In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a recent study that looks at treating post traumatic stress disorder with an Interventional technique called a stellate ganglion block. A stellate ganglion block is a procedure that is most commonly used in chronic neuropathic pain processes such as complex regional pain syndrome. The stellate ganglion is the sympathetic chain the lives in the cervicothoracic region and is responsible for th...
Dec 17, 2019•19 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves talk impaired sleep and try to answer the age old question: what came first, impaired sleep or chronic pain? Sleep is an important and unique component of the human condition that is vital for many components in the body. Studies have shown that patients living with chronic pain (both neuropathic, widespread and nociceptive, focal) experience significantly impaired sleep- duration and quality. Liste...
Dec 09, 2019•24 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves conclude our introduction to neuromodulation series by discussing peripheral nerve stimulation. Peripheral nerve stimulation utilizes similar technology as is used in other realms of neuromodulation, with the main difference being the targeted structures. Peripheral nerve and peripheral field stimulation, as the names suggest, focus on sending signals to a specific nerve in the peripheral nervous sy...
Dec 05, 2019•27 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves dive a little deeper into the world of neuromodulation therapy with a focus on wave forms and the various wave forms available. Neuromodulation is a powerful and exciting treatment option for difficult to treat chronic pain conditions. Some common conditions that neuromodulation is commonly utilized to treat include post laminectomy syndrome (or failed back surgery syndrome) and complex regional pai...
Nov 18, 2019•27 min
In this week's episode of the Spine & Nerve podcast, Dr. Gurai and Dr. Joves continue our discussion of neuromodulation by diving deeper into radio frequency ablation. Radio frequency ablation is a procedure that uses needles to target an anatomical structure (usually in our case nerves) and a probe delivers energy (usually thermal energy) to change the way those nerves are able to serve the pain signals. Now, radio frequency ablation is not always looked upon as a component of the neuromodu...
Nov 11, 2019•17 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss a how a needle may go down in history for changing the course of the 2019 World Series! This needle was brought into the national spot light during the World Series between the Washington Nationals and Houston Astros, when one of the starting pitchers for the Nationals (Max Scherzer) developed severe neck pain and muscle spasms and was unable to use his arm. Max Scherzer is known for his fie...
Nov 06, 2019•18 min
In this week's episode of the Spine & Nerve podcast Dr. Gurai and Dr. Joves give us a quick introduction into neuromodulation. Some of you may be asking what neuromodulation is... It is defined by the International Neuromodulation Society as "technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area." Best known as a treatment for chronic pain (and the reason we are passionate ab...
Oct 22, 2019•24 min
In this week's episode of the Spine & Nerve podcast Drs Nicolas Karvelas and Brian Joves give us an introduction to traumatic brain injuries (TBI) have been on my mind this weekend. TBI is defined as "a disruption of brain function due to an external force or blow to the head." Patients who experience a TBI can present with decreased level of consciousness, memory loss before or after injury, alteration of mental status, neurologic deficits, and/or intracranial lesions. The etiology of TBI f...
Oct 15, 2019•22 min
In this week's episode of the Spine & Nerve podcast Dr. Brian Joves and Dr. Nicolas Karvelas are talking opiates again. They discuss the steps to take to ensure we are doing what we can to optimize the safety of not only the patient but also the healthcare provider when dealing with opioid medications. In situations where chronic opioid use is indicated, there are certain steps that can be taken to optimize safety for all involved. Some key points to take away from today's discussion include...
Oct 11, 2019•24 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves are introducing electrodiagnostic evaluations. An electrodiagnostic evaluation is a combination of nerve conduction studies and electromyography, or in simple terms a way to look at the health of nerves. The nerve conduction study uses electrodes and an electrical impulse to send a signal through a nerve and pick it up at a different point along that nerve. Electromyography is a small needle (usuall...
Oct 01, 2019•25 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves nerd out about chronic pain pathways, specifically the changes that take place in the signaling over time. Chronic, persistent pain changes the physiologic signaling in the body. This means that it is not purely a nociceptive process. Along the pathway, we have the classic components of transmission, transduction, modulation, and perception that are each involved in the signaling cascade of our noci...
Sep 24, 2019•24 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves chat about "non specific" lies back pain. Back pain has been well documented as the most common reason people present to a healthcare professional with some studies quoting an incidence as high as 30%. It is also one of the largest causes of disability, morbidity, and lost production in the United States. But as shocking as those stats can be, maybe even more shocking are studies that quote anywhere...
Sep 16, 2019•29 min
In this week's episode of the Spine & Nerve podcast, Dr. Raman Gurai and Dr. Brian Joves introduce the field of regenerative medicine. Regenerative medicine at its core is a theory that we can influence the body's natural healing abilities to help with pain. The field has been developing over the past few decades, but really made it into the mainstream lexicon when professional athletes began utilizing it in the mid 2000s. Since that time, science and the medical literature have continued to...
Sep 09, 2019•23 min
Last week, Andrew Luck shocked the NFL world by announcing his retirement. In his retirement speech, he stated "I've been in this cycle of injury, pain, rehab, injury, pain, rehab, and it's been unceasing, unrelenting... The only way I see out of it is to no longer play football." This is probably one of the most high profile retirements in the history of the NFL and adds to the growing list of players retiring in or before their "primes". The NFL has dealt with a lot of fall out over chronic tr...
Sep 05, 2019•17 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves continue the discussion on complex regional pain syndrome. As we discussed last episode, CRPS is essentially nerves not behaving themselves in the peripheral and Central nervous systems, and is one of the models for centralized pain. Because CRPS is so variable in its clinical presentation and the way that our affects patients, the treatment plans and algorithms have to be tailored specifically to each individual...
Sep 03, 2019•40 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss complex regional pain syndrome, better known as CRPS. This topic and diagnosis is one that is very poorly understood by the general public, and many within the medical and healthcare communities. CRPS is essentially nerves not behaving themselves in the peripheral and Central nervous systems, and is one of the models for centralized pain. CRPS is variable in its clinical presentation, but typically is cha...
Aug 26, 2019•40 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss one of the most common musculoskeletal pain complaints, especially in an older demographic-the hip joint. Listen as the doctors dive deeper into this topic and give some practical tips for people living with or treating chronic pain. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. This p...
Aug 23, 2019•27 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss the behavioral health aspects of chronic pain. It is very well documented that chronic pain has very significant psychologic connections. The International Association for the Study of Pain define pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage"; which is derived from a 1964 definition and was first published i...
Aug 12, 2019•31 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss peripheral neuropathy. Neuropathic pain is defined as a process that affects the somatosensory nervous system. When the nerves that are affected lie outside of the central nervous system (brain and spinal cord), it is considered peripheral neuropathy. Painful peripheral neuropathy has been identified in up to 3% of the general population, but provides a much greater challenge in patients with diabetes whe...
Jul 29, 2019•33 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss a procedure called minimally invasive lumbar decompression or MILD. What exactly is MILD? Well, it's a way to create more space in the spine with utilizing small entry ports- which means no large incisions, less recovery time after the procedure and decreased risk for the patient. Listen as the docs discuss the two main studies that brought the MILD procedure back into relevance (and coverage by CMS - Cen...
Jul 23, 2019•18 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss CBD and it's utility in modern pain management. The doctors discuss a very brief introduction of the 2018 Farm Bill and how it has changed and opened an entire industry. They dive into some of the research that has been done, discuss how they are seeing it used in practice, and future considerations for research. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a com...
Jul 11, 2019•28 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss shoulder pain. Shoulder pain is the third must common musculoskeletal complaint that brings patients to seek medical care. The shoulder is a complex arrangement of joints, tendons, and muscles... Each of which can be injured and contribute to pain. Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more...
Jul 02, 2019•29 min
In this week's episode, Drs. Gurai and Joves discuss one of the under appreciated pain generators for low back pain- the sacroiliac joint (SI joint). The sacroiliac joint is the place where the spine meets the pelvis. It is, as the name suggests, a joint between the sacrum (lowest portion of the spine) and the ilium (one of the bones of the pelvis). Medical studies attribute between 10 and 40 percent of back pain to the SI joint. The most common patients affected are pregnant women and patients ...
Jun 17, 2019•24 min
In this special episode, Dr. Karvelas and Dr. Joves discuss something near and dear to their hearts, the injury the Kevin Durant sustained in the NBA finals. This is a discussion between two long time Warriors fans, who happen to be physical medicine and rehabilitation physicians. The doctors do not know the details of the injury and are simply talking it through from a medical perspective. This is not meant to be medical advice, a medical opinion, or to have any opinion on the circumstances of ...
Jun 13, 2019•15 min
In this week's episode of the Spine & Nerve podcast, Dr. Karvelas and Dr. Joves discuss nutrition, exercise, and pain management. This is a topic that we don't spend enough time on with patients, despite the growing evidence that it can make a significant difference. In the episode, Dr. Andrew Weil's website was mentioned - https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/ amongst many other great online resources (Mayo clinic, well vegan, etc). Follow our practice on Fac...
May 28, 2019•26 min
We have a special treat this week! This is a recording of a lecture Dr. Karvelas gave discussing chronic pain and non-opioid treatment options. He did a fantastic job of describing chronic pain management in 2019 and ways that we can help patients live there best lives. There are some portions of the recording where the audio quality isn't perfect- thank you for your patience at these portions, it was the best our audio team could do with the recording. Follow our practice on Facebook at Spine &...
May 20, 2019•51 min
Have you heard of text neck or tech neck?? Tech neck is a real thing! Join Dr. Karvelas and Dr. Joves as they explore this topic. Generally speaking, tech neck is the pain in your neck and upper back (periscapular region) muscles. It is caused (or at least exacerbated) by spending a significant amount of time looking down at a tablet or cell phone, improper positioning at a computer workstation (or any workstation for that matter). Imagine your head as a bowling ball- if it stays directly on top...
May 13, 2019•26 min
In this week's episode, Dr. Karvelas and Dr. Joves discuss buprenorphine... What it is, what it isn't, and some ways that it is being utilized to help patients with chronic pain. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve.
May 06, 2019•27 min
Opioids and the opioid epidemic are everywhere in today's news media. Dr. Karvelas and Dr. Joves discuss a sensitive subject today- how to determine when opioids are failing our patients. This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve...
Apr 29, 2019•25 min
Dr. Karvelas and Dr. Joves give an introduction to fibromyalgia. What is it? How has this diagnosis changed within the medical community over the past couple decades? What are the main ways to manage and treat the disease? This podcast is meant for education and entertainment only. This is not medical advice. If you would like further information on any of the topics discussed, please seek council with you healthcare provider. The views expressed are those of the individuals expressing them and ...
Apr 22, 2019•27 min
