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Painexam Podcast Episode Show Notes
Episode Title: Exploring Naturopathy in Pain Medicine with Dr. Sarah Trahan
Host: David Rosenblum, MD
David Rosenblum is a dedicated pain management specialist with extensive experience in treating chronic pain conditions. He is passionate about integrating various approaches to improve patient outcomes and enhance quality of life. His expertise and commitment to patient-centered care make him a trusted voice in the field of pain medicine. His NY Practice is located in Brooklyn and Garden City and through his international educaitonal platform he has attracted physicians and pateints from all over the world to seek out consultation on the latest breakthroughs in interventional pain management.
Guest: Dr. Sarah Trahan
Dr. Sarah Trahan is a licensed naturopathic physician with a focus on holistic approaches to pain management and regenerative therapies. With a background in both conventional and alternative medicine, Dr. Trahan is committed to empowering patients through education and personalized treatment plans that address the root causes of pain.
Episode Summary:
In this episode, David Rosenblum, MD, interviews Dr. Sarah Trahan to explore the role of naturopathy in pain medicine and the potential of regenerative therapies. Dr. Trahan shares her insights on how naturopathic principles can complement traditional pain management approaches, offering a comprehensive view of patient care.
Key Discussion Points:
- ntroduction to Naturopathy:
Dr. Trahan explains the philosophy of naturopathic medicine and its emphasis on treating the whole person rather than just symptoms.
- The Role of Naturopathy in Pain Management:
The conversation delves into how naturopathy can be integrated into pain management strategies, including dietary changes, lifestyle modifications, and natural supplements.
- Regenerative Therapies:
Dr. Trahan discusses the latest advancements in regenerative therapies, focusing on how these approaches can be applied in the context of pain management without delving into stem cell treatments.
- Patient-Centered Care:
Emphasizing the importance of a collaborative approach, Dr. Trahan shares strategies for working with patients to develop tailored treatment plans that align with their individual needs and preferences.
- Success Stories
Dr. Trahan recounts some of her most impactful approaches and success stories, illustrating the benefits of combining naturopathic and conventional approaches to pain relief.
- NRAP Academy Online Courses and Workshops:
Dr. Trahan highlights the educational opportunities available through the NRAP Academy, which offers online courses and workshops aimed at healthcare professionals interested in enhancing their understanding of naturopathic principles in pain management. Private ultrasound training is also available for those seeking hands-on experience. For more information, visit NRAPpain.org
Resources
Pain Management CME Workshop Calendar
Pain Medicine CME Board Prep and Online Courses
Tune in to this insightful conversation to learn more about how naturopathy and regenerative therapies can play a vital role in managing pain and improving patient outcomes.
Stay connected with Painexam for more episodes on pain management and treatment innovations. Don't forget to subscribe and leave a review!
For questions or feedback, reach out to us at info@nrappain.org
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This episode promises to provide valuable insights for healthcare professionals and patients alike, highlighting the importance of a holistic approach to pain management.
Podcast Show Notes
Episode Title: Optimizing Genicular Nerve Chemical Ablation: Insights from Dr. David Rosenblum
Episode Summary:
In this episode, we are joined by Dr. David Rosenblum, a New York-based interventional pain physician, who discusses optimizing genicular nerve chemical ablation. Dr. Rosenblum shares insights as well as his upcoming ultrasound course schedyke in New York City, focusing on regional anesthesia, interventional pain, and IV ultrasound placement. He emphasizes the significance of ultrasound in enhancing pain management procedures and the latest advancements in the field.
Key Topics Discussed:
- Overview of Dr. Rosenblum's upcoming ultrasound courses in NYC, including regional anesthesia and IV ultrasound placement. More information can be found here or at NRAPpain.org.
- The role of ultrasound in interventional pain management, specifically in optimizing genicular nerve chemical ablation.
- Discussion on the recent study comparing genicular nerve phenol neurolysis and radiofrequency ablation.
- Importance of updating anatomical targets for pain management.
- Recommendations for expanding the number of targets in pain interventions.
- Insights on the safety and efficacy of chemical neurolysis versus radiofrequency procedures.
- Challenges and considerations in performing neurolytic blocks.
- Future directions in personalized treatment for chronic pain patients.
For Anesthesia Board Prep go to AnesthesiaExam at NRAPpain.org
Featured Article:
Dr. Rosenblum references an article from The Korean Journal of Pain discussing the optimization of genicular nerve chemical ablation. Key takeaways include:
- The evolution of anatomical understanding related to genicular nerves.
- The recommendation to consider multiple targets for pain management instead of the traditional three.
- The need for careful patient examination to map pain effectively before intervention.
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Discussion on Knee Pain Management
• ArticlebyAndresRochaRomero:
• Discussion on knee pain targeting genicular nerve ablation.
• Co-authored by Tony Ng and King K Stanley Lam.
• Published in Korean Journal of Pain.
• Highlights differences in pain management practices outside the U.S.Other Points on Genicular Nerve Chemical Ablation discussed
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Phenol ablation being used more internationally vs. radiofrequency ablations.
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Considerations for more extensive targeting of genicular nerves:
• Importance of the median branch of the nerve to the vastus intermedius. • Expansion of targeting to include 6 nerves, not just 3.
• Anatomical variations require different approaches.Recommendations and Observations
• Importance of considering patient-specific anatomy and pain. • Repeat procedures and rehabilitation:
• Concerns about bio intensity and fascia integrity.
• Emphasizes muscle strengthening exercises to support knee.
• CRPS Considerations:
• Elderly patients may develop CRPS post-knee replacement.
• Importance of lumbar sympathetic block in diagnosis and treatment. -
Host Bio:
Dr. David Rosenblum, MD is an interventional pain physician based in New York City. With extensive experience in pain management techniques, Dr. Rosenblum is dedicated to advancing the field through education and innovative practices. He is particularly focused on the integration of ultrasound technology into pain management procedures.
Course Information:
Dr. Rosenblum's upcoming ultrasound courses are CME supported, monthly hands on workshops to give clinicians experience with ultrasound imaging to identify targets for nerve block joint injection, soft tissue injection and more..
• Monthly IV Ultrasound Course in Manhattan:
• Ideal for nurses, PAs, anesthesiologists, ER docs.
• Provides practice with phantoms, short lecture on IV ultrasound. • Offers CME credits.
• Ultrasound Courses:
• Held one Saturday a month, mostly in New York, but travels if needed. • Upcoming dates: December 21st, January 11th in Manhattan.
• Presentation Invitation at Pain Expo in Dubai: April 26-27. •
• Next LAPS conference in September in Chile.
Call to Action:
- Subscribe to our podcast for more episodes on advancements in pain management.
- Follow us on social media for updates on upcoming courses and events.
- Share this episode with colleagues who may benefit from learning about ultrasound techniques in pain management.
Upcoming Opportunities and Closing Remarks
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Dr. Rosenblum encourages attending his ultrasound courses and conferences.
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Mention of upcoming conferences in ASPN inMiami, Pain Expo in Dubai, and LAPS inChile.
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Recommendations to subscribe to newsletters for updates and free info.
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The podcast aims to support pain management professionals.
Exploring the Efficacy of Autologous Platelet Leukocyte Rich Plasma Injections in Chronic Low Back Pain & Understanding Degenerative Lumbar Spinal Stenosis
Host David Rosenblum, MD
Episode Date: October 25, 2024
In this episode, Dr. David Rosenblum discusses two significant studies related to chronic low back pain and degenerative lumbar conditions. The first study focuses on the use of autologous platelet leukocyte rich plasma (PLRP) injections for treating atrophied lumbar multifidus muscles, while the second study investigates the correlation between muscle atrophy and the severity of degenerative lumbar spinal stenosis (DLSS).
Featured Article 1:
- Effect of Autologous Platelet Leukocyte Rich Plasma Injections on Atrophied Lumbar Multifidus Muscle in Low Back Pain Patients with Monosegmental Degenerative Disc Disease
- **Authors:** Mohamed Hussein, Tamer Hussein
Key Points Discussed
1. Background: Correlation between lumbar multifidus muscle dysfunction and chronic low back pain.
2. Study Overview: 115 patients treated with weekly PLRP injections for six weeks, followed for 24 months.
3. Outcome Measures: Significant improvements in NRS and ODI scores, with high patient satisfaction.
4. Conclusions: PLRP injections into the atrophied multifidus muscle are safe and effective for managing chronic low back pain.
Featured Article 2:
- Degenerative Lumbar Spinal Stenosis
Authors:* Gen Xia, Xueru Li, Yanbing Shang, Bin Fu, Feng Jiang, Huan Liu, Yongdong Qiao
Key Points Discussed
1. Background: DLSS is a common condition in older adults, often leading to muscle atrophy and disability.
2. Study Overview: A retrospective analysis involving 232 patients to investigate the correlation between muscle atrophy and spinal stenosis severity.
3. Results:
- Significant differences in the ratio of fat-free multifidus muscle cross-sectional area between stenotic and non-stenotic segments.
- A strong positive correlation was found between multifidus atrophy and the severity of spinal stenosis.
- The atrophy was more pronounced on symptomatic sides of the spine compared to contralateral sides.
4. Conclusions: The findings suggest that more severe spinal stenosis is associated with greater muscle atrophy, emphasizing the importance of addressing muscle health in DLSS patients.
Discussion:
Dr. Rosenblum provides insights into how these studies inform clinical practices for treating chronic low back pain and managing degenerative conditions. He emphasizes the need for comprehensive treatment strategies that consider both muscle health and spinal integrity which may be achieved via peripheral nerve stimulation of the medial branch nerve and multifidus muscle or PRP injection in to the multifidus muscle.
Closing Remarks:
Listeners are encouraged to stay informed about innovative treatment options and the importance of muscle assessment in managing spinal disorders.
**Follow Us:**
- Subscribe to the Painexam Podcast for more episodes discussing the latest in pain management research and treatments.
- Connect with us on social media [insert social media links].
NRAP Academy also offers:
- Board Review
- Regenerative Medicine Training
- The Virtual Pain Fellowship (online training program with discount to live workshops)
Regional Anesthesia & Pain Ultrasound Course
Private Training Available
Email Info@NRAPpain.org
**Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns.
References
Podcast Show Note Summary:
Episode Title: "New Guidelines for Corticosteroid Injections in Chronic Pain Management"
This podcast is a discussion about the recent review article
In this episode, we dive into the recently published guidelines on the use of corticosteroid injections for managing chronic pain, developed by the American Society of Regional Anesthesia and Pain Medicine, along with several other prominent pain societies. These guidelines address the safety and efficacy of corticosteroid injections for sympathetic and peripheral nerve blocks, as well as trigger point injections.
Key Discussion Points:
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Background and Need for Guidelines:
- Overview of potential adverse events from corticosteroid injections, such as increased blood glucose levels, decreased bone mineral density, and suppression of the hypothalamic–pituitary axis.
- Importance of using lower doses of corticosteroids, which studies have found to be just as effective as higher doses.
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Development of the Guidelines:
- The guidelines were approved by multiple pain societies and structured into three categories: sympathetic and peripheral nerve blocks, joint injections, and neuraxial injections.
- Extensive literature review and consensus-building through a modified Delphi process.
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Key Recommendations:
- The addition of corticosteroids to local anesthetics is recommended for certain nerve blocks, such as the greater occipital nerve block for cluster headaches and ilioinguinal/iliohypogastric nerve blocks for post-herniorrhaphy pain.
- Corticosteroid addition is not recommended for sympathetic nerve blocks, greater occipital nerve blocks for migraines, and pudendal nerve blocks for pudendal neuralgia.
- Imaging guidance (ultrasound or fluoroscopy) improves the safety and accuracy of certain procedures.
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Efficacy and Safety:
- Detailed analysis of various studies on the effectiveness of corticosteroid injections for different types of chronic pain.
- Discussion on the minimal benefit of corticosteroids in trigger point injections and the potential risks associated with their use.
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Clinical Implications:
- How these guidelines can assist clinicians in making informed decisions regarding corticosteroid use in chronic pain management.
- Emphasis on the need for personalized treatment plans based on individual patient characteristics and clinical data.
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Future Directions:
- Identification of gaps in the current research and the need for well-designed studies to further assess the benefits and risks of corticosteroid injections.
Join us as we explore these comprehensive guidelines and their potential impact on improving chronic pain management practices.
Upcoming Conferences
Resources:
- Link to the full guidelines: Journal Online
- PainExam App is ready for iphone
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
References
https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdf
Disclaimer
Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
- PainExam App is ready for iphone
-
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
References
Nicholas A Telischak, Jeremy J Heit, Lucas W Campos, Omar A Choudhri, Huy M Do, Xiang Qian, Fluoroscopic C-Arm and CT-Guided Selective Radiofrequency Ablation for Trigeminal and Glossopharyngeal Facial Pain Syndromes, Pain Medicine, Volume 19, Issue 1, January 2018, Pages 130–141, https://doi.org/10.1093/pm/pnx088
Allam, Abdallah El-Sayed, et al. "Ultrasound‐Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques." Pain Research and Management 2018.1 (2018): 5480728.
isclaimer
Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.
Dr. Rosenblum addresses 2 Studies on this Pain Management Journal Club Podcast
Article 1:
The Treatment of Bone Marrow Lesions Associated with Advanced Knee Osteoarthritis: Comparing Intraosseous and Intraarticular Injections with Bone Marrow Concentrate and Platelet Products
Article 2:
Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: Aminimum of 2-year follow-up retrospective comparative study
Editorial:
Dr. Rosenblum poses some important questions:
Why are regenerative therapies not covered? Why is CMS limiting trigger point injections and not paying for certain peripheral nerve blocks? Who is making the decision? Do lobbying groups or big pharma have a role?
- PainExam App is ready for iphone
-
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
References
Alessio-Mazzola M, Repetto I, Biti B, Trentini R, Formica M, Felli L. Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study. Journal of Orthopaedic Surgery. 2018;26(1).
Centeno, Christopher, et al. "The treatment of bone marrow lesions associated with advanced knee osteoarthritis: comparing intraosseous and intraarticular injections with bone marrow concentrate and platelet products." Pain Physician24.3 (2021): E279.
Join us on this episode of the PainExam Podcast where rising star, Christopher Robinson, MD PhD discusses his upcoming paper on exosomes featuring some of the largest names in pain managment. Dr. Rosenblum also alludes to degenerative disc disease being a partially infectious podcast.
Other topics discussed on this podcast:
The Anesthesiology Job Market
Pain Management Fellowship
Duration of Pain Management Fellowships
Should Pain Management be an Independent Residency?
- PainExam App almost ready
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
Journal Club: Treating Degenerative Disc Disease with Leukocyte Rich PRP
Dr. Rosenblum discusses an article written by Dr. Gregory Lutz describing Leukocyte RIch PRP's role in treating Degenerative Disc Disease and the theory that there is an infectious disease component to disc injury.
Dr. Lutz describes multiple articles, as well as anectodal experience in which bacterial infectious was demonstrated in pathological discs, and PRP was successful in alleviating symptoms, modic changes and improved clinical as well as radiographic appearance.
- PainExam App almost ready
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
References
Lutz, Gregory E. "Intradiscal Leukocyte Rich Platelet Rich Plasma for Degenerative Disc Disease." Physical Medicine and Rehabilitation Clinics of North America 34.1 (2023): 117-133.https://www.binasss.sa.cr/bibliotecas/bhm/feb23/61.pdf
- PainExam App almost ready
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
Advocating for Transparency and Oversight in Pain Management
Introduction:
- Welcome back to Painexam, where we delve into the latest advancements and challenges in pain management.
- Today's episode highlights a significant advocacy effort made by leading Interventional Pain Physicians and industry experts.
Summary of Lobbying Effort:
- On March 20, 2024, a group of esteemed physicians and industry leaders, including Drs. Sean Li, Peter Staats, Mehul J. Desai, David Reece, Hemant Kalia, and David Rosenblum, alongside industry figures Mark Stultz, Christopher Conrad, and Cecelia Ruble, visited Capitol Hill to advocate for greater oversight and transparency in independent review organizations.
- Despite their busy schedules, they recognized the critical need to address the 0% turnover rate in appeals for denied treatments, which disproportionately affects patients seeking alternatives to surgery and opioid medication.
Importance of Transparency:
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- The issue extends beyond pain management, impacting patients across various medical fields.
- While opioid therapy may seem economically favorable initially, the long-term consequences, including delayed care and medication side effects, often outweigh the costs.
- The group emphasized the importance of an unbiased review for accessible, cutting-edge treatments to improve patient outcomes and reduce overall healthcare expenses.
Purpose of the Lobbying Effort:
Contrary to pushing any specific company agenda, the initiative aims to highlight the challenges patients and physicians encounter in securing optimal treatment outcomes.
For Board Prep, Ultrasound Training and more, visit:
Dr. David Rosenblum, a pioneer in interventional pain medicine, particularly in ultrasound-
guided procedures and regenerative pain medicine, underscores the necessity of addressing these issues for the benefit of countless patients suffering from chronic pain.
Conclusion and Actionable Steps:
- To schedule a consultation with Dr. Rosenblum, patients can visit www.AABPpain.com or contact the Brooklyn Office at 718-436-7246 or the Garden City Office at 516-482-7246.
- Stay tuned for more updates on advancements and advocacy efforts in pain management.
Outro:
- Thank you for joining us on this episode of Painexam. Be sure to subscribe for future discussions on navigating the complexities of pain management.
- PainExam App almost ready
- Pain Management Board Prep migrated to NRAPpain.org
- AnesthesiaExam Board Prep migrated to NRAPpain.org
- PMRExam Board Prep migrated to NRAPpain.org
Dr. Rosenblum interviews West Viriginia Society of Interventional Pain Physician's President Rudy Malayil, MD and discusses the upcoming WVSIPP meeting in April 2024 as well as Dr. Rosenblum's upcoming ultrasound course.
Rudy Mathew Malayil, M.D., completed his internship in General Surgery at New York Presbyterian/Cornell Hospital in New York City, followed by residency training in Physical Medicine and Rehabilitation at New York University Medical School. Dr. Malayil further completed a Pain Medicine Fellowship at the Albert Einstein School of Medicine at the Beth Israel Medical Center Campus in New York City.
After training he went settled in West Virginia and eventually became the president of West Virginia Society of Interventional Pain Physicians and started private practice Pain Management 360.
In this episode, Garden City (long island) based Pain Physician, Dr. David Rosenblum explores Peripheral Nerve Stimulation, Biologics and Ablations for hip pain.
He reviews a case report of a 67-year-old female with a history of a mechanical fall causing injury to her lumbar spine and pelvis resulting in hip and pelvic pain is presented. The patient had hypertrophic non-union of the right iliac wing fracture and displacement of the pubic symphysis and right sacroiliac joint. Medications were not effectively managing her pain, so she sought treatment at a pain management clinic.
The patient underwent diagnostic obturator and femoral articular nerve branch injections, as well as a middle cluneal nerve steroid injection, all guided by fluoroscopy and ultrasound. She experienced improvement in her pain following these procedures. Subsequently, she had a peripheral nerve stimulator (PNS) trial and underwent implantation of leads targeting the right middle cluneal nerve and right obturator and femoral articular nerve branches.
The patient reported significant relief in both the posterior and anterior distribution of her pain. Her activities of daily living improved, and she was able to sleep without pain after the PNS implantation. The successful use of combined fluoroscopy and ultrasound in targeting the specific nerves and replicating the patient's pain distribution before permanent PNS implantation is highlighted in this case.
Additionally, the show notes mention an events calendar located at this link: https://www.nrappain.org/pages/ultrasound-course-calendar.
Upcoming Course schedule for NRAP Academy includes the following events:
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Ultrasound Guided Pain & Regional Anesthesia Course in New York City on February 10, 2024. This course will cover nerve blocks, joint injections, and more. Attendees will have the opportunity to scan live models after the didactic session.
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MSK Pain & Regional Anesthesia Course in Miami, Florida on February 18, 2024. This course will focus on ultrasound-guided nerve blocks and MSK (musculoskeletal) pain management.
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Ultrasound Guided Pain Course in Key West, Florida on February 23, 2024. This 4 CME (Continuing Medical Education) course will cover ultrasound-guided nerve blocks, MSK, PRP (platelet-rich plasma), BMAC (bone marrow aspirate concentrate) targets, and regional anesthesia.
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Regional Anesthesia and US Guided Pain Management Course in New York City on March 9, 2024. This course will provide training in ultrasound-guided interventional pain management and regional anesthesia.
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Ultrasound Guided IPM (Interventional Pain Management) Course in West Virginia on April 14, 2024. This course is part of the Appalachian Regional Spine and Pain Meeting and will be conducted by NRAP Academy. It will focus on interventional pain management using ultrasound guidance.
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Regenerative Pain Medicine Course in New York City on May 4, 2024. This course will cover PRP (platelet-rich plasma) and other regenerative pain medicine techniques.
In addition to the live training, attendees will receive bonus material including access to the On Demand Ultrasound Guided MSK Interventional Pain Management Course, a course workbook and certificate, post-course guidance and discounts, and the opportunity to join the mailing list for calendar updates.
Please note that these course details are subject to change, so it's recommended to visit the NRAP Academy website for the most up-to-date information.
Reference
- #35977 Peripheral nerve stimulation implant for chronic post-traumatic hip and pelvic pain
Painexam Podcast Show Notes: Journal Club on "Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves"
Special Thanks to Robert Stall, MD
Introduction:
- Welcome to another episode of the Painexam Podcast! In today's journal club edition, we delve into a fascinating study by Dr. Joel E. Pessa on cerebrospinal fluid (CSF) circulation in human nerves.
Background:
- The study addresses the growing evidence of CSF circulation in human nerves and its implications in various conditions encountered by plastic surgeons.
- Conditions such as nerve transection, stretch injuries, and peripheral neuropathy may be related to dysregulation of the CSF system.
Methods:
- Dr. Pessa and his team developed the ventricular infusion technique using buffered saline in 2017.
- The technique was applied to eight fresh cadavers before dissecting the median nerve.
- Fluorescent imaging and nanoprobe injections were combined with ventricular infusion in selected specimens.
Results:
- The eight cadaver specimens (six female, two male) aged 46–97 underwent successful ventricular infusion.
- Ventricular cannulation was performed successfully using specific coordinates.
- Results suggest that CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma).
Conclusions:
- Ventricular infusion and nanoprobes effectively identify CSF flow in neural sheaths of human nerves.
- CSF flow in nerves is described as an open circulatory system occurring via channels, intracellular flow, and cell-to-cell transport associated with glial cells.
- Neural sheaths, including neurolemma, may play a role in glucose and solute transport to axons.
- The techniques showcased in this study can be utilized in anatomic dissection and live animal models and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways.
Significance:
- This study opens new avenues for understanding the intricate mechanisms of CSF circulation in neural tissues.
- Plastic surgeons and researchers can benefit from these techniques in studying and addressing conditions related to CSF dysregulation in nerves.
- The findings have implications not only for nerve-related conditions but also for broader applications in the central nervous system.
Closing:
- Thank you for joining us on this insightful journey through Dr. Joel E. Pessa's study. Stay tuned for more engaging discussions on pain management and neurology in future Painexam Podcast episodes!
Reference
Pessa JE. Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves. Plast Reconstr Surg Glob Open. 2022 Feb 17;10(2):e4126. doi: 10.1097/GOX.0000000000004126. PMID: 35198353; PMCID: PMC8856590.