Spine & Nerve

In this week's episode of the Spine & 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.

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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. Karvelas and Dr. Joves discuss one of the most common musculoskeletal pain complaints, especially in an older demographic-the hip joint.

Listen as the doctors dive deeper into this topic and give some practical tips for people living with or treating chronic pain.

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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. 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 & 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. 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...

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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. 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 & 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. 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 & 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 & Nerve.

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

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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 & Nerve.

In this special episode, Dr. Karvelas and Dr. Joves discuss something near and dear to their hearts, the injury the Kevin Durant sustained in the NBA finals.

This is a discussion between two long time Warriors fans, who happen to be physical medicine and rehabilitation physicians. The doctors do not know the details of the injury and are simply talking it through from a medical perspective. This is not meant to be medical advice, a medical opinion, or to have any opinion on the circumstances of the injury.

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, the may not represent the views of Spine & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss nutrition, exercise, and pain management.

This is a topic that we don't spend enough time on with patients, despite the growing evidence that it can make a significant difference.

In the episode, Dr. Andrew Weil's website was mentioned - https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/ amongst many other great online resources (Mayo clinic, well vegan, etc).

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, the may not represent the views of Spine & Nerve.