Advocating for Transparency and Oversight in Pain Management
Introduction:
Summary of Lobbying Effort:
Importance of Transparency:
Purpose of the Lobbying Effort:
Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes.
For Board Prep, Ultrasound Training and more, visit:
Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound-
guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain.
Conclusion and Actionable Steps:
Outro:
Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course.
Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City.
After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360.
In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain.
He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic.
The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches.
The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case.
Additionally, the show notes mention an events calendar located at this link: https://www.nrappain.org/pages/ultrasound-course-calendar.
Upcoming Course schedule for NRAP Academy includes the following events:
Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session.
MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management.
Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia.
Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia.
Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance.
Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques.
In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates.
Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information.
Reference
Special Thanks to Robert Stall, MD
Reference
Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.
Exploring the Role of Ultrasound in Headache Evaluation and Treatment
A Journal Club based on Dr. Andrea Trescott's article:
Ultrasound for evaluation and treatment of headaches. Anaesth Pain & Intensive Care 2017;21(2):241-253.
Click Here to Claim CME for reflecting on content presented in this journal club.
David Rosenblum, MD
Accepting New Patients
Patients Interested in scheduling a consultation with Dr. David Rosenblum can call
516 482 7246 (Garden City) or 718 436 7246 (Brooklyn)
In this Podcast, Dr. Rosenblum discusses patient's in his practice who responsed to ultrasound guided nerve blocks in the treatment of headaches. He discusses the use of ultrasound injections as opposed to medication to manage the pain and references Dr. Trescott's comprehensive article on the various nerves and clinical presentations of headaches related to terminal nerve entrapment or irritation.
Dr. Rosenblum discusses
Summary of Dr. Trescott's Article and Key Points:
Peripheral Triggers and Plastic Surgery:
Ultrasound Advantages:
Exploring Extracranial Causes:
Conclusion:
NRAP Academy also offers:
Private Ultrasound Training Available
Email Info@NRAPpain.org
Reference:
Publication Details:
This podcast explores the dynamic relationship between intracranial and extracranial factors in headaches, shedding light on potential breakthroughs in their evaluation and treatment.
#interventionalpain #painboards #painfellowship #painexam #regionalanesthesia #ultrasoundguidedpain #ultrasoundpain #ultrasoundmsk #paincme #paincmecourse
References
For up to date Calendar, Click Here!
#painboards #painfellowship #abpm #aspn #abipp #Asipp
#nans #painexam #painexampodcast #regionalanesthesia #regemed #regenerativepainmedicine #jointinjections #prppain #bmac #painqbank #uspaininjections #Usjointinjections #interventionalpain
References
| Saturday, December 16, 2023 7:30 AM | |
| Saturday, January 6, 2024 7:30 AM |
References
Dr. Rosenblum reviews an ASRA Newsletter article discussing the technique, relevant anatomy and more for performing Shoulder Articular Branch Radiofrequency ablation for chronic pain.
David Rosenblum, MD practices Interventional Pain Medicine in New York.
To schedule a conusultation call 718 436 7246 for Brooklyn and 516 482 7246 for Garden City locations or go to www.AABPpain.com
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/PFcXGy
Upcoming Workshops and Events
| Saturday, October 28, 2023 8:00 AM | |
| Saturday, November 11, 2023 8:00 AM | |
| Saturday, December 16, 2023 7:30 AM | |
| Saturday, January 6, 2024 7:30 AM |
For up to date Calendar, Click Here!
Reference
Dr. Rosenblum explores Peptides, the various types, usess and applications for health and wellness.
Upcoming Pain Management Conferences
Upcoming Workshops and Events
| Saturday, October 28, 2023 8:00 AM | |
| Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop | Sunday, October 29, 2023 9:00 AM |
| Saturday, November 11, 2023 8:00 AM | |
| Saturday, December 16, 2023 7:30 AM | |
| Saturday, January 6, 2024 7:30 AM |
For up to date Calendar, Click Here!
References
https://healthgains.com/wellness/peptide-therapy/#Selank
Dr. Rosenblum discusses his concerns over:
RFA of the Genicular Nerves being a non reimbursed service when the patient already had them in the past with excellent relief.
Plus a discussion on CMS policy toward Peripheral Nerve Block reimbursement limitations and documentation!
Pain Management, Anesthesiology, PMR Board Review
Upcoming Workshops and Events
| Saturday, October 28, 2023 8:00 AM | |
| Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop | Sunday, October 29, 2023 9:00 AM |
| Saturday, November 11, 2023 8:00 AM | |
| Saturday, December 16, 2023 7:30 AM | |
| Saturday, January 6, 2024 7:30 AM |
For up to date Calendar, Click Here!
ASPN Webinar: Continuing Eduction and Board Prep | October 4, 2023 8PM |
Maximizing Profit: Understanding the 2024 Physician Fee Schedule | Wednesday, September 20, 2023 8:00 PM |
Saturday, October 28, 2023 8:00 AM | |
Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop | Sunday, October 29, 2023 9:00 AM |
Saturday, November 11, 2023 8:00 AM | |
Saturday, December 16, 2023 7:30 AM | |
Saturday, January 6, 2024 7:30 AM |
Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode:
Upcoming Pain Management Conferences
Course Calendar
2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
Oct. 28 Regional Anesthesia and Interventional Pain Medicine NYC
Nov.11 Regenerative Pain Medicine Course: NYC
Dec. 16th Regional Anesthesia and Interventional Pain Ultrasound Training NYC
2024
Jan. 6 Regional Anesthesia and Interventional Pain Ultrasound Training NYC
For up to date Calendar, Click Here!
References
Pierre Laumonerie https://doi.org/10.1093/pm/pnab061
, Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature, Pain Medicine, Volume 22, Issue 5, May 2021, Pages 1149–1157,Pinho, A.R.; Leite, M.J.; Lixa, J.; Silva, M.R.; Vieira, P.; Nery-Monterroso, J.; Bezerra, M.C.; Alves, H.; Madeira, M.D.; Pereira, P.A. Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region. Diagnostics 2023, 13, 2314. https://doi.org/10.3390/diagnostics13142314
Lung K, Lui F. Anatomy, Abdomen and Pelvis: Superior Gluteal Nerve. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535408/
David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses: a case of paresthesia in the upper neck realted to C3 and C4 stenosis and considers a selective nerve root block while wondering if a deep cervical plexus block would suffice.
Rational :
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/lubWXJ
Also discussed on this podcast:
The Superficial Cervical Plexus and applications for headache, neck pain, and clavicular fractures.
Caution: Phrenic Nerve
Anatomy
The cervical plexus is a complex network of nerves located in the neck region, originating from the anterior rami (branches) of the cervical spinal nerves, specifically those stemming from the upper cervical segments (C1 to C4). This intricate network serves to provide sensory and motor innervation to various structures within the neck and surrounding areas.
The cervical plexus is positioned within a groove between the longus capitis and the middle scalene muscles in the neck. It is organized into different nerve loops and branches that radiate outwards to supply various regions. The cervical plexus can be divided into deep and superficial components, each with distinct functions and innervation patterns.
Cervical Plexus: The plexus involves nerve loops and branches that provide both sensory and motor functions. The superficial sensory branches originating from adjacent anterior spinal nerves (C2 to C4) are responsible for providing sensation to specific areas of the skin, particularly in the head, neck, and shoulder regions. These sensory branches include the lesser occipital nerve (C2, C3), great auricular nerve (C2, C3), transverse cervical nerve (C2, C3), and supraclavicular nerves (C3, C4). These nerves typically run posteriorly and then penetrate the prevertebral fascia before reaching the skin and superficial structures.
For Pain Management and Anesethesiology Board Review, go to
For the Virtual Pain Fellowship Experience, Go to:
Ultrasound Workshops and Courses
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
Regenerative Pain Medicine Course NYC- November 11, 2023
For up to date Calendar, Click Here!
Refereces
Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol. 2018 Aug;71(4):274-288. doi: 10.4097/kja.d.18.00143. Epub 2018 Jul 4. PMID: 29969890; PMCID: PMC6078883. Read more!
ISPN Dubai 2023
David Rosenblum, MD interviews Reda Tolba, MD on the PainExam Podcast
In this episode, we delve into the realm of Pain Management in the US and the Middle East. Our international pain experts discuss the upcoming ISPN (International Society for Pain and Neuroscience) meeting in Dubai this december.
Dr. Reda Tolba, MD, chairs the Pain Management Department at Cleveland Clinic Abu Dhabi. He's internationally recognized for his contributions to Pain Medicine, boasting a wealth of experience from institutions like Wake Forest University Medical Center and Ochsner Health System.
Dr. David Rosenblum, MD, is the Director of Pain Management at Maimonides Medical Center and a driving force behind pain education platforms like PainExam.com and NRAP Academy. He's a pioneer in ultrasound-guided pain procedures, having trained thousands of physicians online and in person.
Tune in to hear Dr. Tolba's journey to being named Chair of Pain at Cleveland Clinic, Abu Dhabi, and his impressive academic and clinical achievements.Dr. Rosenblum, on the other hand, is known through his contributions to safe pain management protocols, and his mission to spread knowledge through podcasts and educational events.
Patients, interested he's scheduling an appointment with Dr. Rosenblum at his Long Island or Brooklyn Locations can go to AABPpain.com or call 718 436 7246 or 516 482 7246
To learn more about their work and educational initiatives, explore NRAPpain.org and PainExam.com/events. Join us in this episode to uncover insights from these leading figures in Pain Management.
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
On this episode, Dr. Rosenblum has a chat with Premier Heritage's Greg Alerte.
Greg has over 15 years of experience helping families and small business to achieve their financial goals. As co-owner and Certified Financial Planner at Premier Heritage, he focuses on helping people to preserve and grow their wealth, and to leave a legacy for future generations to build on. Greg’s research and professional opinions, have been quoted in several financial publications, including Wall Street Journal, NerdWallet, Financial Planning magazine, and the Huffington Post. Greg’s favorite quote is by the late Mia Angelou “when you learn teach, when you get give”
For more information, Email: galerte@premier-heritage.com
David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:
Attend and NRAP Course!
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs discusses Central post-stroke pain (CPSP).
Central Post Stroke Pain is a debilitating condition that affects a significant number of stroke survivors. It is characterized by persistent neuropathic pain, often described as burning, shooting, or electric shock-like sensations, in the areas of the body affected by the stroke. CPSP can significantly impact a patient's quality of life and functional recovery, making it crucial for physicians to have a comprehensive understanding of its pathophysiology.
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/HQ69sg
Ultrasound Workshops and Courses
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
Neuropathic Pain and Central Sensitization:CPSP is classified as a neuropathic pain syndrome, which means it arises from a dysfunction or damage to the nervous system. The exact pathophysiology of CPSP is complex and multifactorial, but it often involves the phenomenon of central sensitization. Central sensitization refers to the increased excitability and responsiveness of neurons within the central nervous system (CNS) in response to peripheral input.
Cortical Reorganization and Plasticity:
One key aspect of CPSP pathophysiology is cortical reorganization and plasticity. Following a stroke, the brain undergoes structural and functional changes as a result of the injury. This neuroplasticity, particularly in the somatosensory cortex, can contribute to the development of CPSP. Maladaptive plasticity may occur, leading to abnormal sensory processing and the generation of pain signals in response to non-painful stimuli.
Disrupted Pain Modulation Pathways:The pain perception and modulation pathways in the CNS play a crucial role in regulating pain signals. In CPSP, these pathways can be disrupted, leading to abnormal pain processing. Alterations in the descending inhibitory pathways, such as reduced inhibitory neurotransmitter release or impaired endogenous opioid system function, can result in increased pain sensitivity and the persistence of pain signals even after the resolution of the initial injury.
Inflammatory Processes and Neurotransmitter Imbalances:Inflammation within the CNS and imbalances in neurotransmitter systems also contribute to CPSP. Following a stroke, there is an inflammatory response that involves the release of pro-inflammatory cytokines and activation of immune cells. This inflammation can lead to sensitization of nociceptive neurons and exacerbate pain signaling. Additionally, imbalances in neurotransmitters, such as glutamate, serotonin, and norepinephrine, may disrupt the normal pain processing pathways, further amplifying pain perception.
Peripheral and Central Lesions:CPSP can arise from both peripheral and central lesions. Peripheral lesions, such as damage to the spinothalamic tract or thalamus, can directly affect the transmission of pain signals. Central lesions, on the other hand, involve damage to the somatosensory cortex, thalamus, or other brain regions involved in pain processing. Both types of lesions can contribute to the development of CPSP through various mechanisms, including altered neuronal activity, disrupted connectivity, and aberrant sensory processing.
The complex interplay of cortical reorganization, disrupted pain modulation pathways, inflammatory processes, and peripheral and central lesions contribute to the development and persistence of CPSP. Further research is needed to unravel the intricacies of CPSP's pathophysiology, leading to the development of targeted therapies to alleviate the burden of this debilitating condition.
References
Liampas, A., Velidakis, N., Georgiou, T. et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther 37, 3278–3291 (2020). https://doi.org/10.1007/s12325-020-01388-w
SYSTEMATIC REVIEW article Front. Neurol., 18 August 2021Sec. Stroke
Volume 12 - 2021 | https://doi.org/10.3389/fneur.2021.678198
David Rosenblum, MD Garden City and Brooklyn Pain Physician, world renown for his work on the PainExam Podcast, PainExam Pain Management Board Review and NRAP Academy’s Continuing Medical Education Programs, discusses:
The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9GkVWu
Ultrasound Workshops and Courss
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
Long Island and Brooklyn based Pain Physician, David Rosenblum, MD describes prolotherapy and discusses mechanism of action, evidence and protocols. Also mentioned in this podcast, Prolotherapy protocols, low dose version high dose dextrose prolotherapy, spine prolotherapy, Spine ligaments Intertransverse ligament, Ilolumbar ligament pain and more!
For Pain Management Board Review go to
Morton’s Neuroma Diagnosis Treatment and Regenerative Medicine Options
Course Calendar
Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!
Regenerative Pain Medicine Course NYC- May 13
Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
Platelet-rich-plasma Injection Therapy For Morton's Neuroma - Page #4. https://www.amssm.org/plateletrichplasma_injecti-csa-268.html?StartPos=130&Part=4a |
References
Join digital health leader and Upside Health CEO Rachel Trobman and PainExam.com founder Dr. David Rosenblum in a conversation about the impact of the end of the public health emergency in May could have on your pain management practice. We'll specifically discuss the changes to telehealth and remote patient monitoring. The webinar will close with one of Upside Health's clients outlining the launch and successes of RTM in their practice and be available for Q&A.
Course Calendar
Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!
Regenerative Pain Medicine Course NYC- May 13
Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR
For up to date Calendar, Click Here!
For more questions Email Rachel Trobman at Rachel@upside.health