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

For  up to date Calendar, Click Here!

Reference

Dr. Rosenblum discusses posterior hip pain/buttock pain near scar after Total Hip Arthroplasty. Included in this episode:

• Patient Testimonial re: SPRINT PNS (superior gluteal and superior cluneal nerve)
• Superior Gluteal Nerve Anatomy
• Hip Innervation
• Upcoming Private and Group Ultrasound Training

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 and others, 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, https://doi.org/10.1093/pm/pnab061

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 :

• Desire to avoid epidural due to proximity to spinal cord
• Ultrasound approach of cervial plexus may anesthetize C3 and C4 roots and may be sufficient to do with ultrasound alone
• Unfortunately, no data found to support this particular situation, however, it may be safe and effective if performed properly.   

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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.

Earn CME Credit

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

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!

Morton’s Neuroma Diagnosis Treatment and Regenerative Medicine Options

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

References

El-Kadiry, A.EH., Lumbao, C., Salame, N. et al. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord 23, 23 (2022). https://doi.org/10.1186/s12891-021-04910-5

Neuromodulation and Headaches-

Dr. Rosenblum discusses a recent review article on Peripheral Neuromodulation and Headaches. Meet Dr. Rosenblum at Upcoming Conferences (ASPN and ASIPP) or schedule a private Ultrasound Course in NY!

Upcoming Ultrasound Training Workshop Event-

May 16th, 2021-
Advanced Ultrasound Guided Regional Injections for Emergency Room Doctors-
https://painexam.com/events/us_guided_pain_for_emergency_medicine_physicians/

Resources:
Urits I, Schwartz R, Smoots D, Koop L, Veeravelli S, et al. Peripheral Neuromodulation for the Management of Headache, Anesth Pain Med. 2020 ; 10(6):e110515. doi: 10.5812/aapm.110515.

New Updates-

• ASIPP and ASPN in June and July!
• Private Ultrasound Courses in NY
• PainExam Complete- the most comprehensive review in pain medicine, regenerative pain treatments and ultrasound guidance!
• WAPMU Collaboration- coming soon!

Download the PainExam Official Apps for Android and IOS Devices!

https://play.google.com/store/apps/details?id=com.painexam.android.painexam&hl=en_US

https://apps.apple.com/us/app/the-pain-management-review/id997396714

Follow PainExam-
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https://www.youtube.com/user/DocRosenblum/videos

March 14th- Virtual Ultrasound Training Courses for Anesthesiologist

April 18th- Live Ultrasound Training course in NYC

See you in Miami at ASPN this July....

Dr. Rosenblum sits down with Tim Deer and discusses work life balance, neuromodulation, pain management training, the American Society of Pain and Neuroscience...

Annual ASPN Conference link:

Dr. Rosenblum interviews Dr. Baxter on her thermo-mechanical neuro-modulatory pain relief platform.

Amy Baxter MD FAAP FACEP is a Clinical Associate Professor in Emergency Medicine at Augusta University and the founder and CEO of Pain Care Labs, the industry leader in noninvasive pain relief solutions. She is an academic, physician and research focused entrepreneur that invented a thermo-mechanical neuro-modulatory pain relief platform. Her patents include VibraCool® Vibrational Cryotherapy to treat tendinopathies and decrease opioid use, and her disruptive Buzzy® device, which has been used to control needle pain for over 37 million needle procedures. Dr. Baxter was awarded over 2.8MM in Fast-Track SBIRs by the NIH.

She also prepared and filed the FDA 510K submission for medical devices, securing the FDA expansion of the utilization to include muscle pain and cosmetic injection pain control. Dr. Baxter and Pain Care Labs were recently honored with the 2020 Tibbetts Award for Innovation for the substantial economic and social benefits the company’s pain-relieving medical devices have contributed to the United States. 

Buzzy for Healthcare, https://shop.paincarelabs.com/collections/healthcare

Buzzy for personal, https://shop.paincarelabs.com/collections/buzzy%C2%AE

VibraCool, https://shop.paincarelabs.com/collections/vibracool-r

Ultrasound Guided Interventional Pain Training

1. Krishnan S, Cascella M. Erector Spinae Plane Block. [Updated 2020 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545305/

2. EnesAydinbEmreSengunaAtifBayramogluaHaci AhmetAlicibHigh-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department. The American Journal of Emergency Medicine. Volume 37, Issue 2, February 2019, Pages 375.e1-375.e3ErdalTekinaAliAhiskalioglubMuhammed 

    

Dr. Rosenblum apologizes on behalf of the Pain Physicians for 2 overlooked topics that could help pain patients...

References

Nutritionalfacts.org

Mendonça CR, Noll M, Castro MCR, Silveira EA. Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients. 2020 Oct 9;12(10):3075. doi: 10.3390/nu12103075. PMID: 33050122; PMCID: PMC7601187.

Dr. Rosenblum Discusses:

• Sickle Cell Disease
• Crisis
• Types of Pain associated with Sickle Cell Disease
• Opiate and non opiate management

Dr. Rosenblum Interviews Panamanian Pain Physician In Spanish
(en Espanol)

Subtitles on the PainExam Youtube Channel or PainExam.com/news page

 Dr. Rosenblum welcomes Justin Harvey to the show to discuss financial planning and COVID preparations.

Announcement!

Dr. Rosenblum discusses a recent consensus guideline on Low Platelets in the Obstetric Patient. 

• Low Platelets and Epidurals in the OB Patient
• ASIPP Board Review Course
• Painexam Alumni Emails
• Congratulations to Graduates!
• Welcome incoming Residents and Pain Fellows!

Whether you did a PM&R residency without a fellowship, an ACGME Pain Fellowship or Unaccredited Pain Fellowship, this is a can't miss episode reviewing the ABIPP Exam and other opportunities available to not only learn pain medicine, but to learn the business and politics of this amazing specialty.

Click Below to Preview our Newest Course

Dr. Rosenblum interviews Amol Soin, MD, ASIPP's (American Society of Interventional Pain Physicians) incoming President.

• Synergy among Pain Physicians
• ASIPP advocating to protect pain patients & physicians
• ABIPP Board Exam
• Ultrasound and Regenerative Pain Courses
• Telehealth and CMS
• Vertebroplasty and Augmentation