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Spine & Nerve podcast

Spine & Nerve podcast

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Spine & Nerve podcast

Spine & Nerve podcast

Spine & Nerve podcast

0
Followers
6
Plays
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About Us

We are physicians who practice pain management and physical medicine and rehabilitation, and believe that the main goal of our practice is to improve the quality of life of our patients and communities.We will dive deep into the world of modern pain management to help healthcare providers and consumers understand various diagnoses, treatment options, and the changing landscape of pain management.This podcast is meant for educational and entertainment purposes only, and is not medical advice.

Latest Episodes

To repeat or not to repeat? A discussion on epidural steroid injections.

In this episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the age old question... whether or not to pursue a repeat epidural steroid injection (ESI) for the possibility of cumulative effect. Historically there was a time when it was fairly common practice to order a pre-determined series of ESIs. Over time, based on analysis of the research performed, and based on clinical experience, taking a more nuanced approach has proven to be the recommendation of most pain societies. Listen as the doctors discuss some of the available literature, as well as their clinical experience regarding this high yield / practical topic. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Lee JH, Lee SH. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?. Medicine (Baltimore). 2016;95(29):e4131. 2. Lee JH, Lee SH. Can Repeat Injection Provide Clinical Benefit in Patients with Lumbosacral Diseases When First Epidural Injection Results Only in Partial Response?. Pain Physician. 2016;19(2):E283-E290. 3. N. K. Arden, C. Price, I. Reading, J. Stubbing, J. Hazelgrove, C. Dunne, M. Michel, P. Rogers, C. Cooper, on behalf of the WEST Study Group, A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study, Rheumatology, Volume 44, Issue 11, November 2005, Pages 1399–1406. 4. Naveen S. Murthy, MD, Jennifer R. Geske, MS, Randy A. Shelerud, MD, John T. Wald, MD, Felix E. Diehn, MD, Kent R. Thielen, MD, Timothy J. Kaufmann, MD, Jonathan M. Morris, MD, Vance T. Lehman, MD, Kimberly K. Amrami, MD, Rickey E. Carter, PhD, Timothy P. Maus, MD, The Effectiveness of Repeat Lumbar Transforaminal Epidural Steroid Injections, Pain Medicine, Volume 15, Issue 10, October 2014, Pages 1686–1694

16 MIN2 d ago
Comments
To repeat or not to repeat? A discussion on epidural steroid injections.

A Pain Medicine Legend joins us to discuss the past, present, and future of our field

In this week's very special episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with another one of the leaders and legends in the field of pain medicine and pain research, Dr. Timothy Deer. Dr. Deer is one of the most recognizable names and faces in pain medicine. Amongst his many accolades, Dr. Deer is the President and CEO of The Center for Pain Relief, Inc., and Clinical Professor of Anesthesiology at West Virginia University. He is co-founder and chairman of the American Society of Pain and Neuroscience, President Emeritus of the West Virginia Society of Interventional Pain Physicians (WVSIPP) and past President of the International Neuromodulation Society (INS). Dr. Deer is a former member of the board of directors of American Society of Interventional Pain Physicians (ASIPP) and has served as faculty, moderator and presenter on many important subjects at national and international meetings, and has authored or been involved in much of the clinical research that has pushed pain medicine forward over the past couple decades. Some of the topics that the doctors dive into: - How the past has shaped what we currently see as modern pain medicine? - How does technology impact patient outcomes? - Where is pain medicine headed in the future? Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

32 MIN1 w ago
Comments
A Pain Medicine Legend joins us to discuss the past, present, and future of our field

Journal club: Platelet Rich Plasma and the Spine

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss a couple recent articles involving the use of platelet rich plasma to treat spine pathology. Listen as the docs summarize and discuss this orthobiologics and the cutting edge use in the spine. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain. Bise et Al. European Radiology. Feb 2020. Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5–9 years. Cheng et al. Regenerative Medicine. Aug 2019.

24 MIN2 w ago
Comments
Journal club: Platelet Rich Plasma and the Spine

Is the treatment making you worse? A review of Opioid Induced Hyperalgesia

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss opioid induced hyperalgesia (OIH)- a topic that is fairly controversial in the pain medicine world. OIH is a medical process defined by worsening of pain with the use of opioids; typically patients will have evidence of central and peripheral sensitization including hyperesthesia and/or allodynia, and the pain can become more widespread/diffuse. The doctors will discuss the theories behind the pathophysiology of OIH, including but definitely not limited to increased NMDA receptor activity. Lastly the doctors will address potential treatment options available to providers to help manage this very difficult to treat condition. Listen as the doctors explore this interesting, and to some degree controversial topic. Regardless of one’s final opinion on OIH, the potential impact of opioids of the nervous system (including the possibility of sensitization) is an important concept to be aware of and consider for any provider utilizing opioids to treat their patients. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

25 MINMAY 30
Comments
Is the treatment making you worse? A review of Opioid Induced Hyperalgesia

Journal Club: gluteal/buttock pain

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss several articles regarding both the diagnosis as well as the treatment of gluteal region musculoskeletal disorders. Topics discussed include the physical exam for sacroiliac joint dysfunction; as well as advanced treatment options for the relatively more rare chronic refractory coccydynia, and the relatively more common greater trochanter region pain syndrome. Listen as the doctors summarize and discuss these articles addressing a very common chief complaint of buttock/gluteal region pain. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Sencan S, Edipoglu IS, Ulku Demir FG, Yolcu G, Gunduz OH. Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial. Korean J Pain. 2019;32(4):301‐306. doi:10.3344/kjp.2019.32.4.301 2. Baker, C. L., & Mahoney, J. R. (2020). Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy. Orthopaedic Journal of Sports Medicine. 3. Byron J Schneider, MD, Reza Ehsanian, MD, PhD, Renee Rosati, DO, Lisa Huynh, MD, Josh Levin, MD, David J Kennedy, MD, Validity of Physical Exam Maneuvers in the Diagnosis of Sacroiliac Joint Pathology, Pain Medicine, Volume 21, Issue 2, February 2020, Pages 255–260.

30 MINMAY 11
Comments
Journal Club: gluteal/buttock pain

Journal club: 5/1/20. Treatments at various stages of chronic knee pain.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a few recent articles regarding treatment options for chronic refractory knee pain. Listen in as the docs discuss treatment of knee pain due to osteoarthritis prior to knee arthroplasty, as well as treatment options in the setting of persistent symptoms after knee arthroplasty. They summarize articles exploring platelet rich plasma injections, hyaluronic acid injections, genicular nerve radiofrequency ablation, and peripheral nerve stimulation. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Belk, J. W., Kraeutler, M. J., Houck, D. A., Goodrich, J. A., Dragoo, J. L., & McCarty, E. C. (2020). Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The American Journal of Sports Medicine. 2. Tate, Q., Conger, A., Burnham, T., Cushman, D.M., Kendall, R., Schneider, B., & McCormick, Z.L. (2019). The Effectiveness and Safety of Genicular Nerve Radiofrequency Ablation for the Treatment of Recalcitrant Knee Pain Due to Osteoarthritis: a Comprehensive Literature Review. Current Physical Medicine and Rehabilitation Reports, 7, 404 - 413.

27 MINMAY 1
Comments
Journal club: 5/1/20. Treatments at various stages of chronic knee pain.

Journal Club: 4/24/2020. Pharmacological management of chronic pain

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas begin a new journal club format to discuss multiple articles that have a similar theme. The goal of this series on the podcast is to summarize recent research, and provide a discussion of some key points in regards to potential impact on clinical care. In this week's podcast the doctors summarize and discuss three recent articles regarding medications for treatment of chronic pain. Please see References section below for the articles discussed in today's podcast. References: 1. Alberti P, et al. Topiramate prevents Oxaliplatin-related axonal hyperexcitability and oxaliplatin induced peripheral neurotoxicity. Neuropharmacology. 2020. 2. Karin Bruun-Plesner, MD, Morten Rune Blichfeldt-Eckhardt, MD, PhD, Henrik Bjarke Vaegter, MSc, PhD, Joergen T Lauridsen, MSc, PhD, Kirstine Amris, MD, MedScD, Palle Toft, MD, PhD, MedScD. Low-Dose Naltrexone for the Treatment of Fibromyalgia: Investigation of Dose–Response Relationships. Pain Medicine. 2020. 3. Lynn Webster, MD, Jeffrey Gudin, MD, Robert B Raffa, PhD, Jay Kuchera, MD, Richard Rauck, MD, Jeffrey Fudin, PharmD, Jeremy Adler, DMSc, PA-C, Theresa Mallick-Searle, NP. Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. Pain Medicine. 2020. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

28 MINAPR 24
Comments
Journal Club: 4/24/2020. Pharmacological management of chronic pain

INTERLUDE: COVID and sport, where do we go from here?

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves take a look at the possibility of sport making a return during the COVID-19 pandemic. Listen in as the docs discuss this and what may be coming down the road for the sport world. This is a discussion between two long time sport fans, who happen to be physical medicine and rehabilitation physicians. The doctors are not epidemiologists, virologists, policy makers, or owners of sport franchises; they are simply talking it through from an informed fan's perspective. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

14 MINAPR 22
Comments
INTERLUDE: COVID and sport, where do we go from here?

Maintaining your health through the pandemic: guidance and science.

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss some of the recent guidance coming from state and federal organizations to decrease some of the secondary effects of the COVID 19 pandemic. The stress and anxiety for our patients, front line healthcare providers and essential workers, and the general public can cause significant significant secondary problems to our overall health and health system. Listen in as the doctors discuss some tactics, and some of the science behind the tactics, to optimize your physical and mental health during these hard times. The strategies that have been recommended by the California department of health and surgeon general include: - Supportive relationships - Exercise - Sleep - Nutrition - Mental health support - Mindfulness We have discussed many of these and their relationship with patients in chronic pain in prior episodes. You can look there for a deeper dive. https://covid19.ca.gov/manage-stress-for-health/#top This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

25 MINAPR 9
Comments
Maintaining your health through the pandemic: guidance and science.

When the nerve root falls far from the disc; a case and literature review.

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas present a case report and do a quick review of lumbar disc herniations. Dr. Karvelas presents a case in which a more cephalad lumbar disc herniation can effect nerve roots more than 1 level caudal to the level of disc herniation. For example typically we would expect a L3-4 disc herniation to impact the L4 or L3 nerve root, but there are cases where the more caudal nerve roots (for example L5) can be impacted. The docs start by taking a step back and review the anatomy of the lumbar disc, and some important information regarding lumbar disc herniations including definitions and risk factors. It is well researched and documented that the most common lumbar disc herniation is a posterolateral disc herniation that would effect the traversing nerve root exiting one level caudal to level of herniation. However, when a patient's symptoms and neurologic exam do not fit with this classic picture it is important to keep an open mind to the differential diagnosis including but not limited to the possibility of more caudal nerve roots being involved. Listen as the doctors not only present there own recent case in clinic, but also review the case reports in the literature documenting clinical instances where a lumbar disc herniation has resulted in a more rare clinical presentation for a patient. This discussion reinforces an important principle in medicine that we always want to emphasize: in medicine it is important that we work as hard as we can to determine the most likely cause of the problem, but then importantly keep our mind open to/and think critically through other possibilities. References: 1. Mekhail N, Costandi S, et al.The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients. Neuromodulation. 2020; 23: 133-139. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

23 MINMAR 18
Comments
When the nerve root falls far from the disc; a case and literature review.

Latest Episodes

To repeat or not to repeat? A discussion on epidural steroid injections.

In this episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the age old question... whether or not to pursue a repeat epidural steroid injection (ESI) for the possibility of cumulative effect. Historically there was a time when it was fairly common practice to order a pre-determined series of ESIs. Over time, based on analysis of the research performed, and based on clinical experience, taking a more nuanced approach has proven to be the recommendation of most pain societies. Listen as the doctors discuss some of the available literature, as well as their clinical experience regarding this high yield / practical topic. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Lee JH, Lee SH. Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?. Medicine (Baltimore). 2016;95(29):e4131. 2. Lee JH, Lee SH. Can Repeat Injection Provide Clinical Benefit in Patients with Lumbosacral Diseases When First Epidural Injection Results Only in Partial Response?. Pain Physician. 2016;19(2):E283-E290. 3. N. K. Arden, C. Price, I. Reading, J. Stubbing, J. Hazelgrove, C. Dunne, M. Michel, P. Rogers, C. Cooper, on behalf of the WEST Study Group, A multicentre randomized controlled trial of epidural corticosteroid injections for sciatica: the WEST study, Rheumatology, Volume 44, Issue 11, November 2005, Pages 1399–1406. 4. Naveen S. Murthy, MD, Jennifer R. Geske, MS, Randy A. Shelerud, MD, John T. Wald, MD, Felix E. Diehn, MD, Kent R. Thielen, MD, Timothy J. Kaufmann, MD, Jonathan M. Morris, MD, Vance T. Lehman, MD, Kimberly K. Amrami, MD, Rickey E. Carter, PhD, Timothy P. Maus, MD, The Effectiveness of Repeat Lumbar Transforaminal Epidural Steroid Injections, Pain Medicine, Volume 15, Issue 10, October 2014, Pages 1686–1694

16 MIN2 d ago
Comments
To repeat or not to repeat? A discussion on epidural steroid injections.

A Pain Medicine Legend joins us to discuss the past, present, and future of our field

In this week's very special episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with another one of the leaders and legends in the field of pain medicine and pain research, Dr. Timothy Deer. Dr. Deer is one of the most recognizable names and faces in pain medicine. Amongst his many accolades, Dr. Deer is the President and CEO of The Center for Pain Relief, Inc., and Clinical Professor of Anesthesiology at West Virginia University. He is co-founder and chairman of the American Society of Pain and Neuroscience, President Emeritus of the West Virginia Society of Interventional Pain Physicians (WVSIPP) and past President of the International Neuromodulation Society (INS). Dr. Deer is a former member of the board of directors of American Society of Interventional Pain Physicians (ASIPP) and has served as faculty, moderator and presenter on many important subjects at national and international meetings, and has authored or been involved in much of the clinical research that has pushed pain medicine forward over the past couple decades. Some of the topics that the doctors dive into: - How the past has shaped what we currently see as modern pain medicine? - How does technology impact patient outcomes? - Where is pain medicine headed in the future? Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

32 MIN1 w ago
Comments
A Pain Medicine Legend joins us to discuss the past, present, and future of our field

Journal club: Platelet Rich Plasma and the Spine

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss a couple recent articles involving the use of platelet rich plasma to treat spine pathology. Listen as the docs summarize and discuss this orthobiologics and the cutting edge use in the spine. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain. Bise et Al. European Radiology. Feb 2020. Treatment of symptomatic degenerative intervertebral discs with autologous platelet-rich plasma: follow-up at 5–9 years. Cheng et al. Regenerative Medicine. Aug 2019.

24 MIN2 w ago
Comments
Journal club: Platelet Rich Plasma and the Spine

Is the treatment making you worse? A review of Opioid Induced Hyperalgesia

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss opioid induced hyperalgesia (OIH)- a topic that is fairly controversial in the pain medicine world. OIH is a medical process defined by worsening of pain with the use of opioids; typically patients will have evidence of central and peripheral sensitization including hyperesthesia and/or allodynia, and the pain can become more widespread/diffuse. The doctors will discuss the theories behind the pathophysiology of OIH, including but definitely not limited to increased NMDA receptor activity. Lastly the doctors will address potential treatment options available to providers to help manage this very difficult to treat condition. Listen as the doctors explore this interesting, and to some degree controversial topic. Regardless of one’s final opinion on OIH, the potential impact of opioids of the nervous system (including the possibility of sensitization) is an important concept to be aware of and consider for any provider utilizing opioids to treat their patients. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

25 MINMAY 30
Comments
Is the treatment making you worse? A review of Opioid Induced Hyperalgesia

Journal Club: gluteal/buttock pain

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss several articles regarding both the diagnosis as well as the treatment of gluteal region musculoskeletal disorders. Topics discussed include the physical exam for sacroiliac joint dysfunction; as well as advanced treatment options for the relatively more rare chronic refractory coccydynia, and the relatively more common greater trochanter region pain syndrome. Listen as the doctors summarize and discuss these articles addressing a very common chief complaint of buttock/gluteal region pain. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Sencan S, Edipoglu IS, Ulku Demir FG, Yolcu G, Gunduz OH. Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial. Korean J Pain. 2019;32(4):301‐306. doi:10.3344/kjp.2019.32.4.301 2. Baker, C. L., & Mahoney, J. R. (2020). Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy. Orthopaedic Journal of Sports Medicine. 3. Byron J Schneider, MD, Reza Ehsanian, MD, PhD, Renee Rosati, DO, Lisa Huynh, MD, Josh Levin, MD, David J Kennedy, MD, Validity of Physical Exam Maneuvers in the Diagnosis of Sacroiliac Joint Pathology, Pain Medicine, Volume 21, Issue 2, February 2020, Pages 255–260.

30 MINMAY 11
Comments
Journal Club: gluteal/buttock pain

Journal club: 5/1/20. Treatments at various stages of chronic knee pain.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a few recent articles regarding treatment options for chronic refractory knee pain. Listen in as the docs discuss treatment of knee pain due to osteoarthritis prior to knee arthroplasty, as well as treatment options in the setting of persistent symptoms after knee arthroplasty. They summarize articles exploring platelet rich plasma injections, hyaluronic acid injections, genicular nerve radiofrequency ablation, and peripheral nerve stimulation. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve. References: 1. Belk, J. W., Kraeutler, M. J., Houck, D. A., Goodrich, J. A., Dragoo, J. L., & McCarty, E. C. (2020). Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. The American Journal of Sports Medicine. 2. Tate, Q., Conger, A., Burnham, T., Cushman, D.M., Kendall, R., Schneider, B., & McCormick, Z.L. (2019). The Effectiveness and Safety of Genicular Nerve Radiofrequency Ablation for the Treatment of Recalcitrant Knee Pain Due to Osteoarthritis: a Comprehensive Literature Review. Current Physical Medicine and Rehabilitation Reports, 7, 404 - 413.

27 MINMAY 1
Comments
Journal club: 5/1/20. Treatments at various stages of chronic knee pain.

Journal Club: 4/24/2020. Pharmacological management of chronic pain

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas begin a new journal club format to discuss multiple articles that have a similar theme. The goal of this series on the podcast is to summarize recent research, and provide a discussion of some key points in regards to potential impact on clinical care. In this week's podcast the doctors summarize and discuss three recent articles regarding medications for treatment of chronic pain. Please see References section below for the articles discussed in today's podcast. References: 1. Alberti P, et al. Topiramate prevents Oxaliplatin-related axonal hyperexcitability and oxaliplatin induced peripheral neurotoxicity. Neuropharmacology. 2020. 2. Karin Bruun-Plesner, MD, Morten Rune Blichfeldt-Eckhardt, MD, PhD, Henrik Bjarke Vaegter, MSc, PhD, Joergen T Lauridsen, MSc, PhD, Kirstine Amris, MD, MedScD, Palle Toft, MD, PhD, MedScD. Low-Dose Naltrexone for the Treatment of Fibromyalgia: Investigation of Dose–Response Relationships. Pain Medicine. 2020. 3. Lynn Webster, MD, Jeffrey Gudin, MD, Robert B Raffa, PhD, Jay Kuchera, MD, Richard Rauck, MD, Jeffrey Fudin, PharmD, Jeremy Adler, DMSc, PA-C, Theresa Mallick-Searle, NP. Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. Pain Medicine. 2020. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

28 MINAPR 24
Comments
Journal Club: 4/24/2020. Pharmacological management of chronic pain

INTERLUDE: COVID and sport, where do we go from here?

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves take a look at the possibility of sport making a return during the COVID-19 pandemic. Listen in as the docs discuss this and what may be coming down the road for the sport world. This is a discussion between two long time sport fans, who happen to be physical medicine and rehabilitation physicians. The doctors are not epidemiologists, virologists, policy makers, or owners of sport franchises; they are simply talking it through from an informed fan's perspective. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

14 MINAPR 22
Comments
INTERLUDE: COVID and sport, where do we go from here?

Maintaining your health through the pandemic: guidance and science.

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss some of the recent guidance coming from state and federal organizations to decrease some of the secondary effects of the COVID 19 pandemic. The stress and anxiety for our patients, front line healthcare providers and essential workers, and the general public can cause significant significant secondary problems to our overall health and health system. Listen in as the doctors discuss some tactics, and some of the science behind the tactics, to optimize your physical and mental health during these hard times. The strategies that have been recommended by the California department of health and surgeon general include: - Supportive relationships - Exercise - Sleep - Nutrition - Mental health support - Mindfulness We have discussed many of these and their relationship with patients in chronic pain in prior episodes. You can look there for a deeper dive. https://covid19.ca.gov/manage-stress-for-health/#top This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

25 MINAPR 9
Comments
Maintaining your health through the pandemic: guidance and science.

When the nerve root falls far from the disc; a case and literature review.

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas present a case report and do a quick review of lumbar disc herniations. Dr. Karvelas presents a case in which a more cephalad lumbar disc herniation can effect nerve roots more than 1 level caudal to the level of disc herniation. For example typically we would expect a L3-4 disc herniation to impact the L4 or L3 nerve root, but there are cases where the more caudal nerve roots (for example L5) can be impacted. The docs start by taking a step back and review the anatomy of the lumbar disc, and some important information regarding lumbar disc herniations including definitions and risk factors. It is well researched and documented that the most common lumbar disc herniation is a posterolateral disc herniation that would effect the traversing nerve root exiting one level caudal to level of herniation. However, when a patient's symptoms and neurologic exam do not fit with this classic picture it is important to keep an open mind to the differential diagnosis including but not limited to the possibility of more caudal nerve roots being involved. Listen as the doctors not only present there own recent case in clinic, but also review the case reports in the literature documenting clinical instances where a lumbar disc herniation has resulted in a more rare clinical presentation for a patient. This discussion reinforces an important principle in medicine that we always want to emphasize: in medicine it is important that we work as hard as we can to determine the most likely cause of the problem, but then importantly keep our mind open to/and think critically through other possibilities. References: 1. Mekhail N, Costandi S, et al.The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients. Neuromodulation. 2020; 23: 133-139. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

23 MINMAR 18
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When the nerve root falls far from the disc; a case and literature review.
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