PainExam Podcast

David Rosenblum, MD
  • 4.0 (29)
  • MEDICINE
  • UPDATED MONTHLY

David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians. Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery. Available at Amazon.com and www.MyKidsSurgery.com

  1. Peptides and BPC-157 for Pain: What's the deal?

    JAN 28

    Peptides and BPC-157 for Pain: What's the deal?

    Peptides in Pain Management: BPC-157, Risks, Reality, and the Business of Regenerative Medicine Episode Length: ~12–15 minutes Target Audience: Pain physicians, anesthesiologists, PM&R, sports medicine, and regenerative medicine clinicians Hosted by: Dr. David Rosenblum, MD Produced by: PainExam | NRAP Academy 🧠 Episode Overview Peptides like BPC-157 have exploded in popularity across regenerative medicine, sports medicine, and cash-based pain practices — but does the science support the hype? In this episode of PainExam, Dr. David Rosenblum takes a critical, evidence-based look at BPC-157 and other peptidesin pain management, examining: The biological rationale behind peptide therapy Preclinical and early human evidence for pain and tissue healing Regulatory status and safety concerns Ethical, legal, and marketing risks for physicians How peptides are currently being incorporated — and monetized — in pain practices This episode is designed to help clinicians separate science from marketing, and to approach peptide therapies with appropriate caution and professionalism. ⏱️ Episode Breakdown 🔹 00:00–01:30 — Introduction Why peptides are trending in pain and regenerative medicine What patients are asking — and what physicians need to know 🔹 01:30–04:30 — What Is BPC-157? Origins of Body Protection Compound-157 Mechanisms: angiogenesis, inflammation modulation, tissue repair Summary of preclinical data and animal pain models 🔹 04:30–07:00 — Evidence for Pain Relief & Healing Early inflammatory and non-inflammatory pain studies Intra-articular BPC-157 for knee pain: what the case series showed Why current human data are hypothesis-generating, not definitive 🔹 07:00–09:30 — Risks, Unknowns & Regulatory Issues FDA status and investigational use Quality, purity, and dosing variability Theoretical biologic risks and drug interactions 🔹 09:30–12:30 — The Business of Peptides in Pain Practice How peptides are marketed in regenerative clinics Cash-based models and patient demand Ethical marketing, informed consent, and medicolegal exposure 🔹 12:30–End — Clinical Takeaways Where peptides fit — and don't fit — in current pain practice Why evidence still matters in regenerative medicine ⚠️ Key Clinical Takeaways BPC-157 shows promising preclinical data, but human evidence remains limited Current studies lack randomization, controls, and long-term outcomes Peptides are not FDA-approved for pain or musculoskeletal indications Marketing peptides without transparency poses ethical and legal risk Physicians must clearly distinguish experimental therapies from standard of care 📚 Key References Discussed Józwiak et al. Multifunctionality and Possible Medical Application of BPC-157 — MDPI Pharmaceuticals (2025) McGuire et al. Regeneration or Risk? A Narrative Review of BPC-157 — Current Reviews in Musculoskeletal Medicine (2025) Sikirić et al. Effects of BPC-157 on Inflammatory and Non-Inflammatory Pain — Inflammopharmacology (1993) Lee & Padgett. Intra-Articular Injection of BPC-157 for Knee Pain — Alternative Therapies in Health and Medicine (2021) 📢 Sponsored Message / Advertisement 🔔 Ready to Master Evidence-Based Pain Medicine? If you're preparing for Pain Medicine boards or looking to strengthen your foundation in interventional and regenerative pain management, check out the educational resources at: 👉 https://www.nrappain.org 🎓 Offered through NRAP Academy: ✅ PainExam® Pain Management Board Review ✅ ABA, ABPM, FIPP, and ABIPP exam preparation ✅ Ultrasound-guided pain procedure training ✅ Regenerative pain medicine education — grounded in evidence, not hype ✅ Virtual Pain Fellowship curriculum All content is designed by practicing pain physicians, for practicing pain physicians. 🎯 Why Learn with NRAP Academy? Evidence-driven, board-relevant education Practical clinical insights you can apply immediately Trusted by physicians nationwide Focused on ethical, safe, and effective pain care 👉 Explore courses and upcoming programs at https://www.nrappain.org 🎧 Subscribe & Stay Sharp If you found this episode helpful: Subscribe to the PainExam Podcast Share it with a colleague Leave a review to help other pain physicians find evidence-based content Disclaimer: This podcast is for educational purposes only. Discussion of investigational therapies does not constitute endorsement or clinical recommendation. Physicians should follow applicable laws, regulations, and professional guidelines when considering experimental treatments.   References Lee, Edwin, and Blake Padgett. "Intra-Articular Injection of BPC 157 for Multiple Types of Knee Pain." Alternative Therapies in Health & Medicine 27.4 (2021). Józwiak, Michalina, et al. "Multifunctionality and Possible Medical Application of the BPC 157 Peptide—Literature and Patent Review." Pharmaceuticals 18.2 (2025): 185. McGuire, F. P., Martinez, R., Lenz, A., Skinner, L., & Cushman, D. M. (2025). Regeneration or risk? A narrative review of BPC-157 for musculoskeletal healing. Current Reviews in Musculoskeletal Medicine, 18(12), 611-619.

    13 min
  2. Meralgia Paresthetica for the Pain Boards

    JAN 14

    Meralgia Paresthetica for the Pain Boards

    Meralgia Paresthetica Education and the Pain Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblu's Brooklyn office for patients seeking treatment   Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

    8 min
  3. Kratom for the Pain Management Board Exam

    12/11/2025

    Kratom for the Pain Management Board Exam

    🎙️ PainExam Podcast Show Notes Kratom (Mitragyna speciosa): What Pain Physicians Must Know for the Boards In this episode, Dr. David Rosenblum reviews the current science, pharmacology, risks, and clinical relevance of Kratom — an herbal substance widely discussed by pain patients and increasingly appearing on pain-medicine board exams. The discussion focuses on evidence-based mechanisms, safety considerations, and counseling points essential for ABA/ABPM/ABIPP/FIPP board preparation. 🔍 Key Board-Relevant Takeaways 1. Pharmacology & Mechanism Kratom's primary alkaloids are mitragynine and 7-hydroxymitragynine. They act as partial mu-opioid receptor agonists and demonstrate G-protein biased signaling, which may reduce β-arrestin–mediated respiratory depression seen with full opioids. No FDA-approved medical use; pharmacokinetics and dose-response remain inconsistent. 2. Reported Effects Potential Benefits (mostly anecdotal or preclinical): Analgesia for chronic pain Mood elevation and increased energy Reduction of opioid withdrawal symptoms Major Limitations: No high-quality randomized controlled trials Not a recommended analgesic for evidence-based pain practice 3. Adverse Effects & Safety Concerns Commonly reported: Nausea, vomiting, constipation Tachycardia, palpitations Hepatotoxicity in some users Dependence and withdrawal syndrome similar to mild-moderate opioid withdrawal Serious risks: Product variability and contamination Potential interactions with CNS depressants Unpredictable potency of alkaloids 4. Regulatory Status Kratom is unregulated, with significant variability in purity and composition. FDA and multiple public-health agencies caution against its use due to safety concerns. Not recommended as a first-line or adjunct pain therapy. 5. What Boards Like to Test Expect questions on: Mechanism: partial MOR agonist, G-protein bias Differences from classical opioids Adverse effects and withdrawal Toxicology and contamination risks Counseling patients who self-medicate Lack of clinical trial data and regulatory approval 🎓 Board Prep Resources Prepare for the ABA, ABPM, ABIPP, FIPP, and AOBPM exams with the PainExam Board Review and full curriculum at the NRAP Academy: 👉 https://www.NRAPpain.org 🫁 Hands-On Ultrasound Training for Pain Physicians Boost your procedural skills with live ultrasound-guided interventional pain and regional anesthesia workshops: 👉 https://www.nrappain.org/pages/ultrasound-training 📚 References (Condensed) Kruegel AC, Grundmann O. Neuropharmacology of kratom alkaloids. Neuropharmacology. Eastlack SC et al. Kratom: Pharmacology & clinical implications. Phytother Res. Striley CW et al. Health effects of kratom. Front Pharmacol. FDA Public Health Advisory on Kratom. Educational Offerings & Learning Opportunities PainExam / NRAP Academy Training & Programs: Neuromodulation & Regional Anesthesia Workshops Ultrasound-Guided Pain Procedures Regenerative Pain Medicine Training Virtual Pain Fellowship Pain Management Board Review & Question Banks Learn More / Register: 🔹 https://PainExam.com 🔹 https://NRAPpain.org Board Prep & Certification Support Prepare for: ABA Pain Boards ABPM ABIPP Pain Management Board Certification Exams (No reference to FIPP included, per request) Access Board Prep Courses & Q-Banks: ➡️ https://PainExam.com ➡️ https://NRAPpain.org Clinical Practice AABP Integrative Pain Care (Brooklyn & Great Neck, NY) To schedule a consultation or referral: 🌐 https://AABPpain.com 📞 Brooklyn: 718-436-7246 About the Host – David Rosenblum, MD Dr. Rosenblum serves as Director of Pain Management at Maimonides Medical Center and Managing Partner at AABP Integrative Pain Care in Brooklyn, NY. He is recognized as an early adopter and leading educator in ultrasound-guided pain procedures, neuromodulation, and regenerative medicine. He has: Developed regional anesthesia training programs Published widely in pain medicine literature Lectured nationally and internationally through ASIPP, ASPN, NANS, IASP, and more Helped over 3000 physicians pass pain board exams Hosted the PainExam, AnesthesiaExam, and PMRExam podcasts Awards (Selected): New York Magazine Top Doctors: 2016–2025 Top Doctors NY Metro Area: 2016–2025 Schneps Media Honors: Multiple Years Connect with Dr. Rosenblum LinkedIn: https://www.linkedin.com/in/davidrosenblummd/ Instagram: https://www.instagram.com/painexam/ Facebook: https://www.facebook.com/david.rosenblum.16 X (Twitter): https://x.com/AlgoSonic Episode Call-to-Action ✅ Join the NRAP Community ✅ Register for an Upcoming Workshop ✅ Access Pain Board Review Training Start here → https://NRAPpain.org | https://PainExam.com

    11 min
  4. PRP in the Caudal Epidural Space for Low Back Pain: Journal Club & Patient's Testimonial

    11/19/2025

    PRP in the Caudal Epidural Space for Low Back Pain: Journal Club & Patient's Testimonial

    Caudal Epidural Steroid Injection with PRP Case Reports and a Testimonial! Upcoming Training Courses and Services Regional Anesthesia and IV Vascular Access Courses: New York and Detroit locations scheduled Pain Management Board Preparation   Private Coaching Services: Ultrasound guidance Preceptorship Board preparation coaching Contact available via email Info@NRAPpain.org for interested physicians PRP Caudal Epidural Research Review Study Overview: Randomized double-blind controlled pilot study comparing leukocyte-rich PRP versus corticosteroids in caudal epidural space 50 patients randomly assigned to two groups Treatment options: triamcinolone 60mg or leukocyte-rich PRP from 60ml autologous blood Follow-up assessments at 1, 3, and 6 months using VAS and SF-36 surveys Key Findings: Both treatments showed significant pain reduction compared to baseline Steroid group had lower VAS scores at one month PRP group demonstrated superior results at 3 and 6 months PRP group showed significant improvement across all SF-36 domains at 6 months No complications or adverse effects in either group during 6-month follow-up Personal Treatment Experience Dr. Rosenblum received transforaminal PRP injection 9-10 weeks ago Gradual improvement noted from weeks 4-8, with more noticeable benefits from weeks 8-10 Current status: minimal pain (0.5/10) only during weather changes Clinical Practice Philosophy Treatment Approach: Minimalist philosophy focusing on turmeric, PRP, and Pilates Medication Strategy: Low-dose naltrexone as go-to medication, avoiding long-term drugs with side effects Surgical Avoidance: Prioritizing conservative treatments over unnecessary surgical interventions Emergency Department PRP Implementation Case Study Results: Ultrasound-guided caudal epidural steroid injection in ER setting 100% pain resolution achieved Patient discharged directly from ER Cost savings: reduced from $33,000 to $4,800 (approximately $28,000 savings) Training Opportunities: Private training sessions available for ER physicians interested in ultrasound-guided procedures Patient Testimonial Highlights Case Background: Nurse with herniated disc from March, previously considering $30,000 surgery Treatment Outcome: PRP injection completed two months ago with nearly complete pain relief Reduced from multiple pain medications to one Advil daily Eliminated antalgic posture and muscle spasms Returned to full 12-hour hospital shifts without difficulty Overall quality of life restored to normal levels David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.    Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Irvan J. Bubic, Jessica Oswald, Ultrasound-Guided Caudal Epidural Steroid Injection for Back Pain: A Case Report of Successful Emergency Department Management of Radicular Low Back Pain Symptoms, The Journal of Emergency Medicine,Volume 61, Issue 3,2021,Pages 293-297,ISSN 0736-4679 Ruiz‐Lopez, Ricardo, and Yu‐Chuan Tsai. "A randomized double‐blind controlled pilot study comparing leucocyte‐rich platelet‐rich plasma and corticosteroid in caudal epidural injection for complex chronic degenerative spinal pain." Pain Practice 20.6 (2020): 639-646. #prppain #paincme #sciatia #ultrasoundmsk #ultrasoundprp #epidural #nypaindoctor #prppainwindsor

    18 min
  5. Supplements for Chronic Pain: The Evidence

    11/06/2025

    Supplements for Chronic Pain: The Evidence

    Episode Overview In this episode, Dr. David Rosenblum discusses the role of supplements and complementary strategies in the management of chronic pain. Drawing from clinical practice at AABP Integrative Pain Care, as well as his teaching and training programs, Dr. Rosenblum reviews how nutraceuticals, regenerative therapies, ultrasound-guided procedures, and neuromodulation can work together to improve patient outcomes and reduce opioid reliance. This episode also highlights educational opportunities and exam-prep resources for pain fellows, residents, anesthesiologists, physiatrists, and APPs looking to expand their interventional pain, ultrasound, and regenerative medicine skill sets. Key Topics Discussed Evidence and clinical rationale for select supplements in chronic pain management The role of ultrasound guidance in improving accuracy and safety in interventional pain procedures How regenerative medicine techniques such as PRP and BMAC are shaping personalized pain care Practical considerations when combining supplements with neuromodulation, RFA, or injections Patient case applications and real-world treatment planning Educational Offerings & Learning Opportunities PainExam / NRAP Academy Training & Programs: Neuromodulation & Regional Anesthesia Workshops Ultrasound-Guided Pain Procedures Regenerative Pain Medicine Training Virtual Pain Fellowship Pain Management Board Review & Question Banks Learn More / Register: www.AABPpain.com 🔹 https://PainExam.com 🔹 https://NRAPpain.org Board Prep & Certification Support Prepare for: ABA Pain Boards ABPM ABIPP Pain Management Board Certification Exams (No reference to FIPP included, per request) Access Board Prep Courses & Q-Banks: ➡️ https://PainExam.com ➡️ https://NRAPpain.org Clinical Practice AABP Integrative Pain Care (Brooklyn & Great Neck, NY) To schedule a consultation or referral: 🌐 https://AABPpain.com 📞 Brooklyn: 718-436-7246 About the Host – David Rosenblum, MD Dr. Rosenblum serves as Director of Pain Management at Maimonides Medical Center and Managing Partner at AABP Integrative Pain Care in Brooklyn, NY. He is recognized as an early adopter and leading educator in ultrasound-guided pain procedures, neuromodulation, and regenerative medicine. He has: Developed regional anesthesia training programs Published widely in pain medicine literature Lectured nationally and internationally through ASIPP, ASPN, NANS, IASP, and more Helped over 3000 physicians pass pain board exams Hosted the PainExam, AnesthesiaExam, and PMRExam podcasts Awards (Selected): New York Magazine Top Doctors: 2016–2025 Top Doctors NY Metro Area: 2016–2025 Schneps Media Honors: Multiple Years Connect with Dr. Rosenblum LinkedIn: https://www.linkedin.com/in/davidrosenblummd/ Instagram: https://www.instagram.com/painexam/ X (Twitter): https://x.com/AlgoSonic   Practical Takeaways Evidence strength varies widely; preclinical support is more robust than human RCT data for most supplements. Potentially reasonable adjuncts in select contexts Vitamin D: plausible benefit in deficiency states, including diabetic neuropathy and chronic pain-related quality-of-life factors; confirm deficiency and monitor. Magnesium: consider IV regimens for refractory neuropathic components (e.g., cancer pain, PHN); oral efficacy uncertain. Curcumin: consider as adjunct, especially formulated phytosome combinations; monitor for additive effects and tolerability. B vitamins: consider B12 in deficiency or neuropathy with suspected demyelination; overall human evidence limited. Zinc: mechanistic rationale with preclinical support; limited human data—consider deficiency correction rather than supraphysiologic dosing. Cautions and contraindications St. John's wort: significant drug–drug interaction potential via CYP/P-gp induction. Alpha lipoic acid: may cause hypoglycemia; monitor glucose, especially in diabetes. Agent-specific toxicity thresholds should guide safe upper limits; prioritize lab-confirmed deficiencies. Risks, Limitations, and Research Gaps Heterogeneity in study designs, small samples, lack of controls, and multi-ingredient formulations limit causal inference. Need for large, well-designed RCTs stratified by neuropathic pain etiology (e.g., CIPN vs. DPN vs. PHN) with standardized outcomes. Translational gap between animal models and human clinical efficacy remains significant.   References Frediani, Jennifer K., et al. "The role of diet and non‐pharmacologic supplements in the treatment of chronic neuropathic pain: A systematic review." Pain Practice 24.1 (2024): 186-210. Huang, Wei MD, PhD*,†; Shah, Shivani DO†; Long, Qi PhD‡; Crankshaw, Alicia K. MD†; Tangpricha, Vin MD, PhD§,∥. Improvement of Pain, Sleep, and Quality of Life in Chronic Pain Patients With Vitamin D Supplementation. The Clinical Journal of Pain 29(4):p 341-347, April 2013. | DOI: 10.1097/AJP.0b013e318255655d   Haddad, H.W., Mallepalli, N.R., Scheinuk, J.E. et al. The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia: A Narrative Review. Pain Ther 10, 827–848 (2021). https://doi.org/10.1007/s40122-021-00266-9 Abdelrahman, K.M.; Hackshaw, K.V. Nutritional Supplements for the Treatment of Neuropathic Pain. Biomedicines 2021, 9, 674. https://doi.org/10.3390/biomedicines9060674

    19 min
  6. BMC and Platelet Products for ACL Tears: Journal Club

    10/15/2025

    BMC and Platelet Products for ACL Tears: Journal Club

    Pain Exam Podcast  Recent Conference Activities London Conference Weekend: Successfully attended and spoke at ISPN and SOMOS care conferences Somos Care Conference: Delivered presentation on pain management for primary care physicians Presentation consisted of 50+ slides with only one slide dedicated to opiates Emphasized shift away from opiate-based treatments in interventional pain management Recommended primary care physicians refer patients to pain specialists for comprehensive treatment options ISPN Conference: Participated in international pain management conference Met with doctors from London, Iraq, and various other countries Observed different international approaches to pain treatment including increased phenol use and varying regenerative medicine restrictions Upcoming Events and Workshops New York-New Jersey Pain Conference: November (NRAP Academy booth presence) IV Ultrasound Placement Workshops: Monthly sessions in New York Regional Anesthesia and Ultrasound-Guided Interventional Pain Medicine Workshops: New York: December 13th, January 10th Florida (Fort Lauderdale/Hollywood): November 8th Detroit: January 18th, February 15th Alternative Options: Online ultrasound courses and shadowing opportunities available Board Prep and NRAP Community at PainExam.com or NRAPpain.org ABA ABPM ABIPP FIPP Pain Management Board prep, Question Banks, and Virtual Pain Fellowship Educational Offerings and Events Training and Courses: Research Review: ACL Treatment Study Study Focus: Non-surgical treatment of ACL tears using bone marrow concentrate (BMAC) and platelet products versus exercise therapy Key Findings: BMAC group showed significantly greater improvement in Lower Extremity Function Scale (LEFS) and Single Assessment Numeric Evaluation (SANE) scores at three months Sustained improvement in function and decreased pain maintained through two-year follow-up Patients reported median subjective improvement of 90% at final follow-up No significant improvements observed in exercise-only group during initial three months Treatment Protocol: Bone marrow harvest from posterior superior iliac crest (60-90ml from 6-8 sites) PRP preparation from 60ml whole blood Fluoroscopy-guided injection directly into ACL ligament Comprehensive 52-week rehabilitation protocol with activity restrictions Clinical Practice Implications Current ACL Treatment Landscape: Over 400,000 ACL reconstruction surgeries performed annually in the US Surgical Limitations: Risk of graft failure, persistent instability, cartilage injury, and increased arthritis risk Return to Sport Statistics: Post-surgical rates vary significantly (33-92% return to sport, 65% return to pre-injury level) Practice Integration Considerations: Potential incorporation of BMAC/PRP protocols for ACL tears, though insurance coverage remains limited   David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.    Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 References Centeno CJ, Berger DR, Pitts J, Markle J, Pelle AJ, Murphy M, Dodson E. Non-surgical treatment of anterior cruciate ligament tears with percutaneous bone marrow concentrate and platelet products versus exercise therapy: a randomized-controlled, crossover trial with 2-year follow-up. BMC Musculoskelet Disord. 2025 Sep 30;26(1):882. doi: 10.1186/s12891-025-09153-2. PMID: 41029301; PMCID: PMC12486544.   #pccwindsor #paincareclinicswindsor #painwindsorontario #paindocwindsorontarior #paincareclinics #prpwindsorontario #prp #aabppain

    18 min
  7. TENS for the Boards: Mechanism, Evidence, Controversy and more!

    10/01/2025

    TENS for the Boards: Mechanism, Evidence, Controversy and more!

    Project Sync / Status Update Summary Podcast Episode Overview The host discussed Transcutaneous Electrical Nerve Stimulation (TENS) as a recurring pain board topic and reviewed mechanisms, efficacy, and clinical considerations. Emphasis that TENS appears on pain boards annually and is a foundational topic from early podcast episodes. Board Prep and NRAP Community at PainExam.com or NRAPpain.org ABA ABPM ABIPP FIPP Pain Management Board prep, Question Banks, and Virtual Pain Fellowship Educational Offerings and Events Training and Courses: Monthly ultrasound courses in New York and upcoming courses in Detroit covering ultrasound-guided regional anesthesia and chronic pain. Ultrasound Guided Acute and Chronic Pain course in November near Hollywood/Fort Lauderdale with venue pending confirmation. Multiple instructors to offer diverse perspectives; registration via the CME calendar at nrappain.org. Conferences and Teaching: New York–New Jersey Pain Conference in November (hosted by Soudir Duwan). ISPN conference in London next week, with ultrasound teaching participation by the host. Community and Coaching: Private coaching and shadowing opportunities available; contact via newsletter replies. Access to the NRAP community forum upon signup at nrappain.org for discussions on neuromodulation, regional anesthesia, and pain. TENS: Mechanisms and Parameters Device and Parameters: TENS delivers adjustable pulse frequency and intensity; configurations include low (50–100+ Hz), and mixed frequencies. Mechanisms of Analgesia: Activation of large-diameter, non-noxious A-beta afferent fibers in the periphery, driving descending inhibitory pathways and reducing hyperalgesia. Board-relevant point: selective activation of A-beta fibers is frequently tested. Central effects: Reduces central excitability and nociceptive dorsal horn neuron activity in uninjured and injured models. Frequency-dependent opioid receptor mediation: High-frequency analgesia blocked by delta receptor antagonists. Low-frequency analgesia blocked by mu receptor antagonists (spinal cord and rostral ventral medulla). Additional receptor involvement: muscarinic M1/M3, GABA-A, and cannabinoid (CB1) receptors; blockade reduces or prevents TENS analgesia depending on frequency. Peripheral effects: High-frequency TENS reduces injury-related increases in substance P in DRG neurons. Blockade of peripheral opioid and CB1 receptors can prevent analgesia from both low- and high-frequency TENS. Clinical dosing considerations: Adequate dosing (timing, frequency of use, intensity achieving strong but non-painful paresthesia) influences efficacy. Analgesia has rapid onset/offset and may require repeated administration throughout the day for sustained relief. Evidence and Efficacy Summary Systematic Review Findings: Cochrane umbrella review of 9 systematic reviews (51 trials; n=2,895) comparing active TENS with sham/usual care found uncertain efficacy due to: Very low-quality evidence (risk of bias, small samples, methodological limitations). Inconsistent adverse event reporting. Heterogeneity in TENS parameters and comparators. Authors note uncertainty may be confounded by inadequate dosing not being an inclusion metric. Practical Interpretation: TENS is inexpensive, low-risk, self-administered, and titratable; commonly used by patients and physical therapists. Clinical experience suggests potential adjunctive benefit for acute pain, but systematic reviews are conflicting; more rigorous studies are needed. For board preparation, the critical takeaway is A-beta fiber activation. Key Takeaways for Board Prep TENS targets large-diameter non-noxious A-beta afferents to reduce nociceptive signaling. High-frequency TENS: analgesia mediated via delta opioid receptors; blocked by delta antagonists. Low-frequency TENS: analgesia mediated via mu opioid receptors; blocked by mu antagonists in spinal cord and RVM. Additional receptor systems influencing TENS efficacy include muscarinic (M1/M3), GABA-A, and CB1. Action Items Review TENS mechanisms with emphasis on A-beta fiber activation for board prep. Verify and publish final venue details for the November Florida ultrasound course. Share registration links and schedules for Detroit and New York ultrasound and chronic pain courses via CME calendar. Prepare teaching materials for ISPN London ultrasound sessions next week. Update board prep resources on painexam.com and nrappain.org with current TENS evidence and dosing guidance. Promote NRAP community forum access and private coaching/shadowing opportunities through the newsletter.   David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Patients can go to www.AABPpain.com or call 718 436 7246 Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023 References  Johnson M. Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence. Rev Pain. 2007 Aug;1(1):7-11. doi: 10.1177/204946370700100103. PMID: 26526976; PMCID: PMC4589923.   Vance, C.G.T.; Dailey, D.L.; Chimenti, R.L.; Van Gorp, B.J.; Crofford, L.J.; Sluka, K.A. Using TENS for Pain Control: Update on the State of the Evidence. Medicina 2022, 58, 1332. https://doi.org/10.3390/medicina58101332 #painnyc #painbrooklyn #prpbrooklyn #prpspine #regionalanesthsia #pccwindsor #paincareclinicswindsor #painwindsorontario #paindocwindsorontarior #paincareclinics #prpwindsorontario #prp

    11 min

  8. 09/16/2025

    BMAC vs Adipose Derived Stem Cell Injections in Knee Osteoarthritis

    Exploring the Efficacy of BMAC and ADSC Injections in Knee Osteoarthritis   Hosts: David Rosenblum,MD Overview: In this episode, we delve into a recent study published in the Indian Journal of Orthopaedics that compares the therapeutic efficacy of Bone Marrow Aspirate Concentrate (BMAC) and Adipose-Derived Stem Cells (ADSCs) for treating knee osteoarthritis (OA). The study aims to provide insights into the effectiveness of these regenerative treatments and their correlation with mesenchymal stem cell (MSC) cellularity. Key Points Discussed: Background on Osteoarthritis: Definition and impact of OA, particularly in older populations. Overview of traditional treatments and the shift towards regenerative medicine. Study Objectives: To compare the efficacy of BMAC and ADSC injections in symptomatic knee OA patients. To analyze MSC quantity and quality in harvested tissues from both sources. Methodology: Description of the study design involving 60 patients with knee OA. Details on patient demographics, injection protocols, and follow-up assessments (VAS, WOMAC, ROM). Results: Significant improvements in clinical scores for both BMAC and ADSC groups at 6 months. Discussion on the lack of significant correlation between MSC quantity and treatment efficacy. Insights into the success rates of MSC cultures from both bone marrow and adipose tissue. Conclusions: Both treatments demonstrated clinical improvements, with no substantial differences between them. BMAC showed higher MSC counts and faster recovery rates, but further research is needed to understand the underlying factors affecting efficacy. Implications for Clinical Practice: Considerations for clinicians when choosing between BMAC and ADSC treatments. Future directions for research in regenerative therapies for knee OA. References: Vitali, M., Ometti, M., Montalbano, F., et al. (2025). Bone Marrow Aspirate Concentrate (BMAC) Versus Adipose-Derived Stem Cells (ADSCs) Intra-articular Injection Therapeutic Efficacy in Knee OA Correlated to Their Mesenchymal Stem Cell (MSC) Cellularity: An Exploratory Comparative Pilot Study. Indian Journal of Orthopaedics. https://doi.org/10.1007/s43465-025-01525-z Listener Engagement: Join the conversation! Share your thoughts on BMAC and ADSC treatments for knee OA on social media using #JournalClubPodcast. Don't forget to subscribe for more discussions on the latest research in orthopaedics and regenerative medicine.

    7 min
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About

David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians. Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery. Available at Amazon.com and www.MyKidsSurgery.com

Information

  • Creator
    David Rosenblum, MD
  • Years Active
    2015 - 2026
  • Episodes
    338
  • Rating
    Clean
  • Copyright
    © QBazaar.com LLC, Copyright 2015
  • Show Website
    PainExam Podcast

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