57 episodes

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.

Spine & Nerve podcast Spine & Nerve podcast

    • Health & Fitness

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.

    2 pain docs and bone mineral density; the effect of epidural steroid injections

    2 pain docs and bone mineral density; the effect of epidural steroid injections

    In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the impact of epidural steroid injections on bone mineral density / risk of osteoporosis / fracture risk.  

    there is conflicting research/data regarding epidural steroid injections and the impact on bone mineral density and fracture risk.  We know that steroids have the potential to have an impact on osteoblast and osteoclast activity, and consequently bone mineral density; however, the exact steroid, the exact dose, the method of delivery, and the patient's response (including possible increase in function/activity/weight bearing exercise) all need to be taken into careful consideration.  

    Listen as the doctors discuss some of the available literature, as well as their clinical experience regarding this high yield, practical, and important 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. Bicket MC, Chakravarthy K, Chang D, Cohen SP. Epidural steroid injections: an updated review on recent trends in safety and complications. Pain Manag. 2015;5(2):129-146.
    2. Carreon L, Ong K, Lau E, Kurtz S, Glassman S. Risk of osteoporotic fracture after steroid injections in Medicare patients. The American Journal of Orthopedics. 2017.
    3. Mandel S, Schilling J, Peterson E, Rao DS, Sanders W. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg Am. 2013;95(11):961-964.

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

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

    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 min
    Journal club: Platelet Rich Plasma and the Spine

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

    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 min
    Journal Club: gluteal/buttock pain

    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 min

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