In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves is joined by a very special guest to continue the discussion on Degenerative Cervical Myelopathy (DCM). Dr. Erich Anderer joins the podcast today to give us the surgeon's perspective on DCM. During his day job as the Chief of Neurosurgery at NYU Langone Hospital- Brooklyn, Dr. Anderer does his best to work with patients to develop a treatment plan that doesn’t require surgery- incorporating yoga, Pilates, or meditation into...
Aug 06, 2021•38 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Degenerative Cervical Myelopathy (DCM). DCM, previously called cervical spondylotic myelopathy, is defined as neurologic injury to the cervical spinal cord due to various age-related degenerative conditions of the cervical spine resulting in injury to the spinal cord secondary to static compression, and/or dynamic injury due to instability. DCM results in symptoms including loss of hand funct...
Jul 12, 2021•39 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of an early 40s female physician who presented with about 1 year of back pain that was progressively impacting her marathon training. Listen as the doctors talk through this case presentation, including the history, physical, workup, conservative management and dive into some of the options they are considering as this case (and the science behind Interventional options) progresses. Th...
Jun 25, 2021•35 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves dive deeper into lumbar discogenic pain and discuss a recent publication reviewing the evidence for regenerative therapies in the management of discogenic pain. Regenerative medicine and orthobiologic therapy utilizes the body's own healing factors to treat the underlying pathology. Listen as the doctors talk through this important topic, and dive into the basic science behind regenerative therapies ...
Jun 18, 2021•31 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to basics and introduce the topic of lumbar discogenic pain. Lumbar discogenic pain is defined as a painful disease process due to compromise of the lumbar disc and is very common, with most studies documenting that around 40% of low back pain is predominantly due to discogenic pain. Disc degeneration is part of the natural degenerative cascade of the spine, but can be more advanced and lead ...
May 28, 2021•32 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a case of a relatively young patient with lumbar facetogenic pain in the setting of spondylolisthesis with some level of dynamic instability. There is strong evidence for the treatment of lumbar facetogenic pain with lumbar medial branch radiofrequency ablation (RFA), including a recent study published in Pain Medicine in 2020 demonstrating sustained benefit after RFA for over 2 years (Conger...
May 07, 2021•19 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves continue the discussion on lumbar facetogenic pain with a journal club. Lumbar spondylosis with a primary pain generator of facet joint pain is a common pathology that can have a significant negative impact on a patient’s function and health. There are multiple Interventional treatment options available to address lumbar facetogenic pain including lumbar medial branch blocks, intraarticular facet joi...
Apr 29, 2021•26 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves introduce the topic of pain coming from the lumbar facet joints - specifically when it is related to the general aging and degeneration of the spine (also known as spondylosis). Lumbar facetogenic pain is defined as pain originating from any structure integral to both the function and configuration of the lumbar facet joints including the fibrous capsule, synovial membrane, hyaline cartilage surfaces...
Apr 14, 2021•32 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves wrap up the series on lumbar radiculopathy with a case presentation. This is a case of a young man who presented with a severe acute on chronic lumbar radiculopathy after the holidays. As he was already managed by our office, he presented very acutely (about 1-2 weeks into his flare). Important concepts that are emphasized with this case are: natural history of lumbar radiculopathy, electrodiagnostic...
Apr 06, 2021•22 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a recent meta-analysis of transforaminal epidural steroid injections. This continues off of their conversation about lumbar radiculopathy. Epidural injections to treat pain have been around for over a hundred years. It is one of the most common procedures done to help patients with back and leg pain, both acute and chronic. This meta-analysis from 2021 evaluates the safety of these procedures ...
Mar 21, 2021•25 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review lumbar radiculopathy. Lumbar radiculopathy is a common diagnosis in which there is irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas such as pain, weakness, numbness, and tingling.. Lumbar radiculopathy is typically due to a structural abnorm...
Mar 15, 2021•24 min
In this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves conclude the discussion regarding Myofascial Pain Syndromes through a case presentation. The doctors present a common clinical scenario where myofascial pain is causing significant negative impact on a patient's function, quality of life, and health. In the prior background and journal club episodes, the pathophysiology of myofascial pain was discussed in detail (see https://anchor.fm/spine/episodes/Bac...
Mar 01, 2021•30 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves expand on the recent discussion of myofascial pain and discuss a recently published article that explored neuroinflammation. In the prior discussion, it was highlighted how prone chronic myofascial pain processes are to the development of central and peripheral sensitization. This contributes to the debilitating nature and treatment resistance commonly seen in patients with myofascial pain syndromes....
Feb 20, 2021•19 min
In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves discuss a very underappreciated component of the chronic pain picture- myofascial pain syndrome. Myofascial pain is pain of the muscle and associated connective tissue. It typically presents as regional pain with associated tension, decreased range of motion, and presence of trigger points. This prevalent condition affects about 85% of patients in chronic pain clinics and will affect an estimated 85% o...
Feb 10, 2021•27 min
In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas expand on their recent discussion of pain chronification. The doctors discuss a fairly common scenario in which a patient with very chronic pain develops a relatively new pain condition. In this setting, the new onset pain process can be significantly amplified and difficult to treat. Previously, the doctors summarized processes including central and peripheral sensitization, which contribute signif...
Feb 03, 2021•29 min
In this week's episode of the Spine & Nerve Podcast, Drs. Nicolas Karvelas and Brian Joves build on last week's episode on pain chronification and discuss a promising therapy for chronic axial low back pain: Peripheral Nerve Stimulation (PNS). PNS is an implanted device (in our discussion, a temporary implant for 60 days) that uses therapeutic electrical stimulation to target specific peripheral nerves, such as the medial branch of the dorsal ramus. PNS has been shown to be effective for the...
Jan 23, 2021•24 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves go back to the basics to discuss a fundamental topic: pain chronification. Pain chronification is defined as the process of acute pain progressing into chronic pain. Acute pain is a normal, predicted physiological response to adverse stimuli (chemical, thermal, mechanical) and has a clear protective function. Chronic pain, however, is pain without apparent biological value (not immediately protective...
Jan 12, 2021•32 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves review a common cause of low back pain, sacroiliac joint (SI) pain. The SI joint is a large complex joint that involves the iliac bone and sacrum. The SI joint is a critical component of the connection between the spine and lower limbs, and one of the primary functions of the SI joint is stability. Chronic SI joint pain is a relatively common cause of low back pain with epidemiologic studies demonstr...
Dec 18, 2020•24 min
In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss how pain medicine has been affected by COVID-19. This pandemic has caused so much devastation for our patients, including some who directly experienced COVID-19 infection and those who have had to weigh seeking medical care against risking infection. It has also impacted our practice as we work to create a safe environment for patients and accommodate their needs. More and more research is e...
Dec 10, 2020•23 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves return to their Bay Area roots and mourn with Dub Nation after a devastating injury to Klay Thompson (shooting guard for the Golden State Warriors). Klay Thompson sustained a season ending right Achilles’ tendon tear. Thompson suffered the injury during a workout... after a year of rehabbing from an ACL injury to his left knee that occurred during the 2019 NBA Finals. If anyone can fight their way ba...
Nov 23, 2020•17 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves highlight a patient centered approach to tapering opioids. Treatment of the chronic pain disease process is challenging, but optimizing patient buy in and creating an active participant in the treatment plan can be very powerful. In many clinical scenarios the goal of tapering / minimizing opioids is medically appropriate to optimize patient safety and health, as well as improve the patient’s functio...
Nov 15, 2020•20 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves want to stay pink past October- they are continuing breast cancer awareness month and discussing one of the overlapping diagnoses: Post-Mastectomy Pain Syndrome (PMPS). Breast cancer is the most frequently diagnosed life threatening cancer in women. There are many different approaches to the treatment of breast cancer, and surgical resection often plays an important role in the management. One potent...
Nov 08, 2020•26 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the recent DTM (Differential Targeted Multiplex) Spinal Cord Stimulation Randomized Controlled Trial with Dr. Michael Fishman. Dr. Fishman was one of the clinical investigators in this ground breaking study and joins our podcast to discuss the 12 month data and what it means for the future of neuromodulation and pain medicine. The DTM clinical trial was birthed out of basic science research d...
Oct 29, 2020•29 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the relationship between diet and chronic pain. Chronic pain including chronic spinal pain is incredibly common and difficult to treat. There are many aspects to a thorough and complete treatment plan including physical modalities, medications, procedures, and surgeries, but one often overlooked component of the treatment plan is diet. What a patient eats has the potential to have a sustained...
Oct 24, 2020•24 min
In this week's episode of the Spine & Nerve podcast, we sit down with Dr. Kevin Mullins. Dr. Mullins joins the podcast to discuss the journey of becoming a sports medicine physician, specifically focusing on what drove Dr. Mullins into this area of expertise and his tips to the next generation of physicians Listen in as the doctors discuss: - Why physical medicine and rehabilitation as a primary specialty? - How did Dr. Mullins decide to sub-specialize and which fellowship to peruse? - What ...
Oct 16, 2020•32 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a clinical case of a patient with advanced metastatic prostate cancer who presented with severe refractory cancer associated pain. The patient’s cancer associated pain is due to multiple factors including bone pain secondary to metastases to bone, as well as neuropathic pain in setting of chemotherapy induced peripheral neuropathy. These cases can be very challenging in regard to the developm...
Oct 09, 2020•25 min
In this week's episode of the Spine & Nerve Podcast, we present a recent webinar that Dr. Raman Gurai gave on the treatment options for patients living with chronic low back pain. In this webinar, Dr. Gurai walks through the definition of pain and chronic pain, and presents his approach to helping patients. He dives deep into three specific procedures that fill the large treatment gap between steroid injections and open surgical intervention. The three main procedures that Dr. Gurai will exp...
Sep 30, 2020•33 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the recent string of major injuries affecting NFL players, and what role the variations on training camp and a lack of a preseason may play. This is a discussion between two long time sports fans, who happen to be physical medicine and rehabilitation physicians. The doctors do not know the details of individual injuries or NFL protocol and oversight, and are simply talking it through from a m...
Sep 25, 2020•17 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss one of the most commonly utilized medications, non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medications with anti-inflammatory, analgesic, and anti-pyretic properties. The mechanism of action of NSAIDs is predominantly through inhibition of cylo-oxygenase, but there are multiple other pathways by which NSAIDs exert their therapeutic effect including but not limited to modulation...
Sep 17, 2020•39 min
In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss chronic pain as a disease process. Chronic pain has significant negative impacts on overall health including but not limited to: increased risk of hypertension, increased risk of cognitive decline, negative impact on sleep, and compromise of the immune system. The key concept is that chronic pain is a disease process, and that this disease process is not solely defined by the experience of pa...
Sep 10, 2020•23 min
