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 that Dr. Joves will explore: Radio frequency ablation Indirect spinal decompression Neuromodulat...
Sep 02, 2020•37 min
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, or intervertebral foramina; it may be local, segmental, or generalized, it may be caused by bone or...
Aug 28, 2020•31 min
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 compromise. It is caused by leakage of cerebrospinal fluid (CSF), and is usually accompanied by neck stiffnes...
Aug 21, 2020•26 min
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 life is a common problem in patients with cancer. Systematic reviews demonstrate that around 50% of ...
Aug 14, 2020•25 min
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. Must notably, the vagus nerve is considered to be essential in the body's parasympathetic response....
Aug 06, 2020•27 min
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 rotators - Recommended resources for students and residents - Three key components to impressing on your ...
Aug 01, 2020•24 min
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 receptor, buprenorphine has superior safety and similar efficacy relative to full mu opioid medicati...
Jul 27, 2020•27 min
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 rehabilitation as a primary specialty? - How did Dr. Karvelas decide to sub-specialize and which fel...
Jul 17, 2020•31 min
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 primary specialty? - How did Dr. Vincent decide to sub-specialize and which fellowship to peruse? -...
Jul 09, 2020•37 min
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 on osteoblast and osteoclast activity, and consequently bone mineral density; however, the exact st...
Jul 02, 2020•22 min
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 based on clinical experience, taking a more nuanced approach has proven to be the recommendation of m...
Jun 29, 2020•16 min
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 for Pain Relief, Inc., and Clinical Professor of Anesthesiology at West Virginia University. He is...
Jun 19, 2020•33 min
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 on Facebook at Spine & Nerve Diagnostic Center. Please leave us a comment or review- these hel...
Jun 12, 2020•24 min
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, and the pain can become more widespread/diffuse. The doctors will discuss the theories behind t...
May 29, 2020•26 min
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 the relatively more common greater trochanter region pain syndrome. Listen as the doctors summarize...
May 11, 2020•30 min
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 articles exploring platelet rich plasma injections, hyaluronic acid injections, genicular nerve radi...
May 01, 2020•28 min
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. In this week's podcast the doctors summarize and discuss three recent articles regarding medications for treatment of chronic pain. Please see Refere...
Apr 24, 2020•29 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves take a look at the possibility of sport making a return during the COVID-19 pandemic. Listen in as the docs discuss this and what may be coming down the road for the sport world. This is a discussion between two long time sport fans, who happen to be physical medicine and rehabilitation physicians. The doctors are not epidemiologists, virologists, policy makers, or owners of sport franchises; they a...
Apr 21, 2020•15 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss some of the recent guidance coming from state and federal organizations to decrease some of the secondary effects of the COVID 19 pandemic. The stress and anxiety for our patients, front line healthcare providers and essential workers, and the general public can cause significant significant secondary problems to our overall health and health system. Listen in as the doctors discuss some tac...
Apr 08, 2020•26 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas present a case report and do a quick review of lumbar disc herniations. Dr. Karvelas presents a case in which a more cephalad lumbar disc herniation can effect nerve roots more than 1 level caudal to the level of disc herniation. For example typically we would expect a L3-4 disc herniation to impact the L4 or L3 nerve root, but there are cases where the more caudal nerve roots (for example L5) can b...
Mar 17, 2020•23 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the impact that smoking tobacco can have on the chronic pain disease processes. Smoking tobacco can contribute to the development / worsening / persistence of chronic pain processes, and additionally tobacco use can also decrease the probability that a treatment will work for patients. It is well researched and documented that smoking has a negative impact on our health including but not lim...
Mar 09, 2020•16 min
This week's episode of the Spine & Nerve podcast is a very special episode. Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with one of the leaders in the field of pain medicine and pain research, Dr. Ricardo Vallejo. Dr. Vallejo is the co-founder and director of research at Millennium Pain Center in Bloomington, Illinois, and founder and lead investigator of Stimgenics, LLC. They have pioneered a novel spinal cord stimulation (SCS) waveform known as Differential Target...
Mar 02, 2020•49 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves warmer weather, spring training and the forthcoming golf season by discussing how to keep up with your golf game, even when living with back pain. Golf is one is the most popular pastimes in the world for weekend warriors, but studies have shown that anywhere from 25-65% of golfers will experience a back injury related to their golf game. Many of these are of the muscle strain variety. But just like...
Feb 24, 2020•29 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a few of the common questions patients have when discussing some of the advanced, minimally invasive options to test their pain. The three main questions that the doctors discuss are: Do we have to do something more invasive? What if I'm scared of something implanted in my body? Is this going to fix me? Listen in as the docs discuss these common questions and help educate patients about the ...
Feb 17, 2020•24 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas dive deeper in buprenorphine. The doctors have given an introduction to this medicine in the past (https://anchor.fm/spine/episodes/An-introduction-to-buprenorphine-e3fe2m) . This discussion dives deeper not only into the clinical utility, but also discuss some options for transitioning patients from a full my agonist to buprenorphine. Listen in as the docs dive deep! In this discussion, a Z Dogg MD...
Feb 10, 2020•32 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss a recent study that evaluated peripheral nerve stimulation for the treatment of chronic shoulder pain. Case Series: Axillary Peripheral Nerve Stimulation for Chronic Shoulder Pain: A Retrospective Case Series John Taylor Mansfield DO Mehul J. Desai MD, MPH Neuromodulation: Technology at the Neural InterfaceEarly View . First published: 13 January 2020 Follow our practice on Facebook at Spine...
Feb 03, 2020•20 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the awesome and stimulating several days of the most recent NANS conference. The doctors share their major takeaways from the conference. The field of neurostimulation has advanced significantly over the years and we are at a point where we can really start to fine tune the exact form of neurostimulation for a specific patient and pathology. The progress that has been made in regards to neur...
Jan 31, 2020•23 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss goal setting... After all, It's half way through January. How's your new years resolution going? Dr. Joves had asked every patient he's seen this year about their resolutions or goals for the new year, and has been shocked by the responses. Every single person has stated that they don't believe in resolutions. Thankfully, a couple patients said things like "just trying to continue improving"...
Jan 20, 2020•23 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss the erector spinae plane block. This is a science heavy chat about a procedure that first made its way into the chronic pain literature in 2016, which is brand new by medical standards! Listen in as the docs give an introduction to this cutting edge procedure and tag about ways that it may be used in clinical practice. In this discussion, the following papers are discussed: 1. Kot P, Rodrigu...
Jan 14, 2020•21 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss vertebral compression fractures with an emphasis on osteoporotic compression fractures. Compression fractures, as the name suggests, are when the bones of the spine fracture and break because the force placed on the spine overcomes the internal strength of the bones. In a young healthy individual this can be seen in trauma, but as three population ages we are seeing this occur not in noon tr...
Dec 23, 2019•24 min
