Spine & Nerve
Spine & Nerve is a medical podcast hosted by physicians specializing in pain management and physical medicine/rehabilitation. The show explores modern pain management topics, including diagnoses, treatment options, and the evolving landscape of pain care. It aims to educate both healthcare providers and patients while clarifying misconceptions. The content is intended for educational and entertainment purposes only, not as medical advice.
Episodes
Wellness isn't a biohack!
Wellness is one of the most overused words in medicine. It's also one of the most important.Not because of biohacks or trends — but because the fundamentals of how we build a body, mind, and life that lasts are consistently overlooked in favor of short-term fixes.In this episode, I break down what wellness actually means, why lifespan and healthspan are not the same thing, and the Six Pillars
Anything but SAD (Standard American Diet)- Nutrition, Cancer, and Pain
In this episode, Dr. Brian Joves shares a personal journey of confronting cancer and how it reshaped his perspective on nutrition. Despite the fact that most physicians receive only a few hours of formal training in nutrition, diet remains one of the most powerful—and underutilized—tools in medicine.We’ll discuss:Why nutrition education is lacking in medical training.The dangers of the Standard Am
Wellness, Pain and an Expanded Journey
In this episode, I take a step back from the usual discussions on interventional pain medicine to share something deeply personal. Recently, I was diagnosed with oral cancer—an unexpected and humbling moment that has given me a new lens through which to look at health, wellness, and the work we do every day in medicine.This experience has reminded me of two important truths:Health is never guarant
Peripheral Nerve Stimulation Updates: Exploring Emerging Evidence in Pain Medicine
In this episode of the Spine & Nerve Podcast, Dr. Brian Joves and Dr. Jason Kung dive into the evolving world of peripheral nerve stimulation (PNS). As the field of pain medicine continues to progress, new studies are offering more insights into advanced therapies for challenging conditions like peripheral neuralgia and chronic pain. This discussion focused on the COMFORT study, which evaluat
Pain Medicine’s Identity Crisis and the Future of Training with Dr. Scott Pritzlaff
Episode Overview:
In this episode, Dr. Brian Joves sits down with Dr. Scott Pritzlaff, an esteemed pain management specialist and the residency program director at UC Davis, to tackle some big questions on the current state and future of pain medicine. They dive into Dr. Pritzlaff's recent thought-provoking editorial, "From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way," which cri
Leading and Growing as a Physician with Dr. Richard Winters
In this episode of the Spine & Nerve podcast, Dr. Brian Joves sits down with Dr. Richard Winters, an emergency physician, leadership coach, and author, to discuss leadership, coaching, and the unique challenges physicians face as they transition into leadership roles. Whether you're early in your career or a seasoned physician looking to expand your leadership skills, this episode offers pract
Unpacking Ambulatory Surgery Centers: Is an ASC the Right Move for Your Pain Medicine Practice?
The Pros and Cons of Ambulatory Surgery Centers (ASCs) vs. Office-Based Procedure SuitesWelcome back to another insightful episode! Today, we’re diving deep into a topic that’s been on the minds of many healthcare providers: the differences between Ambulatory Surgery Centers (ASCs) and office-based procedure suites. Joining us is Teri Yates, an expert in helping physicians navigate the complexitie
Reviewing the CA Medical Board Pain Guidelines
In this episode of The Spine & Nerve Podcast, Dr. Jason Kung and Dr. Brian Joves break down the new California opioid guidelines with insights that every healthcare provider and pain management specialist should know.
Our doctors explore the latest guidelines from the California Medical Board, published in July 2023 and designed to navigate the complexities of prescribing opioids in chronic pa
Unlocking the Power of Fitness in Aging with Mike Ochoa, DPT
In this episode of the Spine & Nerve podcast, join Brian Joves, MD for an enlightening conversation with Mike Ochoa, DPT, a passionate advocate for fitness in aging populations.
Dr. Mike brings valuable insights into the importance of exercise, particularly weightlifting, in promoting longevity and overall well-being as we age. Discover the truth behind common misconceptions about aging and exerc
Journal club: Innovations and insights in Neuromodulation
Episode Summary:Join Dr. Jason Kung and Dr. Brian Joves for an in-depth discussion on the latest in neuromodulation. This episode covers a range of topics from the North American Neuromodulation Society 2024 Annual Meeting highlights to a journal club traversing the topics of spinal cord stimulation, closed-loop technology, and the impact of paraspinal muscle atrophy on vertebral endplates. With a
A Year in Review: Global Insights, Spinal Health, and Looking Ahead to 2024
In this episode of The Spine & Nerve Podcast, Dr. Dr. Jason Kung and Dr. Brian Joves have a reflective and forward-looking discussion as we transition from 2023 into 2024, sharing our podcast's journey, personal insights, biggest happenings in pain medicine, and anticipations for the new year.
1. Podcast Journey and Global Reach:
Transitioning through 2023: The evolution of our podcast
Managing Chronic Pain through Education with Dr. Andrea Furlan
In this episode of the Spine & Nerve Podcast, Dr. Brian Joves has the distinct pleasure to welcome Dr. Andrea Furlan to the show. Dr.
Furlan is a pain specialist in Toronto Canada. She is a physiatrist (specialist in Physical Medicine & Rehabilitation). She holds a
medical degree from the University of Sao Paulo and a Ph.D. degree from the University of Toronto. She has 30 years of experience he
Growing a strong and healthy thrower with Dr. Robert Bowers
In this episode of the Spine & Nerve Show, Dr. Robert Bowers joins Dr. Brian Joves to discuss the progression of young athletes in throwing sports, such as baseball. He emphasizes the importance of allowing children to play multiple sports and avoid specializing too early. Dr. Bowers also highlights the risks associated with overuse injuries and the need for rest periods. He discusses the role of
To Anticoagulate or not to Anticoagulate with Interventional Spine Procedures
In this episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves delve into a comprehensive discussion surrounding anticoagulation guidelines and their implications in interventional pain procedures.
With over a hundred thousand downloads and over 1,000 YouTube subscribers, we would like to express our sincere gratitude to all the listeners for your engagement and support. Ple
Going it alone with Dr. Nikhil Verma
In this episode, we have a special guest, Dr. Nikhil Verma, who shares his inspiring journey from undergrad to establishing his own medical practice. Dr. Verma opens up about the challenges he faced, the pivotal moments that shaped his career, and the lessons he learned along the way. Join us as we delve into his story of perseverance, passion, and the pursuit of personalized medicine.
Episode H
Find yourself a health coach with Dr. Hunter Vincent
In this week's episode of the Spine & Nerve podcast, we have a return guest! Dr. Hunter Vincent returns to the show to chat with Dr. Brian Joves about health coaches and how they can help your patients to be more successful in their journey with and through chronic pain.
In this episode we'll discuss:
What is a health coach?
Where does this fit into the treatment and provider paradi
IPGs, Artificial Intelligence and Cochrane! An SCS Update with Dr. Jason Kung and Dr. Brian Joves
In this week's episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves try to digest all the recent happenings in the world of neuromodulation.
They address:
Internal Pulse Generators
Artificial Intelligence
The Cochran Study
Listen as the doctors get excited, frustrated, and try to bring a silver lining to the whirlwind of headlines that have been discussing neuromodulati
Allow us to Introduce Dr. Jason Kung
In this week's episode of the Spine & Nerve Podcast we would like to introduce you all to the newest member of the Spine & Nerve family... Dr. Jason Kung. Jason Kung, MD, is a board-eligible anesthesiologist and interventional pain physician who joined Spine & Nerve last year. Listen in as Brian Joves, MD gets to know Dr. Kung better and explore his journey into medicine and to d
Spinal stenosis
In this week's episode we take a deep dive into lumbar spinal stenosis, discussing the underlying disease process as well as treatment options in the medical literature. The studies referenced in this podcast are given at the end of the podcast. This is meant for education and entertainment only, this is not to be interpreted as medical advice. If you feel t
Movement as Medicine with Evan Hauger, DPT
In this week's episode of The Spine & Nerve Podcast, Evan Hauger, DPT joins Brian Joves, MD to discuss movement as medicine.
Dr. Evan Hauger
Evan specializes in sports physical therapy, strength, and conditioning. He knows the ins & outs of injury from years of personal experience. Growing up, he was a multi-sport athlete and went on to play baseball at Shasta College. Through multiple person
Trauma Informed Care with Krystyna Holland, DPT
In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings connects with Dr. Krystyna Holland, PT, DPT to learn about trauma informed care.
Trauma informed care has many definitions, including some fantastic work done by the Substance Abuse and Mental Health Services Administration. One definition is a consistent and intentional effort to reduce our propensity for harm. Another descr
Infectious Spondylodiscitis
In this week's episode of the Spine & Nerve podcast, Drs. Nicolas Karvelas and Brian Joves discuss infectious spondylodiscitis, a relatively rare inflammatory process involving an intervertebral disc and the adjacent vertebral bodies.
Spondylodiscitis has a prevalence of about 4-24 per million, and has been increasing as patients have more risk factors (advanced age, immunocompromised states suc
Journal Club: Interventional Options to Treat Persistent Pelvic Pain Syndrome
In this week's episode of the Spine & Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome.
Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms.
Listen as the doctors dive
Allow us to Re-Introduce Dr. Raman Gurai - A Journey Through a Distant Land to Achieve Your Goals
In this week's episode of the Spine & Nerve podcast, Dr. Joves welcomes Dr. Raman Gurai back to the show. Dr. Gurai walks us through his journey in medicine and how he took the road less traveled to achieve his goals and dreams!
Dr. Gurai's Bio:
Dr. Raman Gurai is a board certified Physical Medicine and Rehabilitation physician with a special interest in Interventional Spine. He was born and rais
Pelvic Physical Therapy with Dr. Julie Hastings and Dr. Shereen Sairafi
In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings sits down with Shereen Sairafi, PT, DPT, WCS to discuss all things pelvic physical therapy related. Pelvic floor physical therapists play an integral role in helping patients who have urinary, bowel, or sexual dysfunction, as well as pelvic pain.
Dr. Shereen Sairafi graduated from Boston University in 2013 with a doctorate
Back to Basics: Persistent Pelvic Pain with Drs. Julie Hastings and Brian Joves
In this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings and Dr. Brian Joves go back to basics and give us an overview of persistent pelvic pain.
Persistent pelvic pain is defined as non malignant pain that is present for more than six months. It may or may not be associated with a woman's cycle or related to intercourse. Studies have shown that approximately 24% of female bodied
100: Allow us to Introduce Dr. Julie Hastings - Be Willing to Learn, Grow, and Ask for Help
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves celebrate the 100th episode and welcome Dr. Julie Hastings to the show!
We are so appreciative of the support, and love to hear the feedback from all of you. We never imagined that we would make 100 episodes of the podcast, let alone reach as many listeners as we have. Thank you for subscribing, shari
Post Acute Sequelae of SARS CoV2/ Long COVID with Dr. Monica Verduzco-Gutierrez
In this week's episode of the Spine & Nerve podcast Dr. Brian Joves is joined by a very special guest, Dr. Monica Verduzco-Gutierrez, to discuss Long COVID, otherwise known as Post Acute Sequalae of SARS CoV2 (PASC).
Long COVID is defined as a condition in which a patient continues with symptoms of COVID-19 more than 2 months after being infected by the virus. Longitudinal studies quote anywhere f
Post Herpetic Neuralgia: a review and journal club
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus).
PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatom
Back (to Basic Physiology to Look) to the Future: Selective Voltage Gated Sodium Channel Modulators
In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves take a look back at basic physiology to try to look into the future. An area of research that has really piqued the interest of Dr. Karvelas in recent years has been the discussion/possibility of selective voltage gated sodium channel (NaV) modulators. NaV are transmembrane proteins that are an integral part
Case Report: Persistent Spinal Pain Syndrome
In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves discuss a clinical case regarding a patient with Persistent Spinal Pain Syndrome (PSPS). To review, PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease with spinal origin. This disease can be linked to the predisposition of the human spine to deve
Journal Club: Landmark Articles for Treating Persistent Spinal Pain Syndrome
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss landmark articles regarding the treatment of patients with Persistent Spinal Pain Syndrome (PSPS).
PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surg
Back to Basics: Persistent Spinal Pain Syndrome
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves go back to Basics with a twist - the doctors discuss Persistent Spinal Pain Syndrome (PSPS).
PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Previousl
The Surgeon's Perspective: Cervical Myelopathy with Dr. Erich Anderer
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves is joined by a very special guest to continue the discussion on Degenerative Cervical Myelopathy (DCM).
Dr. Erich Anderer joins the podcast today to give us the surgeon's perspective on DCM. During his day job as the Chief of Neurosurgery at NYU Langone Hospital- Brooklyn, Dr. Anderer does his best to work with patients to deve
Back to Basics: Degenerative Cervical Myelopathy
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Degenerative Cervical Myelopathy (DCM). DCM, previously called cervical spondylotic myelopathy, is defined as neurologic injury to the cervical spinal cord due to various age-related degenerative conditions of the cervical spine resulting in injury to the spinal cord secondary to static compressio
Case Report: Lumbar Discogenic Pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of an early 40s female physician who presented with about 1 year of back pain that was progressively impacting her marathon training.
Listen as the doctors talk through this case presentation, including the history, physical, workup, conservative management and dive into some of the options
Journal Club: Regenerative Medicine and Discogenic Pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves dive deeper into lumbar discogenic pain and discuss a recent publication reviewing the evidence for regenerative therapies in the management of discogenic pain.
Regenerative medicine and orthobiologic therapy utilizes the body's own healing factors to treat the underlying pathology.
Listen as the doctors
Back to Basics: Lumbar Discogenic Pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to basics and introduce the topic of lumbar discogenic pain.
Lumbar discogenic pain is defined as a painful disease process due to compromise of the lumbar disc and is very common, with most studies documenting that around 40% of low back pain is predominantly due to discogenic pain. Disc degener
Case Report: Lumbar Facet Joint pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of a relatively young patient with lumbar facetogenic pain in the setting of spondylolisthesis with some level of dynamic instability.
There is strong evidence for the treatment of lumbar facetogenic pain with lumbar medial branch radiofrequency ablation (RFA), including a recent study pu
Journal Club: Interventions for Lumbar Facetogenic Pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves continue the discussion on lumbar facetogenic pain with a journal club.
Lumbar spondylosis with a primary pain generator of facet joint pain is a common pathology that can have a significant negative impact on a patient’s function and health. There are multiple Interventional treatment options available
Back to Basics: Lumbar Facet Joint Pain / Lumbar Spondylosis
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves introduce the topic of pain coming from the lumbar facet joints - specifically when it is related to the general aging and degeneration of the spine (also known as spondylosis).
Lumbar facetogenic pain is defined as pain originating from any structure integral to both the function and configuration of the
Case Report: Acute on Chronic Lumbar Radiculopathy
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves wrap up the series on lumbar radiculopathy with a case presentation.
This is a case of a young man who presented with a severe acute on chronic lumbar radiculopathy after the holidays. As he was already managed by our office, he presented very acutely (about 1-2 weeks into his flare).
Important concept
Journal Club: Lumbar Radiculopathy: A Review of Lumbar Tranforaminal Epidurals Steroid Injection
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a recent meta-analysis of transforaminal epidural steroid injections. This continues off of their conversation about lumbar radiculopathy.
Epidural injections to treat pain have been around for over a hundred years. It is one of the most common procedures done to help patients with back and leg p
Back to Basics: (Acute) Lumbar Radiculopathy
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 suc
Case Report: Myofascial pain syndrome
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
Journal Club: Neuroinflammation in Myofascial Pain Disorders
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves expand on the recent discussion of myofascial pain and discuss a recently published article that explored neuroinflammation.
In the prior discussion, it was highlighted how prone chronic myofascial pain processes are to the development of central and peripheral sensitization. This contributes to the de
Back to Basics: Myofascial Pain Syndrome
In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves discuss a very underappreciated component of the chronic pain picture- myofascial pain syndrome.
Myofascial pain is pain of the muscle and associated connective tissue. It typically presents as regional pain with associated tension, decreased range of motion, and presence of trigger points. This prevalent co
Case Report: The Chronification of Pain - Low back pain in setting of chronic pancreatitis treated with long term opioids
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.
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Journal Club - PNS for axial low back pain, impact on pain chronification
In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves build on last week's episode on pain chronification and discuss a promising therapy for chronic axial low back pain: Peripheral Nerve Stimulation (PNS).
PNS is an implanted device (in our discussion, a temporary implant for 60 days) that uses therapeutic electrical stimulation to target specific peripheral n
Back to basics: the Chronification of Pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to the basics to discuss a fundamental topic: pain chronification.
Pain chronification is defined as the process of acute pain progressing into chronic pain. Acute pain is a normal, predicted physiological response to adverse stimuli (chemical, thermal, mechanical) and has a clear protective func
Say Kroe ILL EE I -tis: a review of sacroiliac joint pain, diagnosis and treatment
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a common cause of low back pain, sacroiliac joint (SI) pain. The SI joint is a large complex joint that involves the iliac bone and sacrum. The SI joint is a critical component of the connection between the spine and lower limbs, and one of the primary functions of the SI joint is sta
COVID and pain medicine: not just telemedicine and delayed procedures
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss how pain medicine has been affected by COVID-19. This pandemic has caused so much devastation for our patients, including some who directly experienced COVID-19 infection and those who have had to weigh seeking medical care against risking infection. It has also impacted our practi
Klay Thompson has us in our feelings- a discussion on achilles tendon injuries
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves return to their Bay Area roots and mourn with Dub Nation after a devastating injury to Klay Thompson (shooting guard for the Golden State Warriors). Klay Thompson sustained a season ending right Achilles’ tendon tear. Thompson suffered the injury during a workout... after a year of rehabbing from an ACL i
To Taper or not to Taper, that is not the question: how to taper very much is
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves highlight a patient centered approach to tapering opioids. Treatment of the chronic pain disease process is challenging, but optimizing patient buy in and creating an active participant in the treatment plan can be very powerful.
In many clinical scenarios the goal of tapering / minimizing opioids is m
Pink Past October - Treating breast cancer survivors with post mastectomy pain syndrome
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves want to stay pink past October- they are continuing breast cancer awareness month and discussing one of the overlapping diagnoses: Post-Mastectomy Pain Syndrome (PMPS).
Breast cancer is the most frequently diagnosed life threatening cancer in women. There are many different approaches to the treatment
Profound Data with Dr. Michael Fishman
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the recent DTM (Differential Targeted Multiplex) Spinal Cord Stimulation Randomized Controlled Trial with Dr. Michael Fishman. Dr. Fishman was one of the clinical investigators in this ground breaking study and joins our podcast to discuss the 12 month data and what it means for the future of neuro
Food is Medicine - diet and chronic pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the relationship between diet and chronic pain.
Chronic pain including chronic spinal pain is incredibly common and difficult to treat. There are many aspects to a thorough and complete treatment plan including physical modalities, medications, procedures, and surgeries, but one often overlooked
The journey to sport medicine with Kevin Mullins, M.D.
In this week's episode of the Spine & Nerve podcast, we sit down with Dr. Kevin Mullins. Dr. Mullins joins the podcast to discuss the journey of becoming a sports medicine physician, specifically focusing on what drove Dr. Mullins into this area of expertise and his tips to the next generation of physicians
Listen in as the doctors discuss:
- Why physical medicine and rehabilitation as a primary
Case report: Beyond the WHO analgesic ladder - what other options are there for cancer related pain?
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a clinical case of a patient with advanced metastatic prostate cancer who presented with severe refractory cancer associated pain. The patient’s cancer associated pain is due to multiple factors including bone pain secondary to metastases to bone, as well as neuropathic pain in setting of chemothe
Dr. Raman Gurai presents a webinar on chronic pain and interventional options to help patients.
In this week's episode of the Spine & Nerve Podcast, we present a recent webinar that Dr. Raman Gurai gave on the treatment options for patients living with chronic low back pain.
In this webinar, Dr. Gurai walks through the definition of pain and chronic pain, and presents his approach to helping patients. He dives deep into three specific procedures that fill the large treatment gap between st
Interlude: Are NFL injuries on the rise and is the shortened preseason to blame?
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the recent string of major injuries affecting NFL players, and what role the variations on training camp and a lack of a preseason may play.
This is a discussion between two long time sports fans, who happen to be physical medicine and rehabilitation physicians. The doctors do not know the details
NSAIDs: the first step of the ladder requires considerations when diving deeper
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss one of the most commonly utilized medications, non-steroidal anti-inflammatory drugs (NSAIDs).
NSAIDs are medications with anti-inflammatory, analgesic, and anti-pyretic properties. The mechanism of action of NSAIDs is predominantly through inhibition of cylo-oxygenase, but there are multiple o
One Bad Apple Spoils the Bin: Chronic pain's impact on overall health
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss chronic pain as a disease process. Chronic pain has significant negative impacts on overall health including but not limited to: increased risk of hypertension, increased risk of cognitive decline, negative impact on sleep, and compromise of the immune system. The key concept is that chronic pain
Minimally Invasive options for chronic low back pain; a recent webinar presented by Dr. Joves
In this week's episode of the Spine & Nerve podcast we present a recent webinar that Dr. Joves gave on the treatment options for patients living with chronic low back pain. In this webinar, Dr. Joves walks through his overall approach and dives deep into three specific procedures that fill the large treatment gap between steroid injections and open surgical intervention.
The three main procedures
Journal Club: Lumbar Spinal Stenosis and the Impact on Mobility, Function, and Quality of Life
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves revisit lumbar stenosis with neurogenic claudication with a journal club of some recent literature. The studies will look at epidemiology, treatment options, and data regarding its impact on mobility / exercise.
Lumbar stenosis is defined as any type of narrowing of the spinal canal, nerve root canals,
Not your every day headache: Post dural puncture headache, managing complications
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss one the potential complications of procedures treating the spine- post dural puncture headaches(PDPHA). Listen in as the docs discuss the typical clinical presentation and the management of PDPHA.
PDPHA is defined as a headache that occurs within 5 days of intended or accidental dural compromis
Journal club: Interventional management of cancer associated pain
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present journal club- therapies for cancer associated pain. They will present recent articles on established treatment modalities like intrathecal drug delivery for advanced cancer pain, as well as more emerging including peripheral nerve stimulation.
Significant pain impacting function and quality of li
Vagus baby, Vagus: Neuromodulation of the vagus nerve in pain medicine
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss neuromodulation of the vagus nerve as a therapy for chronic pain conditions.
The vagus nerve is an incredibly complex and important nerve. The critical and wide array of effects that the vagus nerve has on the body make it an intriguing target for treatment of a variety of different conditions. M
How to prepare for a pain medicine rotation? What we actually expect from a resident or student
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss preparing for an interventional pain medicine rotation.
This discussion is most relevant for PGY-2 and PGY-3 residents looking to go in to a pain medicine fellowship, but is easily relatable to all levels of training.
Some of the discussion points:
- The bare minimum the docs expect from rotator
Buprenorphine and the challenging transition, a discussion and review of literature
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves review some key concepts regarding one of their favorite topics: buprenorphine.
Our goal as healthcare providers is to optimize diagnosis and treatment so that medications are minimized or not needed. When it is medically appropriate and indicated to utilize long term medications acting on the opioid
The Dr. Karvelas story: A journey through sport to find a passion for interventional pain medicine
In this week's episode of the Spine & Nerve podcast, we’re changing things up again and Dr. Brian Joves sits down with Dr. Nicolas Karvelas to get personal on how he progressed from a high school basketball star to a leading pain medicine physician.
Listen in as the doctors discuss:
- How did Dr. Karvelas sleeping with a basketball evolve into a passion for health?
- Why physical medicine and reh
The journey to pain medicine. A discussion with Dr. Hunter Vincent from The Orthohealing Center
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves sits down with Dr. Hunter Vincent of The Orthohealing Center in Los Angeles. Dr. Vincent joins the podcast to discuss the journey of becoming a pain medicine physician, specifically focusing on what drove Dr. Vincent into this area of expertise.
Listen in as the doctors discuss:
- Why physical medicine and rehabilitation as a pr
2 pain docs and bone mineral density; the effect of epidural steroid injections
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the impact of epidural steroid injections on bone mineral density / risk of osteoporosis / fracture risk.
there is conflicting research/data regarding epidural steroid injections and the impact on bone mineral density and fracture risk. We know that steroids have the potential to have an impact
To repeat or not to repeat? A discussion on epidural steroid injections.
In this episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the age old question... whether or not to pursue a repeat epidural steroid injection (ESI) for the possibility of cumulative effect.
Historically there was a time when it was fairly common practice to order a pre-determined series of ESIs. Over time, based on analysis of the research performed, and b
A Pain Medicine Legend joins us to discuss the past, present, and future of our field
In this week's very special episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with another one of the leaders and legends in the field of pain medicine and pain research, Dr. Timothy Deer.
Dr. Deer is one of the most recognizable names and faces in pain medicine. Amongst his many accolades, Dr. Deer is the President and CEO of The Center f
Journal club: Platelet Rich Plasma and the Spine
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss a couple recent articles involving the use of platelet rich plasma to treat spine pathology.
Listen as the docs summarize and discuss this orthobiologics and the cutting edge use in the spine.
Please see References section below for the articles discussed in today's podcast.
Follow our practice
Is the treatment making you worse? A review of Opioid Induced Hyperalgesia
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss opioid induced hyperalgesia (OIH)- a topic that is fairly controversial in the pain medicine world.
OIH is a medical process defined by worsening of pain with the use of opioids; typically patients will have evidence of central and peripheral sensitization including hyperesthesia and/or allodynia
Journal Club: gluteal/buttock pain
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss several articles regarding both the diagnosis as well as the treatment of gluteal region musculoskeletal disorders.
Topics discussed include the physical exam for sacroiliac joint dysfunction; as well as advanced treatment options for the relatively more rare chronic refractory coccydynia, and
Journal club: 5/1/20. Treatments at various stages of chronic knee pain.
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a few recent articles regarding treatment options for chronic refractory knee pain.
Listen in as the docs discuss treatment of knee pain due to osteoarthritis prior to knee arthroplasty, as well as treatment options in the setting of persistent symptoms after knee arthroplasty.
They summarize
Journal Club: 4/24/2020. Pharmacological management of chronic pain
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.
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