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Dr. David Rosenblum sits down with Nora Rabah Rodden, founder and CEO of Nervana, a digital health app for people living with chronic pain and other persistent symptoms. During her senior year at Cornell, Nora was hit by a car, which led to five years of mid and low back pain. She tried radiofrequency ablation, PRP, steroid injections, chiropractic care, physical therapy and acupuncture, and none of them gave her lasting relief. While earning her MBA and MS in Biotechnology at Harvard, Nora enrolled as a participant in a clinical study of Psychophysiologic Symptom Relief Therapy (PSRT), led by Dr. Michael Donnino. The study combined pain education, graded exposure and journaling. Within weeks her pain dropped from a 7/10 to zero, and her insomnia and digestive problems improved too. Topics covered: How Nora went from a skeptical pain patient to building an app around the biopsychosocial model How Nervana works: pain neuroscience education, a voice-to-voice AI coach, journaling, meditation and somatic exercises. The app does not diagnose or prescribe. Why the app is "meant to be deleted," and how patients can export a one-page summary for their clinician The gap between how much the biopsychosocial model is emphasized in medical school and on the boards, and how hard it is to apply in a busy interventional practice A clinical story: a patient who asked for an injection for abdominal pain one month after losing her baby Why a diagnostic block is only a snapshot, and how life stressors can change pain scores How to bring up the emotional side of pain without making patients feel dismissed Why a pain physician should never tell a patient "there's nothing I can do for you" Bottom line: chronic pain is real, but the brain can turn the volume up or down. Understanding the biopsychosocial model helps clinicians offer patients more than procedures alone, and never leave them feeling there is nothing more that can be done. Guest resources: Nervana, https://www.trynervana.com. Clinicians can get free access at https://www.trynervana.com/for-clinicians For Anesthesiologists & Residents - AnesthesiaExam Board Review: Basic AnesthesiaExam Board Review - high-yield questions and explanations for residents preparing for the ABA BASIC exam. Advanced AnesthesiaExam Board Review - comprehensive review for ABA ADVANCED certification. MOCA AnesthesiaExam Comprehensive Board Review - question bank for ABA certification and MOCA. Ultrasound CME Course Calendar - live ultrasound-guided regional anesthesia and interventional pain workshops in NYC, Costa Rica and elsewhere. Conferences & Webinars: https://www.nrappain.org/pages/upcoming-pain-management-conferences Pain Medicine Fellowship-bound? Virtual Pain Fellowship: https://www.nrappain.org/bundles/Virtual-Pain-Fellowship About the Host David Rosenblum, MD is Director of Pain Management at Maimonides Medical Center and Co-Owner/Clinic Director of AABP Integrative Pain Care and Wellness in Brooklyn, NY. Dual board-certified in Anesthesiology and Pain Medicine, he is a co-author of the ASIPP Peripheral Nerve Stimulation (PNS) guidelines and a widely recognized educator in regenerative pain medicine (PRP, BMAC, amniotic therapies). As founder of NRAP Academy, he has trained 3,500+ physicians for board certification since 2008, and hosts the PainExam, AnesthesiaExam, and PMRExam podcasts. He has been named a New York Magazine "Top Doctor" from 2016–2026. Living with chronic pain? Dr. Rosenblum sees patients for interventional and regenerative pain treatment - including epidurals, nerve blocks, spinal cord & peripheral nerve stimulation, and PRP/BMAC - at his Brooklyn, NY office. Visit RosenblumPain.com for more information, or call 718 436 7246. This episode is brought to you by NRAP Academy and AnesthesiaExam - visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine. This podcast is for educational purposes only and is not medical advice.

It's the day before the pain boards, so Dr. David Rosenblum skipped the Zoom and recorded a rapid-fire, last-minute review of the high-yield keywords and "board traps" most likely to show up on the ABA Pain Medicine exam. Listen on your commute or at the gym. High-yield topics covered Neonatal pain: A-delta and C fibers and ascending pathways work before birth, but descending inhibition is immature, so neonatal pain may be exaggerated or prolonged. Board trap: incomplete myelination does not mean neonates can't feel pain. Dorsal horn anatomy: Rexed laminae I, II and V. Lamina II is the substantia gelatinosa. Peripheral vs. central sensitization: the "inflammatory soup" (prostaglandins, bradykinin, H+, ATP, histamine, serotonin, cytokines, NGF) causes primary hyperalgesia. NMDA activation, wind-up and expanded receptive fields cause secondary hyperalgesia and allodynia. Superficial cervical plexus (C2–C4): lesser occipital, great auricular, transverse cervical and supraclavicular nerves. Blocked behind the SCM, and useful for clavicle pain. Eagle syndrome: an elongated styloid process irritating the glossopharyngeal nerve. Pain scales: NIPS, CRIES, FLACC and modified FLACC, Wong-Baker FACES, FPS-R, NRS, VAS and PROMIS-10 Global Health. Statistics: sensitivity and specificity don't depend on prevalence, but PPV and NPV do. Type I error is a false positive (α = 0.05) and Type II error is a false negative. Acetaminophen toxicity: use the Rumack-Matthew nomogram at 4 hours or later (acute single ingestion only). N-acetylcysteine is the antidote. Buprenorphine: a high-affinity partial mu agonist and kappa antagonist, with a ceiling effect on respiratory depression. Drug toxicities: carbamazepine (SIADH, SJS with HLA-B*1502, CYP3A4 induction), methotrexate (leucovorin rescue), hydroxychloroquine (retina), TNF-α inhibitors (TB reactivation), JAK inhibitors (boxed warning for MACE, thrombosis, malignancy), NSAIDs, SSRIs/SNRIs and tramadol (hyponatremia). Muscle relaxants: baclofen, tizanidine, cyclobenzaprine, methocarbamol, metaxalone, carisoprodol (meprobamate), chlorzoxazone, dantrolene, diazepam and botulinum toxin (cleaves SNARE proteins). Upcoming events Coming up: the NY/NJ Pain Congress in November and the Latin American Pain Society meeting next year. Hands-on NRAP ultrasound courses in New York are coming up in October and November. See the calendar at nrappain.org. Taking the boards next year? Start here: More CME, board review and ultrasound training at www.NRAPpain.org. Patients: in pain in Brooklyn or NYC? Dr. Rosenblum treats patients with back, neck, joint and nerve pain in Brooklyn, NY, and offers virtual second opinions. Visit RosenblumPain.com or call (718) 436-7246 to book an appointment. For educational purposes only. Not medical advice.

Artificial intelligence is moving fast from buzzword to clinical tool — and pain medicine is no exception. In this episode, Dr. David Rosenblum breaks down how AI is already touching the field, drawing on "Artificial Intelligence and Pain Medicine: An Introduction" by Hagedorn, George, Aiyer, Schmidt, Halamka, and D'Souza (Journal of Pain Research, 2024;17:509–518). Topics covered: Why AI is expected to be a genuine turning point for healthcare, not just another tech trend Using machine learning to optimize clinical trial design and patient selection in pain research Natural language processing (NLP) tools that streamline physician workflow and improve doctor-patient communication Deep learning approaches to analyzing patient outcomes and predicting who responds best to a given treatment What better disease recognition and treatment selection could look like in day-to-day pain practice Practical implications for cost and time savings, product development, and clinical decision-making Where the evidence is still early, and what physicians should watch for as AI tools move toward the bedside Bottom line: AI won't replace clinical judgment in pain medicine, but it's already starting to augment it — from trial design to the exam room. Physicians who understand where the technology is headed will be best positioned to use it well. Reference: Hagedorn JM, George TK, Aiyer R, Schmidt K, Halamka J, D'Souza RS. Artificial Intelligence and Pain Medicine: An Introduction. J Pain Res. 2024;17:509–518. https://pmc.ncbi.nlm.nih.gov/articles/PMC10848920/ About the Host David Rosenblum, MD is Director of Pain Management at Maimonides Medical Center and Co-Owner/Clinic Director of AABP Integrative Pain Care and Wellness in Brooklyn, NY. Dual board-certified in Anesthesiology and Pain Medicine, he is a co-author of the ASIPP Peripheral Nerve Stimulation (PNS) guidelines and a widely recognized educator in regenerative pain medicine (PRP, BMAC, amniotic therapies). As founder of NRAP Academy, he has trained 3,500+ physicians for pain board certification since 2008, and hosts the PainExam, AnesthesiaExam, and PMRExam podcasts. He has been named a New York Magazine "Top Doctor" from 2016–2026. Living with chronic pain? Dr. Rosenblum sees patients for interventional and regenerative pain treatment - including epidurals, nerve blocks, spinal cord & peripheral nerve stimulation, and PRP/BMAC - at his Brooklyn, NY office. Visit RosenblumPain.com for more information. or call 718 436 7246 For Physicians & APPs - Continue Your Education: CME Course Calendar: https://www.nrappain.org/pages/upcoming-pain-management-conferences Virtual Pain Fellowship: https://www.nrappain.org/bundles/Virtual-Pain-Fellowship PainExam Board Prep: https://www.nrappain.org/pages/pain-management-cme-courses This episode is brought to you by NRAP Academy and PainExam - visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine.

Ketamine clinics have exploded worldwide, offering low-dose intravenous infusions for chronic pain patients who've run out of options. But is this practice actually backed by evidence, or has off-label use outpaced the science? In this episode of the PainExam Podcast, Dr. David Rosenblum reviews the current literature on subanaesthetic-dose ketamine infusions (SDKIs) for chronic pain, drawing on the 2023 British Journal of Pain review by Harry M. Griffiths, "Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice?" Topics covered: Why conventional analgesics (opioids, anticonvulsants, antidepressants) fail in 60–70% of chronic pain patients How ketamine works as an NMDA receptor antagonist, and why that mechanism is likely an oversimplification Typical SDKI dosing (~0.35–0.5 mg/kg) versus anesthetic dosing, and why the IV route dominates the evidence base What the meta-analyses actually show: modest, time-limited pain reduction (mean difference around -1.83 on a 0–10 scale) with higher efficacy but more side effects at higher doses Key trials — Corriger et al.'s 1-year follow-up (256 patients), Orhurhu et al.'s systematic review and meta-analysis, and smaller RCTs in CRPS, fibromyalgia, and ischemic limb pain Common side effects (nausea, psychomimetic symptoms) versus rare but serious adverse events (hepatic, cardiac, urogenital) — and how dose and premedication with clonidine/midazolam affect risk Why blinding failure (up to 93% of patients correctly guessing their treatment in one trial) may be inflating reported effect sizes The absence of standardized protocols, guidelines, or a clear "exit strategy" for patients on long-term SDKI therapy What needs to happen next: larger multicenter RCTs, ketamine clinic registries, and better outcome measures beyond simple pain scores Bottom line: SDKIs offer a promising but still under-evidenced option for refractory chronic pain — reserved for the right patient, with modest expectations and careful monitoring. Reference: Griffiths HM. Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice? Br J Pain. 2023;17(5). https://journals.sagepub.com/doi/full/10.1177/20494637231182804 Show Image About the Host David Rosenblum, MD is Director of Pain Management at Maimonides Medical Center and Co-Owner/Clinic Director of AABP Integrative Pain Care and Wellness in Brooklyn, NY. Dual board-certified in Anesthesiology and Pain Medicine, he is a co-author of the ASIPP Peripheral Nerve Stimulation (PNS) guidelines and a widely recognized educator in regenerative pain medicine (PRP, BMAC, amniotic therapies). As founder of NRAP Academy, he has trained 3,500+ physicians for pain board certification since 2008, and hosts the PainExam, AnesthesiaExam, and PMRExam podcasts. He has been named a New York Magazine "Top Doctor" from 2016–2026. Living with chronic pain? Dr. Rosenblum sees patients for interventional and regenerative pain treatment — including epidurals, nerve blocks, spinal cord & peripheral nerve stimulation, and PRP/BMAC — at his Brooklyn, NY office. Visit RosenblumPain.com for more information. For Physicians & APPs — Continue Your Education: CME Course Calendar: https://www.nrappain.org/pages/upcoming-pain-management-conferences Virtual Pain Fellowship: https://www.nrappain.org/bundles/Virtual-Pain-Fellowship PainExam Board Prep: https://www.nrappain.org/pages/pain-management-cme-couåçrses This episode is brought to you by NRAP Academy and PainExam — visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine.

*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-(--sticky-padding-top)" dir="auto" data-turn-id="c3881c21-13af-4075-a5be-171053d37466" data-turn-id-container="c3881c21-13af-4075-a5be-171053d37466" data-testid="conversation-turn-3" data-turn="user">   *]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id= "request-WEB:435fda1a-0142-445e-a974-3323f9f0ded7-1" data-turn-id-container= "request-WEB:435fda1a-0142-445e-a974-3323f9f0ded7-1" data-testid= "conversation-turn-4" data-turn="assistant"> PainExam Podcast Show Notes NAD+ Supplementation in Pain and Inflammation: Hype, Hope, or Emerging Science? Hosted by: PainExam Podcast Presented by: NRAP Academy (Neuromodulation, Regional Anesthesia & Pain) Host: David Rosenblum, MD Episode Overview In this episode of the PainExam Podcast, we explore the growing interest in NAD+ (Nicotinamide Adenine Dinucleotide) supplementation and its potential role in pain management, inflammation reduction, cellular recovery, and healthy aging. NAD+ is a naturally occurring coenzyme found in every living cell and is essential for energy production, mitochondrial function, DNA repair, and cellular resilience. As NAD+ levels decline with age, chronic stress, inflammation, and disease, researchers have begun investigating whether restoring NAD+ levels may improve outcomes in chronic pain conditions and inflammatory disorders. We review the current science, discuss potential mechanisms of action, and examine how NAD+ therapy is being integrated into regenerative medicine, wellness programs, and pain management practices. What is NAD+? NAD+ is a coenzyme involved in: ✅ Cellular energy production (ATP generation) ✅ Mitochondrial health ✅ DNA repair pathways ✅ Oxidative stress reduction ✅ Neuroprotection ✅ Cellular signaling ✅ Activation of longevity-associated proteins called sirtuins Without adequate NAD+, cells become less efficient at producing energy and managing inflammation. Why Might NAD+ Matter in Chronic Pain? Many chronic pain conditions involve: Mitochondrial dysfunction Oxidative stress Neuroinflammation Peripheral and central sensitization Impaired cellular recovery Researchers hypothesize that optimizing NAD+ levels may help address several of these pathways simultaneously. Potential areas of interest include: Neuropathic Pain NAD+ may support: Nerve repair Axonal recovery Mitochondrial function within neurons Reduction of oxidative injury Inflammatory Pain NAD+ influences inflammatory signaling pathways and may help modulate: Cytokine production Immune cell activity Cellular stress responses Fatigue and Recovery Patients with chronic pain frequently report: Fatigue Brain fog Reduced exercise tolerance Poor recovery Because NAD+ plays a critical role in energy metabolism, some clinicians report improvements in energy and recovery following supplementation. Potential Mechanisms of Action 1. Improved Mitochondrial Function Mitochondria generate ATP, the body's energy currency. Reduced NAD+ levels are associated with: Cellular aging Impaired energy production Increased inflammation Supplementation may help restore mitochondrial efficiency. 2. Activation of Sirtuins Sirtuins are proteins involved in: Cellular repair Longevity Metabolic regulation Inflammation control NAD+ serves as a critical substrate for sirtuin activity. 3. DNA Repair Support NAD+ is required for enzymes known as PARPs (Poly ADP Ribose Polymerases), which participate in DNA repair processes following cellular injury. 4. Reduction of Oxidative Stress Chronic inflammation often produces excessive reactive oxygen species (ROS). NAD+ may help maintain cellular antioxidant defenses and reduce oxidative injury. Routes of NAD+ Supplementation Intravenous (IV) NAD+ Most commonly marketed in wellness and recovery clinics. Potential advantages: Direct systemic delivery Avoids gastrointestinal absorption issues Allows higher dosing protocols Potential limitations: Cost Time commitment Variable evidence base Oral Precursors Rather than NAD+ itself, many supplements provide precursors such as: Nicotinamide Riboside (NR) Nicotinamide Mononucleotide (NMN) These compounds are converted into NAD+ within the body. What Does the Evidence Show? Current evidence remains preliminary. While preclinical and mechanistic studies are promising, large-scale randomized controlled trials evaluating NAD+ specifically for chronic pain are still limited. Areas under active investigation include: Neuropathic pain Neurodegenerative disorders Chronic fatigue syndromes Recovery optimization Healthy aging Patients should understand that NAD+ therapy remains an emerging treatment rather than a standard evidence-based pain intervention. Safety Considerations Reported side effects may include: Nausea Flushing Chest tightness during rapid infusions Headache Fatigue Lightheadedness Most adverse effects appear infusion-rate dependent and can often be minimized through slower administration protocols. Patients should discuss treatment with a qualified healthcare professional, especially if they have: Cardiovascular disease Active cancer Significant medical comorbidities Clinical Pearls for Pain Physicians ✔ Consider NAD+ as a potential adjunct—not a replacement—for evidence-based pain care. ✔ Continue emphasizing exercise, sleep optimization, nutrition, behavioral health, and appropriate interventional therapies. ✔ Discuss realistic expectations with patients. ✔ Recognize that evidence continues to evolve. ✔ Focus on patient-centered outcomes rather than laboratory markers alone. Key Takeaways NAD+ is essential for cellular energy production and repair. Declining NAD+ levels may contribute to aging, inflammation, and chronic disease. Early evidence suggests possible benefits in inflammation, recovery, fatigue, and nerve health. Robust pain-specific clinical trials remain limited. NAD+ therapy should currently be viewed as an adjunctive and investigational strategy in pain management. Resources for Physicians Pain Medicine Board Preparation Prepare for the ABA Pain Medicine Boards with: 🎯 Comprehensive Question Banks 🎯 Virtual Pain Fellowship 🎯 Flashcards and Mock Exams 🎯 Weekly Board Review Content 👉 Pain Management Board Prep at NRAP Academy Hands-On Ultrasound Courses – New York Learn: Peripheral nerve imaging Ultrasound-guided injections Regenerative medicine procedures Diagnostic musculoskeletal ultrasound Advanced pain intervention techniques 👉 NRAP Ultrasound Courses in New York Ultrasound & Regenerative Medicine Training – Costa Rica Join physicians from around the world for immersive training in: 🌴 Playa Grande, Costa Rica ☀️ Small-group hands-on instruction 🦴 Regenerative medicine applications 📡 Ultrasound-guided pain procedures 👉 Costa Rica Ultrasound Training Courses Connect With PainExam 🌐 NRAP Academy Website 🎙️ Search PainExam Podcast on your favorite podcast platform. 📚 Explore the Virtual Pain Fellowship, Board Review Programs, Ultrasound Training, and CME opportunities. References Hudson Health. NAD+ Infusion Therapy: Full Clinical Review and Background Paper. 2023. Verdin E. NAD⁺ in aging, metabolism, and neurodegeneration. Science. 2015. Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD⁺ metabolism and its roles in cellular processes. Nature Reviews Molecular Cell Biology. 2021. Rajman L, Chwalek K, Sinclair DA. Therapeutic potential of NAD-boosting molecules. Cell Metabolism. 2018. Katsyuba E, Auwerx J. Modulating NAD⁺ metabolism for health and longevity. Nature Reviews Endocrinology. 2017. Disclaimer: This podcast is intended for educational purposes only and should not be construed as medical advice. Always consult qualified healthcare professionals before initiating any treatment.

PainExam Podcast Show Notes Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the ABA Pain Medicine Boards In this episode of the PainExam Podcast, Dr. David Rosenblum reviews two frequently tested topics on the ABA Pain Medicine Board Examination: Occipital Neuralgia and Vertebral Compression Fractures, including the indications, techniques, complications, and evidence surrounding vertebroplasty and kyphoplasty. Whether you are preparing for the ABA Pain Medicine Boards, ABPM, ABIPP, FIPP, or simply looking to strengthen your interventional pain knowledge, this episode covers essential board pearls, anatomy, diagnosis, imaging findings, and treatment options. Episode Highlights Occipital Neuralgia Topics discussed include: Anatomy of the greater, lesser, and third occipital nerves C2 dorsal ramus anatomy and clinical relevance Diagnostic criteria for occipital neuralgia Differentiating occipital neuralgia from: Cervicogenic headache Migraine Cluster headache Tension headache Physical examination findings Occipital nerve blocks Pulsed radiofrequency ablation Cryoneurolysis Peripheral nerve stimulation (PNS) Board Pearl The greater occipital nerve originates from the dorsal ramus of C2 and temporary pain relief following a diagnostic occipital nerve block strongly supports the diagnosis. Vertebral Compression Fractures Topics reviewed include: Osteoporotic vertebral compression fractures Thoracolumbar fracture patterns MRI findings STIR sequence interpretation Patient selection for vertebral augmentation Conservative treatment versus intervention Vertebroplasty technique Kyphoplasty technique Cement leakage and other complications Evidence supporting vertebral augmentation procedures Board Pearl Bone marrow edema on MRI STIR imaging is one of the most important findings suggesting an acute compression fracture. Kyphoplasty vs Vertebroplasty Vertebroplasty Direct injection of PMMA cement into the vertebral body Stabilizes micro-motion within the fracture Can provide rapid pain relief Kyphoplasty Balloon tamp creates a cavity before cement placement May partially restore vertebral body height May reduce risk of cement extravasation Often preferred in selected patients with significant vertebral collapse Commonly Tested Complications Cement leakage Pulmonary cement embolism Adjacent level fractures Infection Neurologic injury (rare) High-Yield ABA Pain Medicine Keywords Occipital Neuralgia Greater Occipital Nerve C2 Dorsal Ramus Third Occipital Nerve Cervicogenic Headache Peripheral Nerve Stimulation Vertebral Compression Fracture Kyphoplasty Vertebroplasty PMMA Cement STIR MRI Osteoporosis Cement Extravasation Upcoming Educational Meetings & Conferences 2026 ASPN Annual Meeting – Miami Learn more about the upcoming meeting hosted by the American Society of Pain and Neuroscience: 📍 ASPN Annual Conference & Miami Meeting Information PainWeek 2026 – Las Vegas Join thousands of pain physicians, APPs, nurses, and industry professionals at: 📍 PAINWeek Las Vegas 2026 Latin American Pain Society Meeting – Brazil For information regarding the upcoming regional pain meeting in Brazil: 📍 Latin American Pain Federation (FEDELAT) Information CME, Ultrasound & Board Review Resources NRAP Academy CME Courses, Virtual Pain Fellowship, Ultrasound Workshops, Regenerative Medicine Training, and Board Review Programs: 📍 NRAP Academy Website CME Calendar Upcoming Ultrasound Workshops, Regenerative Medicine Courses, Board Review Programs, and Conferences: 📍 NRAP Academy CME Calendar Virtual Pain Fellowship Comprehensive longitudinal pain management education: 📍 Virtual Pain Fellowship Program Pain Management Board Review Prepare for: ABA Pain Medicine Boards ABPM ABIPP FIPP 📍 PainExam Board Review Resources Connect With Dr. David Rosenblum Patients Seeking Care Appointments and consultation requests: 📍 AABP Integrative Pain Care & Wellness Physician Education CME, Ultrasound Training, Regenerative Medicine, and Board Review: 📍 NRAP Academy References Margetis K, Patel A, Petrone B, et al. Percutaneous Vertebroplasty and Kyphoplasty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated April 6, 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK525963/ Daher M, Kreichati G, Kharrat K, Sebaaly A. Vertebroplasty versus Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Meta-Analysis. World Neurosurgery. 2023;171:65-71. Masala S, Fiori R, Massari F, Simonetti G. Kyphoplasty: Indications, Contraindications and Technique. Radiologia Medica. 2005;110(1-2):97-105. Headache Classification Committee of the International Headache Society (IHS). International Classification of Headache Disorders (ICHD-3). Cephalalgia. 2018. Bogduk N. The Clinical Anatomy of the Cervical Dorsal Rami. Spine-related anatomy and occipital nerve pain syndromes. Subscribe to the PainExam Podcast For weekly board review content, ultrasound-guided procedures, regenerative medicine updates, pain medicine literature reviews, and expert interviews, subscribe to the PainExam Podcast and visit: 📍 PainExam Podcast & Board Review Resources 🎓 Earn CME and advance your skills through the NRAP Academy and Virtual Pain Fellowship.

🎙️ PainExam Podcast Show Notes CRPS & Intrathecal Pain Pumps — High-Yield ABA Pain Board Review 🔥 Episode Overview In this episode of the PainExam Podcast, David Rosenblum reviews two essential ABA Pain Medicine Board topics: Complex Regional Pain Syndrome (CRPS) Intrathecal Drug Delivery Systems (Pain Pumps) This episode focuses on: High-yield board pearls Clinical decision-making Interventional treatment strategies Common exam pitfalls Whether you are preparing for the: ABA Pain Medicine Boards ABPM ABIPP FIPP —or looking to sharpen your interventional pain knowledge—this episode delivers practical and testable concepts. 🧠 Topic 1: Complex Regional Pain Syndrome (CRPS) 🔬 What is CRPS? CRPS is a chronic neuropathic pain condition characterized by: Disproportionate pain Autonomic dysfunction Sensory abnormalities Motor and trophic changes 📋 CRPS Types CRPS Type I No confirmed nerve injury Formerly "Reflex Sympathetic Dystrophy" CRPS Type II Confirmed nerve injury Formerly "Causalgia" ⚠️ Pathophysiology CRPS involves: Peripheral sensitization Central sensitization Sympathetic dysfunction Neurogenic inflammation Cortical reorganization 🩺 High-Yield Clinical Features Burning pain Allodynia Hyperalgesia Temperature asymmetry Skin color changes Edema Weakness and trophic changes 📚 Budapest Criteria (BOARD FAVORITE) Diagnosis requires: Continuing pain disproportionate to injury Symptoms in ≥3 categories Signs in ≥2 categories 💊 Treatment First-Line Physical therapy (MOST important) Early mobilization Medications Gabapentin Pregabalin TCAs Interventional Sympathetic blocks Spinal cord stimulation 🚨 Board Pearls Early treatment improves outcomes CRPS may spread beyond the initial site Immobilization worsens symptoms 💉 Topic 2: Intrathecal Drug Delivery Systems (Pain Pumps) 🔬 What Are Intrathecal Pumps? Intrathecal pumps deliver medications directly into the CSF, allowing: Lower systemic doses Better analgesia Reduced systemic side effects 🎯 Indications Failed back surgery syndrome Cancer pain Refractory neuropathic pain Severe chronic pain not responsive to conservative therapy 💊 Common Intrathecal Medications Opioids Morphine Hydromorphone Non-Opioid Ziconotide Other Baclofen (spasticity) ⚠️ Ziconotide — HIGH-YIELD BOARD PEARL Ziconotide: Blocks N-type calcium channels Does NOT cause respiratory depression Can cause psychiatric side effects ⚠️ Major Complications Infection Catheter malfunction Pump failure Withdrawal syndromes Catheter-tip granuloma formation 🚨 Granuloma Formation High-dose intrathecal opioids may cause: Catheter-tip inflammatory masses Cord compression Neurologic deficits 📋 Trialing Patients typically undergo: Bolus trial Continuous infusion trial before permanent implantation. 🎯 Board Pearls Ziconotide = no respiratory depression Pump failure can cause life-threatening withdrawal Granulomas are associated with opioid concentration 📝 High-Yield Board Takeaways CRPS Budapest criteria = critical Early PT = first-line Autonomic dysfunction = hallmark Intrathecal Pumps Ziconotide is highly testable Know granuloma risks Understand pump complications and withdrawal 🎓 Pain Board Prep Resources Prepare for your ABA Pain Medicine boards with: 👉 https://painexam.com 👉 https://nrappain.org 🏆 Why Physicians Choose NRAP Academy Comprehensive board prep High-yield MCQs Virtual Pain Fellowship Ultrasound-guided pain training Interventional pain education 🎤 Upcoming Training Join upcoming: Ultrasound-guided procedure workshops Regenerative medicine courses Pain board review sessions 📢Register today! If you're serious about: ✅ Passing your pain boards ✅ Mastering interventional pain ✅ Improving patient outcomes Subscribe to the PainExam Podcast and join the Virtual Pain Fellowship. 👉 https://nrappain.org 👉 https://painexam.com Reference  https://dontforgetthebubbles.com/complex-regional-pain-syndrome/ https://www.ncbi.nlm.nih.gov/books/NBK459151/

🎙️ PainExam Podcast Show Notes Corticosteroids & Contrast Agents in Pain Management + Evidence-Based Steroid Selection 🔥 Episode Overview In this high-yield episode of the PainExam Podcast, David Rosenblum breaks down a must-know board topic: 👉 Injectable corticosteroids vs contrast agents in interventional pain procedures This episode goes beyond basics and dives into: Particulate vs non-particulate steroids Comparative profiles of dexamethasone, betamethasone, triamcinolone, and methylprednisolone Contrast agent selection and safety Critical complications including embolization and neurotoxicity A recent study comparing steroid effectiveness in transforaminal epidural injections This is essential for physicians preparing for the ABA Pain Medicine boards and for clinicians performing spine interventions. 🧠 Core Concept Corticosteroids = therapeutic (reduce inflammation) Contrast agents = diagnostic + safety tools (confirm needle placement) 👉 Board pearl: Steroids treat pain — contrast prevents complications 💉 Corticosteroids — High-Yield Comparison 🔬 Mechanism Inhibit phospholipase A2 Reduce inflammatory mediators Decrease nerve root irritation ⚖️ Key Steroids Compared Steroid Type Particle Profile Key Advantage Major Risk Dexamethasone Non-particulate No aggregation Safest for TFESI Possibly shorter duration Triamcinolone Particulate Large particles Longer depot effect Embolic infarction Methylprednisolone Particulate Aggregates Strong anti-inflammatory Avoid in cervical TFESI Betamethasone Mixed Depends on formulation Potent Acetate = particulate risk 🚨 Major Steroid Risks Local: Tissue atrophy Depigmentation Systemic: Hyperglycemia Adrenal suppression Immunosuppression Catastrophic (Board Tested): Spinal cord infarction Stroke 👉 Caused by intra-arterial injection of particulate steroids 📊 Contrast Agents — High-Yield Review Common Agents Iohexol (Omnipaque) Iopamidol (Isovue) Iodixanol (Visipaque) 🎯 Purpose Confirm needle placement Detect intravascular injection Prevent intrathecal injection ⚠️ Risks Allergic reaction Anaphylaxis Contrast-induced nephropathy 👉 Board pearl: Shellfish allergy ≠ contrast allergy ⚠️ Critical Safety Topic: Gadolinium Gadolinium-based contrast agents are: ❌ NOT approved for epidural or intrathecal use ❌ NOT safe substitutes for iodinated contrast in spine procedures 🚨 Intrathecal Gadolinium Risks Encephalopathy Seizures Respiratory distress Death 👉 Extremely high-yield board concept 📚 Evidence-Based Medicine Segment Study Review: Steroid Selection in TFESI A recent study comparing: Dexamethasone Methylprednisolone Betamethasone 🔑 Key Findings Dexamethasone showed comparable or better outcomes No clear advantage of particulate steroids Similar rates of: Repeat injections Surgical progression 🎯 Clinical Implication 👉 Efficacy differences are smaller than previously thought 👉 Safety is driving practice change 🚨 Board-Level Takeaway Non-particulate steroids = safer Outcomes ≈ similar Technique matters more than steroid choice 👉 Best exam answer: dexamethasone for TFESI 🎯 Board Prep Summary Dexamethasone = safest for transforaminal injections Particulate steroids = embolic risk Contrast must be used before steroid injection Gadolinium = dangerous in neuraxial space Clinical outcomes often similar across steroid types 🎓 Pain Board Prep Resources Prepare for your ABA Pain Medicine boards with: 👉 https://painexam.com 👉 https://nrappain.org 🏆 Why Physicians Choose NRAP Academy High-yield board review content Thousands of MCQs Virtual Pain Fellowship Ultrasound + regenerative training Real-world clinical integration Register Today! 🎤 Upcoming Training Ultrasound-guided pain procedures Regenerative medicine courses (PRP, biologics) Hands-on workshops Register Today! 📢 Call to Action If you're serious about passing your boards and practicing safer interventional pain medicine: ✅ Subscribe to the PainExam Podcast ✅ Join the Virtual Pain Fellowship ✅ Visit https://nrappain.org   References Calvo N, Jamil M, Feldman S, Shah A, Nauman F, Ferrara J. Neurotoxicity from intrathecal gadolinium administration: Case presentation and brief review. Neurol Clin Pract. 2020 Feb;10(1):e7-e10. doi: 10.1212/CPJ.0000000000000696. PMID: 32190427; PMCID: PMC7057078. Moreira, Alexandra M., et al. "Comparing the effectiveness and safety of dexamethasone, methylprednisolone and betamethasone in lumbar transforaminal epidural steroid injections." Pain physician 27.5 (2024): 341.

🎙️ AnesthesiaExam Podcast & Video Show Notes Spine Pain, Facet Syndromes, and Interventional Concepts for the Anesthesia Boards 🔥 Episode Overview In this episode of the AnesthesiaExam Podcast, David Rosenblum delivers a high-yield, board-focused review of spine pain concepts every anesthesiologist must know: Lumbar, cervical, and thoracic facet-mediated pain Key anatomy and spinal innervation patterns Medial branch blocks and radiofrequency ablation (RFA) Important clinical correlations for anesthesia and pain boards This episode bridges the gap between anesthesiology board knowledge and real-world interventional pain practice. 🧠 Key Topics Covered 🦴 Facet-Mediated Spine Pain Common cause of axial back and neck pain Mechanical pain pattern: Worse with extension Improved with flexion 🔬 High-Yield Anatomy for Boards Dual innervation of facet joints L5–S1 facet → L5 dorsal ramus (classic exam question) C2–3 facet → third occipital nerve 💉 Diagnostic & Interventional Concepts Diagnosis via medial branch blocks (MBB) RFA for longer-term pain relief Understanding procedural anatomy is key for: Regional anesthesia Pain procedures Board exams ⚡ Why This Matters for Anesthesia Boards Even if you don't perform interventional pain procedures, these concepts are critical for: Spine anatomy questions Regional anesthesia understanding Pain management scenarios Oral boards and OSCE-style cases 🎯 Board Prep Takeaways Facet pain = axial, mechanical Dual innervation = high-yield test concept L5 dorsal ramus = commonly tested Understand difference between: Radicular vs axial pain Facet vs discogenic pain 🎓 Anesthesia Board Prep Resources If you're preparing for the ABA Anesthesiology boards, start here: 👉 AnesthesiaExam Board Review Platform: https://nrappain.org 👉 Full Question Bank + Lecture Series: https://nrappain.org 👉 Pain + Anesthesia Integrated Learning: https://painexam.com 🏆 Why Anesthesiologists Choose NRAP Academy Comprehensive ABA anesthesiology board prep Integrated pain + anesthesia curriculum High-yield MCQs and rapid review lectures Ultrasound and regional anesthesia content Real-world clinical correlations 🎤 Live Courses & Advanced Training Enhance your skills beyond the boards: Ultrasound-guided regional anesthesia courses Pain + regenerative medicine workshops Hands-on training for real clinical application 🔗 Connect & Learn More 🌐 NRAP Academy: https://nrappain.org 📚 PainExam: https://painexam.com 🎥 YouTube: NRAP Academy 🎓 Courses: Ultrasound + Regional Anesthesia 📢 Call to Action If you're serious about passing your anesthesia boards and mastering pain + regional techniques: ✅ Subscribe to the AnesthesiaExam Podcast ✅ Join the NRAP Board Review Platform ✅ Explore advanced training courses

🎙️ PainExam Podcast Show Notes Phantom Limb Pain & Sacroiliac Joint Dysfunction — High-Yield Pain Board Review 🔥 Episode Overview In this episode of the PainExam Podcast, David Rosenblum delivers a high-yield review of two must-know topics for the ABA Pain Medicine Board Certification exam: Phantom Limb Pain — mechanisms, risk factors, and advanced treatment strategies Sacroiliac (SI) Joint Dysfunction — diagnosis, provocative testing, and interventional management Whether you're preparing for the ABA, ABPM, ABIPP, or FIPP boards, or looking to sharpen your clinical practice, this episode focuses on testable concepts, real-world applications, and interventional pearls. 👉 Explore full board prep and CME: PainExam.com 🧠 Topic 1: Phantom Limb Pain — Key Points Phantom limb pain is a neuropathic pain syndrome following amputation, driven by both peripheral and central mechanisms. High-Yield Pearls Caused by cortical reorganization + central sensitization Strongly associated with pre-amputation pain Distinct from: Phantom sensation (non-painful) Stump pain (localized) Clinical Features Burning, cramping, or electric pain Perceived in the missing limb May be triggered by stress or environmental factors Treatment Strategies First-line: gabapentinoids, TCAs Advanced: ketamine, neuromodulation Key non-pharmacologic therapy: mirror therapy 🚨 Board Pearl Preemptive analgesia reduces the risk of phantom limb pain 🦴 Topic 2: Sacroiliac Joint Dysfunction — Key Points SI joint dysfunction is a major cause of axial low back pain, accounting for up to 25% of cases. High-Yield Pearls Pain is typically: Unilateral Buttock-dominant Radiates to posterior thigh (rarely below knee) Physical Exam Positive provocative tests: FABER Gaenslen Thigh thrust Compression 👉 3 or more positive tests = high diagnostic accuracy Diagnosis Confirmed with image-guided intra-articular injection Imaging alone is NOT diagnostic Treatment Physical therapy SI joint injections Lateral branch RFA SI joint fusion (refractory cases) 🚨 Board Pearl Diagnostic SI joint injection is the gold standard 🎯 Board Prep Takeaways Always distinguish central vs peripheral mechanisms in neuropathic pain Know diagnostic confirmation strategies (blocks vs imaging) Focus on first-line vs interventional escalation pathways Understand procedure indications for boards 🎓 Upcoming Events & Live Training 🏆 ASPN 2026 Annual Meeting Join Dr. Rosenblum for: Ultrasound-guided peripheral nerve blocks Spine interventions Regenerative medicine techniques (PRP, biologics) Hands-on procedural training 💉 Ultrasound-Guided Regenerative Medicine Course Learn: PRP injection techniques Ultrasound-guided joint and nerve procedures Real-world workflows for integrating regenerative medicine into your practice 👉 Hosted through NRAP Academy 🎤 PainWeek 2026 Lectures Dr. Rosenblum will be presenting on: Precision image-guided pain procedures Ultrasound integration in clinical practice Regenerative medicine in interventional pain Future directions: AI and neuromodulation 🔗 Resources 🌐 Pain Board Review: PainExam.com 🎓 Courses & CME: NRAPPain.org 📺 YouTube: NRAP Academy 🧠 Question Bank + Virtual Fellowship: Available now 📢 Call to Action If you're preparing for the pain boards or want to elevate your clinical skillset: ✅ Subscribe to the PainExam Podcast ✅ Join our Virtual Pain Fellowship ✅ Attend a live ultrasound or regenerative medicine course

PainExam Podcast Show Notes Red Light Therapy (Photobiomodulation) for Pain Evidence, Mechanisms, and Clinical Applications Host: Dr. David Rosenblum Red light therapy, also known as photobiomodulation (PBM) or low-level laser therapy (LLLT), is an emerging non-invasive treatment modality increasingly used in pain medicine, rehabilitation, and regenerative medicine practices. In this episode of the PainExam Podcast, Dr. Rosenblum reviews the mechanisms, clinical evidence, indications, and safety considerations surrounding photobiomodulation therapy for pain. Red and near-infrared wavelengths stimulate mitochondrial activity, increase ATP production, reduce inflammatory mediators, and promote tissue healing. These physiologic effects may translate into analgesic benefits for a variety of musculoskeletal and neuropathic pain conditions. Clinical research suggests potential benefit in temporomandibular disorders, chronic neck pain, and inflammatory oral conditions, though results vary due to differences in dosing parameters and treatment protocols. Despite these limitations, PBM has a favorable safety profile and is increasingly being integrated into multimodal pain management strategies. Key Topics Covered • What is photobiomodulation therapy (PBM) • How red and near-infrared light interact with mitochondria • Mechanisms of analgesia and tissue repair • Evidence from clinical trials in TMD, neck pain, and oral inflammatory pain • The biphasic dose response (Arndt-Schulz law) • Safety profile and contraindications • How PBM may integrate with regenerative pain medicine Mechanism of Action Photobiomodulation works primarily through stimulation of mitochondrial chromophores, particularly cytochrome c oxidase. This leads to: • Increased ATP production • Modulation of inflammatory cytokines • Increased angiogenesis and tissue repair • Reduced oxidative stress These effects may improve pain, inflammation, and healing in certain musculoskeletal conditions. Evidence Discussed in This Episode Temporomandibular Disorders Randomized trial demonstrating improvements in pain and mandibular function with red light therapy. De Carvalho et al., Pain Research and Treatment (2019) https://onlinelibrary.wiley.com/doi/full/10.1155/2019/8578703 Chronic Neck Pain Clinical trial demonstrating improvements in pain scores and pressure pain thresholds after photobiomodulation therapy. Chen et al., Lasers in Medical Science (2022) https://link.springer.com/article/10.1007/s10103-022-03540-0 Oral Pain and Dental Inflammation Randomized study demonstrating reduced pain and improved healing following PBM treatment. Almeida et al., BMC Oral Health (2023) https://link.springer.com/article/10.1186/s12903-023-02784-8 Who May Benefit From Photobiomodulation? Red light therapy may be considered as an adjunct treatment for: • myofascial pain • cervical spine pain • temporomandibular disorder • tendinopathy • peripheral neuropathy • musculoskeletal injury recovery Safety and Contraindications Photobiomodulation has a very favorable safety profile. Reported adverse effects are rare and usually mild: • transient erythema • warmth at treatment site • headache • eye irritation without proper protection Precautions include: • avoiding direct retinal exposure • avoiding treatment over malignancy • avoiding application over the uterus during pregnancy • caution in photosensitive disorders Resources For Patients Seeking Treatment Learn more about integrative and regenerative pain treatments including PRP, ultrasound-guided injections, and advanced pain therapies: AABP Integrative Pain Care & Wellness https://www.AABPpain.com For Pain Physicians and Advanced Practice Providers Training in ultrasound, interventional pain procedures, and pain board preparation: NRAP Academy CME Education https://www.NRAPpain.org

Dr. Rosenblum from NRAP Academy presented a webinar on the integration of regenerative medicine into pain practices, highlighting its benefits and applications. He discussed the evolution of treating pain, emphasizing the shift from neural blockade to addressing tissue health. Dave explained the use of PRP and BMAC in treating conditions like knee pain, and shared patient success stories. He addressed common misconceptions about regenerative medicine, including its cost and effectiveness. Dave also mentioned upcoming events and training opportunities in regenerative medicine.   Regenerative Medicine Pain Management Events Dr. Rosenblum  announced his upcoming involvement in two significant events: a webinar on regenerative medicine for ASIPP and co-directing the ASPN Ultrasound and Regenerative Medicine Pain Workshop in Miami with Dr. Ali Valimoed. He encouraged attendees to register for these events, emphasizing their importance in the field of pain management. He also mentioned a previous lecture he gave on the integration of regenerative medicine into pain practices, though the recording was not successful. Regenerative Medicine in Pain Practices Dr. Rosenblum  discussed the integration of regenerative medicine into pain practices, emphasizing its importance in 2026 and beyond. He explained that traditional approaches like steroids and RFA only manage pain without addressing tissue health, using the knee as an example. He suggested combining visco supplements with regenerative techniques like PRP or BMAC to preserve joints in patients seeking alternatives to knee replacement. He noted that while other stem cell products are promising, more research is needed for wider adoption, and he plans to focus on PRP and BMAC for now. Regenerative Medicine Patient Education Dr. Rosenblum  discussed the importance of educating patients about regenerative medicine and pain treatment options. He explained that while regenerative treatments cannot fully reverse severe issues like meniscus damage, they can help heal and repair tissues, reduce inflammation, and improve function. He highlighted the growing demand for non-surgical, opiate-sparing solutions and mentioned the role of government and physician-led campaigns in addressing the opiate crisis. PRP's Role in Chronic Pain Management Dr. Rosenblum discussed the growing demand for alternative treatments to opioids and surgeries, highlighting the role of Platelet-Rich Plasma (PRP) in addressing chronic pain by modulating inflammation and stimulating tissue repair. He emphasized the importance of using high-quality PRP preparation methods, such as a double-spin kit, to achieve optimal results, and criticized studies claiming PRP's ineffectiveness, often due to poor preparation techniques. David also noted that effective PRP treatments can improve pain and function better than corticosteroids, and he expressed hope that patients would refer others, leading to business growth. PRP Therapy: A Promising Alternative Dr. Rosenblum discussed the effectiveness of PRP (platelet-rich plasma) therapy compared to steroids and viscosupplements in treating various musculoskeletal conditions. He cited a meta-analysis showing that PRP provided better relief than steroid and viscosupplement treatments for patients with moderate arthritis after one year. David also shared a recent case where he used PRP to treat coccydynia, a condition involving pain in the coccyx, and mentioned its potential use in treating other conditions such as radiculopathy and foraminal stenosis. PRP Injection Treatment Flexibility Dr. Rosenblum discussed a medical procedure involving PRP and lidocaine injections in various areas of the body, including the coccygeal ligaments, caudal space, and transforaminal spaces, to address pain and inflammation. He emphasized the importance of tailoring treatment to individual patients rather than adhering to insurance company guidelines, which can limit the number of injections given in a single session. David highlighted that when patients pay out-of-pocket, practitioners have more flexibility to effectively treat their conditions, potentially avoiding surgery or improving post-surgical outcomes. PRP in Orthopedic Practice Dr. Rosenblum shared his experience treating a patient with PRP for post-operative knee surgery, despite the orthopedic surgeon's skepticism. He discussed how regenerative medicine can enhance a practice by positioning it as innovative and attracting younger patients who prefer non-surgical treatments. David noted that while some orthopedic surgeons may refer patients for PRP, others might be hesitant due to potential decreases in surgical procedures. He also mentioned that primary care doctors may not be aware of the growing evidence supporting PRP's effectiveness and safety. PRP: A Cost-Effective Alternative Dr. Rosenblum discussed regenerative medicine, particularly PRP, highlighting its potential to avoid surgeries and improve patient satisfaction with an estimated 70% success rate. He emphasized the financial benefits for physicians, as it provides a cash stream with no need for prior authorizations or denials. David also addressed patient responsibility in healthcare costs, comparing the cost of regenerative treatments to other lifestyle expenses. He noted that while training is necessary, most interventional pain physicians possess the skills to administer PRP treatments. PRP Treatment Success Stories Dr. Rosenblum shared patient testimonials highlighting successful outcomes from PRP (platelet-rich plasma) treatments for various pain conditions, including shoulder, back, and neck issues. Patients reported significant improvements in pain relief and mobility, with some noting long-lasting effects beyond cortisone shots or surgery. David emphasized the importance of individualized treatment approaches and quality care, encouraging both patients and physicians to reach out for training and consultations. He concluded by inviting listeners to share the content with colleagues and patients, emphasizing the value of PRP treatments when done correctly.

Meralgia Paresthetica Education and the Anesthesiology Boards This podcast episode from the NRAP Academy features Dr. David Rosenblum discussing Meralgia Paresthetica, a mononeuropathy affecting the lateral femoral cutaneous nerve. The condition involves entrapment or compression of this purely sensory nerve as it passes under the inguinal ligament near the anterior superior iliac spine, causing burning pain, tingling, and numbness in the anterior lateral thigh. Key clinical points covered include the nerve's L2-3 origin from the lumbar plexus, common causes such as obesity, tight clothing, pregnancy, and diabetes, and the absence of motor weakness or reflex changes. Diagnosis is primarily clinical, though ultrasound can visualize nerve entrapment effectively. Treatment approaches range from conservative management including weight loss, avoiding tight clothing, physical therapy, and neuropathic pain medications (gabapentinoids, duloxetine, tricyclics) to interventional procedures. Dr. Rosenblu strongly advocates for ultrasound-guided nerve blocks over fluoroscopic or blind approaches, citing better visualization and reduced risk of nerve trauma. Advanced treatments mentioned include peripheral neuromodulation and cryoablation for refractory cases. The episode emphasizes that this condition is commonly tested on pain management board examinations (ABA, ABPM, FIPP, osteopathic boards) and can be significantly more painful and disabling than typically appreciated. Upcoming Courses and Training Opportunities: Ultrasound training available at nrappain.org Regenerative medicine training courses Comprehensive Anestheisia and Question Bank for Pain Management board preparation covering ABA, ABPM, FIPP, and osteopathic examinations CME credits available through the platform Clinical consultation services available at Dr. Rosenblum's Brooklyn office for patients seeking treatment. Call 718 436 7246 or go to www.AABPpain.com    Meralgia Paresthetica Education and Clinical Guidance Overview: Focused on definition, anatomy, diagnosis, management, and board exam relevance for meralgia paresthetica. Anatomy and Pathophysiology: Nerve: lateral femoral cutaneous nerve (sensory only), typically arising from L2–L3. Course: traverses across the iliacus, passes under or through the inguinal ligament just medial to the ASIS, then enters the thigh. Sensory distribution: anterolateral thigh; anterior cutaneous division extends toward the knee. Etiology and Risk Factors: Common contributors: obesity, tight belts or clothing, pregnancy, prolonged sitting, diabetes, prior pelvic or hip surgery. Entrapment site: under the inguinal ligament near the ASIS (most frequent). Clinical Presentation: Symptoms: burning pain, tingling, numbness, dysesthesia localized to the anterolateral thigh. Provocation/relief: worse with standing or walking; relief with sitting or hip flexion. Neurologic exam: no motor weakness; no reflex changes. Diagnosis: Primarily clinical; Tinel's sign over the inguinal ligament may reproduce symptoms. EMG and nerve conduction studies are typically normal. Ultrasound: superficial nerve, generally easy to visualize, including in obese patients; can identify entrapment. Management Recommendations: First-line conservative care: weight loss; avoidance of tight belts/clothing; physical therapy; NSAIDs for inflammation. Pharmacologic options: gabapentin, pregabalin, duloxetine, tricyclic antidepressants; consider topical analgesic creams (e.g., lidocaine or anti-inflammatory combinations). Interventional approach: Ultrasound-guided nerve block is strongly recommended; the nerve lies lateral to the sartorius; real-time visualization enables precise, safe injection. Avoid fluoroscopic and blind approaches due to risk of further nerve trauma and post-procedure pain. Advanced interventions: Peripheral neuromodulation may provide benefit in select cases. Cryoablation has shown beneficial outcomes for the lateral femoral cutaneous nerve. Surgery is rarely required; options include neurolysis, decompression, or neurectomy as a last resort. Board Exam Preparation Emphasis: Key facts commonly tested: Involved nerve: lateral femoral cutaneous nerve. Nerve roots: L2–L3 (with population variants). Sensory-only nerve; absence of motor deficits. Compression site: under the inguinal ligament near the ASIS. First-line therapy: conservative measures; refractory cases: ultrasound-guided nerve block. Keywords to study: meralgia paresthetica; lateral femoral cutaneous nerve (also called lateral cutaneous nerve of the thigh). Practice Considerations: Severity: can be profoundly painful and disabling; often underappreciated. Referral: clinicians not trained in interventional techniques should refer patients to an interventionalist for diagnosis and treatment. Decisions and Recommendations Ultrasound guidance is the preferred modality for lateral femoral cutaneous nerve interventions, superseding fluoroscopic or blind approaches. Rationale: superior visualization, real-time feedback, and reduced risk of nerve trauma and post-procedural pain. Outreach and Resources NRAP Academy resources: Ultrasound training, regenerative medicine training, CME credits, and a comprehensive pain board question bank (ABA, ABPM, FIPP, osteopathic, and related exams). Clinical availability: Patient consultations for meralgia paresthetica offered in Brooklyn at www.AABPpain.com 718 436 7246 .

🎙️ PainExam Podcast Show Notes Kratom (Mitragyna speciosa): What Pain Physicians Must Know for the Boards In this episode, Dr. David Rosenblum reviews the current science, pharmacology, risks, and clinical relevance of Kratom — an herbal substance widely discussed by pain patients and increasingly appearing on pain-medicine board exams. The discussion focuses on evidence-based mechanisms, safety considerations, and counseling points essential for ABA/ABPM/ABIPP/FIPP board preparation. 🔍 Key Board-Relevant Takeaways 1. Pharmacology & Mechanism Kratom's primary alkaloids are mitragynine and 7-hydroxymitragynine. They act as partial mu-opioid receptor agonists and demonstrate G-protein biased signaling, which may reduce β-arrestin–mediated respiratory depression seen with full opioids. No FDA-approved medical use; pharmacokinetics and dose-response remain inconsistent. 2. Reported Effects Potential Benefits (mostly anecdotal or preclinical): Analgesia for chronic pain Mood elevation and increased energy Reduction of opioid withdrawal symptoms Major Limitations: No high-quality randomized controlled trials Not a recommended analgesic for evidence-based pain practice 3. Adverse Effects & Safety Concerns Commonly reported: Nausea, vomiting, constipation Tachycardia, palpitations Hepatotoxicity in some users Dependence and withdrawal syndrome similar to mild-moderate opioid withdrawal Serious risks: Product variability and contamination Potential interactions with CNS depressants Unpredictable potency of alkaloids 4. Regulatory Status Kratom is unregulated, with significant variability in purity and composition. FDA and multiple public-health agencies caution against its use due to safety concerns. Not recommended as a first-line or adjunct pain therapy. 5. What Boards Like to Test Expect questions on: Mechanism: partial MOR agonist, G-protein bias Differences from classical opioids Adverse effects and withdrawal Toxicology and contamination risks Counseling patients who self-medicate Lack of clinical trial data and regulatory approval 🎓 Board Prep Resources Prepare for the ABA, ABPM, ABIPP, FIPP, and AOBPM exams with the PainExam Board Review and full curriculum at the NRAP Academy: 👉 https://www.NRAPpain.org 🫁 Hands-On Ultrasound Training for Pain Physicians Boost your procedural skills with live ultrasound-guided interventional pain and regional anesthesia workshops: 👉 https://www.nrappain.org/pages/ultrasound-training 📚 References (Condensed) Kruegel AC, Grundmann O. Neuropharmacology of kratom alkaloids. Neuropharmacology. Eastlack SC et al. Kratom: Pharmacology & clinical implications. Phytother Res. Striley CW et al. Health effects of kratom. Front Pharmacol. FDA Public Health Advisory on Kratom. Educational Offerings & Learning Opportunities PainExam / NRAP Academy Training & Programs: Neuromodulation & Regional Anesthesia Workshops Ultrasound-Guided Pain Procedures Regenerative Pain Medicine Training Virtual Pain Fellowship Pain Management Board Review & Question Banks Learn More / Register: 🔹 https://PainExam.com 🔹 https://NRAPpain.org Board Prep & Certification Support Prepare for: ABA Pain Boards ABPM ABIPP Pain Management Board Certification Exams (No reference to FIPP included, per request) Access Board Prep Courses & Q-Banks: ➡️ https://PainExam.com ➡️ https://NRAPpain.org Clinical Practice AABP Integrative Pain Care (Brooklyn & Great Neck, NY) To schedule a consultation or referral: 🌐 https://AABPpain.com 📞 Brooklyn: 718-436-7246 About the Host – David Rosenblum, MD Dr. Rosenblum serves as Director of Pain Management at Maimonides Medical Center and Managing Partner at AABP Integrative Pain Care in Brooklyn, NY. He is recognized as an early adopter and leading educator in ultrasound-guided pain procedures, neuromodulation, and regenerative medicine. He has: Developed regional anesthesia training programs Published widely in pain medicine literature Lectured nationally and internationally through ASIPP, ASPN, NANS, IASP, and more Helped over 3000 physicians pass pain board exams Hosted the PainExam, AnesthesiaExam, and PMRExam podcasts Awards (Selected): New York Magazine Top Doctors: 2016–2025 Top Doctors NY Metro Area: 2016–2025 Schneps Media Honors: Multiple Years Connect with Dr. Rosenblum LinkedIn: https://www.linkedin.com/in/davidrosenblummd/ Instagram: https://www.instagram.com/painexam/ Facebook: https://www.facebook.com/david.rosenblum.16 X (Twitter): https://x.com/AlgoSonic Episode Call-to-Action ✅ Join the NRAP Community ✅ Register for an Upcoming Workshop ✅ Access Pain Board Review Training Start here → https://NRAPpain.org | https://PainExam.com

Caudal Epidural Steroid Injection with PRP Case Reports and a Testimonial! Upcoming Training Courses and Services Regional Anesthesia and IV Vascular Access Courses: New York and Detroit locations scheduled Pain Management Board Preparation   Private Coaching Services: Ultrasound guidance Preceptorship Board preparation coaching Contact available via email [email protected] for interested physicians PRP Caudal Epidural Research Review Study Overview: Randomized double-blind controlled pilot study comparing leukocyte-rich PRP versus corticosteroids in caudal epidural space 50 patients randomly assigned to two groups Treatment options: triamcinolone 60mg or leukocyte-rich PRP from 60ml autologous blood Follow-up assessments at 1, 3, and 6 months using VAS and SF-36 surveys Key Findings: Both treatments showed significant pain reduction compared to baseline Steroid group had lower VAS scores at one month PRP group demonstrated superior results at 3 and 6 months PRP group showed significant improvement across all SF-36 domains at 6 months No complications or adverse effects in either group during 6-month follow-up Personal Treatment Experience Dr. Rosenblum received transforaminal PRP injection 9-10 weeks ago Gradual improvement noted from weeks 4-8, with more noticeable benefits from weeks 8-10 Current status: minimal pain (0.5/10) only during weather changes Clinical Practice Philosophy Treatment Approach: Minimalist philosophy focusing on turmeric, PRP, and Pilates Medication Strategy: Low-dose naltrexone as go-to medication, avoiding long-term drugs with side effects Surgical Avoidance: Prioritizing conservative treatments over unnecessary surgical interventions Emergency Department PRP Implementation Case Study Results: Ultrasound-guided caudal epidural steroid injection in ER setting 100% pain resolution achieved Patient discharged directly from ER Cost savings: reduced from $33,000 to $4,800 (approximately $28,000 savings) Training Opportunities: Private training sessions available for ER physicians interested in ultrasound-guided procedures Patient Testimonial Highlights Case Background: Nurse with herniated disc from March, previously considering $30,000 surgery Treatment Outcome: PRP injection completed two months ago with nearly complete pain relief Reduced from multiple pain medications to one Advil daily Eliminated antalgic posture and muscle spasms Returned to full 12-hour hospital shifts without difficulty Overall quality of life restored to normal levels David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.    Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Irvan J. Bubic, Jessica Oswald, Ultrasound-Guided Caudal Epidural Steroid Injection for Back Pain: A Case Report of Successful Emergency Department Management of Radicular Low Back Pain Symptoms, The Journal of Emergency Medicine,Volume 61, Issue 3,2021,Pages 293-297,ISSN 0736-4679 Ruiz‐Lopez, Ricardo, and Yu‐Chuan Tsai. "A randomized double‐blind controlled pilot study comparing leucocyte‐rich platelet‐rich plasma and corticosteroid in caudal epidural injection for complex chronic degenerative spinal pain." Pain Practice 20.6 (2020): 639-646. #prppain #paincme #sciatia #ultrasoundmsk #ultrasoundprp #epidural #nypaindoctor #prppainwindsor