PVD for the Physiatry and Pain Boards

Podcast Show Notes: Peripheral Vascular Disease in PainManagement

Episode Highlights:
- Host: Dr. David Rosenblum
- Podcast: Pain Exam Podcast
- Focus: Peripheral Arterial Disease (PAD) in Pain Management

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Key Topics Covered:
1. Peripheral Arterial Disease (PAD) Overview
- Definition: Arterial sclerosis condition developing over long term
- WHO Definition: Exercise-related pain or ankle-brachial index (ABI) < 0.9
- Prevalence:
  * 3-4% in 60-65 year olds
  * Increases to 15-20% in 85-90 year olds
  * Up to 50% of patients may progress to symptomatic stages

2. Diagnostic Considerations
Diagnostic Tests:
- Ankle Brachial Index (ABI)
- Ultrasound
- CT Angiography
- Physical examination
- Pulse volume recordings
- Transcutaneous oximetry

ABI Interpretation:
- 1.0-1.4: Normal
- 0.9-1.0: Acceptable
- 0.8-0.9: Some arterial disease
- 0.5-0.8: Moderate arterial disease
- < 0.5: Severe arterial disease

3. Pain Characteristics
Types of Pain:
- Intermittent claudication
- Chronic limb ischemia
- Nociceptive pain
- Neuropathic pain
- Mixed pain syndrome

4. Pain Management Strategies
Pharmacological Approaches:
- Mild Pain: Paracetamol, NSAIDs
- Neuropathic Pain: Lidocaine patches, gabapentin, duloxetine
- Severe Pain: Morphine, fentanyl, ketamine

Non-Pharmacological Interventions:
- Music therapy
- Aromatherapy
- Psychotherapy
- Massage
- Acupuncture
- TENS
- Intermittent pneumatic compression

Upcoming Conferences Mentioned:
- ASPN
- ASIPP
- Pain Week
- Latin American Pain Society

Additional Resources:
- Pain Exam newsletter: painexam.com
- Virtual pain fellowship at nrappain.org

Disclaimer: Always consult with a healthcare professional for personalized medical advice.

Reference

Garba Rimamskep Shamaki, Favour Markson, Demilade Soji-Ayoade, Chibuike Charles Agwuegbo, Michael Olaseni Bamgbose, Bob-Manuel Tamunoinemi,
Peripheral Artery Disease: A Comprehensive Updated Review,
Current Problems in Cardiology, Volume 47, Issue 11, 2022,101082,

Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512

Maier, J.A.; Andrés, V.; Castiglioni, S.; Giudici, A.; Lau, E.S.; Nemcsik, J.; Seta, F.; Zaninotto, P.; Catalano, M.; Hamburg, N.M. Aging and Vascular Disease: A Multidisciplinary Overview. J. Clin. Med. 2023, 12, 5512. https://doi.org/10.3390/jcm12175512