

Sunday, October 29, 2023 9:00 AM

NRAP Academy: Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, December 16, 2023 7:30 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, January 6, 2024 7:30 AM

For up to date Calendar, Click Here!

Reference

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The 2024 Physician Fee Schedule and Remote Patient Care with Rachel Trobman, CEO of Upside Health. Dr. Rosenblum and Rachel Trobman cover topics ranging from Remote Patient Care coding, acronyms, implementation, reimbursement and much more! Upcoming Workshops and Events ASPN Webinar: Continuing Eduction and Board Prep October 4, 2023 8PM Maximizing Profit: Understanding the 2024 Physician Fee Schedule

Wednesday, September 20, 2023 8:00 PM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, October 28, 2023 8:00 AM

Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop

Sunday, October 29, 2023 9:00 AM

NRAP Academy: Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, December 16, 2023 7:30 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, January 6, 2024 7:30 AM

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Drawing from her own experience of transformation from being a burnout physician to regaining, designing, and retaining control of her physician life, Dr. Myrdalis Diaz-Ramirez created the maxAllure Mastermind. It is now her passion to help physicians who feel overwhelmed and lost in medicine to find a new path and control their lives through entrepreneurship. She is a born and self-made entrepreneur with experience in owning different clinics which she successfully sold in the past. She has also owned other businesses, including an entertainment company. Dr. Myrdalis Díaz-Ramírez is a dual Board-Certified Anesthesiologist and Interventional Pain Management Physician. She is also a Medical Expert, Professor, Author, Speaker, Podcaster, Entrepreneur, and Mastermind Facilitator. Through her Mastermind, physicians can transform their personal and professional lives. They have been able to define, plan, and execute a designed vision for their life and business that was once only a dream!

Upcoming Workshops and Events Regional Anesthesia and Pain Ultrasound CME Workshop- San Juan, PR

Friday, September 15, 2023 8:00 AM

Maximizing Profit: Understanding the 2024 Physician Fee Schedule

Wednesday, September 20, 2023 8:00 PM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, October 28, 2023 8:00 AM

Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop

Sunday, October 29, 2023 9:00 AM

NRAP Academy: Regenerative Pain Medicine Course NYC

Saturday, November 11, 2023 8:00 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, December 16, 2023 7:30 AM

NYC Regional Anesthesia and Pain Ultrasound CME Workshop

Saturday, January 6, 2024 7:30 AM

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Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode:

Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve)
Superior Gluteal Nerve Anatomy
Hip Innervation
Upcoming Private and Group Ultrasound Training

Upcoming Pain Management Conferences

Course Calendar

2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

Oct. 28 Regional Anesthesia and Interventional Pain Medicine NYC

Nov.11 Regenerative Pain Medicine Course: NYC

Dec. 16th Regional Anesthesia and Interventional Pain Ultrasound Training NYC

2024

Jan. 6 Regional Anesthesia and Interventional Pain Ultrasound Training NYC

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Pain Management Board Review

Subscribe to Receive Free Content, Discounts and Course Updates! * indicates required Email Address *    References

Pierre Laumonerie and others, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157, https://doi.org/10.1093/pm/pnab061

Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. https://doi.org/10.3390/diagnostics13142314

Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/

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David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses: a case of paresthesia in the upper neck realted to C3 and C4 stenosis and considers a selective nerve root block while wondering if a deep cervical plexus block would suffice.

Rational :

Desire to avoid epidural due to proximity to spinal cord
Ultrasound approach of cervial plexus may anesthetize C3 and C4 roots and may be sufficient to do with ultrasound alone
Unfortunately, no data found to support this particular situation, however, it may be safe and effective if performed properly.

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The Superficial Cervical Plexus and applications for headache, neck pain, and clavicular fractures.

Caution: Phrenic Nerve

Anatomy

The cervical plexus is a complex network of nerves located in the neck region, originating from the anterior rami (branches) of the cervical spinal nerves, specifically those stemming from the upper cervical segments (C1 to C4). This intricate network serves to provide sensory and motor innervation to various structures within the neck and surrounding areas.

The cervical plexus is positioned within a groove between the longus capitis and the middle scalene muscles in the neck. It is organized into different nerve loops and branches that radiate outwards to supply various regions. The cervical plexus can be divided into deep and superficial components, each with distinct functions and innervation patterns.

Cervical Plexus: The plexus involves nerve loops and branches that provide both sensory and motor functions. The superficial sensory branches originating from adjacent anterior spinal nerves (C2 to C4) are responsible for providing sensation to specific areas of the skin, particularly in the head, neck, and shoulder regions. These sensory branches include the lesser occipital nerve (C2, C3), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). These nerves typically run posteriorly and then penetrate the prevertebral fascia before reaching the skin and superficial structures.

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Refereces

Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug;71(4):274-288. doi: 10.4097/kja.d.18.00143. Epub 2018 Jul 4. PMID: 29969890; PMCID: PMC6078883. Read more!

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ISPN Dubai 2023

David Rosenblum, MD interviews Reda Tolba, MD on the PainExam Podcast

In this episode, we delve into the realm of Pain Management in the US and the Middle East. Our international pain experts discuss the upcoming ISPN (International Society for Pain and Neuroscience) meeting in Dubai this december.

Subscribe to the PainExam Newsletter to Receive Free Content, Discounts and Course Updates! Email Address *    Dr. Reda Tolba, MD, chairs the Pain Management Department at Cleveland Clinic Abu Dhabi. He's internationally recognized for his contributions to Pain Medicine, boasting a wealth of experience from institutions like Wake Forest University Medical Center and Ochsner Health System.

Dr. David Rosenblum, MD, is the Director of Pain Management at Maimonides Medical Center and a driving force behind pain education platforms like PainExam.com and NRAP Academy. He's a pioneer in ultrasound-guided pain procedures, having trained thousands of physicians online and in person.

Tune in to hear Dr. Tolba's journey to being named Chair of Pain at Cleveland Clinic, Abu Dhabi, and his impressive academic and clinical achievements.Dr. Rosenblum, on the other hand, is known through his contributions to safe pain management protocols, and his mission to spread knowledge through podcasts and educational events.

Patients, interested he's scheduling an appointment with Dr. Rosenblum at his Long Island or Brooklyn Locations can go to AABPpain.com or call 718 436 7246 or 516 482 7246

To learn more about their work and educational initiatives, explore NRAPpain.org and PainExam.com/events. Join us in this episode to uncover insights from these leading figures in Pain Management.

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

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On this episode, Dr. Rosenblum has a chat with Premier Heritage's Greg Alerte.

Greg has over 15 years of experience helping families and small business to achieve their financial goals. As co-owner and Certified Financial Planner at Premier Heritage, he focuses on helping people to preserve and grow their wealth, and to leave a legacy for future generations to build on. Greg’s research and professional opinions, have been quoted in several financial publications, including Wall Street Journal, NerdWallet, Financial Planning magazine, and the Huffington Post. Greg’s favorite quote is by the late Mia Angelou “when you learn teach, when you get give”

For more information, Email: galerte@premier-heritage.com

David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:

Attend and NRAP Course!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

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David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs discusses Central post-stroke pain (CPSP).

Central Post Stroke Pain is a debilitating condition that affects a significant number of stroke survivors. It is characterized by persistent neuropathic pain, often described as burning, shooting, or electric shock-like sensations, in the areas of the body affected by the stroke. CPSP can significantly impact a patient's quality of life and functional recovery, making it crucial for physicians to have a comprehensive understanding of its pathophysiology.

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Neuropathic Pain and Central Sensitization:CPSP is classified as a neuropathic pain syndrome, which means it arises from a dysfunction or damage to the nervous system. The exact pathophysiology of CPSP is complex and multifactorial, but it often involves the phenomenon of central sensitization. Central sensitization refers to the increased excitability and responsiveness of neurons within the central nervous system (CNS) in response to peripheral input.

Cortical Reorganization and Plasticity:

One key aspect of CPSP pathophysiology is cortical reorganization and plasticity. Following a stroke, the brain undergoes structural and functional changes as a result of the injury. This neuroplasticity, particularly in the somatosensory cortex, can contribute to the development of CPSP. Maladaptive plasticity may occur, leading to abnormal sensory processing and the generation of pain signals in response to non-painful stimuli.

Disrupted Pain Modulation Pathways:The pain perception and modulation pathways in the CNS play a crucial role in regulating pain signals. In CPSP, these pathways can be disrupted, leading to abnormal pain processing. Alterations in the descending inhibitory pathways, such as reduced inhibitory neurotransmitter release or impaired endogenous opioid system function, can result in increased pain sensitivity and the persistence of pain signals even after the resolution of the initial injury.

Inflammatory Processes and Neurotransmitter Imbalances:Inflammation within the CNS and imbalances in neurotransmitter systems also contribute to CPSP. Following a stroke, there is an inflammatory response that involves the release of pro-inflammatory cytokines and activation of immune cells. This inflammation can lead to sensitization of nociceptive neurons and exacerbate pain signaling. Additionally, imbalances in neurotransmitters, such as glutamate, serotonin, and norepinephrine, may disrupt the normal pain processing pathways, further amplifying pain perception.

Peripheral and Central Lesions:CPSP can arise from both peripheral and central lesions. Peripheral lesions, such as damage to the spinothalamic tract or thalamus, can directly affect the transmission of pain signals. Central lesions, on the other hand, involve damage to the somatosensory cortex, thalamus, or other brain regions involved in pain processing. Both types of lesions can contribute to the development of CPSP through various mechanisms, including altered neuronal activity, disrupted connectivity, and aberrant sensory processing.

The complex interplay of cortical reorganization, disrupted pain modulation pathways, inflammatory processes, and peripheral and central lesions contribute to the development and persistence of CPSP. Further research is needed to unravel the intricacies of CPSP's pathophysiology, leading to the development of targeted therapies to alleviate the burden of this debilitating condition.

References

Liampas, A., Velidakis, N., Georgiou, T. et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 37, 3278–3291 (2020). https://doi.org/10.1007/s12325-020-01388-w

SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke
Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.678198

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David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:

Genicular Nerve Ablation with Phenol
The history of phenol
The mechanism of action
Indications
Complications
Clinical concerns when considering neurolysis with phenol

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Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

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References D'Souza RS, Warner NS. Phenol Nerve Block. [Updated 2023 Jan 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Risso CR e tal.Chemical Ablation of Genicular Nerve with Phenol for Pain Relief in Patients with Knee Osteoarthritis: A Prospective StudyVolume21, Issue4. April 2021Pages 438-444

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Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ATmqM6 David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses Ketamine infusions, optimal infusion protocols and the evidence or lack of to support them. Ketamine infusions have been used for chronic neuropathic pain, CRPS and depression. Dr. Rosenblum is accepting new patients and consultations could be scheduled by visiting www.AABPPain.com or calling 718 436 7246 or 516 482 7246. Pain Management Board Prep Anesthesiology Board Prep Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For up to date Calendar, Click Here!

References Maher, Dermot P MD, MS; Chen, Lucy MD; Mao, Jianren MD, PhD. Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesthesia & Analgesia 124(2):p 661-674, February 2017. | DOI: 10.1213/ANE.0000000000001787

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Blocks for Head, Neck, and Spinal Surgeries

Claim CME Credit: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/t3z3kR In this episode, we will explore the various regional anesthesia techniques used in neurosurgery, specifically focusing on blocks for head, neck, and spinal surgeries.

Segment 1: Blocks used in Head and Neck Surgeries

Scalp Block:
The scalp block involves blocking six nerves that provide sensory innervation to the scalp.
It is performed by subcutaneous infiltration of local anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine) for each nerve.
Ultrasound guidance has improved the precision of block administration.
The main indication for a scalp block is awake craniotomy, but it is also used in other procedures like deep brain stimulation and cranioplasty surgery.
Scalp block offers advantages such as accurate neurological evaluation, pre-emptive analgesia, and hemodynamic stability during surgery.
It also reduces postoperative pain, the need for rescue analgesics, and pain scores in the early postoperative period.
Infraorbital Block (IOB):
The infraorbital nerve block targets the infraorbital nerve, which supplies the skin and mucous membrane of the upper lip, lower eyelid, and cheek.
The IOB can be performed using the classical landmark technique or ultrasound guidance.
Ultrasound guidance provides real-time visualization and accurate needle placement.
IOB combined with general anesthesia is beneficial for postoperative pain relief in procedures like endoscopic trans-nasal trans-sphenoidal (TNTS) approach for pituitary tumor excision.
Other regional techniques like sphenopalatine ganglion block and maxillary nerve blocks have also been attempted for transsphenoidal surgeries.
Trigeminal Nerve Block:
Trigeminal nerve block is used for patients unresponsive to medical management of trigeminal neuralgia.
Traditionally performed using the paresthesia technique, ultrasound guidance allows real-time visualization and confirmation of local anesthetic spread.
Ultrasound guidance helps locate the Gasserian ganglion and visualize the trigeminal ganglion, providing a safe and radiation-free procedure for pain relief.

Segment 2: Blocks used for Spinal Surgeries

Cervical Plexus Block (CPB):
CPB is commonly used in carotid endarterectomy (CEA) and cervical spine surgery.
Different levels of CPB can be performed depending on the depth of injection.
Superficial CPB involves injecting local anesthetic superficially into the deep cervical fascia.
Deep CPB requires depositing local anesthetic deep to the prevertebral fascia.
CPB helps in monitoring cerebral blood flow during CEA and provides postoperative pain relief.
Ultrasound guidance can be used for superficial CPB, ensuring accurate needle placement and local anesthetic spread.
Erector Spinae Block (ESB):
ESB is used for pain control in spinal surgeries.
It involves depositing local anesthetic in the plane between the erector spinae muscle and the transverse process.
ESB provides effective postoperative analgesia and reduces opioid consumption.

Regional anesthesia techniques play a crucial role in neurosurgery, providing effective pain relief and improving patient outcomes. Blocks like scalp block, infraorbital block, trigeminal nerve block, cervical plexus block, and erector spinae block offer numerous advantages in specific procedures. Ultrasound guidance has enhanced the precision and safety of block administration. These techniques contribute to improved surgical outcomes and patient satisfaction in neurosurgical procedures.

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Course Calendar

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

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References Kaushal A, Haldar R. Regional Anesthesia in Neuroanesthesia Practice. Discoveries (Craiova). 2020 Jun 29;8(2):e111. doi: 10.15190/d.2020.8. PMID: 32637571; PMCID: PMC7332314.

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Long Island and Brooklyn based Pain Physician, David Rosenblum, MD describes prolotherapy and discusses mechanism of action, evidence and protocols. Also mentioned in this podcast, Prolotherapy protocols, low dose version high dose dextrose prolotherapy, spine prolotherapy, Spine ligaments Intertransverse ligament, Ilolumbar ligament pain and more!

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References Geonhyeong Bae, Suyeon Kim, Sangseok Lee, Woo Yong Lee, Yunhee Lim. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis Anesth Pain Med 2021;16(1):81-95. Solmaz, İ. & Örsçelik, A. (2022). Approximately Three Years of Prolotherapy Experience of a Traditional and Complementary Medicine Center: An Epidemiologic Study . International Journal of Traditional and Complementary Medicine Research , 3 (2) , 64-70 . DOI: 10.53811/ijtcmr.1040648 Harmon, Dominic, and Vladimir Alexiev. "Sonoanatomy and injection technique of the iliolumbar ligament." Pain Physician 14.5 (2011): 469. https://clinicaltrials.gov/ct2/show/NCT04680936 David Rosenblum, MD Sit, R.W.S., Wu, R.W.K., Reeves, K.D. et al. Efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline for knee osteoarthritis: a protocol for a triple-blinded randomized controlled trial. BMC Complement Altern Med 18, 157 (2018). https://doi.org/10.1186/s12906-018-2226-5

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Title: Pediatric Anesthesia Concerns and Management for Orthopedic Procedures

Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries.

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Claim CME Credit Select Pediatric Perioperative Concerns:

Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term.
Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution.

Anesthetic Management for Orthopedic Procedures:

Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population.
Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss.

Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being.

Reference

Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179.

Anesthesiology Board Review Newsletter

Subscribe for Discounts, Free Videos, Course Calendar & More! * indicates required Email Address * Ultrasound Block Course applicable in Pediatric Anesthesia for Orthopedic Procedures includes: * Certificate of Completion * Ultrasound Guided Interventional Pain Atlas * Continuing Medical Education Credit * Online access to Webinar (additional CME Credit)

Regional Anesthesia:

Lower Extremity Nerve Blocks for

Femoral Nerve Block
Genicular Nerve Block
Sciatic Nerve Block
Popliteal Nerve Block
Common Peroneal Block
Tibial Nerve Block Block
Ankle Block

Upper Extremity Anesthesia for Fractures and Reductions * Brachial Plexus Block * Axillary Nerve Block * Suprascapular Nerve Blocks

Truncal and Fascial Plane Blockade

Transversus abdominis plane block
Paravertebral Nerve Block
Intercostal Nerve Block
Erector Spinae Block
PENG Nerve Block
IPACK Nerve Block

and much more!

Caudal Epidural and Spine demonstrations available as well.

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Or Email DRosenblum@rmcpain.com to arrange a private workshop with your Department.

NRAP Academy: Ultrasound Guided Regional Anesthesia and Interventional Pain Workshops

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Morton’s Neuroma Diagnosis Treatment and Regenerative Medicine Options

Claim CME for listening The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/7Oo1wq Dr Rosenblum discusses Morton’s Neuroma and describes typical presentation, diagnosis, treatments such as corticosteroid injection, nerve ablation, regenerative medicine and more! Morton's neuroma is a painful condition that affects the foot, specifically the ball of the foot. It occurs when the tissue surrounding the nerves leading to the toes thickens, causing intense pain, numbness, or a burning sensation. Course Calendar

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For up to date Calendar, Click Here!

References Platelet-rich-plasma Injection Therapy For Morton's Neuroma - Page #4. https://www.amssm.org/plateletrichplasma_injecti-csa-268.html?StartPos=130&Part=4a Bhatia M, Thomson L. Morton's neuroma - Current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):406-409. doi: 10.1016/j.jcot.2020.03.024. Epub 2020 Apr 10. PMID: 32405199; PMCID: PMC7211826. Barbara De Angelis, Lucilla Lucarini, Fabrizio Orlandi, Annarita Agovino, Alessia Migner, Valerio Cervelli, Valentina Izzo, Cristiano Curcio. Regenerative surgery of the complications with Morton's neuroma surgery: use of platelet rich plasma and hyaluronic acidVolume10, Issue4 August 2013 Pages 372-376

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2023 Update to the Sacroiliac Joint CMS Covered Indications for SI Joint Injection Long Island Based Interventional Pain Physician, David Rosenblum, MD discusses Sacroiliac Joint Dysfunction, and CMS’s Covered Indications for Sacroiliac Joint Injection and Diagnostic Nerve Block The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ryGmAg For Board Review, Click Here! Sacroiliac Joint Injections are considered necessary and reasonable when all of the following criteria are met: 1. Moderate to severe low back pain primarily experienced over the anatomical location of the SI joints between the upper level of the iliac crests and the gluteal fold, AND 2. Low back pain duration of at least three (3) months, AND 3. Low back pain below L5 without radiculopathy, AND 4. Clinical findings and/or imaging studies do not suggest any other diagnosed or obvious cause of the lumbosacral pain (such as central spinal stenosis with neurogenic claudication/myelopathy, foraminal stenosis or disc herniation with concordant radicular pain/radiculopathy, infection, tumor, fracture, pseudoarthrosis, or pain related to spinal instrumentation), AND 5. At least three positive findings with provocative maneuvers: FABER, Gaenslen, Thigh Thrust or Posterior Shear, SI Compression, SI Distraction and Yeoman Tests,3,4 AND 6. Low back pain persists despite a minimum of four weeks of conservative therapies.5

Workshop and Calendar Regenerative Pain Medicine Course NYC- May 13 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR For up to date Calendar, Click Here! References

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39383&ver=9

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Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Join digital health leader and Upside Health CEO Rachel Trobman and PainExam.com founder Dr. David Rosenblum in a conversation about the impact of the end of the public health emergency in May could have on your pain management practice. We'll specifically discuss the changes to telehealth and remote patient monitoring. The webinar will close with one of Upside Health's clients outlining the launch and successes of RTM in their practice and be available for Q&A.

Course Calendar

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For up to date Calendar, Click Here!

For more questions Email Rachel Trobman at Rachel@upside.health

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Regenerative Medicine Journal Club Dr. Rosenblum reviews a case report discussing Platelet Rich Plasma Intra-discal Injection using ultrasound and fluoroscopy. The author mentions use of ultrasound to avoid the Internal jugular vein, carotid artery, phrenic nerve, esophagus and neural structures. The author mentions mixing lidocaine with PRP and Dr. Rosenblum comments on his experience and knowledge of the technique. Dr. Rosenblum mentions the risk of disci tis. Course Calendar Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain! Register to our Free Upcoming Practice Management Webinar on April 24th Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Regenerative Pain Medicine Course NYC- May 13 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 For up to date Calendar, Click Here! Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wpE4BfThe CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/wpE4Bf References Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Technical Innovation and Presentation of Two Cases Tsung-Ju Wu et al. Journal of Pain Research Published online: 16 Nov 2022

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The MOTION Study: Minimally Invasive Lumbar Decompression CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/W8x3jd Journal Club. Minimally Invasive Lumbar Decompression (mild® Procedure) with Conventional Medical Management vs. Conventional Medical Management Alone. Descripton of Procedure, Safety, Technique, study outcome, personal experience with this minimally invasive technique that interventional pain physicians are using to treat neurogenic claudication related to ligamentum flavum hypertrophy. Dr. Rosenblum discusses spinal stenosis pathophysiology and neurogenic claudication. Dr. Rosenblum also mentions upcoming courses and webinars: Upcoming Courses and Workshops! Course Calendar Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain! Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Regenerative Pain Medicine Course NYC- May 13 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023 For up to date Calendar, Click Here! References

Timothy R Deer, MD, Shrif J Costandi, MD, Edward Washabaugh, MD, Timothy B Chafin, MD, Sayed E Wahezi, MD, Navdeep Jassal, MD, Dawood Sayed, MD, The MOTION Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year Results, Pain Medicine, Volume 23, Issue 4, April 2022, Pages 625–634, https://doi.org/10.1093/pm/pnac028

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Biologics and the Peripheral Nerve. Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/TgB18M Dr. Rosenblum discuss his upcoming talk at the Appalachian Region Spine and Pain Meeting: Incorporating Ultrasound into a Spine and Pain Practice on April 14-16 2023 and the topics he plans to include: Ultrasound Guided Knee therapies, cluneal nerve, caudal, brachial plexus and more! Today’s podcast (inspired by TOBI and Dr. Sudhir Diwan, Dr. Sheldon Jordon and Dr. Rikin Patel's ASIPP Lectures) focuses on the risk and benefits of performing PRP injection onto a nerve. Dr. Rosenblum discusses: Possible fibrosis of the ulna nerve after using PRP for partial ulnar collateral ligament tears Best Time for PRP Injection after Nerve Regeneration Alpha 2-macroglobulin (what is it?) PRP for moderate to severe carpal tunnel syndrome Featured Courses! May 25, 2023 Private Pain Group Ultrasound Course- NYC (Sold out) Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Regenerative Pain Medicine Course NYC- May 13 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 see the full schedule for our July and August US IPM Courses! References Robert G. Thompson, Kendall Bradley, Gary M. Lourie, Ulnar nerve dysfunction at the elbow after platelet-rich plasma treatment for partial ulnar collateral ligament injuries,JSES Reviews, Reports, and Techniques,Volume 1, Issue 1,2021,Pages 41-44,ISSN 2666-6391, Si-Ru Chen, Yu-Ping Shen, Tsung-Yen Ho, Tsung-Ying Li, Yu-Chi Su, Yu-Ching Chou, Liang-Cheng Chen, Yung-Tsan Wu,One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial,Archives of Physical Medicine and RehabilitationVolume 102, Issue 5,2021, Pages 951-958,ISSN 0003-9993,https://doi.org/10.1016/j.apmr.2020.12.025. Rehman, A.A., Ahsan, H. and Khan, F.H. (2013), Alpha-2-macroglobulin: A physiological guardian. J. Cell. Physiol., 228: 1665-1675. https://doi.org/10.1002/jcp.24266 Muhammad Pandunugrahadi, Komang Agung Irianto, Oen Sindrawati, "The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study", International Journal of Biomaterials, vol. 2022, Article ID 9601547, 7 pages, 2022. https://doi.org/10.1155/2022/9601547

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Knee Osteoarthritis and Regenerative Pain Medicine Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/TJXGw0 Dr. Rosenblum reviews the latest evidence comparing Bone Marrow Aspirate and Platelet Rich Plasma for knee pain. He also reviews the latest publication by Di Martino et al’s study which compared Leukocyte-rich PRP vs. Leukocyte-poor PRP in the treatment of knee osteoarthritis. Upcoming Courses Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

References

El-Kadiry, A.EH., Lumbao, C., Salame, N. et al. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord 23, 23 (2022). https://doi.org/10.1186/s12891-021-04910-5

Hede, Kris, et al. "Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results." Cartilage 13.1_suppl (2021): 937S-947S. Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):618-629. doi:10.1177/03635465211072554 Di Martino A, Boffa A, Andriolo L, et al. Leukocyte-Rich versus Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):609-617. doi:10.1177/03635465211064303

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Carpal Tunnel Syndrome

Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/JiPKnm Diagnosis, Pathophysiology, Clinical Findings and Management of the Carpal Tunnel Syndrome In this episode, we will be discussing Carpal Tunnel Syndrome, a common condition that affects millions of people worldwide. But before we dive into the topic, we want to tell you about a great opportunity to advance your medical knowledge through the NRAP Academy CME courses offered on our website.

Discussion on Carpal Tunnel Syndrome: Carpal Tunnel Syndrome is a condition that occurs when the median nerve, which runs from the forearm to the hand, becomes compressed or squeezed at the wrist. This compression can lead to pain, numbness, and tingling in the hand and arm, which can be debilitating. There are many causes of Carpal Tunnel Syndrome, including repetitive hand movements, wrist injuries, pregnancy, and medical conditions such as diabetes and thyroid disorders. Treatment options for Carpal Tunnel Syndrome range from non-invasive approaches like rest, ice, and wrist splints to more invasive treatments like surgery. It's important to diagnose and treat Carpal Tunnel Syndrome early to prevent long-term damage to the median nerve. A proper diagnosis can be made through a physical exam and imaging tests like an electromyography (EMG) or nerve conduction study (NCS). Don't forget to check out the NRAP Academy CME courses offered on our website, www.painexam.com/events page, to continue your medical education and enhance your patient care. NRAP Academy Events Hands on Training for medical professional looking to enhance your knowledge and skills in pain management? Offering courses are designed to help you stay up-to-date with the latest advances in pain management and to help you improve patient outcomes. Visit our website, www.painexam.com/events page, to learn more about the courses available and to sign up today. References Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/ Sevy JO, Varacallo M. Carpal Tunnel Syndrome. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846321.

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Claim CME The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/tn70Yk Dr. Rosenblum discuss a challenging case and reviews the pathology, treatment and evidence for interventional pain in the the treatment of Post Herpetic Neuralgia. Discussed in this podcast: Intrathecal injection of methylprednisolone Dorsal Root Ganglion Paraveterbral Nerve Block Stellate Ganglion Block Spinal Cord Stimulation Botulinum Toxin Injection And more! Course Calendar Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Puerto Rico- Feb. 10, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Regenerative Pain Medicine Course NYC- May 13 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 References Lin, Chia-Shiang, et al. "Interventional treatments for postherpetic neuralgia: a systematic review." Pain physician22.3 (2019): 209.

https://www.painphysicianjournal.com/current/pdf?article=NjMwMg%3D%3D&journal=120

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David Rosenblum, MD, creator of PainExam.com, AnesthesiaExam.com, PMRExam.com, NRAP Academy and International Pain Academy Co-Founder presents an excerpt from Grand Rounds Given on January 2, 2023 to the Metropolitan Hospital Physical Medicine and Rehabilitation Department.

Reflect on Ultrasound Guided Interventional Spine Procedures and Claim CME Credit

Agenda:

Ultrasound Guided Cluneal Nerve Blocks
Ultrasound Guided Stellate Ganglion Block
Ultrasound Guided Facet Joint Injection
Ultrasound Guided Medial Branch Blocks
Ultrasound Guided Sacroiliac Joint Injections
Ultrasound Guided Caudal Epidural Injections

Dr. Rosenblum offers live regional anesthesia, regenerative medicine, board review and interventional pain management CME courses in NY and around the world. For more information, go to www.NRAPpain.org or PainExam.com/events

Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Great Neck Office 516 482 7246

Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite

For up to date Calendar, Click Here!

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David Rosenblum, MD, creator of PainExam.com, AnesthesiaExam.com, PMRExam.com, NRAP Academy and International Pain Academy Co-Founder presents an excerpt from Grand Rounds Given on January 2, 2023 to the Metropolitan Hospital Physical Medicine and Rehabilitation Department.

Reflect on Ultrasound Guided Interventional Spine Procedures and Claim CME Credit

Agenda:

Ultrasound Guided Cluneal Nerve Blocks
Ultrasound Guided Stellate Ganglion Block
Ultrasound Guided Facet Joint Injection
Ultrasound Guided Medial Branch Blocks
Ultrasound Guided Sacroiliac Joint Injections
Ultrasound Guided Caudal Epidural Injections

Dr. Rosenblum offers live regional anesthesia, regenerative medicine, board review and interventional pain management CME courses in NY and around the world. For more information, go to www.NRAPpain.org or PainExam.com/events

Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Great Neck Office 516 482 7246

Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite

For up to date Calendar, Click Here!

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Rachel Trobman, CEO of Upside Health and David Rosenblum, MD discuss updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes, Remote Patient Monitoring and more!

Claim CME Credit!

This Podcast is not worth any CME Credit, but Credit can be Claimed for reflecting on content: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9AX9LN

Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite

For up to date Calendar, Click Here!

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1 CME Available

What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain

Monday, November 21 at 6:00 pm EDT

NYSPS Legal Briefs

New 2022 CDC Guidelines on

OPIOID USE FOR TREATMENT OF PAIN

The CE experience for this Webinar is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/p1nfCi

The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented.

Larry Kobak, Esq.

Senior Counsel

Frier Levitt

ATTORNEYS AT LAW

101 Greenwich Street, Suite 8B

New York, NY 10006

(516) 755-7553 direct

(973) 618-1660 office

lkobak@frierlevitt.com

www.frierlevitt.com

Course Calendar

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

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Journal Club where David Rosenblum, MD reviews the possible complications related to an intrathecal pump. Discussed in this podcast: Intrathecal pump malfunction, disconnect, granuloma, infection, MRI compatibility, related malfunctions, and evaluation of pump failure.
Claim CME Credit This CME credit is not for listening to the podcast. No credit is offered for the podcast itself, but reflect on information learned and claim credit. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/QzrQ19 Upcoming Workshops Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022 Regenerative Interventional Pain Course NYC- Jan, 28, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 For up to date Calendar, Click Here!

For Pain Management board review go to ...

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Regenerative Pain Medicine in Knee OA- The Interosseous Injection of BMAC and PRP In anticipation of NRAP Academy’s upcoming Regenerative Medicine Course, Dr. Rosenblum reviews interosseous injections of PRP and Bone Marrow Aspirate in the treatment of Knee Osteoarthritis. Dr. Rosenblum reviews key points and quotes Delgado et al in the below article. Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/FOIuSR Upcoming Courses and Workshops! Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022 Regenerative Interventional Pain Course NYC- Jan, 28, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 For up to date Calendar, Click Here! Reference Delgado D, Garate A, Vincent H, Bilbao AM, Patel R, Fiz N, Sampson S, Sánchez M. Current concepts in intraosseous Platelet-Rich Plasma injections for knee osteoarthritis. J Clin Orthop Trauma. 2019 Jan-Feb;10(1):36-41. doi: 10.1016/j.jcot.2018.09.017. Epub 2018 Sep 28. Erratum in: J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1169-1171. PMID: 30705529; PMCID: PMC6349647.

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A review of the evidence David Rosenblum, MD reviews the description and evidence provided by Loibi et al in the published article referenced below. Dr. Rosenblum discusses personal experiences with treating back pain with regenerative medicine procedures. Discussed in this podcast: Patient selection Pathophysiology Environment of the disc and it’s impact on MSCs Risks and safety concerns of Intervertebral mesenchymal stem cell transplantation Pain relief and recommendations for MSC injection into the disc in patients suffering from discogenic pain Claim CME Credit The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/WAltmH
Course Calendar * Ultrasound Training Dominican Republic- November 12, 2022 * Physician Networking Event- November 17, 2022 * Ultrasound Training NYC- December 3, 2022 * Regenerative Interventional Pain Course January 28th, 2023 * Ultrasound Training Costa Rica- February 29, 2023

Pain Management Board Review and Refresher, June 10-12, 2023- NYC Location TBA Reserve a spot! References

Loibl, M, Wuertz-Kozak, K, Vadala, G, Lang, S, Fairbank, J, Urban, JP. Controversies in regenerative medicine: Should intervertebral disc degeneration be treated with mesenchymal stem cells? JOR Spine. 2019; 2:e1043. https://doi.org/10.1002/jsp2.1043

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**The Glossopharyngeal Nerve Revisited-**

The CE experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/VOw8zH

Glossopharyngeal Neuralgia, Anatomy, Pathophysiology, Diagnosis, and Treatment-

Dr. Rosenblum reviews Neuralgia and Compression of CN IX pathology, discusses the management, treatment and more. David Rosenblum MD, pain physician in Great Neck, Long Island discusses the different approaches to treating patients with medications and interventional pain procedures such as nerve blocks, neurolysis and radiofrequency lesioning...

Upcoming Events...

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IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 30, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

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Dominican Republic: Regional Anesthesia & Pain Ultrasound CME Workshop, Nov 12th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Physician Networking Event- NYC Nov. 17th, 2022

Physician Networking Event- Nov. 17th, NYC

Join us for our a cool session of networking with your colleagues. Our last event hit the mark, and our docs left happy and excited for the next one. So we've planned it. As always, there will be food and drinks served. Come prepared to speak to others about medicine, healthcare. side gigs, new opportunities for career growth, innovation, fun activities, and more.

Lock in Your Spot Today! Register Now!

NYC Ultrasound Guided Chronic Pain/Regional Anesthesia Training Workshop- Dec. 3rd, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYC Regenerative Pain Medicine Workshop- Jan. 28th, 2023

Regenerative Pain Medicine Training Workshop! Lock in Your Spot Today! Register Now!

IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Pain Management Board Review & Refresher Workshop June 10-12, 2023 - TBA

Annual NRAP/IPA/ Pain Management Board Review Workshop! Registration Set to Open Soon...

Email to Reserve a Spot!

Podcast Resources:

https://europepmc.org/article/nbk/nbk541041

https://en.wikipedia.org/wiki/Glossopharyngeal_nerve

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**Treating Long COVID, Parosmia and Anosmia with Stellate Ganglion Blocks-**

A new application of an old therapy-

Dr. Rosenblum reports his experience with a patient who reported long term relief of anosmia and parosmia with a unilateral stellate ganglion block. Dr. Rosenblum discusses the pathophysiology of the imbalances between the Sympathetic, parasympathetic nervous system, and feedback loops in the Neuro-immune system.

For more information see attached texts.

For Ultrasound Training to enable safe application of this therapy go to www.PainExam.com/events

Links to PDF files-

Stellate ganglion block reduces symptoms of Long Covid- A Case Series- Click here to download

Regulation of acute reflectory hyperinflammation in viral and other diseases by SGB- Click here to download

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NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NSPC's Annual Conference 2022-

THE BUSINESS OF PAIN MEDICINE- Oct. 20th, 2022

NSPC's Annual Conference 2022- THE BUSINESS OF PAIN MEDICINE! Lock in Your Spot Today! Register Now!

IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 30, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

Dominican Republic: Regional Anesthesia & Pain Ultrasound CME Workshop, Nov 12th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Podcast Resources:

David Rosenblum, M.D.

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**Protect and Cover your ASSets! -**

Interview with attorney Ken Falcon-

Is Malpractice insurance enough? Dr. Rosenblum sits down and asks Ken Falcon about protecting assets, trusts, and more. Ken is an attorney practicing in Rockville Center, NY. For more information, see his contact information below.

Ken Falcon
Falcon Rappaport & Berkman PLLC

265 Sunrise Highway, Suite 50 (MAIL)
Rockville Centre, New York 11570
T: (516) 599-0888
F: (516) 599-0889

Upcoming Events...

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NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NSPC's Annual Conference 2022-

THE BUSINESS OF PAIN MEDICINE- Oct. 20th, 2022

NSPC's Annual Conference 2022- THE BUSINESS OF PAIN MEDICINE! Lock in Your Spot Today! Register Now!

IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 27, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Podcast Resources:

David Rosenblum, M.D.

Ken Falcon, Falcon Rappaport & Berkman PLLC

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**What You Need to Know About CMS' New Chronic Pain Management Codes? -**

CMS’s Push into Remote Patient Care-

Dr. Rosenblum interviews PainExam Podcast Sponsor, Rachel Trobman. Rachel Trobman is a digital health executive and leader in the remote care space. Her company, Upside Health, is dedicated to transforming pain care and has helped clinicians, health systems and tens of thousands of patients through their product, Branch Health. She is actively involved in legislation surrounding remote billing codes and collaborates with the AMA, CMS and leading law firms...

Find out more about Upside Health! https://Upside.health

Upcoming Events...

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NRAP’s Acute and Chronic Pain Ultrasound CME Workshop in NYC- Sept. 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 27, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Podcast Resources:

David Rosenblum, M.D.

Rachel Trobman, Upside Health

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**SoMeDocs Founder, Dana Corriel, MD! -**

Doctors on Social Media, Physician Entrepreneurship and more! -

Dr Rosenblum welcomes his friend and Colleague Dana Corriel, MD. Dana runs the Facebook group SoMeDocs and has over 40,000 followers across her platform.

Her website doctorsonsocialmedia.com is a platform to help physicians network, showcase and develop their brands.

Follow Dana on Facebook at SoMeDocs and get updates on all of her online and offline events and projects.

Upcoming Events...

Want to view the complete events agenda? Click Here Now!

NRAP’s Acute and Chronic Pain Ultrasound CME Workshop in NYC- Sept. 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 27, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Podcast Resources:

David Rosenblum, M.D.

Dana Corriel, M.D.

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**Dr. Mydralis Diaz-Ramirez on Business, Medicine and more! -**

Maxallure Mastermind Physician Coaching -

Dr. Rosenblum discusses business, coaching, work life balance and more with Dr. Mydralis Diaz-Ramirez.

To find out more about her physician coaching program, go to

MaxAllure.com/PainExam

Upcoming Events...

Want to view the complete events agenda? Click Here Now!

NRAP’s Acute and Chronic Pain Ultrasound CME Workshop in NYC- Sept. 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 27, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

Podcast Resources:

David Rosenblum, M.D.

Mydralis Diaz-Ramirez, M.D.

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**Supply Chain Shortages in Interventional Pain Medicine -**     **The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/wVAtJK**

ASRA’s Contrast Shortage Position Statement -

Facing supply chain shortages, Dr. Rosenblum review’s ASRA’s position statement on contrast administration. For the full article, click here ...

Subscribe to the NEW International Pain Academy's Newsletter

http://eepurl.com/gcRCbz

Upcoming Events...

Want to view the complete events agenda? Click Here Now!

NRAP’s Acute and Chronic Pain Ultrasound CME Workshop in NYC- Sept. 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

Podcast Resources:

Kohan L, Pellis Z, Provenzano DA, et alAmerican Society of Regional Anesthesia and Pain Medicine contrast shortage position statementRegional Anesthesia & Pain Medicine Published Online First: 17 June 2022. doi: 10.1136/rapm-2022-103830

New Updates- * New 1 on 1 Training Service! * New Hospital and Medical Network Group Training Program! * Exclusive Dr/Medical Professional affiliate program! Leverage Your Social Network! * PainExam "Complete" Complete CME Course now available!

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**Alaa Abd Elsayed, MD on Nociception and Physiology -**     **The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/1HrheI**

IPA Pain Management Board Review Course-

Dr. Rosenblum presents his friend and colleague, co-founder of the International Pain Academy, Alaa Abd Elsayed, MD. In this podcast, Dr. Elsayed Dallas 2022 Lecture on the anatomy and physiology of nociception, Dr. Elsayed covers high yield testable material, sample multiple choice questions and pain management board preparation strategies...

Subscribe to the International Pain Academy's Newsletter

http://eepurl.com/gcRCbz

Upcoming Events...

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC July 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

ASPN's Annual Conference- July 14th-17th, 2022!

American Society of Pain and Neuroscience Annual Conference is organized by ASPN and will be held from July 14th-17th, 2022 at the Loew's Hotel in Miami Beach, FL. Get Your Tickets to ASPN's Annual Conference Today!
Register Now!

NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!

**NYSIPP/ NJSIPP's Annual Pain Medicine Symposium**

Come and join us in New Jersey in November | NYNJ-PS 2022

Save the Date! Nov. 3rd-6th, 2022

Get Your Tickets Today!
Register Now!

Clarius Discount!

Click on the following link and you can enter your credit card info, billing and shipping and your code (DARO) for 20% off!

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Podcast Resources:

-David Rosenblum, M.D.

-Alaa Abd Elsayed, M.D., MPH, FASA

New Updates- * New 1 on 1 Training Service! * New Hospital and Medical Network Group Training Program! * Exclusive Dr/Medical Professional affiliate program! Leverage Your Social Network! * PainExam "Complete" Complete CME Course now available!

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**Former DEA Agent, Dennis Wichern -**     **The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more:**

https://earnc.me/CwNOyg

Common Sense Opiate Prescribing-

Dr. Rosenblum interviews Dennis Wichern on his career and consulting experiences...

Upcoming Events...

Advanced Pain Board Review Conference Multi Day June 10-12th, 2022

Multi-Day Advanced Pain Board Review Conference- June 10-12th, 2022 This 2/3 day intensive advanced pain board review workshop has been developed for both novices and advanced pain physicians providers who would like to further advance their skills in pain management procedures. The 3rd day is for the Advanced Ultrasound Guided Injection Training CME Course, also available via Zoom. Participants will have up to 5 hours of hands on ultrasound scanning on live models of different body habitus to learn and identify different sono‐anatomy. Get Your Tickets to the Multi-Day Advanced Pain Board Review & Ultrasound Guided Training Workshop! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC July 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

ASPN's Annual Conference- July 14th-17th, 2022!

American Society of Pain and Neuroscience Annual Conference is organized by ASPN and will be held from July 14th-17th, 2022 at the Loew's Hotel in Miami Beach, FL. Get Your Tickets to ASPN's Annual Conference Today!
Register Now!

Clarius Discount!

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Podcast Resources:

-David Rosenblum, M.D.

-Dennis Wichern, Former DEA Agent

New Updates- * New 1 on 1 Training Service! * New Hospital and Medical Network Group Training Program! * Exclusive Dr/Medical Professional affiliate program! Leverage Your Social Network! * PainExam "Complete" Complete CME Course now available!

Subscribe to the PainExam mailing list * indicates required Email Address * Download the PainExam Official Apps for Android and IOS Devices! https://play.google.com/store/apps/details?id=com.painexam.android.painexam&hl=en_US

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**Remote Patient Monitoring-**     **The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more:**

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How to Implement Digital Health Tools and Billing Codes to Optimize and Grow Your Pain Practice?

The emergence of new CMS codes in the space of remote physiologic monitoring, remote therapeutic monitoring, chronic care management and more offers a unique opportunity for clinicians and practice owners to get reimbursed for bringing digital health tools into their practice. However, if not done correctly, they can increase the clinical and administrative burden and decrease the patient experience. In this webinar, industry experts will explain the details of these codes and the best ways to introduce them into your practice for optimal growth, without taking on additional burden or risk.

**This is a sponsored episode by UpSide Health****

Upcoming Events...

Advanced Pain Board Review Conference Multi Day June 10-12th, 2022

Multi-Day Advanced Pain Board Review Conference- June 10-12th, 2022 This 2-3 day intensive advanced pain board review workshop has been developed for both novices and advanced pain physicians providers who would like to further advance their skills in pain management procedures. Additional 3rd day is for the Advanced Ultrasound Guided Injection Training CME Course. Participants will have up to 5 hours of hands on ultrasound scanning on live models of different body habitus to learn and identify different sono‐anatomy. Get Your Tickets to the Multi-Day Advanced Pain Board Review & Ultrasound Guided Training Workshop! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC July 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

ASPN's Annual Conference- July 14th-17th, 2022!

American Society of Pain and Neuroscience Annual Conference is organized by ASPN and will be held from July 14th-17th, 2022 at the Loew's Hotel in Miami Beach, FL. Get Your Tickets to ASPN's Annual Conference Today!
Register Now!

Clarius Discount!

Click on the following link and you can enter your credit card info, billing and shipping and your code (DARO) for 20% off!

https://store.clarius.com/collections/accessories/products/package-2-in-1-charging-station-hd

Podcast Resources:

-David Rosenblum, M.D.

-This is a sponsored episode by UpSide Health

New Updates- * New 1 on 1 Training Service! * New Hospital and Medical Network Group Training Program! * Exclusive Dr/Medical Professional affiliate program! Leverage Your Social Network! * PainExam "Complete" Complete CME Course now available!

Subscribe to the PainExam mailing list * indicates required Email Address * Download the PainExam Official Apps for Android and IOS Devices! https://play.google.com/store/apps/details?id=com.painexam.android.painexam&hl=en_US

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**Why You Are Still Sick?: Author Gary Kaplan DO-**      ***Integrative Medicine and Pain Management?***

Dr. Rosenblum Interviews Dr. Gary Kaplan...

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more:

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Upcoming Events...

Advanced Pain Board Review Conference Multi Day June 10-12th, 2022

Multi-Day Advanced Pain Board Review Conference- June 10-12th, 2022 This 2-3 day intensive advanced pain board review workshop has been developed for both novices and advanced pain physicians providers who would like to further advance their skills in pain management procedures. Additional 3rd day is for the Advanced Ultrasound Guided Injection Training CME Course. Participants will have up to 5 hours of hands on ultrasound scanning on live models of different body habitus to learn and identify different sono‐anatomy. Get Your Tickets to the Multi-Day Advanced Pain Board Review & Ultrasound Guided Training Workshop! Register Now!

NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC July 10th, 2022

Advanced Ultrasound Guided Injection Training Workshop! Lock in Your Spot Today! Register Now!

ASPN's Annual Conference- July 14th-17th, 2022!

American Society of Pain and Neuroscience Annual Conference is organized by ASPN and will be held from July 14th-17th, 2022 at the Loew's Hotel in Miami Beach, FL. Get Your Tickets to ASPN's Annual Conference Today!
Register Now!

Clarius Discount!

Click on the following link and you can enter your credit card info, billing and shipping and your code (DARO) for 20% off!

https://store.clarius.com/collections/accessories/products/package-2-in-1-charging-station-hd

Podcast Resources:

-David Rosenblum, M.D.

-Gary Kaplan D.O.

New Updates- * New 1 on 1 Training Service! * New Hospital and Medical Network Group Training Program! * Exclusive Dr/Medical Professional affiliate program! Leverage Your Social Network! * PainExam "Complete" Complete CME Course now available!

Subscribe to the PainExam mailing list * indicates required Email Address * Download the PainExam Official Apps for Android and IOS Devices! https://play.google.com/store/apps/details?id=com.painexam.android.painexam&hl=en_US

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**Caudal Epidurals on Anti-thrombotics?-**     ***Is it safe?*** *Dr. Rosenblum takes a close look at ASIPP’s guidelines, and data discussing the risk of hematoma when performing a caudal epidural on a patient who is taking an anti-thrombotic agents and are at high risk for stopping these medications.*  *Also discussed, Caudal Epidural history, technique and more!*

The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/daNmJq

Upcoming Events...

ASIPP's 24th Annual Meeting- May 5th-May 7th, 2022!

American Society of Interventional Pain Physicians 24th Annual Meeting is organized by ASIPP and will be held from May 5th–7th, 2022 at the Ceaser’s Palace in Las Vegas, Nevada.

Get Your Tickets to ASIPP's 24th Annual Meeting Register Now!

Ultrasound Experts & NRAP's Ultrasound Workshop May 14th, 2022!

1 day workshop for physicians of all levels who treat pain, perform regenerative medicine procedures, joint injections, and nerve blocks.

Get Your Tickets to the Advanced Ultrasound Training Workshop! Register Now!

Live Webinar Event- May 18th, 2022! How to Implement Digital Health Tools and Billing Codes to Optimize and Grow your Pain Practice

The emergence of new CMS codes in the space of remote physiologic monitoring, remote therapeutic monitoring, chronic care management and more offers a unique opportunity for clinicians and practice owners to get reimbursed for bringing digital health tools into their practice. However, if not done correctly, they can increase the clinical and administrative burden and decrease the patient experience.

In this webinar, industry experts will explain the details of these codes and the best ways to introduce them into your practice for optimal growth, without taking on additional burden or risk.

Register Now!

Advanced Pain Board Review Conference Multi Day June 10-12th, 2022

Multi-Day Advanced Pain Board Review Conference- June 10-12th, 2022 This 2-3 day intensive advanced pain board review workshop has been developed for both novices and advanced pain physicians providers who would like to further advance their skills in pain management procedures. Additional 3rd day is for the Advanced Ultrasound Guided Injection Training CME Course. Participants will have up to 5 hours of hands on ultrasound scanning on live models of different body habitus to learn and identify different sono‐anatomy. Get Your Tickets to the Multi-Day Advanced Pain Board Review & Ultrasound Guided Training Workshop! Register Now!

ASPN's Annual Conference- July 14th-17th, 2022!

American Society of Pain and Neuroscience Annual Conference is organized by ASPN and will be held from July 14th-17th, 2022 at the Loew's Hotel in Miami Beach, FL. Get Your Tickets to ASPN's Annual Conference Today!
Register Now!

Clarius Discount!

Click on the following link and you can enter your credit card info, billing and shipping and your code (DARO) for 20% off!

https://store.clarius.com/collections/accessories/products/package-2-in-1-charging-station-hd

Podcast Resources:

Kaye AD, Manchikanti L, Novitch MB, Mungrue IN, Anwar M, Jones MR, Helander EM, Cornett EM, Eng MR, Grider JS, Harned ME, Benyamin RM, Swicegood JR, Simopoulos TT, Abdi S, Urman RD, Deer TR, Bakhit C, Sanapati M, Atluri S, Pasupuleti R, Soin A, Diwan S, Vallejo R, Candido KD, Knezevic NN, Beall D, Albers SL, Latchaw RE, Prabhakar H, Hirsch JA. Responsible, Safe, and Effective Use of Antithrombotics and Anticoagulants in Patients Undergoing Interventional Techniques: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2019 Jan;22(1S):S75-S128. PMID: 30717501.

Simon JI, Caudal Epidural Steroid Injections in the Setting of Remaining on Antithrombotics: A Retrospective StudyPain Physician 2021; 24:E821-E828 • ISSN 2150-1149

New Updates- * New 1 on 1 Training Service! * New Hospital and Medical Network Group Training Program! * Exclusive Dr/Medical Professional affiliate program! Leverage Your Social Network! * PainExam "Complete" Complete CME Course now available!

Subscribe to the PainExam mailing list * indicates required Email Address * Download the PainExam Official Apps for Android and IOS Devices! https://play.google.com/store/apps/details?id=com.painexam.android.painexam&hl=en_US

https://apps.apple.com/us/app/the-pain-management-review/id997396714

Follow PainExam-
https://painexam.com/blog/
https://www.facebook.com/PainExam/
https://twitter.com/painexams
https://www.instagram.com/painexam/
https://www.linkedin.com/company/painexam
https://www.pinterest.com/painexam
https://www.youtube.com/user/DocRosenblum/videos

View Details

**Tricyclics Revisited-**     ***Tricyclics and Chronic Pain!*** *Dr. Rosenblum reviews the indications, considerations, side effects, contraindications and treatment of toxicity of these commonly used anti-depressants which are often used to treat chronic pain...* **The CME experience for this Podcast is powered by CMEfy - click here to reflect and unlock credits & more: https://earnc.me/Aj2gSk**