100 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
    • 4.8 • 38 Ratings

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.

    Post Acute Sequelae of SARS CoV2/ Long COVID with Dr. Monica Verduzco-Gutierrez

    Post Acute Sequelae of SARS CoV2/ Long COVID with Dr. Monica Verduzco-Gutierrez

    In this week's episode of the Spine & Nerve podcast Dr. Brian Joves is joined by a very special guest, Dr. Monica Verduzco-Gutierrez, to discuss Long COVID, otherwise known as Post Acute Sequalae of SARS CoV2 (PASC).
    Long COVID is defined as a condition in which a patient continues with symptoms of COVID-19 more than 2 months after being infected by the virus. Longitudinal studies quote anywhere from a 15-80% prevalence of long COVID. Although every patient presents with a different compilation of symptoms, the most common symptoms of Long COVID are fatigue, impaired respiratory function, “brain fog”, headache, attention disorder, hair loss and pain. Though the risk factors for developing Long COVID are not fully known, studies suggest anosmia and ageusia, GI symptoms, and more severe acute infection may contribute to long term symptoms. There are many proposed mechanisms for these symptoms including inflammation, peripheral organ dysfunction, and virus shedding from the gut emphasizing the gut-brain connection that still needs to be researched further.
    Listen as Dr. Gutierrez educates on her experience in helping these patients and provides us with practical considerations when patient's present to the clinic. Most importantly, Dr. Gutierrez recommends one simple way to optimize outcomes for patient's suffering from Long COVID, and all patients for that matter.
    This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

    You can find Dr. Monica Verduzco-Gutierrez:
    twitter.com/MVGutierrezM
    instagram.com/monicavgutierrez
    https://www.linkedin.com/in/monica-verduzco-gutierrez-m-d-74aab370/

    • 43 min
    Post Herpetic Neuralgia: a review and journal club

    Post Herpetic Neuralgia: a review and journal club

    In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus).

    PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found that PHN occurs in about 20% of patients who have Herpes Zoster. With the relatively recent development of the preventative vaccine Shingrix (which has been found to be 97% effective in preventing Herpes Zoster) it is anticipated that the total prevalence of Herpes Zoster and PHN will decrease. However, research has repeatedly demonstrated that immunocompromised patients are at a significantly increased risk for Herpes Zoster and PHN (20-100 times increased risk of development of PHN). As of today, the Advisory Committee on Immunization Practices has not cleared immunocompromised patients to receive the Shingrex (or Zostavax) vaccine; therefore for multiple reasons PHN will most likely continue to be a prevalent diagnosis.

    Treatment options for PHN include physical modalities (TENS, desensitization), topical medications (including Lidocaine 5% patch, and Capsaicin), oral medications (including Gabapentin, Pregabalin, Tricyclic Antidepressants), and procedures.

    Listen as the doctors review Herpes Zoster, PHN, and a recent research article evaluating the effect of the Erector Spinae Plane Block in regards to prevention of PHN once Herpes Zoster has already developed.


    This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel 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. Zeng-Mao Lin, MD, Hai-Feng Wang, MD, Feng Zhang, MD, Jia-Hui Ma, MD, PhD, Ni Yan, RN, and Xiu-Fen Liu, MD. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. 2021;24;E1109-E1118.
    2. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108.

    • 26 min
    Back (to Basic Physiology to Look) to the Future: Selective Voltage Gated Sodium Channel Modulators

    Back (to Basic Physiology to Look) to the Future: Selective Voltage Gated Sodium Channel Modulators

    In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves take a look back at basic physiology to try to look into the future. An area of research that has really piqued the interest of Dr. Karvelas in recent years has been the discussion/possibility of selective voltage gated sodium channel (NaV) modulators. NaV are transmembrane proteins that are an integral part of the initiation and propagation of action potentials in neurons and other electrically excitable cells. We have seen that small changes in NaV function are biologically relevant because there are several human diseases that are the result of mutations in these channels. This has led to research into selective NaV modulators as a potential target as we continue to search for treatment options with significant analgesic potential and decreased risk of side effects / adverse effects.

    The medical / research community continues to work to optimize medication options to treat painful disease processes.
    From an analgesic medication perspective, although there are a variety of different medications available including: topical medications, acetaminophen, non-steroidal anti-inflammatory drugs, gabapentin, pregabalin, serotonin norepinephrine reuptake inhibitors, tricyclic anti-depressant medications, non-selective sodium channel blockers, NMDA receptor modulations (Memantine, Ketamine), alpha-2 agonists, glial cell modulators (Low Dose Naltrexone), Buprenorphine, full mu opioids. These Medications are not without their limitations for multiple reasons including but not limited to side effects, risks, and contraindications depending on patient’s age and/or comorbidities.

    To the best of our knowledge there are 10 different NaV subtypes; and specifically NaV 1.3, 1.7, 1.8, 1.9 have been demonstrated to play a critical role in pain signaling. NaV 1.8 is a sensory neuron specific channel with preferential expression in the dorsal root ganglion and trigeminal ganglion neurons, and it is highly expressed on nociceptors. Similar to the other NaV subtypes that have been identified to play essential roles in pain, mutations in NaV 1.8 have been demonstrated to lead to significant alterations in the nervous system / pain pathways; specifically gain of function NaV 1.8 mutations clinically manifest as painful small fiber peripheral polyneuropathy. NaV 1.8 modulation is being aggressively researched with the goal of positive impact on painful diseases. VX-150 is a oral pro-drug that is a highly selective inhibitor of NaV1.8, and a recent study by Dr. Hijma and colleagues was published evaluating the analgesic potential and safety of VX-150.

    Listen as the doctors discuss this exciting and important area of research. The discussion includes a detailed review of the fore-mentioned recent research article.

    This podcast is for information and educational purposes only, it is not meant to be medical or career 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. Hijma HJ, Siebenga PS, de Kam ML, Groeneveld GJ. A Phase 1, Randomized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Pharmacodynamic Effects of VX-150, a Highly Selective NaV1.8 Inhibitor, in Healthy Male Adults. Pain Med. 2021 Aug 6;22(8):1814-1826.

    • 30 min
    Case Report: Persistent Spinal Pain Syndrome

    Case Report: Persistent Spinal Pain Syndrome

    In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves discuss a clinical case regarding a patient with Persistent Spinal Pain Syndrome (PSPS).  To review, PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease with spinal origin. This disease can be linked to the predisposition of the human spine to develop painful pathology over time. The distribution of the symptoms in PSPS can be axial and/or radicular, and although commonly involves the lumbosacral spine, the cervical, and thoracic spine can also be the site of pathology. Importantly, spinal surgery may or may not have occurred, and may or may not be the primary contributor. 



    Listen as the doctors talk through this clinical scenario of a gentleman in his 50s with PSPS and discuss treatment options including neuromodulation, specifically in this case Differential Target Multiplexed spinal cord stimulation (DTM SCS). DTM SCS targets not only neurons, but also glial cells (all forms of SCS most likely impact glial cells to some degree, however DTM SCS specifically works to optimize the neuromodulation of glial cells). Glial cells include oligodendrocytes, microglia, and astrocytes in the central nervous system; as well as Schwann cells and satellite glial cells in the periphery. All of these cells play critical roles in essential functions which include, but are not limited to regulation of fluid and ion homeostasis, protection of neurons, and creation and maintenance of blood-brain barrier. When glial cells are pathologically, chronically, and abnormally activated they play a critical role in the development and maintenance of chronic pain disease processes. In the setting of abnormal glial cell activity, the most common clinical manifestations for patients include pain sensitivity, fatigue, cognitive disruption, sleep disorders, and mood disorders. For a deeper dive specifically into glial cells, please see our prior conversation (https://anchor.fm/spine/episodes/Glial-cells--glial-cells--glial-cells----The-pain-cascade--modulation--and-chronic-pain-e5fb38) including a discussion with Dr. Ricardo Vallejo (https://anchor.fm/spine/episodes/More-glial-cells---Dr--Ricardo-Vallejo--science-that-matters--and-thinking-beyond-the-neuron-eb4m4i). And please listen to the conversation with Dr. Michael Fishman for a deeper dive on this study (https://anchor.fm/spine/episodes/Profound-Data-with-Dr--Michael-Fishman-elmp3f). 



    This podcast is for information and educational purposes only, it is not meant to be medical or career 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, the may not represent the views of Spine & Nerve. 



    References:

    1. Fishman M, Cordner H, Justiz R, Provenzano D, Merrell C, Shah B, Naranjo J, Kim P, Calodney A, Carlson J, Bundschu R, Sanapati M, Mangal V, Vallejo R. Twelve-Month results from multicenter, open-label, randomized controlled clinical trial comparing differential target multiplexed spinal cord stimulation and traditional spinal cord stimulation in subjects with chronic intractable back pain and leg pain. Pain Pract. 2021 Aug 7. 

    2. Vallejo R, Kelley CA, Gupta A, Smith WJ, Vallejo A, Cedeño DL. Modulation of neuroglial interactions using differential target multiplexed spinal cord stimulation in an animal model of neuropathic pain. Mol Pain. 2020 Jan-Dec;16:1744806920918057. doi: 10.1177/1744806920918057. PMID: 32290778; PMCID: PMC7160773.

    • 27 min
    Journal Club: Landmark Articles for Treating Persistent Spinal Pain Syndrome

    Journal Club: Landmark Articles for Treating Persistent Spinal Pain Syndrome

    In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss landmark articles regarding the treatment of patients with Persistent Spinal Pain Syndrome (PSPS).

    PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Please listen to the Back to Basics episode for a full description and discussion of the pathophysiology.

    Though this is a new term, many studies have looked at the outcomes of interventions such as dorsal column spinal cord stimulation and repeat spine surgery when managing patients who had continued chronic pain after spine surgery. Listen as the doctors dive in and discuss these legendary articles that have transformed the management of patients with PSPS.
     
    This podcast is for information and educational purposes only, it is not meant to be medical or career 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. North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005;56(1):98-106.
    2. Alf L Nachemson (1993) Evaluation of results in lumbar spine surgery, Acta Orthopaedica Scandinavica, 64:sup251, 130-133.
    3. Arts MP, Kols NI, Onderwater SM, Peul WC. Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients. Acta Neurochir 2012;154(7):1213–1217.

    • 20 min
    Back to Basics: Persistent Spinal Pain Syndrome

    Back to Basics: Persistent Spinal Pain Syndrome

    In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves go back to Basics with a twist - the doctors discuss Persistent Spinal Pain Syndrome (PSPS).

    PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Previously, certain diagnoses were utilized to describe these pathologies including but not limited to Failed Back Surgery Syndrome and Post-laminectomy syndrome.  These terms are not without their limitations: terms such as failed back surgery Syndrome can carry a very negative connotation, and also patients can have the clinical presentation consistent with this diagnosis without having a history of spine surgery (for example a chronic disc herniation can lead to the development of fibrosis around a nerve root ).  

    The aforementioned group of experts published an article in Pain Medicine in April of 2021 proposing the adoption of PSPS with the goal of continuing to optimize the most accurate diagnosis for all appropriate patients, advancement of research in this field, and communication between healthcare providers.  
     
    PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease processes of spinal origin linked to the predisposition of the human spine to develop painful pathology over time.  The distribution of the symptoms in PSPS can be axial and/or radicular, and although commonly involves the lumbosacral spine, the cervical and thoracic spine can be the site of pathology.  Importantly, spinal surgery may or may not have occurred, and may or many not be the primary contributor to the clinical presentation.  
     
    Listen as the doctors discuss the article regarding this important new nomenclature, as well as review some important pathophysiology for PSPS including epidural fibrosis and adjacent level syndrome.
     
    This podcast is for information and educational purposes only, it is not meant to be medical or career 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. Nick Christelis, MD, Brian Simpson, MD, Marc Russo, MD, Michael Stanton-Hicks, MD, Giancarlo Barolat, MD, Simon Thomson, MD, Stephan Schug, MD, Ralf Baron, MD, Eric Buchser, MD, Daniel B Carr, MD, Timothy R Deer, MD, Ivano Dones, MD, Sam Eldabe, MD, Rollin Gallagher, MD, Frank Huygen, MD, David Kloth, MD, Robert Levy, MD, Richard North, MD, Christophe Perruchoud, MD, Erika Petersen, MD, Philippe Rigoard, MD, Konstantin Slavin, MD, Dennis Turk, PhD, Todd Wetzel, MD, John Loeser, MD, Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11, Pain Medicine, Volume 22, Issue 4, April 2021, Pages 807–818.
    2. Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011 Apr;12(4):577-606. doi: 10.1111/j.1526-4637.2011.01089.x. Epub 2011 Apr 4. PMID: 21463472.
    3. Bosscher, H.A. and Heavner, J.E. (2010), Incidence and Severity of Epidural Fibrosis after Back Surgery: An Endoscopic Study. Pain Practice, 10: 18-24.

    • 23 min

Customer Reviews

4.8 out of 5
38 Ratings

38 Ratings

Pezcador ,

Excellent for those interested in pain management

Great discussions, manageable content, nice format. Short podcasts you can listen to on the way to work. It’s kinda funny, I talk to the podcast and 9 of 10 times they answer my question before then end of the show. Great job guys.

fitfoodie819 ,

Informative and entertaining!

I couldn’t ask for a more educational podcast. This is exactly what I needed! Thank you Dr. Joves and Dr. Karvelas for delivering!

grandma LMJ ,

My back thanks you!

As a long time back pain suffered, I am so grateful to learn so much from these doctors!

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