Spine & Nerve

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas begin a new journal club format to discuss multiple articles that have a similar theme. The goal of this series on the podcast is to summarize recent research, and provide a discussion of some key points in regards to potential impact on clinical care. In this week's podcast the doctors summarize and discuss three recent articles regarding medications for treatment of chronic pain.

Please see References section below for the articles discussed in today's podcast.

References:

1. Alberti P, et al. Topiramate prevents Oxaliplatin-related axonal hyperexcitability and oxaliplatin induced peripheral neurotoxicity. Neuropharmacology. 2020.

2. Karin Bruun-Plesner, MD, Morten Rune Blichfeldt-Eckhardt, MD, PhD, Henrik Bjarke Vaegter, MSc, PhD, Joergen T Lauridsen, MSc, PhD, Kirstine Amris, MD, MedScD, Palle Toft, MD, PhD, MedScD. Low-Dose Naltrexone for the Treatment of Fibromyalgia: Investigation of Dose–Response Relationships. Pain Medicine. 2020.

3. Lynn Webster, MD, Jeffrey Gudin, MD, Robert B Raffa, PhD, Jay Kuchera, MD, Richard Rauck, MD, Jeffrey Fudin, PharmD, Jeremy Adler, DMSc, PA-C, Theresa Mallick-Searle, NP. Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. Pain Medicine. 2020.

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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. Nicolas Karvelas and Dr. Brian Joves take a look at the possibility of sport making a return during the COVID-19 pandemic.

Listen in as the docs discuss this and what may be coming down the road for the sport world. This is a discussion between two long time sport fans, who happen to be physical medicine and rehabilitation physicians. The doctors are not epidemiologists, virologists, policy makers, or owners of sport franchises; they are simply talking it through from an informed fan's perspective.

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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. Brian Joves and Dr. Nicolas Karvelas discuss some of the recent guidance coming from state and federal organizations to decrease some of the secondary effects of the COVID 19 pandemic. The stress and anxiety for our patients, front line healthcare providers and essential workers, and the general public can cause significant significant secondary problems to our overall health and health system.

Listen in as the doctors discuss some tactics, and some of the science behind the tactics, to optimize your physical and mental health during these hard times.

The strategies that have been recommended by the California department of health and surgeon general include:

- Supportive relationships

- Exercise

- Sleep

- Nutrition

- Mental health support

- Mindfulness

We have discussed many of these and their relationship with patients in chronic pain in prior episodes. You can look there for a deeper dive.

https://covid19.ca.gov/manage-stress-for-health/#top

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. Brian Joves and Dr. Nicolas Karvelas present a case report and do a quick review of lumbar disc herniations.

Dr. Karvelas presents a case in which a more cephalad lumbar disc herniation can effect nerve roots more than 1 level caudal to the level of disc herniation.  For example typically we would expect a L3-4 disc herniation to impact the L4 or L3 nerve root, but there are cases where the more caudal nerve roots (for example L5) can be impacted.  

The docs start by taking a step back and review the anatomy of the lumbar disc, and some important information regarding lumbar disc herniations including definitions and risk factors.  

 

It is well researched and documented that the most common lumbar disc herniation is a posterolateral disc herniation that would effect the traversing nerve root exiting one level caudal to level of herniation.  However, when a patient's symptoms and neurologic exam do not fit with this classic picture it is important to keep an open mind to the differential diagnosis including but not limited to the possibility of more caudal nerve roots being involved.  

 

Listen as the doctors not only present there own recent case in clinic, but also review the case reports in the literature documenting clinical instances where a lumbar disc herniation has resulted in a more rare clinical presentation for a patient.  This discussion reinforces an important principle in medicine that we always want to emphasize: in medicine it is important that we work as hard as we can to determine the most likely cause of the problem, but then importantly keep our mind open to/and think critically through other possibilities.  

 

 

References:

1. Mekhail N, Costandi S, et al.The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients. Neuromodulation. 2020; 23: 133-139.

 

 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. Brian Joves and Dr. Nicolas Karvelas discuss the impact that smoking tobacco can have on the chronic pain disease processes.

Smoking tobacco can contribute to the development / worsening / persistence of chronic pain processes, and additionally tobacco use can also decrease the probability that a treatment will work for patients.  

 

It is well researched and documented that smoking has a negative impact on our health including but not limited to cardiovascular disease, lung disease, cancer risk; but there is also growing evidence that smoking tobacco can contribute to and worsen common chronic pain disease processes including chronic low back pain.  Just as we have blood vessels supplying our heart and lungs which smoking can compromise, there are blood vessels supplying our spine and smoking tobacco can have a negative impact on this blood supply and ultimately the spine.

 

Smoking tobacco has been shown through research to contribute to inappropriate inflammation, immune system abnormalities, autonomic nervous system dysfunction, ischemic states (compromised blood supply to important systems throughout the body).  This has a significant negative effect on chronic pain processes and the treatments we have available to us.

Complex Regional Pain Syndrome (CRPS) was discussed in a prior episode (https://anchor.fm/spine/episodes/What-exactly-is-complex-regional-pain-syndrome--Part-1-e52ql0 ) and is one of the correlates used for chronic pain. It has been shown that smoking tobacco and CRPS cause similar pathologic processes in the body, and this may help explain why patients with CRPS who smoke tobacco do not respond as well to one of our most powerful treatment options available for CRPS, spinal cord stimulation.  

Listen in as the doctors explore the recent research, and apply the results to the overall approach to a chronic pain patient who also utilizes smoking tobacco.

 

References:

1. Mekhail N, Costandi S, et al.The Impact of Tobacco Smoking on Spinal Cord Stimulation Effectiveness in Complex Regional Pain Syndrome Patients. Neuromodulation. 2020; 23: 133-139.

 

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.

This week's episode of the Spine & 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 & Nerve.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves warmer weather, spring training and the forthcoming golf season by discussing how to keep up with your golf game, even when living with back pain.

Golf is one is the most popular pastimes in the world for weekend warriors, but studies have shown that anywhere from 25-65% of golfers will experience a back injury related to their golf game. Many of these are of the muscle strain variety. But just like any low back injury, we have to work through a differential diagnosis that includes the various anatomical structures in the lumbar spine.

The low back injury and golf correlation has become very well known at the professional level, where players like Tiger Woods and Jason Day worked through very public injuries. In these world class athletes, we have seen significant increases in the torque and loading forces across the spine as the athletes have evolved more powerful swings. This has seemingly led to higher rates of injury, and given more concern to the amateur athlete trying to replicate the Tiger Woods drive or the Rory McElroy fairway wood.

Listen in as the docs discuss the biomechanics behind these injuries, what to do if you tweak your back, and how to continue playing the sport you love for decades and decades.

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 few of the common questions patients have when discussing some of the advanced, minimally invasive options to test their pain.

The three main questions that the doctors discuss are:

Do we have to do something more invasive?

What if I'm scared of something implanted in my body?

Is this going to fix me?

Listen in as the docs discuss these common questions and help educate patients about the amazing treatment options available to treat 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. Brian Joves and Dr. Nicolas Karvelas dive deeper in buprenorphine. The doctors have given an introduction to this medicine in the past (https://anchor.fm/spine/episodes/An-introduction-to-buprenorphine-e3fe2m) . This discussion dives deeper not only into the clinical utility, but also discuss some options for transitioning patients from a full my agonist to buprenorphine. Listen in as the docs dive deep!

In this discussion, a Z Dogg MD podcast is referenced: https://zdoggmd.com/podcasting/buprenorphine/

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. Brian Joves and Dr. Nicolas Karvelas discuss a recent study that evaluated peripheral nerve stimulation for the treatment of chronic shoulder pain.

Case Series: Axillary Peripheral Nerve Stimulation for Chronic Shoulder Pain: A Retrospective Case Series

John Taylor Mansfield DO Mehul J. Desai MD, MPH

Neuromodulation: Technology at the Neural InterfaceEarly View . First published: 13 January 2020

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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.