In this episode of the Spine &amp; Nerve podcast, Dr. Jason Kung and Dr. Brian Joves delve into a comprehensive discussion surrounding anticoagulation guidelines and their implications in interventional pain procedures.  With over a hundred thousand downloads and over 1,000 YouTube subscribers, we would like to express our sincere gratitude to all the listeners for your engagement and support. Please continue to share and subscribe to help more people discover the podcast.  Today's episode focuses on the safety of epidural steroid injections and the critical role of anticoagulation management.Understanding the rationale behind a patient's anticoagulation therapy is vital for interventional pain physicians. This approach empowers clinicians to make informed decisions about whether to continue or withhold anticoagulation medications prior to procedures. There is a delicate balance between patient-specific risks and the benefits of these interventions.  One of the things that must be known and emphasized is the remarkable safety profile of epidural steroid injections. Approximately nine million epidural steroid injections are administered annually, resulting in an adverse event rate of about one in 780,000. This reassuring statistic is attributed to the collaborative efforts of medical societies and the implementation of strict anticoagulation guidelines. The hosts emphasize the role of fluoroscopic guidance, non-particulate steroids, and avoidance of deep sedation in enhancing the safety of these procedures.  The episode further delves into the nuances of assessing bleeding risks in patients undergoing interventional pain procedures. As always, we must underscore the importance of a comprehensive physical examination, with a specific focus on identifying signs of easy bruising and mucosal bleeding. The hosts discuss the relevance of specific medications, including aspirin and NSAIDs, and their implications for procedural safety.  The hosts engage in an insightful exploration of the guidelines for managing anticoagulation medications pre- and post-procedure. They stress the need for pain physicians to consider the anatomical location of the intervention and evaluate the potential risks versus benefits.   The doctors conclude the episode by highlighting the crucial role of shared decision-making and patient education. By fostering collaboration between patients and physicians, the hosts emphasize the creation of a safe and informed healthcare environment.In this thought-provoking episode, the doctors try to help you navigate the complexities of anticoagulation management in interventional pain procedures, and offer some insights for practitioners seeking to provide the highest level of care to their patients.  References:  Anesthesia Quality Institute Closed Claims Database Review 2011 through 2021 for Epidural Steroid Complications. Naeem Haider. Pain Physician 26 (3), E251, 2023 Stephen Endres, MD and others, The Risks of Continuing or Discontinuing Anticoagulants for Patients Undergoing Common Interventional Pain Procedures, Pain Medicine, Volume 18, Issue 3, March 2017, Pages 403–409, https://doi.org/10.1093/pm/pnw108 Narouze S, Benzon HT, Provenzano D, et alInterventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of PainRegional Anesthesia &amp; Pain Medicine 2018; 43:225-262. The ASRA App: https://www.asra.com/the-asra-family/asra-app 

In this episode of the Spine &amp; Nerve podcast, Dr. Jason Kung and Dr. Brian Joves delve into a comprehensive discussion surrounding anticoagulation guidelines and their implications in interventional pain procedures. With over a hundred thousand downloads and over 1,000 YouTube subscribers, we would like to express our sincere gratitude to all the listeners for your engagement and support. Please continue to share and subscribe to help more people discover the podcast. Today's episode focuses on the safety of epidural steroid injections and the critical role of anticoagulation management.Understanding the rationale behind a patient's anticoagulation therapy is vital for interventional pain physicians. This approach empowers clinicians to make informed decisions about whether to continue or withhold anticoagulation medications prior to procedures. There is a delicate balance between patient-specific risks and the benefits of these interventions. One of the things that must be known and emphasized is the remarkable safety profile of epidural steroid injections. Approximately nine million epidural steroid injections are administered annually, resulting in an adverse event rate of about one in 780,000. This reassuring statistic is attributed to the collaborative efforts of medical societies and the implementation of strict anticoagulation guidelines. The hosts emphasize the role of fluoroscopic guidance, non-particulate steroids, and avoidance of deep sedation in enhancing the safety of these procedures. The episode further delves into the nuances of assessing bleeding risks in patients undergoing interventional pain procedures. As always, we must underscore the importance of a comprehensive physical examination, with a specific focus on identifying signs of easy bruising and mucosal bleeding. The hosts discuss the relevance of specific medications, including aspirin and NSAIDs, and their implications for procedural safety. The hosts engage in an insightful exploration of the guidelines for managing anticoagulation medications pre- and post-procedure. They stress the need for pain physicians to consider the anatomical location of the intervention and evaluate the potential risks versus benefits. The doctors conclude the episode by highlighting the crucial role of shared decision-making and patient education. By fostering collaboration between patients and physicians, the hosts emphasize the creation of a safe and informed healthcare <a href="http://environment.In" rel="nofollow" target="_blank">environment.In</a> this thought-provoking episode, the doctors try to help you navigate the complexities of anticoagulation management in interventional pain procedures, and offer some insights for practitioners seeking to provide the highest level of care to their patients. References: Anesthesia Quality Institute Closed Claims Database Review 2011 through 2021 for Epidural Steroid Complications. Naeem Haider. Pain Physician 26 (3), E251, 2023 Stephen Endres, MD and others, The Risks of Continuing or Discontinuing Anticoagulants for Patients Undergoing Common Interventional Pain Procedures, Pain Medicine, Volume 18, Issue 3, March 2017, Pages 403–409, <a href="https://doi.org/10.1093/pm/pnw108" rel="nofollow" target="_blank">https://doi.org/10.1093/pm/pnw108</a> Narouze S, Benzon HT, Provenzano D, et alInterventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of PainRegional Anesthesia &amp; Pain Medicine 2018; 43:225-262. The ASRA App: <a href="https://www.asra.com/the-asra-family/asra-app" rel="nofollow" target="_blank">https://www.asra.com/the-asra-family/asra-app</a>

To Anticoagulate or not to Anticoagulate with Interventional Spine Procedures

 In this episode, we have a special guest, Dr. Nikhil Verma, who shares his inspiring journey from undergrad to establishing his own medical practice. Dr. Verma opens up about the challenges he faced, the pivotal moments that shaped his career, and the lessons he learned along the way. Join us as we delve into his story of perseverance, passion, and the pursuit of personalized medicine.  Episode Highlights:  Dr. Verma recounts his early struggles and the uncertainties he faced during his pursuit of medical school. Despite not getting accepted initially, he used the time to reflect and explore different options, eventually finding his way to St. George's University. The importance of resilience and perseverance shines through as he shares how he overcame setbacks and stayed motivated.  Dr. Verma's interest in rehabilitation medicine and sports medicine grew during his residency. He shares how his personal experience with a sports-related injury shaped his perspective and ignited his passion for helping others through physical therapy and non-surgical interventions.  Dr. Verma discusses the decision to open his own medical practice, highlighting the challenges and rewards of being an independent practitioner. From finding the ideal location to setting up the practice and acquiring necessary equipment, he shares the steps involved in laying the groundwork for his venture.  Dr. Verma emphasizes the importance of tailoring treatments to individual patients, providing temporary relief while considering long-term solutions. He highlights advanced procedures and technologies that enable more targeted and effective interventions, showcasing the potential impact of personalized medicine.  Dr. Verma encourages med students and early residents to stay open-minded and embrace change. He shares the significance of finding passion and purpose in one's work, reminding listeners that it's okay to evolve and pursue new interests within the medical field.   Dr. Nikhil Verma's story is a testament to the power of determination, adaptability, and following one's true calling. His journey from facing initial rejections to establishing a successful practice showcases the importance of resilience and finding personal fulfillment in the medical profession. Join us in thanking Dr. Verma for sharing his insights and experiences. Tune in to the full episode to hear his story in his own words.    You can find Dr. Verma on all your favorite social platforms, as well as our hosts.     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 &amp; Nerve.  

In this episode, we have a special guest, Dr. Nikhil Verma, who shares his inspiring journey from undergrad to establishing his own medical practice. Dr. Verma opens up about the challenges he faced, the pivotal moments that shaped his career, and the lessons he learned along the way. Join us as we delve into his story of perseverance, passion, and the pursuit of personalized medicine. Episode Highlights: Dr. Verma recounts his early struggles and the uncertainties he faced during his pursuit of medical school. Despite not getting accepted initially, he used the time to reflect and explore different options, eventually finding his way to St. George's University. The importance of resilience and perseverance shines through as he shares how he overcame setbacks and stayed motivated. Dr. Verma's interest in rehabilitation medicine and sports medicine grew during his residency. He shares how his personal experience with a sports-related injury shaped his perspective and ignited his passion for helping others through physical therapy and non-surgical interventions. Dr. Verma discusses the decision to open his own medical practice, highlighting the challenges and rewards of being an independent practitioner. From finding the ideal location to setting up the practice and acquiring necessary equipment, he shares the steps involved in laying the groundwork for his venture. Dr. Verma emphasizes the importance of tailoring treatments to individual patients, providing temporary relief while considering long-term solutions. He highlights advanced procedures and technologies that enable more targeted and effective interventions, showcasing the potential impact of personalized medicine. Dr. Verma encourages med students and early residents to stay open-minded and embrace change. He shares the significance of finding passion and purpose in one's work, reminding listeners that it's okay to evolve and pursue new interests within the medical field. Dr. Nikhil Verma's story is a testament to the power of determination, adaptability, and following one's true calling. His journey from facing initial rejections to establishing a successful practice showcases the importance of resilience and finding personal fulfillment in the medical profession. Join us in thanking Dr. Verma for sharing his insights and experiences. Tune in to the full episode to hear his story in his own words. You can find Dr. Verma on all your favorite social platforms, as well as our hosts. 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 &amp; Nerve.

Going it alone with Dr. Nikhil Verma

In this week's episode of the Spine &amp; Nerve podcast, we have a return guest! Dr. Hunter Vincent returns to the show to chat with Dr. Brian Joves about health coaches and how they can help your patients to be more successful in their journey with and through chronic pain.  In this episode we'll discuss:  What is a health coach?  Where does this fit into the treatment and provider paradigm?  How can ancillary team members like health coaches help your patients and your team to be more successful?   Dr. Vincent is the CEO of Pogo Health. He is a double board certified physician who received his residency training from UC Davis in Physical Medicine &amp; Rehabilitation (PM&amp;R) with a subspecialty certification in Pain Medicine from UCLA. Prior to starting his medical training, he received a Bachelor's of Science in Exercise Biology. He has spent the last decade actively involved in healthcare initiatives focused on maximizing patient engagement in their own health journey. He has worked with various healthcare teams in the fields of clinical obesity, chronic pain, and neurological disorders.    Pogo Health is a virtual platform Virtual that utilizes a team approach to treating chronic pain. Their interdisciplinary opioid-free approach integrates the pain physician, pain therapist and specialized health coach to create a completely virtual and customized treatment program. The Pogo Health multi-modal approach utilizes evidence based techniques to provide long term physical and mental health benefits to combat chronic pain.  Learn more at https://pogo-health.com/   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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, we have a return guest! Dr. Hunter Vincent returns to the show to chat with Dr. Brian Joves about health coaches and how they can help your patients to be more successful in their journey with and through chronic pain. In this episode we'll discuss: What is a health coach? Where does this fit into the treatment and provider paradigm? How can ancillary team members like health coaches help your patients and your team to be more successful? Dr. Vincent is the CEO of Pogo Health. He is a double board certified physician who received his residency training from UC Davis in Physical Medicine &amp; Rehabilitation (PM&amp;R) with a subspecialty certification in Pain Medicine from UCLA. Prior to starting his medical training, he received a Bachelor's of Science in Exercise Biology. He has spent the last decade actively involved in healthcare initiatives focused on maximizing patient engagement in their own health journey. He has worked with various healthcare teams in the fields of clinical obesity, chronic pain, and neurological disorders.  Pogo Health is a virtual platform Virtual that utilizes a team approach to treating chronic pain. Their interdisciplinary opioid-free approach integrates the pain physician, pain therapist and specialized health coach to create a completely virtual and customized treatment program. The Pogo Health multi-modal approach utilizes evidence based techniques to provide long term physical and mental health benefits to combat chronic pain. Learn more at <a href="https://pogo-health.com/" rel="nofollow" target="_blank">https://pogo-health.com/</a> 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 &amp; Nerve.

Find yourself a health coach with Dr. Hunter Vincent

Brian Joves

In this week's episode of the Spine &amp; Nerve podcast, Dr. Jason Kung and Dr. Brian Joves try to digest all the recent happenings in the world of neuromodulation.They address:Internal Pulse Generators Artificial Intelligence The Cochran StudyListen as the doctors get excited, frustrated, and try to bring a silver lining to the whirlwind of headlines that have been discussing neuromodulation so far this year!There were many references in this episode, but most importantly here is the Cochran review on SCS for low back pain:Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023 Mar 7;3(3):CD014789. doi: 10.1002/14651858.CD014789.pub2. PMID: 36878313; PMCID: PMC9990744.Here is the Hara study:Hara S, Andresen H, Solheim O, Carlsen SM, Sundstrøm T, Lønne G, Lønne VV, Taraldsen K, Tronvik EA, Øie LR, Gulati AM, Sagberg LM, Jakola AS, Solberg TK, Nygaard ØP, Salvesen ØO, Gulati S. Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial. JAMA. 2022 Oct 18;328(15):1506-1514. doi: 10.1001/jama.2022.18231. PMID: 36255427; PMCID: PMC9579901.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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Jason Kung and Dr. Brian Joves try to digest all the recent happenings in the world of neuromodulation. They address: Internal Pulse Generators Artificial Intelligence The Cochran Study Listen as the doctors get excited, frustrated, and try to bring a silver lining to the whirlwind of headlines that have been discussing neuromodulation so far this year! There were many references in this episode, but most importantly here is the Cochran review on SCS for low back pain: Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low back pain. Cochrane Database Syst Rev. 2023 Mar 7;3(3):CD014789. doi: 10.1002/14651858.CD014789.pub2. PMID: 36878313; PMCID: PMC9990744. Here is the Hara study: Hara S, Andresen H, Solheim O, Carlsen SM, Sundstrøm T, Lønne G, Lønne VV, Taraldsen K, Tronvik EA, Øie LR, Gulati AM, Sagberg LM, Jakola AS, Solberg TK, Nygaard ØP, Salvesen ØO, Gulati S. Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial. JAMA. 2022 Oct 18;328(15):1506-1514. doi: 10.1001/jama.2022.18231. PMID: 36255427; PMCID: PMC9579901. 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 &amp; Nerve.

IPGs, Artificial Intelligence and Cochrane! An SCS Update with Dr. Jason Kung and Dr. Brian Joves

In this week's episode of the Spine &amp; Nerve Podcast we would like to introduce you all to the newest member of the Spine &amp; Nerve family... Dr. Jason Kung.  Jason Kung, MD, is a board-eligible anesthesiologist and interventional pain physician who joined Spine &amp; Nerve last year. Listen in as Brian Joves, MD gets to know Dr. Kung better and explore his journey into medicine and to discovering his passion for pain medicine.  He  graduated from the University of San Francisco in California with a  bachelor's degree in biology. He then went to Boston University School  of Medicine in Massachusetts for his medical degree.  Dr. Kung  completed his residency in Anesthesiology and fellowship in  Interventional Pain at Harvard Medical School, Massachusetts General  Hospital in 2020.  Dr. Kung specializes in several interventional  procedures, including spinal cord stimulation, epidural injections,  radiofrequency ablations, implantable devices, and ultrasound-guided  nerve/joint injections. He strives to provide  compassionate evidence-based care to all his patients.  He is certified as an instructor in  medical simulation. Dr. Kung has completed research and published in the  areas of bone healing and the effects of natural sources of vitamin D.  During  his free time, he enjoys playing guitar, surfing/snowboarding, and  exploring California with his wife and dog.   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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve Podcast we would like to introduce you all to the newest member of the Spine &amp; Nerve family... Dr. Jason Kung.  Jason Kung, MD, is a board-eligible anesthesiologist and interventional pain physician who joined Spine &amp; Nerve last year. Listen in as Brian Joves, MD gets to know Dr. Kung better and explore his journey into medicine and to discovering his passion for pain medicine. He  graduated from the University of San Francisco in California with a  bachelor's degree in biology. He then went to Boston University School  of Medicine in Massachusetts for his medical degree. Dr. Kung  completed his residency in Anesthesiology and fellowship in  Interventional Pain at Harvard Medical School, Massachusetts General  Hospital in 2020. Dr. Kung specializes in several interventional  procedures, including spinal cord stimulation, epidural injections,  radiofrequency ablations, implantable devices, and ultrasound-guided  nerve/joint injections. He strives to provide  compassionate evidence-based care to all his patients. He is certified as an instructor in  medical simulation. Dr. Kung has completed research and published in the  areas of bone healing and the effects of natural sources of vitamin D. During  his free time, he enjoys playing guitar, surfing/snowboarding, and  exploring California with his wife and dog.  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 &amp; Nerve.

Allow us to Introduce Dr. Jason Kung

In this week's episode we take a deep dive into lumbar spinal stenosis, discussing the underlying disease process as well as treatment options in the medical literature.                        The studies referenced in this podcast are given at the end of the podcast.                  This is meant for education and entertainment only, this is not to be interpreted as medical advice. If you feel that something discussed may be relevant to you, please discuss with your medical provider. The views and opinions discussed in this podcast are those of the individuals who express them, and are not the views and opinions of Spine &amp; Nerve Diagnostic Center.

Spinal stenosis

Evan Hauger

In this week's episode of The Spine &amp; Nerve Podcast, Evan Hauger, DPT joins Brian Joves, MD to discuss movement as medicine.Dr. Evan HaugerEvan specializes in  sports physical therapy, strength, and conditioning. He knows the ins  &amp; outs of injury from years of personal experience. Growing up, he  was a multi-sport athlete and went on to play baseball at Shasta College. Through multiple personal injuries related to his athletic career, Evan realized that he had a passion for improving the way people  move and enhancing their performance in sport and life. Also a  StrongFirst Certified Level 1 instructor, Evan earned his Doctorate in  Physical Therapy from Sacramento State University and has worked with  athletes of all calibers, including MLB, NFL, NBA, UFC, and Olympians.  He has also spent time with some of the best minds in sports physical  therapy in Boston, MA, been a medical team leader for the USA Track and  Field National Championships, assisted with NFL combine training at Exos  in Phoenix, AZ, and been the performance coach for a group of Olympic athletes.                                   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 &amp; Nerve.

In this week's episode of The Spine &amp; Nerve Podcast, Evan Hauger, DPT joins Brian Joves, MD to discuss movement as medicine. Dr. Evan Hauger Evan specializes in  sports physical therapy, strength, and conditioning. He knows the ins  &amp; outs of injury from years of personal experience. Growing up, he  was a multi-sport athlete and went on to play baseball at Shasta College. Through multiple personal injuries related to his athletic career, Evan realized that he had a passion for improving the way people  move and enhancing their performance in sport and life. Also a  StrongFirst Certified Level 1 instructor, Evan earned his Doctorate in  Physical Therapy from Sacramento State University and has worked with  athletes of all calibers, including MLB, NFL, NBA, UFC, and Olympians.  He has also spent time with some of the best minds in sports physical  therapy in Boston, MA, been a medical team leader for the USA Track and  Field National Championships, assisted with NFL combine training at Exos  in Phoenix, AZ, and been the performance coach for a group of Olympic athletes. 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 &amp; Nerve.

Movement as Medicine with Evan Hauger, DPT

Krystyna Holland

In this week's episode of the Spine &amp; Nerve podcast, Dr. Julie Hastings connects with Dr. Krystyna Holland, PT, DPT to learn about trauma informed care.Trauma informed care has many definitions, including some fantastic work done by the Substance Abuse and Mental Health Services Administration. One definition is a consistent and intentional effort to reduce our propensity for harm. Another describes it as an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma.Listen in as Drs. Hastings and Holland discuss this very important topic and share some tips on how to better show up for our patients.Krystyna Holland, DPT (she/her)  is a physical therapist in Denver, Colorado specializing in the provision of trauma informed pelvic floor care to individuals across the gender identity spectrum. In addition to helping folks feel confident in their ability to live without leaking and have pleasurable sex, Krystyna aims to change the fundamental patient provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider. She is a well-known Instagram educator (@krystyna.holland) and an instructor of trauma-informed care webinars.  She owns a small private practice called Inclusive Care and lives in Denver, CO.https://instagram.com/krystyna.holland https://www.inclusivecarellc.com/

In this week's episode of the Spine &amp; Nerve podcast, Dr. Julie Hastings connects with Dr. Krystyna Holland, PT, DPT to learn about trauma informed care. Trauma informed care has many definitions, including some fantastic work done by the Substance Abuse and Mental Health Services Administration. One definition is a consistent and intentional effort to reduce our propensity for harm. Another describes it as an approach in the human service field that assumes that an individual is more likely than not to have a history of trauma. Listen in as Drs. Hastings and Holland discuss this very important topic and share some tips on how to better show up for our patients. Krystyna Holland, DPT (she/her)  is a physical therapist in Denver, Colorado specializing in the provision of trauma informed pelvic floor care to individuals across the gender identity spectrum. In addition to helping folks feel confident in their ability to live without leaking and have pleasurable sex, Krystyna aims to change the fundamental patient provider relationship from one that centers the provider as a problem solver to one that focuses on collaboration between the patient and the provider. She is a well-known Instagram educator (@krystyna.holland) and an instructor of trauma-informed care webinars.  She owns a small private practice called Inclusive Care and lives in Denver, CO. <a href="https://instagram.com/krystyna.holland" rel="nofollow" target="_blank">https://instagram.com/krystyna.holland</a> <a href="https://www.inclusivecarellc.com/" rel="nofollow" target="_blank">https://www.inclusivecarellc.com/</a>

Trauma Informed Care with Krystyna Holland, DPT

In this week's episode of the Spine &amp; Nerve podcast, Drs. Nicolas Karvelas and Brian Joves discuss infectious spondylodiscitis, a relatively rare inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Spondylodiscitis has a prevalence of about 4-24 per million, and has been increasing as patients have more risk factors (advanced age, immunocompromised states such as HIV infection, intravenous drug users, healthcare-associated infections, expansion of spinal surgery indications) and improved diagnostic modalities.Patients generally present with pain and tenderness in the region, about 50% present with high fever, and about 1/4 with neurologic compromise. The symptoms can be fairly non-specific, so patients with risk factors must be evaluated with a high degree of suspicion.Infection is the most common cause of spondylodiscitis, which is often spontaneous and hematogenous in origin and most commonly affects the lumbar spine, followed by thoracic, cervical, and sacral. The infectious pathogens can be pyogenic (bacterial), granulomatous (tuberculosis, fungal), or parasitic, though many noninfectious processes affecting the spine such as pseudarthrosis in ankylosing spondylitis, amyloidosis, destructive spondyloarthropathy of hemodialysis, Modic changes type 1, neuropathic arthropathy, calcium pyrophosphate dehydrate (CPPD) spondyloarthropathy and gout can mimic infectious discitis/ osteomyelitis. To determine whether a particular patient’s spinal process is due to an infectious versus non-infectious cause and to determine the pathogencan be challenging. Clinical findings and laboratory studies including erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can be helpful in the diagnosis due to their high sensitivity; however, their specificity is low. Magnetic resonance imaging and biopsy have become the standard when working up this process, particularly in cases where the origin of the pathogen is unknown.Listen as the doctors give a high-level overview of this disease process, and walk us through the challenging diagnostic process of a disease that may have an insidious onset, with subtle and misleading clinical features and briefly discuss management requiring a multidisciplinary approach involving radiologists, infectious diseases specialists, spine surgeons and rehabilitation personnel.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 &amp; Nerve.1. Salaffi, F., Ceccarelli, L., Carotti, M. et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician?. Radiol med 126, 843–859 (2021). 2. Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, et al. Spondylodiscitis revisited. EFORT Open Rev. 2017;2(11):447-461. Published 2017 Nov 15. doi:10.1302/2058-5241.2.160062

In this week's episode of the Spine &amp; Nerve podcast, Drs. Nicolas Karvelas and Brian Joves discuss infectious spondylodiscitis, a relatively rare inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Spondylodiscitis has a prevalence of about 4-24 per million, and has been increasing as patients have more risk factors (advanced age, immunocompromised states such as HIV infection, intravenous drug users, healthcare-associated infections, expansion of spinal surgery indications) and improved diagnostic modalities. Patients generally present with pain and tenderness in the region, about 50% present with high fever, and about 1/4 with neurologic compromise. The symptoms can be fairly non-specific, so patients with risk factors must be evaluated with a high degree of suspicion. Infection is the most common cause of spondylodiscitis, which is often spontaneous and hematogenous in origin and most commonly affects the lumbar spine, followed by thoracic, cervical, and sacral. The infectious pathogens can be pyogenic (bacterial), granulomatous (tuberculosis, fungal), or parasitic, though many noninfectious processes affecting the spine such as pseudarthrosis in ankylosing spondylitis, amyloidosis, destructive spondyloarthropathy of hemodialysis, Modic changes type 1, neuropathic arthropathy, calcium pyrophosphate dehydrate (CPPD) spondyloarthropathy and gout can mimic infectious discitis/ osteomyelitis. To determine whether a particular patient’s spinal process is due to an infectious versus non-infectious cause and to determine the pathogencan be challenging. Clinical findings and laboratory studies including erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) can be helpful in the diagnosis due to their high sensitivity; however, their specificity is low. Magnetic resonance imaging and biopsy have become the standard when working up this process, particularly in cases where the origin of the pathogen is unknown. Listen as the doctors give a high-level overview of this disease process, and walk us through the challenging diagnostic process of a disease that may have an insidious onset, with subtle and misleading clinical features and briefly discuss management requiring a multidisciplinary approach involving radiologists, infectious diseases specialists, spine surgeons and rehabilitation personnel. 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 &amp; Nerve. 1. Salaffi, F., Ceccarelli, L., Carotti, M. et al. Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician?. Radiol med 126, 843–859 (2021).  2. Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, et al. Spondylodiscitis revisited. EFORT Open Rev. 2017;2(11):447-461. Published 2017 Nov 15. doi:10.1302/2058-5241.2.160062

Infectious Spondylodiscitis

In this week's episode of the Spine &amp; Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome.Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms.Listen as the doctors dive in and discuss these articles and discuss ways these articles might help patients living with persistent pelvic pain syndrome and the physicians caring for them.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 &amp; Nerve.References:1. Hong DG, Hwang SM, Park JM. Efficacy of ganglion impar block on vulvodynia: Case series and results of mid- and long-term follow-up. Medicine (Baltimore). 2021;100(30):e26799.2. Agarwal-Kozlowski K, Lorke DE, Habermann CR, Am Esch JS, Beck H. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique,safety, and efficacy. Clin J Pain. 2009 Sep;25(7):570-6.3. Istek A, Gungor Ugurlucan F, Yasa C, Gokyildiz S, Yalcin O. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 2014;290(2):291–84. Hunter CW, Yang A. Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration. Neuromodulation. 2019 Jan;22(1):87-95. doi: 10.1111/ner.12801. Epub 2018 Aug 1. PMID: 30067887.

In this week's episode of the Spine &amp; Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome. Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms. Listen as the doctors dive in and discuss these articles and discuss ways these articles might help patients living with persistent pelvic pain syndrome and the physicians caring for them. 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 &amp; Nerve. References: 1. Hong DG, Hwang SM, Park JM. Efficacy of ganglion impar block on vulvodynia: Case series and results of mid- and long-term follow-up. Medicine (Baltimore). 2021;100(30):e26799. 2. Agarwal-Kozlowski K, Lorke DE, Habermann CR, Am Esch JS, Beck H. CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy. Clin J Pain. 2009 Sep;25(7):570-6. 3. Istek A, Gungor Ugurlucan F, Yasa C, Gokyildiz S, Yalcin O. Randomized trial of long-term effects of percutaneous tibial nerve stimulation on chronic pelvic pain. Arch Gynecol Obstet 2014;290(2):291–8 4. Hunter CW, Yang A. Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain: A Case Series and Technical Report on a Novel Lead Configuration. Neuromodulation. 2019 Jan;22(1):87-95. doi: 10.1111/ner.12801. Epub 2018 Aug 1. PMID: 30067887.

Journal Club: Interventional Options to Treat Persistent Pelvic Pain Syndrome 

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.

Thank you for sharing such amazing information and education!!

So much information!!!

One of the most informative and educational podcasts for all medical professionals!!

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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

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves nerd out about chronic pain pathways, specifically the changes that take place in the signaling over time. Chronic, persistent pain changes the physiologic signaling in the body. This means that it is not purely a nociceptive process. Along the pathway, we have the classic components of transmission, transduction, modulation, and perception that are each involved in the signaling cascade of our nociceptive nervous system. Each one of these components can have signaling errors that can lead to chronic pain. Today, we specifically discuss the modulation component and wind up. Wind up is the process by which the signaling in the body changes, so that when the pain signal comes into the central nervous system- it is stronger and lasts longer. The nerves fire more frequently and with greater strength. The longer this lasts in the body, the more wind up occurs. Eventually, the nerves can keep firing these signals without any ongoing stimulus- meaning that over time, even though the anatomy has "healed", the pain signals will still be firing continually. And thus, chronic pain.The docs will also dive deep into glial cells- how they become a part of the modulation of these painful signals and ways that we may be able to intervene into this cascade.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves nerd out about chronic pain pathways, specifically the changes that take place in the signaling over time. Chronic, persistent pain changes the physiologic signaling in the body. This means that it is not purely a nociceptive process. Along the pathway, we have the classic components of transmission, transduction, modulation, and perception that are each involved in the signaling cascade of our nociceptive nervous system. Each one of these components can have signaling errors that can lead to chronic pain. Today, we specifically discuss the modulation component and wind up. Wind up is the process by which the signaling in the body changes, so that when the pain signal comes into the central nervous system- it is stronger and lasts longer. The nerves fire more frequently and with greater strength. The longer this lasts in the body, the more wind up occurs. Eventually, the nerves can keep firing these signals without any ongoing stimulus- meaning that over time, even though the anatomy has "healed", the pain signals will still be firing continually. And thus, chronic pain. The docs will also dive deep into glial cells- how they become a part of the modulation of these painful signals and ways that we may be able to intervene into this cascade. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Glial cells, glial cells, glial cells... The pain cascade, modulation, and chronic pain.

Ricardo Vallejo

This week's episode of the Spine &amp; Nerve podcast is a very special episode. Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with one of the leaders in the field of pain medicine and pain research, Dr. Ricardo Vallejo.Dr. Vallejo is the co-founder and director of research at Millennium Pain Center in Bloomington, Illinois, and founder and lead investigator of Stimgenics, LLC. They have pioneered a novel spinal cord stimulation (SCS) waveform known as Differential Target Multiplexed (DTM) Spinal Cord Stimulation. Stimgenics’ preclinical research on the neuronal-glial mechanism of action has been recognized at various medical society meetings, receiving six “best of” awards for their research, three of which were specific to research investigating the DTM mechanism of action. NANS awarded the “Best Basic Science Research Award” to Stimgenics at their annual meeting in both 2018 and 2019.In this discussion, the docs dive deep into:- glial cells and their role in chronic pain.- What exactly is DTM?- How is the basic science translating into clinical outcomes?- What do we, as a field/specialty, have to do to continue to progress and change things for our patients?There were many studies referenced in this discussion, here is a short list of the most relevant literature:1. Fishman M, Cordner H, Justiz R, et al. Randomized Controlled Clinical Trial to Study the Effects of SGX-SCS in Treating Intractable Chronic Low Back Pain: 3 Month Results. North American Neuromodulation Society (NANS); 2020; Las Vegas, Nevada.2. Calodney AK, Kim PS, Slezak J, et al. Prospective study evaluating differential-target- multiplexed SCS for chronic intractable back pain with or without leg pain. Neuromodulation: Technology at the Neural Interface. 2019;22(3):e40-e295.3. Fishman M, Calodney A, Kim P, et al. Prospective, multicenter trial to evaluate Multiplexed SCS for differential targets in subjects with chronic intractable back pain with or without leg pain. North American Neuromodulation Society (NANS); 2019; Las Vegas, NV.4. Cedeno DL, Cass CL, Kelley CA, et al. Pre-clinical comparison of differential-target multiplexed scstm with low and high rate SCS. Neuromodulation: Technology at the Neural Interface. 2019;22(3):e40-e295.5. Vallejo R, Kelley C, Smith W, Tilley D, Cedeno D. Cell-specific targeting in neural tissue using Differential Target Multiplexed (DTM) SCS. American Society of Regional Anesthesiology and Pain Medicine (ASRA); 2019; New Orleans, LA.6. Vallejo R, Kelley CA, Smith WJ, Tilley DM, Cedeno D. Targeting specific cell populations in neural tissue with DTM-SCS. North American Neuormodulation Society (NANS); 2020; Las Vegas, NV.7. Vallejo R, Smith W, Kelley C, Tilley D, Cedeno D. Neuron-glial inflammasome enhanced reversal by DTM-SCS relative to high rat and low rate SCS in a neuropathic pain model. American Society of Regional Anesthesiology and Pain Medicine (ASRA); 2019; New Orleans, LA.8. Cedeno D, Smith WJ, Kelley CA, Tilley DM, Sanapati S, Vallejo R. DTM-SCS enhances reversal of neuron-glial inflammasome relative to high rate and low rate. North American Neuromodulation Society (NANS); 2020; Las Vegas, NV.9. Vallejo R, Tilley D, Kelley C, Smith W, Cedeno D. Proteomics of Differential Target Muliplexed- SCS applied to an animal model of neuropathic pain. American Society of Regional Anesthesiologists and Pain Medicine (ASRA); 2019; New Orleans, LA.10. Vallejo R, Kelley CA, Smith WJ, Tilley DM, Cedeno D. Proteomics of differential target multiplexed-SCS applied to an animal model of neuropathic pain. North American Neuromodulation Society 2020; Las Vegas, NV. 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 &amp; Nerve.

This week's episode of the Spine &amp; Nerve podcast is a very special episode. Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with one of the leaders in the field of pain medicine and pain research, Dr. Ricardo Vallejo. Dr. Vallejo is the co-founder and director of research at Millennium Pain Center in Bloomington, Illinois, and founder and lead investigator of Stimgenics, LLC. They have pioneered a novel spinal cord stimulation (SCS) waveform known as Differential Target Multiplexed (DTM) Spinal Cord Stimulation. Stimgenics’ preclinical research on the neuronal-glial mechanism of action has been recognized at various medical society meetings, receiving six “best of” awards for their research, three of which were specific to research investigating the DTM mechanism of action. NANS awarded the “Best Basic Science Research Award” to Stimgenics at their annual meeting in both 2018 and 2019. In this discussion, the docs dive deep into: - glial cells and their role in chronic pain. - What exactly is DTM? - How is the basic science translating into clinical outcomes? - What do we, as a field/specialty, have to do to continue to progress and change things for our patients? There were many studies referenced in this discussion, here is a short list of the most relevant literature: 1. Fishman M, Cordner H, Justiz R, et al. Randomized Controlled Clinical Trial to Study the Effects of SGX-SCS in Treating Intractable Chronic Low Back Pain: 3 Month Results. North American Neuromodulation Society (NANS); 2020; Las Vegas, Nevada. 2. Calodney AK, Kim PS, Slezak J, et al. Prospective study evaluating differential-target- multiplexed SCS for chronic intractable back pain with or without leg pain. Neuromodulation: Technology at the Neural Interface. 2019;22(3):e40-e295. 3. Fishman M, Calodney A, Kim P, et al. Prospective, multicenter trial to evaluate Multiplexed SCS for differential targets in subjects with chronic intractable back pain with or without leg pain. North American Neuromodulation Society (NANS); 2019; Las Vegas, NV. 4. Cedeno DL, Cass CL, Kelley CA, et al. Pre-clinical comparison of differential-target multiplexed scstm with low and high rate SCS. Neuromodulation: Technology at the Neural Interface. 2019;22(3):e40-e295. 5. Vallejo R, Kelley C, Smith W, Tilley D, Cedeno D. Cell-specific targeting in neural tissue using Differential Target Multiplexed (DTM) SCS. American Society of Regional Anesthesiology and Pain Medicine (ASRA); 2019; New Orleans, LA. 6. Vallejo R, Kelley CA, Smith WJ, Tilley DM, Cedeno D. Targeting specific cell populations in neural tissue with DTM-SCS. North American Neuormodulation Society (NANS); 2020; Las Vegas, NV. 7. Vallejo R, Smith W, Kelley C, Tilley D, Cedeno D. Neuron-glial inflammasome enhanced reversal by DTM-SCS relative to high rat and low rate SCS in a neuropathic pain model. American Society of Regional Anesthesiology and Pain Medicine (ASRA); 2019; New Orleans, LA. 8. Cedeno D, Smith WJ, Kelley CA, Tilley DM, Sanapati S, Vallejo R. DTM-SCS enhances reversal of neuron-glial inflammasome relative to high rate and low rate. North American Neuromodulation Society (NANS); 2020; Las Vegas, NV. 9. Vallejo R, Tilley D, Kelley C, Smith W, Cedeno D. Proteomics of Differential Target Muliplexed- SCS applied to an animal model of neuropathic pain. American Society of Regional Anesthesiologists and Pain Medicine (ASRA); 2019; New Orleans, LA. 10. Vallejo R, Kelley CA, Smith WJ, Tilley DM, Cedeno D. Proteomics of differential target multiplexed-SCS applied to an animal model of neuropathic pain. North American Neuromodulation Society 2020; Las Vegas, NV. 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 &amp; Nerve.

More glial cells!! Dr. Ricardo Vallejo, science that matters, and thinking beyond the neuron.

Dr. Karvelas and Dr. Joves discuss the various treatment options for patients living with pain. For patients and healthcare providers alike, once an appropriate diagnosis is made, the hard work begins. This is when we have to figure out the next steps towards getting back to function, quality of life, and the activities that make our patients happy. We believe that having a consistent and systematic approach to treatment options is the best way to maximize the efficiency of this journey, and we walk you through our treatment algorithms during this episode.                                                      As always, this is meant for education and entertainment purposes only. This is not medical advice. Please seek a healthcare provider to further discuss any topics that are discussed. The views expressed are those of the individuals, and may not reflect the views of Spine &amp; Nerve Diagnostic Center.

Treatment options and algorithms for patients living with pain

In this week's episode, Drs. Gurai and Joves discuss one of the under appreciated pain generators for low back pain- the sacroiliac joint (SI joint). The sacroiliac joint is the place where the spine meets the pelvis. It is, as the name suggests, a joint between the sacrum (lowest portion of the spine) and the ilium (one of the bones of the pelvis). Medical studies attribute between 10 and 40 percent of back pain to the SI joint. The most common patients affected are pregnant women and patients with ankylosing spondylitis, though many patients present with pain from trauma, cummulative injuries, and acquired stress such as with prior lumbar fusion.The SI joint is a complex structure with many possible pain generators- the bones, the joint (which is interesting because it has two components; an anterior diarthrodal joint with a complex capsule and a posterior syndesmosis with extracapsular ligaments and muscles involved), the ligaments (at least 11 different ones involved in stabilization), and of course the muscles.SI joint pain generally is aching pain in the low back and buttock. It can radiate further down the leg or anteriorly towards the groin as well. The most consistent sign for SI mediated pain is pointing to the posterior superior iliac spine as the maximal point of tenderness, but there are multiple physical examination maneuvers a provider can utilize to provoke this pain.Diagnostic injection is still considered the gold standard for diagnosis of true SI joint pathology. Once the appropriate diagnosis, we work through the normal treatment algorithms for pain diagnoses including conservative measures such as education, therapy and physical modalities such as bracing and low level laser therapy, and medications. If these conservative treatments are not able to control the pain and improve the patient's quality of life, we move on to invasive procedures. Steroid injections into the joint are the standard of care and work very well for many patients. If steroid injections are either ineffective or don't last long enough, other needle based options such as radiofrequency ablation and platelet rich plasma injections are great options for more prolonged pain relief. For patients that do not get the improvement that we're hoping, there are great surgical options to fuse the SI joint and prevent movement, which in turn should decrease the pain.Follow our practice on Facebook at Spine &amp; 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, the may not represent the views of Spine &amp; Nerve.

In this week's episode, Drs. Gurai and Joves discuss one of the under appreciated pain generators for low back pain- the sacroiliac joint (SI joint). The sacroiliac joint is the place where the spine meets the pelvis. It is, as the name suggests, a joint between the sacrum (lowest portion of the spine) and the ilium (one of the bones of the pelvis). Medical studies attribute between 10 and 40 percent of back pain to the SI joint. The most common patients affected are pregnant women and patients with ankylosing spondylitis, though many patients present with pain from trauma, cummulative injuries, and acquired stress such as with prior lumbar fusion. The SI joint is a complex structure with many possible pain generators- the bones, the joint (which is interesting because it has two components; an anterior diarthrodal joint with a complex capsule and a posterior syndesmosis with extracapsular ligaments and muscles involved), the ligaments (at least 11 different ones involved in stabilization), and of course the muscles. SI joint pain generally is aching pain in the low back and buttock. It can radiate further down the leg or anteriorly towards the groin as well. The most consistent sign for SI mediated pain is pointing to the posterior superior iliac spine as the maximal point of tenderness, but there are multiple physical examination maneuvers a provider can utilize to provoke this pain. Diagnostic injection is still considered the gold standard for diagnosis of true SI joint pathology. Once the appropriate diagnosis, we work through the normal treatment algorithms for pain diagnoses including conservative measures such as education, therapy and physical modalities such as bracing and low level laser therapy, and medications. If these conservative treatments are not able to control the pain and improve the patient's quality of life, we move on to invasive procedures. Steroid injections into the joint are the standard of care and work very well for many patients. If steroid injections are either ineffective or don't last long enough, other needle based options such as radiofrequency ablation and platelet rich plasma injections are great options for more prolonged pain relief. For patients that do not get the improvement that we're hoping, there are great surgical options to fuse the SI joint and prevent movement, which in turn should decrease the pain. Follow our practice on Facebook at Spine &amp; 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, the may not represent the views of Spine &amp; Nerve.

An underappreciated cause of low back pain, the sacroiliac joint

In this week's episode of the Spine &amp; Nerve podcast Dr. Gurai and Dr. Joves give us a quick introduction into neuromodulation. Some of you may be asking what neuromodulation is... It is defined by the International Neuromodulation Society as "technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area."Best known as a treatment for chronic pain (and the reason we are passionate about it), neuromodulation also includes deep brain stimulation (DBS) treatment for Parkinson's disease, sacral nerve stimulation for pelvic disorders and incontinence, spinal cord stimulation for ischemic disorders (angina, peripheral vascular disease), and targeting other parts of the nerve for focal nerve disorders such as ilioinguinal neuralgia after hernia repair or pain after total joint replacements.Neuromodulation works by stimulating nerves to produce a response. When we think of this in the pain management world, we usually explain to patients that we send signals to nerves that change the signaling cascades at the level of stimulation. This changes painful signals to less painful signals, therefore changing the patient's pain experience.Listen in as the docs walk us through this field from a 50,000 for view. Follow our practice on Facebook at Spine &amp; Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details.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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast Dr. Gurai and Dr. Joves give us a quick introduction into neuromodulation. Some of you may be asking what neuromodulation is... It is defined by the International Neuromodulation Society as "technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area." Best known as a treatment for chronic pain (and the reason we are passionate about it), neuromodulation also includes deep brain stimulation (DBS) treatment for Parkinson's disease, sacral nerve stimulation for pelvic disorders and incontinence, spinal cord stimulation for ischemic disorders (angina, peripheral vascular disease), and targeting other parts of the nerve for focal nerve disorders such as ilioinguinal neuralgia after hernia repair or pain after total joint replacements. Neuromodulation works by stimulating nerves to produce a response. When we think of this in the pain management world, we usually explain to patients that we send signals to nerves that change the signaling cascades at the level of stimulation. This changes painful signals to less painful signals, therefore changing the patient's pain experience. Listen in as the docs walk us through this field from a 50,000 for view. Follow our practice on Facebook at Spine &amp; Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details. 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 &amp; Nerve.

Neuromodulation: an introduction.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss CBD and it's utility in modern pain management.The doctors discuss a very brief introduction of the 2018 Farm Bill and how it has changed and opened an entire industry.They dive into some of the research that has been done, discuss how they are seeing it used in practice, and future considerations for research.Follow our practice on Facebook at Spine &amp; 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, the may not represent the views of Spine &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss CBD and it's utility in modern pain management. The doctors discuss a very brief introduction of the 2018 Farm Bill and how it has changed and opened an entire industry. They dive into some of the research that has been done, discuss how they are seeing it used in practice, and future considerations for research. Follow our practice on Facebook at Spine &amp; 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, the may not represent the views of Spine &amp; Nerve.

What is CBD and why is everyone talking about it?

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss the erector spinae plane block. This is a science heavy chat about a procedure that first made its way into the chronic pain literature in 2016, which is brand new by medical standards!Listen in as the docs give an introduction to this cutting edge procedure and tag about ways that it may be used in clinical practice.In this discussion, the following papers are discussed:1. Kot P, Rodriguez P, Granell M, et al. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72(3):209–220.2. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss the erector spinae plane block. This is a science heavy chat about a procedure that first made its way into the chronic pain literature in 2016, which is brand new by medical standards! Listen in as the docs give an introduction to this cutting edge procedure and tag about ways that it may be used in clinical practice. In this discussion, the following papers are discussed: 1. Kot P, Rodriguez P, Granell M, et al. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019;72(3):209–220. 2. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.  Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

You down with E...S...P!?!? The erector spinae plane block...

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves conclude our introduction to neuromodulation series by discussing peripheral nerve stimulation. Peripheral nerve stimulation utilizes similar technology as is used in other realms of neuromodulation, with the main difference being the targeted structures. Peripheral nerve and peripheral field stimulation, as the names suggest, focus on sending signals to a specific nerve in the peripheral nervous system (ilioinguinal, lumbar medial branch, cluneal, etc) or in the vicinity of a focal chronic pain.Listen in as the doctors discuss this exciting option for patients. They discuss some of the recent literature studying these devices, a couple of which are listed below.Percutaneous Peripheral Nerve Stimulation (PNS) for the Treatment of Chronic Low Back Pain Provides Sustained ReliefChristopher A. Gilmore MD et Al. Neuromodulation: Technology at the Neural InterfaceVolume 22, Issue 5 . 03 October 2018Prospective, Multicenter, Randomized, Double‐Blinded, Partial Crossover Study to Assess the Safety and Efficacy of the Novel Neuromodulation System in the Treatment of Patients With Chronic Pain of Peripheral Nerve OriginTimothy Deer MD , et Al. Neuromodulation: Technology at the Neural InterfaceVolume 19, Issue 1. 22 January 2016Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves conclude our introduction to neuromodulation series by discussing peripheral nerve stimulation. Peripheral nerve stimulation utilizes similar technology as is used in other realms of neuromodulation, with the main difference being the targeted structures. Peripheral nerve and peripheral field stimulation, as the names suggest, focus on sending signals to a specific nerve in the peripheral nervous system (ilioinguinal, lumbar medial branch, cluneal, etc) or in the vicinity of a focal chronic pain. Listen in as the doctors discuss this exciting option for patients. They discuss some of the recent literature studying these devices, a couple of which are listed below. Percutaneous Peripheral Nerve Stimulation (PNS) for the Treatment of Chronic Low Back Pain Provides Sustained Relief Christopher A. Gilmore MD et Al. Neuromodulation: Technology at the Neural InterfaceVolume 22, Issue 5 . 03 October 2018 Prospective, Multicenter, Randomized, Double‐Blinded, Partial Crossover Study to Assess the Safety and Efficacy of the Novel Neuromodulation System in the Treatment of Patients With Chronic Pain of Peripheral Nerve Origin Timothy Deer MD , et Al. Neuromodulation: Technology at the Neural InterfaceVolume 19, Issue 1. 22 January 2016 Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Neuromodulation: Peripheral nerve stimulation

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss complex regional pain syndrome, better known as CRPS. This topic and diagnosis is one that is very poorly understood by the general public, and many within the medical and healthcare communities.CRPS is essentially nerves not behaving themselves in the peripheral and Central nervous systems, and is one of the models for centralized pain.CRPS is variable in its clinical presentation, but typically is characterized by severe pain and impaired function out of proportion to the original injury. Listen as the doctors dive deeper into this topic and give some practical tips for people living with or treating chronic pain.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss complex regional pain syndrome, better known as CRPS. This topic and diagnosis is one that is very poorly understood by the general public, and many within the medical and healthcare communities. CRPS is essentially nerves not behaving themselves in the peripheral and Central nervous systems, and is one of the models for centralized pain. CRPS is variable in its clinical presentation, but typically is characterized by severe pain and impaired function out of proportion to the original injury. Listen as the doctors dive deeper into this topic and give some practical tips for people living with or treating chronic pain. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

What exactly is complex regional pain syndrome? Part 1

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss the behavioral health aspects of chronic pain.It is very well documented that chronic pain has very significant psychologic connections. The International Association for the Study of Pain define pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"; which is derived from a 1964 definition and was first published in 1979.Listen as the doctors dive deeper into this topic and give some practical tips for people living with or treating chronic pain.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss the behavioral health aspects of chronic pain. It is very well documented that chronic pain has very significant psychologic connections. The International Association for the Study of Pain define pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"; which is derived from a 1964 definition and was first published in 1979. Listen as the doctors dive deeper into this topic and give some practical tips for people living with or treating chronic pain. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Is it really all in their heads? The mind-body connection when living with chronic pain.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss peripheral neuropathy.Neuropathic pain is defined as a process that affects the somatosensory nervous system. When the nerves that are affected lie outside of the central nervous system (brain and spinal cord), it is considered peripheral neuropathy.Painful peripheral neuropathy has been identified in up to 3% of the general population, but provides a much greater challenge in patients with diabetes where as many as 25-50% of patients experience symptoms.Numbness, burning, and weakness are characteristic of peripheral neuropathy, and these symptoms can have devastating consequences on a person's quality of life and daily function. Listen in as we dive deeper...Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss peripheral neuropathy. Neuropathic pain is defined as a process that affects the somatosensory nervous system. When the nerves that are affected lie outside of the central nervous system (brain and spinal cord), it is considered peripheral neuropathy. Painful peripheral neuropathy has been identified in up to 3% of the general population, but provides a much greater challenge in patients with diabetes where as many as 25-50% of patients experience symptoms. Numbness, burning, and weakness are characteristic of peripheral neuropathy, and these symptoms can have devastating consequences on a person's quality of life and daily function. Listen in as we dive deeper... Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Narcissistic nerves - what exactly is peripheral neuropathy and why you should care

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a recent study that looks at treating post traumatic stress disorder with an Interventional technique called a stellate ganglion block.A stellate ganglion block is a procedure that is most commonly used in chronic neuropathic pain processes such as complex regional pain syndrome. The stellate ganglion is the sympathetic chain the lives in the cervicothoracic region and is responsible for the sympathetically mediated processes (think fight or flight responses) in this region. This procedure blocks the stellate ganglion (as the name suggests) and therefore blocks the signals from transmitting.Multiple case reports have been published over the past decade, however just last month (November 2019), a randomized controlled double blind study was published in JAMA psychiatry with impressive results.Listen in as the doctors discuss this recent literature and practical ways to approach this challenging issue.Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms. JAMA Psychiatry, November 2019. Kristine L. Rae Olmsted, et Al. http://dx.doi.org/10.1001/jamapsychiatry.2019.3474Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a recent study that looks at treating post traumatic stress disorder with an Interventional technique called a stellate ganglion block. A stellate ganglion block is a procedure that is most commonly used in chronic neuropathic pain processes such as complex regional pain syndrome. The stellate ganglion is the sympathetic chain the lives in the cervicothoracic region and is responsible for the sympathetically mediated processes (think fight or flight responses) in this region. This procedure blocks the stellate ganglion (as the name suggests) and therefore blocks the signals from transmitting. Multiple case reports have been published over the past decade, however just last month (November 2019), a randomized controlled double blind study was published in JAMA psychiatry with impressive results. Listen in as the doctors discuss this recent literature and practical ways to approach this challenging issue. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms. JAMA Psychiatry, November 2019. Kristine L. Rae Olmsted, et Al. <a href="http://dx.doi.org/10.1001/jamapsychiatry.2019.3474" rel="nofollow" target="_blank">http://dx.doi.org/10.1001/jamapsychiatry.2019.3474</a> Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Interlude: injections in the news- stellate ganglion block for PTSD

In this week's episode, Dr. Karvelas and Dr. Joves discuss buprenorphine... What it is, what it isn't, and some ways that it is being utilized to help patients with chronic pain. 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, the may not represent the views of Spine &amp; Nerve.

An introduction to buprenorphine

In this week's episode of the Spine &amp; Nerve podcast, Dr. Gurai and Dr. Joves continue our discussion of neuromodulation by diving deeper into radio frequency ablation.Radio frequency ablation is a procedure that uses needles to target an anatomical structure (usually in our case nerves) and a probe delivers energy (usually thermal energy) to change the way those nerves are able to serve the pain signals.Now, radio frequency ablation is not always looked upon as a component of the neuromodulation realm, but if we look back to the definition we have previously presented- "technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area." Radio frequency ablation definitely falls within this realm.Listen is as the docs dive deeper into radio frequency and the various pathologies that can be treated.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Gurai and Dr. Joves continue our discussion of neuromodulation by diving deeper into radio frequency ablation. Radio frequency ablation is a procedure that uses needles to target an anatomical structure (usually in our case nerves) and a probe delivers energy (usually thermal energy) to change the way those nerves are able to serve the pain signals. Now, radio frequency ablation is not always looked upon as a component of the neuromodulation realm, but if we look back to the definition we have previously presented- "technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area." Radio frequency ablation definitely falls within this realm. Listen is as the docs dive deeper into radio frequency and the various pathologies that can be treated. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Neuromodulation: Burning nerves may actually help your pain; Radio frequency ablation may be the way

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss a procedure called minimally invasive lumbar decompression or MILD.What exactly is MILD? Well, it's a way to create more space in the spine with utilizing small entry ports- which means no large incisions, less recovery time after the procedure and decreased risk for the patient.Listen as the docs discuss the two main studies that brought the MILD procedure back into relevance (and coverage by CMS - Centers for Medicaid and Medicare Services)References: Benyamin RM, Staats PS.MiDAS ENCORE: Randomized Controlled Study Design and Protocol.Pain Physician. 2015 Jul-Aug;18(4):307-16.Mekhail, Nagy, et al. (2012), Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Practice, 12(6): 417-425.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss a procedure called minimally invasive lumbar decompression or MILD. What exactly is MILD? Well, it's a way to create more space in the spine with utilizing small entry ports- which means no large incisions, less recovery time after the procedure and decreased risk for the patient. Listen as the docs discuss the two main studies that brought the MILD procedure back into relevance (and coverage by CMS - Centers for Medicaid and Medicare Services) References: Benyamin RM, Staats PS.MiDAS ENCORE: Randomized Controlled Study Design and Protocol.Pain Physician. 2015 Jul-Aug;18(4):307-16. Mekhail, Nagy, et al. (2012), Functional and Patient-Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression. Pain Practice, 12(6): 417-425. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Can something called MILD change patients' lives?

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves dive a little deeper into the world of neuromodulation therapy with a focus on wave forms and the various wave forms available.Neuromodulation is a powerful and exciting treatment option for difficult to treat chronic pain conditions.  Some common conditions that neuromodulation is commonly utilized to treat include post laminectomy syndrome (or failed back surgery syndrome) and complex regional pain syndrome; but there are many other applications of this therapy.   Advances in neuromodulation technology give the ability to individualize a patient's therapy depending of the specific patient and the specific disease process we are treating.  One of the largest advancements has been the progression of the internal pulse generators to provide different wave forms.  A waveform has different components that can be modulated to have the desired therapeutic effect for patients, these different components include the amplitude, the frequency, and the pulse width.  Different wave forms available currently include the following: 1. Traditional spinal cord stimulation (tonic stimulation):-low frequency (20-120 Hz)-patients tend to feel the individual pulses 2. High frequency stimulation:-high frequency (500-10,000 Hz)-paresthesia free-benefits include but are not limited to potential improved ability to target traditionally difficult to address areas of pain including low back pain 3. Burst stimulation:-groups of high frequency pulsed stimulatory phases separated by pulse free phases, followed by a passive recharge phase-based upon available research, this wave form is most similar to the natural occurring neuronal firing in our central nervous system, which potentially would lower risk of decreasing response to the treatment over time-less energy demand Ultimately, neuromodulation is a powerful treatment option (that has evolved significantly over the recent years and continues to advance); that is an effective treatment option for difficult to treat chronic refractory pain conditions.Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves dive a little deeper into the world of neuromodulation therapy with a focus on wave forms and the various wave forms available. Neuromodulation is a powerful and exciting treatment option for difficult to treat chronic pain conditions.  Some common conditions that neuromodulation is commonly utilized to treat include post laminectomy syndrome (or failed back surgery syndrome) and complex regional pain syndrome; but there are many other applications of this therapy.     Advances in neuromodulation technology give the ability to individualize a patient's therapy depending of the specific patient and the specific disease process we are treating.  One of the largest advancements has been the progression of the internal pulse generators to provide different wave forms.  A waveform has different components that can be modulated to have the desired therapeutic effect for patients, these different components include the amplitude, the frequency, and the pulse width.  Different wave forms available currently include the following:   1. Traditional spinal cord stimulation (tonic stimulation): -low frequency (20-120 Hz) -patients tend to feel the individual pulses   2. High frequency stimulation: -high frequency (500-10,000 Hz) -paresthesia free -benefits include but are not limited to potential improved ability to target traditionally difficult to address areas of pain including low back pain   3. Burst stimulation: -groups of high frequency pulsed stimulatory phases separated by pulse free phases, followed by a passive recharge phase -based upon available research, this wave form is most similar to the natural occurring neuronal firing in our central nervous system, which potentially would lower risk of decreasing response to the treatment over time -less energy demand   Ultimately, neuromodulation is a powerful treatment option (that has evolved significantly over the recent years and continues to advance); that is an effective treatment option for difficult to treat chronic refractory pain conditions. Disclosure!!! Dr. Brian Joves is a speaker and researcher for companies that produce devices in this space; please see his LinkedIn profile for full details. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

Neuromodulation: Riding the WAVE of technology to provide stimulating relief

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss shoulder pain.Shoulder pain is the third must common musculoskeletal complaint that brings patients to seek medical care. The shoulder is a complex arrangement of joints, tendons, and muscles... Each of which can be injured and contribute to pain.Follow our practice on Facebook at Spine &amp; 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, the may not represent the views of Spine &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Karvelas and Dr. Joves discuss shoulder pain. Shoulder pain is the third must common musculoskeletal complaint that brings patients to seek medical care. The shoulder is a complex arrangement of joints, tendons, and muscles... Each of which can be injured and contribute to pain. Follow our practice on Facebook at Spine &amp; 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, the may not represent the views of Spine &amp; Nerve.

The Shoulder

Front

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves chat about "non specific" lies back pain.Back pain has been well documented as the most common reason people present to a healthcare professional with some studies quoting an incidence as high as 30%. It is also one of the largest causes of disability, morbidity, and lost production in the United States. But as shocking as those stats can be, maybe even more shocking are studies that quote anywhere between 90 and 99% of acute low back pain as "non specific"! What is that and how can something that has such a huge personal and societal impact really be called "non-specific"!?! Listen as the doctors dive deeper into this topic. They will discuss their takes on this, from the perspective of double board certified specialists that focus on back pain, and share some practical tips for patients and primary care practitioners to help this large population.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves chat about "non specific" lies back pain. Back pain has been well documented as the most common reason people present to a healthcare professional with some studies quoting an incidence as high as 30%. It is also one of the largest causes of disability, morbidity, and lost production in the United States. But as shocking as those stats can be, maybe even more shocking are studies that quote anywhere between 90 and 99% of acute low back pain as "non specific"! What is that and how can something that has such a huge personal and societal impact really be called "non-specific"!?! Listen as the doctors dive deeper into this topic. They will discuss their takes on this, from the perspective of double board certified specialists that focus on back pain, and share some practical tips for patients and primary care practitioners to help this large population. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

 "Non specific" low back pain: a practical conversation for the front lines (primary care)

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves talk impaired sleep and try to answer the age old question: what came first, impaired sleep or chronic pain?Sleep is an important and unique component of the human condition that is vital for many components in the body. Studies have shown that patients living with chronic pain (both neuropathic, widespread and nociceptive, focal) experience significantly impaired sleep- duration and quality.Listen in as the doctors discuss some recent literature and practical ways to approach this challenging issue.Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

In this week's episode of the Spine &amp; Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves talk impaired sleep and try to answer the age old question: what came first, impaired sleep or chronic pain? Sleep is an important and unique component of the human condition that is vital for many components in the body. Studies have shown that patients living with chronic pain (both neuropathic, widespread and nociceptive, focal) experience significantly impaired sleep- duration and quality. Listen in as the doctors discuss some recent literature and practical ways to approach this challenging issue. Follow our practice on Facebook at Spine &amp; 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 &amp; Nerve.

What came first: chronic pain or impaired sleep? A conversation on sleep disturbance

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