Brian Joves - Podcast Details

Shows

Spine & Nerve Anything but SAD (Standard American Diet)- Nutrition, Cancer, and PainIn this episode, Dr. Brian Joves shares a personal journey of confronting cancer and how it reshaped his perspective on nutrition. Despite the fact that most physicians receive only a few hours of formal training in nutrition, diet remains one of the most powerful—and underutilized—tools in medicine.We’ll discuss:Why nutrition education is lacking in medical training.The dangers of the Standard American Diet (SAD) and its role in chronic disease and pain.The science behind ketogenic diets, the Warburg effect, and what emerging research says about cancer and metabolism.How nutrition quality directly impacts chronic spinal...

2025-09-1222 min

Spine & Nerve Peripheral Nerve Stimulation Updates: Exploring Emerging Evidence in Pain Medicine In this episode of the Spine & Nerve Podcast, Dr. Brian Joves and Dr. Jason Kung dive into the evolving world of peripheral nerve stimulation (PNS). As the field of pain medicine continues to progress, new studies are offering more insights into advanced therapies for challenging conditions like peripheral neuralgia and chronic pain. This discussion focused on the COMFORT study, which evaluates the efficacy of the Nalu PNS System, and discuss recent data presented at the American Society of Regional Anesthesia and Pain Medicine (ASRA) meeting concerning the SPRINT PNS System. Key Topics Covered: COMFORT Study Insights: The doctors analyze...

2024-12-1026 min

Spine & Nerve Pain Medicine’s Identity Crisis and the Future of Training with Dr. Scott Pritzlaff Episode Overview: In this episode, Dr. Brian Joves sits down with Dr. Scott Pritzlaff, an esteemed pain management specialist and the residency program director at UC Davis, to tackle some big questions on the current state and future of pain medicine. They dive into Dr. Pritzlaff's recent thought-provoking editorial, "From Pain Medicine to Pain Surgery: How Our Specialty Lost Its Way," which critiques the field’s shifting focus toward procedures at the expense of comprehensive patient care. Together, Dr. Joves and Dr. Pritzlaff discuss challenges in pain medicine, including recruitment issues, the evolving landscape of interventional pr...

2024-11-0547 min

Spine & Nerve Leading and Growing as a Physician with Dr. Richard WintersIn this episode of the Spine & Nerve podcast, Dr. Brian Joves sits down with Dr. Richard Winters, an emergency physician, leadership coach, and author, to discuss leadership, coaching, and the unique challenges physicians face as they transition into leadership roles. Whether you're early in your career or a seasoned physician looking to expand your leadership skills, this episode offers practical advice on how to build a successful career in medicine while growing as a leader. Key Takeaways: 🩺 Leadership at All Levels: Dr. Winters explains that leadership doesn't just come from holding formal titles—it's about how w...

2024-09-3042 min

The Making of a Dental Startup Growth, Retreats, and Family Adventures: The Making of with Ashley & Brian Joves‍‍‍Episode Summary: In this lively and personal episode of "The Making Of," Dr. Ashley Joves is joined by her husband, Brian Joves, as they dive into the latest happenings at Smile & Co., their recent family adventures, and the exciting upcoming retreat in Vail, Colorado. From discussing the growth of their dental practice to navigating the challenges of family vacations, this episode offers a blend of professional insights and relatable life moments. Plus, get all the details on this year’s incredible retreat lineup and why you don’t want to miss it!What You...

2024-08-2329 min

Spine & Nerve Reviewing the CA Medical Board Pain GuidelinesIn this episode of The Spine & Nerve Podcast, Dr. Jason Kung and Dr. Brian Joves break down the new California opioid guidelines with insights that every healthcare provider and pain management specialist should know. Our doctors explore the latest guidelines from the California Medical Board, published in July 2023 and designed to navigate the complexities of prescribing opioids in chronic pain management. Whether you're in California or beyond, this episode is a must-listen to understand the evolving landscape of pain treatment. Understanding the New Guidelines Published in July 2023, these guidelines are a response to the...

2024-06-1038 min

Spine & Nerve Unlocking the Power of Fitness in Aging with Mike Ochoa, DPTIn this episode of the Spine & Nerve podcast, join Brian Joves, MD for an enlightening conversation with Mike Ochoa, DPT, a passionate advocate for fitness in aging populations. Dr. Mike brings valuable insights into the importance of exercise, particularly weightlifting, in promoting longevity and overall well-being as we age. Discover the truth behind common misconceptions about aging and exercise, and learn how to tailor fitness routines to individual needs and goals. Key Takeaways: Learn why weightlifting is a powerful tool for enhancing muscle health and longevity in older adults. Understand the importance of challenging, albeit sometimes uncomfortable, exercise for optimal...

2024-04-1850 min

Spine & Nerve Journal club: Innovations and insights in NeuromodulationEpisode Summary:Join Dr. Jason Kung and Dr. Brian Joves for an in-depth discussion on the latest in neuromodulation. This episode covers a range of topics from the North American Neuromodulation Society 2024 Annual Meeting highlights to a journal club traversing the topics of spinal cord stimulation, closed-loop technology, and the impact of paraspinal muscle atrophy on vertebral endplates. With a blend of expert insights and a review of recent studies, this episode offers a comprehensive look into the advancements and challenges within the field of neuromodulation. Key Points Discussed: North American Neuromodulation Society Meeting Recap: Dr. Kung shares his experiences...

2024-02-2636 min

Spine & Nerve A Year in Review: Global Insights, Spinal Health, and Looking Ahead to 2024 In this episode of The Spine & Nerve Podcast, Dr. Dr. Jason Kung and Dr. Brian Joves have a reflective and forward-looking discussion as we transition from 2023 into 2024, sharing our podcast's journey, personal insights, biggest happenings in pain medicine, and anticipations for the new year. 1. Podcast Journey and Global Reach: Transitioning through 2023: The evolution of our podcast through the year. Spotify Wrapped Insights: A deep dive into our audience demographics, celebrating a significant international listenership with a special shoutout to our friends in New Zealand, India, Spain, Brazil, and Hungary. 2. Engaging Medical Discussions: Spotlight Episode - Spinal Stenosis: Discussion on...

2024-01-0832 min

Spine & Nerve Managing Chronic Pain through Education with Dr. Andrea FurlanIn this episode of the Spine & Nerve Podcast, Dr. Brian Joves has the distinct pleasure to welcome Dr. Andrea Furlan to the show. Dr. Furlan is a pain specialist in Toronto Canada. She is a physiatrist (specialist in Physical Medicine & Rehabilitation). She holds a medical degree from the University of Sao Paulo and a Ph.D. degree from the University of Toronto. She has 30 years of experience helping people with chronic pain to get better quality of life. In this insightful conversation, Dr. Furlan shares her vast experience in managing chronic pain, addressing key aspects of pain management that are...

2023-10-1140 min

Spine & Nerve Growing a strong and healthy thrower with Dr. Robert BowersIn this episode of the Spine & Nerve Show, Dr. Robert Bowers joins Dr. Brian Joves to discuss the progression of young athletes in throwing sports, such as baseball. He emphasizes the importance of allowing children to play multiple sports and avoid specializing too early. Dr. Bowers also highlights the risks associated with overuse injuries and the need for rest periods. He discusses the role of mechanics and training programs in preventing injuries and increasing velocity. Dr. Bowers also touches on the use of biologics, such as PRP, in the treatment of injuries in young athletes. About The Guest: Dr. Robert Bo...

2023-08-311h 00

Spine & Nerve To Anticoagulate or not to Anticoagulate with Interventional Spine ProceduresIn this episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves delve into a comprehensive discussion surrounding anticoagulation guidelines and their implications in interventional pain procedures. With over a hundred thousand downloads and over 1,000 YouTube subscribers, we would like to express our sincere gratitude to all the listeners for your engagement and support. Please continue to share and subscribe to help more people discover the podcast. Today's episode focuses on the safety of epidural steroid injections and the critical role of anticoagulation management.Understanding the rationale behind a...

2023-08-1127 min

Spine & Nerve Find yourself a health coach with Dr. Hunter VincentIn this week's episode of the Spine & Nerve podcast, we have a return guest! Dr. Hunter Vincent returns to the show to chat with Dr. Brian Joves about health coaches and how they can help your patients to be more successful in their journey with and through chronic pain. In this episode we'll discuss: What is a health coach? Where does this fit into the treatment and provider paradigm? How can ancillary team members like health coaches help your...

2023-06-0125 min

Spine & Nerve IPGs, Artificial Intelligence and Cochrane! An SCS Update with Dr. Jason Kung and Dr. Brian JovesIn this week's episode of the Spine & Nerve podcast, Dr. Jason Kung and Dr. Brian Joves try to digest all the recent happenings in the world of neuromodulation. They address: Internal Pulse Generators Artificial Intelligence The Cochran Study Listen as the doctors get excited, frustrated, and try to bring a silver lining to the whirlwind of headlines that have been discussing neuromodulation so far this year! There were many references in this episode, but most importantly here is the Cochran review on SCS for low back pain: Traeger AC, Gilbert SE, Harris IA, Maher CG. Spinal cord stimulation for low...

2023-05-1832 min

Spine & Nerve Allow us to Introduce Dr. Jason KungIn this week's episode of the Spine & Nerve Podcast we would like to introduce you all to the newest member of the Spine & Nerve family... Dr. Jason Kung. Jason Kung, MD, is a board-eligible anesthesiologist and interventional pain physician who joined Spine & Nerve last year. Listen in as Brian Joves, MD gets to know Dr. Kung better and explore his journey into medicine and to discovering his passion for pain medicine. He graduated from the University of San Francisco in California with a bachelor's degree in biology. He then went to Boston University School of Medicine in Mass...

2023-03-0932 min

Spine & Nerve Movement as Medicine with Evan Hauger, DPTIn this week's episode of The Spine & Nerve Podcast, Evan Hauger, DPT joins Brian Joves, MD to discuss movement as medicine. Dr. Evan Hauger Evan specializes in sports physical therapy, strength, and conditioning. He knows the ins & outs of injury from years of personal experience. Growing up, he was a multi-sport athlete and went on to play baseball at Shasta College. Through multiple personal injuries related to his athletic career, Evan realized that he had a passion for improving the way people move and enhancing their performance in sport and life. Also a StrongFirst Certified Level 1 instructor, Evan earned his Docto...

2022-09-1532 min

Spine & Nerve Infectious SpondylodiscitisIn this week's episode of the Spine & Nerve podcast, Drs. Nicolas Karvelas and Brian Joves discuss infectious spondylodiscitis, a relatively rare inflammatory process involving an intervertebral disc and the adjacent vertebral bodies. Spondylodiscitis has a prevalence of about 4-24 per million, and has been increasing as patients have more risk factors (advanced age, immunocompromised states such as HIV infection, intravenous drug users, healthcare-associated infections, expansion of spinal surgery indications) and improved diagnostic modalities. Patients generally present with pain and tenderness in the region, about 50% present with high fever, and about 1/4 with neurologic compromise. The symptoms can be fairly non-specific, so...

2022-06-2040 min

Spine & Nerve Journal Club: Interventional Options to Treat Persistent Pelvic Pain SyndromeIn this week's episode of the Spine & Nerve podcast, Drs. Julie Hastings, Nicolas Karvelas, and Brian Joves present a journal club on interventional management of patients with persistent pelvic pain syndrome. Three different interventions are covered in the articles presented, showing a range on invasiveness and diversity of targets to help moderate the pain symptoms. Listen as the doctors dive in and discuss these articles and discuss ways these articles might help patients living with persistent pelvic pain syndrome and the physicians caring for them. This podcast is for information and educational purposes only, it is not meant to be...

2022-05-1627 min

Spine & Nerve Back to Basics: Persistent Pelvic Pain with Drs. Julie Hastings and Brian JovesIn this week's episode of the Spine & Nerve podcast, Dr. Julie Hastings and Dr. Brian Joves go back to basics and give us an overview of persistent pelvic pain. Persistent pelvic pain is defined as non malignant pain that is present for more than six months. It may or may not be associated with a woman's cycle or related to intercourse. Studies have shown that approximately 24% of female bodied individuals will experience significant pelvic pain. Persistent pelvic pain tends to have a multifactorial presentation and it can be hard to differentiate the primary source of pain. Pelvic pain is associated...

2022-02-0729 min

Spine & Nerve 100: Allow us to Introduce Dr. Julie Hastings - Be Willing to Learn, Grow, and Ask for HelpIn this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves celebrate the 100th episode and welcome Dr. Julie Hastings to the show! We are so appreciative of the support, and love to hear the feedback from all of you. We never imagined that we would make 100 episodes of the podcast, let alone reach as many listeners as we have. Thank you for subscribing, sharing the podcast and contributing to our continued success in our desire to educate others. Listen in as Dr. Joves and Dr. Hastings discuss her unconventional...

2021-12-0749 min

Spine & Nerve Post Acute Sequelae of SARS CoV2/ Long COVID with Dr. Monica Verduzco-GutierrezIn this week's episode of the Spine & Nerve podcast Dr. Brian Joves is joined by a very special guest, Dr. Monica Verduzco-Gutierrez, to discuss Long COVID, otherwise known as Post Acute Sequalae of SARS CoV2 (PASC). Long COVID is defined as a condition in which a patient continues with symptoms of COVID-19 more than 2 months after being infected by the virus. Longitudinal studies quote anywhere from a 15-80% prevalence of long COVID. Although every patient presents with a different compilation of symptoms, the most common symptoms of Long COVID are fatigue, impaired respiratory function, “brain fog”, headache, attention disorder, hair loss...

2021-11-1943 min

Spine & Nerve Post Herpetic Neuralgia: a review and journal clubIn this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus). PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found...

2021-11-1226 min

Spine & Nerve Back (to Basic Physiology to Look) to the Future: Selective Voltage Gated Sodium Channel ModulatorsIn this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves take a look back at basic physiology to try to look into the future. An area of research that has really piqued the interest of Dr. Karvelas in recent years has been the discussion/possibility of selective voltage gated sodium channel (NaV) modulators. NaV are transmembrane proteins that are an integral part of the initiation and propagation of action potentials in neurons and other electrically excitable cells. We have seen that small changes in NaV function are biologically relevant because there are several human diseases...

2021-10-2030 min

Spine & Nerve Case Report: Persistent Spinal Pain SyndromeIn this week's episode of the Spine & Nerve podcast Drs. Nicolas Karvelas and Brian Joves discuss a clinical case regarding a patient with Persistent Spinal Pain Syndrome (PSPS). To review, PSPS is not a single diagnosis, but rather an encompassing term that includes persistent painful disease with spinal origin. This disease can be linked to the predisposition of the human spine to develop painful pathology over time. The distribution of the symptoms in PSPS can be axial and/or radicular, and although commonly involves the lumbosacral spine, the cervical, and thoracic spine can also be the site of pathology. I...

2021-09-2727 min

Spine & Nerve Journal Club: Landmark Articles for Treating Persistent Spinal Pain SyndromeIn this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss landmark articles regarding the treatment of patients with Persistent Spinal Pain Syndrome (PSPS). PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Please listen to the Back to Basics episode for a full description and discussion of the pathophysiology. Though this is a new term, many studies have looked at the outcomes of interventions such as dorsal column spinal cord stimulation a...

2021-09-1420 min

Spine & Nerve Back to Basics: Persistent Spinal Pain SyndromeIn this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves go back to Basics with a twist - the doctors discuss Persistent Spinal Pain Syndrome (PSPS). PSPS is a new term that was recently proposed by an expert international committee to describe patients with chronic, severe pain of spinal origin, refractory to treatments, including at times surgery. Previously, certain diagnoses were utilized to describe these pathologies including but not limited to Failed Back Surgery Syndrome and Post-laminectomy syndrome. These terms are not without their limitations: terms such as failed back surgery Syndrome can carry a...

2021-08-1623 min

Spine & Nerve The Surgeon's Perspective: Cervical Myelopathy with Dr. Erich AndererIn 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 someone’s care. He has preached this "less is more" philosophy across Instagram, teaching yoga classes, or lecturing at w...

2021-08-0638 min

Spine & Nerve Back to Basics: Degenerative Cervical MyelopathyIn 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 function / dexterity, imbalance/falls, weakness, numbness, pain, bladder / bowel dysfunction. DCM is a common disease process- it is the most common cause of spinal cord injury in t...

2021-07-1238 min

Spine & Nerve Case Report: Lumbar Discogenic PainIn 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. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain t...

2021-06-2534 min

Spine & Nerve Journal Club: Regenerative Medicine and Discogenic PainIn 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 specifically targeting disc degeneration, as well as the clinical evidence that has been presented. This podcast is for information and educational purposes only, it is not meant t...

2021-06-1831 min

Spine & Nerve Back to Basics: Lumbar Discogenic PainIn 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 to significant symptoms and impairments. Discogenic pain is often characterized by centralized low back pain that t...

2021-05-2832 min

Spine & Nerve Case Report: Lumbar Facet Joint painIn 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 et al., Pain Medicine. 2020). However, when the anatomy is considered including the fact that the medial branch targeted with RFA also innervates the multifidus musculature; on...

2021-05-0719 min

Spine & Nerve Journal Club: Interventions for Lumbar Facetogenic PainIn 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 joint injections, and lumbar medial branch radiofrequency ablation (RFA). There is high quality evidence for the utilization of RFA for axial low back pain due to...

2021-04-2925 min

Spine & Nerve Back to Basics: Lumbar Facet Joint Pain / Lumbar SpondylosisIn 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, and bony articulations. This disease process is common and estimated to account for about 15% of chronic low back pain. The facet joints ar...

2021-04-1431 min

Spine & Nerve Case Report: Acute on Chronic Lumbar RadiculopathyIn 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 evaluation for lumbar radiculopathy, and a stepwise approach to diagnostic workup and management of a debilitating case of lumbar r...

2021-04-0622 min

Spine & Nerve Journal Club: Lumbar Radiculopathy: A Review of Lumbar Tranforaminal Epidurals Steroid InjectionIn 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 and looks at the evidence for their use in treating different pathologies of the lumbar spine. Listen as the doctors discuss transforaminal epidural s...

2021-03-2124 min

Spine & Nerve Back to Basics: (Acute) Lumbar RadiculopathyIn 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 abnormality: specifically disc herniation and/or impingement due to spondylosis. Disc herniation (a rupture in the fibrous o...

2021-03-1624 min

Spine & Nerve Case Report: Myofascial pain syndromeIn 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/Back-to-Basics-Myofascial-Pain-Syndrome-eq461q and https://anchor.fm/spine/episodes/Journal-Club-Neuroinflammation-in-Myofascial-Pain-Disorders-eqlc5l). This episode’s discussion brings things a...

2021-03-0129 min

Spine & Nerve Journal Club: Neuroinflammation in Myofascial Pain DisordersIn 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. Myofascial pain may not be the primary underlying process for many patients living with chronic pain, but it is very common for many to have a strong component of...

2021-02-2018 min

Spine & Nerve Back to Basics: Myofascial Pain SyndromeIn 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% of the general population at some point in their lives. Persistent myofascial nociceptive input appears particularly effective at inducing central sensitization. Notably, a 2012 article in The Pain...

2021-02-1026 min

Spine & Nerve Case Report: The Chronification of Pain - Low back pain in setting of chronic pancreatitis treated with long term opioidsIn 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 significantly to the severity and refractory nature of chronic pain conditions. Listen as the doctors review chronification of pain in the context of a pat...

2021-02-0329 min

Spine & Nerve Journal Club - PNS for axial low back pain, impact on pain chronificationIn 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 treatment of chronic low back pain and is believed to have a positive impact on the processes of peripheral and central sensiti...

2021-01-2324 min

Spine & Nerve Back to basics: the Chronification of PainIn 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) that has persisted beyond the normal tissue healing time (usually about 3 months). The Change Pain Chronic Advisory Board provides the following definition of pain chronification: “Pain chr...

2021-01-1231 min

Spine & Nerve Say Kroe ILL EE I -tis: a review of sacroiliac joint pain, diagnosis and treatmentIn 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 demonstrating that SI joint pain significantly contributes to...

2020-12-1824 min

Spine & Nerve COVID and pain medicine: not just telemedicine and delayed proceduresIn 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 emerging on a persistent syndrome following acute COVID-19 infection. Although we don't understand its entire clinical picture, it...

2020-12-1022 min

Spine & Nerve Klay Thompson has us in our feelings- a discussion on achilles tendon injuriesIn 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 back through 2 consecutive grueling rehab processes and return to the level of play we expect from a play...

2020-11-2317 min

Spine & Nerve To Taper or not to Taper, that is not the question: how to taper very much isIn 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 function and pain severity. The tapering of opioids can be very difficult and challenging for the patient and the healthcare provider for a multi...

2020-11-1520 min

Spine & Nerve Pink Past October - Treating breast cancer survivors with post mastectomy pain syndromeIn 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 potential complication after surgical resection is chronic pain, specifically referred to as PMPS. The definition of PMPS according to the International Association for the Study of P...

2020-11-0826 min

Spine & Nerve Profound Data with Dr. Michael FishmanIn 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 done by Dr. Ricardo Vallejo and his team at Stimgenics- research that we have had the opportunity to explore in depth previously...

2020-10-2929 min

Spine & Nerve Food is Medicine - diet and chronic painIn 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 and powerful impact on symptoms and overall health. Listen as the doctors discuss the details of a recent study investigating the impact of die...

2020-10-2424 min

Spine & Nerve Case report: Beyond the WHO analgesic ladder - what other options are there for cancer related pain?In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present a clinical case of a patient with advanced metastatic prostate cancer who presented with severe refractory cancer associated pain. The patient’s cancer associated pain is due to multiple factors including bone pain secondary to metastases to bone, as well as neuropathic pain in setting of chemotherapy induced peripheral neuropathy. These cases can be very challenging in regard to the development of a treatment regimen that is adequately controlling the patient’s symptoms without significant side effects. Cancer associated pain is common with epidemio...

2020-10-0924 min

Spine & Nerve Interlude: Are NFL injuries on the rise and is the shortened preseason to blame?In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the recent string of major injuries affecting NFL players, and what role the variations on training camp and a lack of a preseason may play. This is a discussion between two long time sports fans, who happen to be physical medicine and rehabilitation physicians. The doctors do not know the details of individual injuries or NFL protocol and oversight, and are simply talking it through from a medical perspective. This is not meant to be medical advice, a medical opinion, or to have...

2020-09-2517 min

Spine & Nerve NSAIDs: the first step of the ladder requires considerations when diving deeperIn 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 of neutrophil function and cell membrane function. It is important to understand that there are multiple different classes of NSAIDs, and each NSAID has its own unique properties resulting in differences in reg...

2020-09-1739 min

Spine & Nerve One Bad Apple Spoils the Bin: Chronic pain's impact on overall healthIn 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 pain and consequent limitations. Chronic pain leads to significant consequences in regards to overall health as well. Chronic pain is ver...

2020-09-1023 min

Spine & Nerve Minimally Invasive options for chronic low back pain; a recent webinar presented by Dr. JovesIn 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 Neuromodulation This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to...

2020-09-0237 min

Spine & Nerve Journal Club: Lumbar Spinal Stenosis and the Impact on Mobility, Function, and Quality of LifeIn 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 soft tissue and the narrowing may involve the bony canal alone, the dural sac, or both. Lumbar stenosis is a common dis...

2020-08-2831 min

Spine & Nerve Not your every day headache: Post dural puncture headache, managing complicationsIn 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 stiffness and/or subjective hearing changes. The symptoms usually remit spontaneously within 2 weeks or after autologous epidural blood patch. The important aspects of the...

2020-08-2225 min

Spine & Nerve Journal club: Interventional management of cancer associated painIn 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 patients with advanced cancer have moderate to severe pain. Additional studies show that around 50% of cancer patients with pain report adequate pain control as their highest priority in reg...

2020-08-1424 min

Spine & Nerve Vagus baby, Vagus: Neuromodulation of the vagus nerve in pain medicineIn 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... Which in pain medicine is interesting because many chronic pain conditions are believed to have a heightened sympathetic r...

2020-08-0626 min

Spine & Nerve How to prepare for a pain medicine rotation? What we actually expect from a resident or studentIn 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 rotation This podcast is for information and educational purposes only, it is not meant to be medical or career...

2020-08-0124 min

Spine & Nerve Buprenorphine and the challenging transition, a discussion and review of literatureIn 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 medications. Benefits of Buprenorphine include but are not limited to decreased risk of respiratory depression and death, decreased risk of hyperalgesia and tolerance, decreased risk of...

2020-07-2727 min

Spine & Nerve The Dr. Karvelas story: A journey through sport to find a passion for interventional pain medicineIn 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 fellowship to peruse? Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Send a me...

2020-07-1731 min

Spine & Nerve The journey to pain medicine. A discussion with Dr. Hunter Vincent from The Orthohealing CenterIn 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? - How does Dr. Vincent feel these choices influenced his job opportunities and career path? Dr. Vincent's bio: Dr...

2020-07-0936 min

Spine & Nerve 2 pain docs and bone mineral density; the effect of epidural steroid injectionsIn 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 steroid, the exact dose, the method of delivery, and the patient's response (including possible increase in function/activity/weight bearing exercise) all need to be ta...

2020-07-0222 min

Spine & Nerve To repeat or not to repeat? A discussion on epidural steroid injections.In this episode of the Spine & Nerve podcast, Dr. Brian Joves and Dr. Nicolas Karvelas discuss the age old question... whether or not to pursue a repeat epidural steroid injection (ESI) for the possibility of cumulative effect. Historically there was a time when it was fairly common practice to order a pre-determined series of ESIs. Over time, based on analysis of the research performed, and based on clinical experience, taking a more nuanced approach has proven to be the recommendation of most pain societies. Listen as the doctors discuss some of the available literature, as well as their clinical experience re...

2020-06-2916 min

Spine & Nerve A Pain Medicine Legend joins us to discuss the past, present, and future of our fieldIn 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 co-founder and chairman of the American Society of Pain and Neuroscience, President Emeritus of...

2020-06-1932 min

Spine & Nerve Journal club: Platelet Rich Plasma and the SpineIn 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 help us to improve and provide value to more people. This podcast is for information and educational purposes only, it is...

2020-06-1324 min

Spine & Nerve Is the treatment making you worse? A review of Opioid Induced HyperalgesiaIn 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 the pathophysiology of OIH, including but definitely not limited to increased NMDA receptor activity. Lastly the doctors will address potential treatment options a...

2020-05-2925 min

Spine & Nerve Journal Club: gluteal/buttock painIn 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 and discuss these articles addressing a very common chief complaint of buttock/gluteal region pain. Please see References section below for the articles discussed in today's podcast. Follow our...

2020-05-1130 min

Spine & Nerve Journal club: 5/1/20. Treatments at various stages of chronic knee pain.In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss a few recent articles regarding treatment options for chronic refractory knee pain. Listen in as the docs discuss treatment of knee pain due to osteoarthritis prior to knee arthroplasty, as well as treatment options in the setting of persistent symptoms after knee arthroplasty. They summarize articles exploring platelet rich plasma injections, hyaluronic acid injections, genicular nerve radiofrequency ablation, and peripheral nerve stimulation. Please see References section below for the articles discussed in today's podcast. Follow our practice on Facebook at Spine & Nerve Diagnostic Cente...

2020-05-0127 min

Spine & Nerve Journal Club: 4/24/2020. Pharmacological management of chronic painIn 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 References section below for the articles discussed in today's podcast. References: 1. Alberti P, et al. Topiramate prevents Oxaliplatin-related axonal...

2020-04-2428 min

Spine & Nerve INTERLUDE: COVID and sport, where do we go from here?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 are simply talking it through from an informed fan's perspective. Follow our practice on Facebook at Spine...

2020-04-2114 min

Spine & Nerve Maintaining your health through the pandemic: guidance and science.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 tactics, and some of the science behind the tactics, to optimize your physical and mental health during these hard times. The strategies that...

2020-04-0825 min

Spine & Nerve When the nerve root falls far from the disc; a case and literature review.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 be impacted. The docs start by taking a step back and re...

2020-03-1723 min

Spine & Nerve Smoking is still the "new smoking": how smoking can make chronic pain worseIn 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 limited to cardiovascular disease, lung disease, cancer risk; but there is also growing evidence that smoking tobacco can contribute to and worsen common ch...

2020-03-0916 min

Spine & Nerve More glial cells!! Dr. Ricardo Vallejo, science that matters, and thinking beyond the neuron.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 Multiplexed (DTM) Spinal Cord Stimulation. Stimgenics’ preclinical research on the neuronal-glial mechanism of action has been recognized at various medical so...

2020-03-0249 min

Spine & Nerve Just keep swinging? Golf and back painIn 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 any low back injury, we have to work through a differential diagnosis that...

2020-02-2428 min

Spine & Nerve Overcoming Objections: Addressing common patient concerns with minimally invasive proceduresIn 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 amazing treatment options available to treat chronic pain. Follow our practice on Facebook at...

2020-02-1723 min

Spine & Nerve Let's dive deeper into buprenorphine!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 podcast is referenced: https://zdoggmd.com/podcasting/buprenorphine/ Follow our practice on Facebook at Spine & Nerve Diagnostic Center. Please leave us...

2020-02-1031 min

Spine & Nerve Interlude: peripheral nerve stimulation for chronic shoulder pain, a review of current literatureIn 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 & Nerve Diagnostic Center. Please leave us a comment or review- these help us to improve and provide value to more people. Disclosure!!! Dr. Brian Joves is a speaker...

2020-02-0320 min

Spine & Nerve Digesting the North American Neuromodulation Society (NANS) 2020 annual meetingIn 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 neurostimulation therapy has significantly increased the breadth of conditions that can be treated by neurostimulation / indications for neurostimulation. This...

2020-01-3122 min

Spine & Nerve It's halfway through January, do you know where your resolution is? A discussion on goal setting.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" or "getting better each day", but the overwhelming response (read over 99%) was a lack of goals. Listen is as...

2020-01-2022 min

Spine & Nerve You down with E...S...P!?!? The erector spinae plane block...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, Rodriguez P, Granell M, et al. The erector spinae plane block: a narrative review. Korean J An...

2020-01-1420 min

Spine & Nerve Drum roll...Most downloaded episode of 2019 is... intro to Spinal Stenosis [Rebroadcast]Thank you all so much for listening to the Spine & Nerve podcast in 2019. We started this podcast to provide another option for both patients and healthcare practitioners to learn more about musculoskeletal medicine and pain medicine. Drs. Raman Gurai, Nicolas Karvelas and Brian Joves have had a great time educating about various diagnoses and treatment options, diving deep into the medical literature, and sharing their experience treating these challenging pathologies. As the decade comes to an end, we believe that just as the 2000s have gone down in history as the decade of pain... The 2010s will be remembered for...

2019-12-3126 min

Spine & Nerve There is a fracture, now what? A review of the guidelines for vertebral compression fractures.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 traumatic circumstances- we tend to refer to those as osteoporotic fractures. Osteoporotic vertebral compression fractures are a common medical p...

2019-12-2324 min

Spine & Nerve Interlude: injections in the news- stellate ganglion block for PTSDIn 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 the sympathetically mediated processes (think fight or flight responses) in this region. This procedure blocks the stellate ganglion (as the name suggests) and...

2019-12-1718 min

Spine & Nerve What came first: chronic pain or impaired sleep? A conversation on sleep disturbanceIn 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. Listen in as the doctors discuss some recent literature and practical ways to approach this challenging issue. Follow our practice on Facebook at...

2019-12-0924 min

Spine & Nerve Neuromodulation: Peripheral nerve stimulationIn 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 system (ilioinguinal, lumbar medial branch, cluneal, etc) or in the vicinity of a focal chronic pain. Listen in as the doctors discuss this exciting option for patients. They discuss...

2019-12-0526 min

Spine & Nerve Neuromodulation: Riding the WAVE of technology to provide stimulating reliefIn 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 pain syndrome; but there are many other applications of this therapy. Advances in neuromodulation technology give the ability to individualize a patient's therapy depending of the...

2019-11-1826 min

Spine & Nerve INTERLUDE: How a needle may have changed baseball history- Max Scherzer's neck and the World SeriesIn 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 fierce competitive nature, and he was determined to return to help his team. He underwent a...

2019-11-0617 min

Spine & Nerve Neuromodulation: an introduction.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 about it), neuromodulation also includes deep brain stimulation (DBS) treatment for Parkinson's disease, sacral nerve stimulation for pelvic disorders and incontinence, spin...

2019-10-2224 min

Spine & Nerve Why am I thinking twice after hitting my head? An intro to mild traumatic brain injury/ concussionIn 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 from CDC data are from falls (35.2%), unknown/other (21%), motor vehicle/traffic (17.3%), struck by/against an object (16.5%), and assaults (10%). ...

2019-10-1522 min

Spine & Nerve Opiates, opiates, and more opiates... We just can't stop talking or educating on themIn 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: -Review CURES (Prescription Drug Monitoring Program) data before any Rx of opioids -Obtain baseline UDS, an...

2019-10-1124 min

Spine & Nerve Small investment, big rewards- why the electrodiagnostic evaluation should be a part of your workupIn 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 (usually 28g) that goes into muscles and listens to the way the muscle and nerves communicate. This study is performed by mainly...

2019-10-0125 min

Spine & Nerve Glial cells, glial cells, glial cells... The pain cascade, modulation, and chronic pain.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 nociceptive nervous system. Each one of these components can have signaling errors that can lead to chronic pain. Today, we specifically discuss the...

2019-09-2423 min

Spine & Nerve "Non specific" low back pain: a practical conversation for the front lines (primary care)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 between 90 and 99% of acute low back pain as "non specific"! What is that and how can...

2019-09-1629 min

Spine & Nerve Regenerative medicine: hype or the future?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 evolve in helping us understand which patients are appropriate for which intervention. Just like all forms of musculoskeletal...

2019-09-0923 min

Spine & Nerve INTERLUDE: Are growing fears of injury (both acute and chronic) putting the NFL in trouble?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 traumatic encephalopathy (CTE) since Dr. Bennet Omalu published a...

2019-09-0616 min

Spine & Nerve IntroductionIntro to the Spine & Nerve podcast, with your hosts Dr. Nicolas Karvelas and Dr. Brian Joves

2019-04-0503 min