Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review lumbar radiculopathy.  Lumbar radiculopathy is a common diagnosis in which there is irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas such as pain, weakness, numbness, and tingling..

Lumbar radiculopathy is typically due to a structural abnormality: specifically disc herniation and/or impingement due to spondylosis. Disc herniation (a rupture in the fibrous outer wall of a lumbar disc allowing the soft nucleus of the disc to bulge outward, which can press against a nerve root) is one of the most common causes of lumbar radiculopathy. Because of how common this pathology is, it is important to understand the usual natural history of radiculopathy due to disc herniation. Acute disc herniations typically improves significantly by 6-12 weeks with conservative treatment, making patient education a key component of helping them through this painful condition.

That being said, the differential diagnosis for lumbar radiculopathy is very broad, and as always it is important to consider and rule out more concerning etiologies.

Listen as the doctors discuss the definition of lumbar radiculopathy, the differential diagnosis, as well as a more detailed discussion of the natural history of radiculopathy and conclude with a look at the pathophysiology of lumbar radiculopathy.

References:

2. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation: The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA. 2006;296(20):2441–2450.

3. Gugliotta M, da Costa BR, Dabis E, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open 2016;6:e012938.

4. Lin JH, Chiang YH, Chen CC. Lumbar radiculopathy and its neurobiological basis. World J Anesthesiol 2014; 3(2): 162-173.

In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves conclude the discussion regarding Myofascial Pain Syndromes through a case presentation. The doctors present a common clinical scenario where myofascial pain is causing significant negative impact on a patient's function, quality of life, and health.

In the prior background and journal club episodes, the pathophysiology of myofascial pain was discussed in detail (see https://anchor.fm/spine/episodes/Back-to-Basics-Myofascial-Pain-Syndrome-eq461q and https://anchor.fm/spine/episodes/Journal-Club-Neuroinflammation-in-Myofascial-Pain-Disorders-eqlc5l).

This episode’s discussion brings things a little more clinical than the prior two. The doctors present a clinical picture of a young woman with chronic neck pain. Listen as they walk through the process of identifying pathology and initiating a treatment protocol that focuses on physical modalities, topical ointments and trigger point therapy.

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

References:

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas expand on their recent discussion of pain chronification.  The doctors discuss a fairly common scenario in which a patient with very chronic pain develops a relatively new pain condition.  In this setting, the new onset pain process can be significantly amplified and difficult to treat.

Previously, the doctors summarized processes including central and peripheral sensitization, which contribute significantly to the severity and refractory nature of chronic pain conditions.  Listen as the doctors review chronification of pain in the context of a patient case example and discuss treatment approaches, particularly optimizing medication management.

Chronic pain disease processes are very challenging to diagnose and treat, especially when multiple body parts are involved.  However, there are a growing number of tools available to make a positive impact for our patients, and with a carefully crafted treatment plan, progress can be made. Although optimizing patients' health, function, and safety may be a long and winding road, this goal is achievable!

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.

References:

2. Ossipov MH, Morimura K, Porreca F. Descending pain modulation and chronification of pain. Curr Opin Support Palliat Care. 2014 Jun;8(2):143-51.

3. Morlion B, Coluzzi F, Aldington D, Kocot-Kepska M, Pergolizzi J, Mangas AC, Ahlbeck K, Kalso E. Pain chronification: what should a non-pain medicine specialist know? Curr Med Res Opin. 2018 Jul;34(7):1169-1178.

4. A Comprehensive Review of the Celiac Plexus Block for the Management of Chronic Abdominal Pain. Current Pain and Headache Reports. 2020.

5. Khanna IK, Pillarisetti S. Buprenorphine - an attractive opioid with underutilized potential in treatment of chronic pain. J Pain Res. 2015 Dec 4;8:859-70.