Spine & Nerve

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the awesome and stimulating several days of the most recent NANS conference.  The doctors share their major takeaways from the conference.  The field of neurostimulation has advanced significantly over the years and we are at a point where we can really start to fine tune the exact form of neurostimulation for a specific patient and pathology.  The progress that has been made in regards to neurostimulation therapy has significantly increased the breadth of conditions that can be treated by neurostimulation / indications for neurostimulation.  This progress is accompanied by more and more literature demonstrating the efficacy and safety of neurostimulation, and most importantly we are seeing better and better outcomes for patients.  

 

One of the major new neurostimulation therapies is a form of spinal cord stimulation that targets Glial cells which we know play an important / critical role in the development and perpetuation of chronic pain states.  This form of spinal cord stimulation is Differential Target Multiplexed (DTM) spinal cord stimulation.  This therapy is backed by years of well done basic science research evaluating how neurostimulation can positively impact glial cell activity in the chronic pain state and consequently have a significant positive impact on an individuals symptoms, function, and health.  The preliminary data is very good for this therapy, and we will continue to analyze the research as more information / results become available.  

 

The NANS conference is always an excellent opportunity for learning and interacting with experts in the field; listen as the doctors discuss this experience and some of the exciting new research being done.

 

References:

1. Fishman M, Cordner H, Justiz R et al. Randomized Controlled Clinical Trial to Study the Effects of DTM-SCS in Treating Intractable Chronic Low Back Pain: 3 Month Results. Presentation at NANS 2020, Las Vegas, Nevada.

2. Cedeno D.L., Cass C.L., Kelley C.A., et al. Pre-clinical comparison of differential-target multiplexed scstm with low and high rate SCS. Neuromodulation 2019 22:3 (E185-)

3. Cedeno D.L., Kelley C.A., Cass C.L., et al. Pre-clinical Comparison of Differential-Target Multiplexed SCS with Low and High Rate SCS. Presentation at ASRA 2018. San Antonio, Texas.

 

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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 & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss goal setting... After all, It's half way through January. How's your new years resolution going?

Dr. Joves had asked every patient he's seen this year about their resolutions or goals for the new year, and has been shocked by the responses. Every single person has stated that they don't believe in resolutions. Thankfully, a couple patients said things like "just trying to continue improving" or "getting better each day", but the overwhelming response (read over 99%) was a lack of goals.

Listen is as the docs discuss this trickling finding and focus in on the way they try to help patients. the conversation with patients is a similar one that we've discussed before... Let’s start with small steps each day/week/month and start to right the ship.

We hope you enjoy this conversation. Look for the top three goal/ resolution making tips from reach of the docs and some actionable advise you can start using today!

Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & 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 & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

Thank you all so much for listening to the Spine & Nerve podcast in 2019. We started this podcast to provide another option for both patients and healthcare practitioners to learn more about musculoskeletal medicine and pain medicine.

Drs. Raman Gurai, Nicolas Karvelas and Brian Joves have had a great time educating about various diagnoses and treatment options, diving deep into the medical literature, and sharing their experience treating these challenging pathologies.

As the decade comes to an end, we believe that just as the 2000s have gone down in history as the decade of pain... The 2010s will be remembered for two main themes: fighting and reversing the opioid epidemic, and the rise of technology in pain medicine. We have addressed both of these topics at length (please refer to our previous episodes:

https://anchor.fm/spine/episodes/When-opiates-fail-your-patients-e3pjl2.

https://anchor.fm/spine/episodes/Opiates--opiates--and-more-opiates----We-just-cant-stop-talking-or-educating-on-them-e62be0

https://anchor.fm/spine/episodes/Neuromodulation-an-introduction-e7r6k0 ).

We are humbled by the response we have received from you, our listeners. We are so grateful that you have taken the time to listen, engage with us, and share the podcast with your friends, colleagues, and patients.

Our most listened to podcast of the year was our introduction to spinal stenosis, and we have chosen to rebroadcast that episode to wrap 2019. Wishing you all a very happy new year and looking forward to continue bringing you value with education and information on all things musculoskeletal, spine, orthobiologic and pain medicine!

Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss vertebral compression fractures with an emphasis on osteoporotic compression fractures.  

Compression fractures, as the name suggests, are when the bones of the spine fracture and break because the force placed on the spine overcomes the internal strength of the bones. In a young healthy individual this can be seen in trauma, but as three population ages we are seeing this occur not in noon traumatic circumstances- we tend to refer to those as osteoporotic fractures.

Osteoporotic vertebral compression fractures are a common medical problem with an estimated prevalence of around 30% in the elderly population over 65 years old.  The consequences of a compression fracture is not limited to significant back pain which can be very debilitating, but there is also increased risk of adjacent spinal fractures in the setting of the vertebral deformity and altered biomechanics, and increased mortality both in the short and long term.  As the population over age 65 continues to grow, the medical community will continue to work to optimize the guidelines for diagnosis and treatment of this medical problem.  

 

Work remains to be done to optimize guidelines, but currently from a diagnostic standpoint, the American College of Radiology does recommend Xrays, DEXA scan, MRI and/or CT for diagnosis.  Once the diagnosis is made the treatment depends on multiple factors including the acuity of the injury.  For severely symptomatic acute compression fractures Vertebroplasty and Kyphoplasty are strong considerations and are on the clinical guideline recommendations for the American College of Radiology and the National Institute for Health and Care Excellence Guidelines.  Especially as the pathology becomes more chronic, stronger consideration may be given to targeting the medial branches of the affected facet joints as a therapeutic target.  Treating the medial branches will positively modulate the pain from the joints affected by the altered biomechanics of the compromised vertebral body.  One of the major benefits of consideration of treating the facet joints themselves to manage the pain associated with vertebral compression fracture (especially more subacute to chronic fractures) is that we can achieve good pain relief with significantly lower risk to the patient.

Listen in as the doctors discuss this recent literature and practical ways to approach this challenging issue.

Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & 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.2019.3474

Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & 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 & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & 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 & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & 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 & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

In this week's episode of the Spine & 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 & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people.

This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.