Categories
Pain Exam Podcast
Recent Conference Activities
- London Conference Weekend: Successfully attended and spoke at ISPN and SOMOS care conferences
- Somos Care Conference: Delivered presentation on pain management for primary care physicians
- Presentation consisted of 50+ slides with only one slide dedicated to opiates
- Emphasized shift away from opiate-based treatments in interventional pain management
- Recommended primary care physicians refer patients to pain specialists for comprehensive treatment options
- ISPN Conference: Participated in international pain management conference
- Met with doctors from London, Iraq, and various other countries
- Observed different international approaches to pain treatment including increased phenol use and varying regenerative medicine restrictions
Upcoming Events and Workshops
- New York-New Jersey Pain Conference: November (NRAP Academy booth presence)
- IV Ultrasound Placement Workshops: Monthly sessions in New York
- Regional Anesthesia and Ultrasound-Guided Interventional Pain Medicine Workshops:
- New York: December 13th, January 10th
- Florida (Fort Lauderdale/Hollywood): November 8th
- Detroit: January 18th, February 15th
- Alternative Options: Online ultrasound courses and shadowing opportunities available
- Board Prep and NRAP Community at PainExam.com or NRAPpain.org
- ABA ABPM ABIPP FIPP Pain Management Board prep, Question Banks, and Virtual Pain Fellowship
Educational Offerings and Events
- Training and Courses:
Research Review: ACL Treatment Study
- Study Focus: Non-surgical treatment of ACL tears using bone marrow concentrate (BMAC) and platelet products versus exercise therapy
- Key Findings:
- BMAC group showed significantly greater improvement in Lower Extremity Function Scale (LEFS) and Single Assessment Numeric Evaluation (SANE) scores at three months
- Sustained improvement in function and decreased pain maintained through two-year follow-up
- Patients reported median subjective improvement of 90% at final follow-up
- No significant improvements observed in exercise-only group during initial three months
- Treatment Protocol:
- Bone marrow harvest from posterior superior iliac crest (60-90ml from 6-8 sites)
- PRP preparation from 60ml whole blood
- Fluoroscopy-guided injection directly into ACL ligament
- Comprehensive 52-week rehabilitation protocol with activity restrictions
Clinical Practice Implications
- Current ACL Treatment Landscape: Over 400,000 ACL reconstruction surgeries performed annually in the US
- Surgical Limitations: Risk of graft failure, persistent instability, cartilage injury, and increased arthritis risk
- Return to Sport Statistics: Post-surgical rates vary significantly (33-92% return to sport, 65% return to pre-injury level)
- Practice Integration Considerations: Potential incorporation of BMAC/PRP protocols for ACL tears, though insurance coverage remains limited
David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.
Awards
New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025
Schneps Media: 2015, 2016, 2017, 2019, 2020
Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025
Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023
Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County’s Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!
Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.
Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators.
He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call
Brooklyn 718 436 7246
References
#pccwindsor #paincareclinicswindsor #painwindsorontario #paindocwindsorontarior #paincareclinics #prpwindsorontario #prp #aabppain
Project Sync / Status Update Summary
Podcast Episode Overview
- The host discussed Transcutaneous Electrical Nerve Stimulation (TENS) as a recurring pain board topic and reviewed mechanisms, efficacy, and clinical considerations.
- Emphasis that TENS appears on pain boards annually and is a foundational topic from early podcast episodes.
- Board Prep and NRAP Community at PainExam.com or NRAPpain.org
- ABA ABPM ABIPP FIPP Pain Management Board prep, Question Banks, and Virtual Pain Fellowship
Educational Offerings and Events
Educational Offerings and Events- Training and Courses:
- Monthly ultrasound courses in New York and upcoming courses in Detroit covering ultrasound-guided regional anesthesia and chronic pain.
- Ultrasound Guided Acute and Chronic Pain course in November near Hollywood/Fort Lauderdale with venue pending confirmation.
- Multiple instructors to offer diverse perspectives; registration via the CME calendar at nrappain.org.
- Conferences and Teaching:
- New York–New Jersey Pain Conference in November (hosted by Soudir Duwan).
- ISPN conference in London next week, with ultrasound teaching participation by the host.
- Community and Coaching:
- Private coaching and shadowing opportunities available; contact via newsletter replies.
- Access to the NRAP community forum upon signup at nrappain.org for discussions on neuromodulation, regional anesthesia, and pain.
TENS: Mechanisms and Parameters
- Device and Parameters:
- TENS delivers adjustable pulse frequency and intensity; configurations include low (<10 Hz), high (>50–100+ Hz), and mixed frequencies.
- Mechanisms of Analgesia:
- Activation of large-diameter, non-noxious A-beta afferent fibers in the periphery, driving descending inhibitory pathways and reducing hyperalgesia.
- Board-relevant point: selective activation of A-beta fibers is frequently tested.
- Central effects:
- Reduces central excitability and nociceptive dorsal horn neuron activity in uninjured and injured models.
- Frequency-dependent opioid receptor mediation:
- High-frequency analgesia blocked by delta receptor antagonists.
- Low-frequency analgesia blocked by mu receptor antagonists (spinal cord and rostral ventral medulla).
- Additional receptor involvement: muscarinic M1/M3, GABA-A, and cannabinoid (CB1) receptors; blockade reduces or prevents TENS analgesia depending on frequency.
- Peripheral effects:
- High-frequency TENS reduces injury-related increases in substance P in DRG neurons.
- Blockade of peripheral opioid and CB1 receptors can prevent analgesia from both low- and high-frequency TENS.
- Clinical dosing considerations:
- Adequate dosing (timing, frequency of use, intensity achieving strong but non-painful paresthesia) influences efficacy.
- Analgesia has rapid onset/offset and may require repeated administration throughout the day for sustained relief.
Evidence and Efficacy Summary
- Clinical experience suggests potential adjunctive benefit for acute pain, but systematic reviews are conflicting; more rigorous studies are needed.
- For board preparation, the critical takeaway is A-beta fiber activation.
Key Takeaways for Board Prep
- TENS targets large-diameter non-noxious A-beta afferents to reduce nociceptive signaling.
- High-frequency TENS: analgesia mediated via delta opioid receptors; blocked by delta antagonists.
- Low-frequency TENS: analgesia mediated via mu opioid receptors; blocked by mu antagonists in spinal cord and RVM.
- Additional receptor systems influencing TENS efficacy include muscarinic (M1/M3), GABA-A, and CB1.
Action Items
David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.
Patients can go to www.AABPpain.com or call 718 436 7246
Awards
New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025
Schneps Media: 2015, 2016, 2017, 2019, 2020
Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025
Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023
References
Johnson M. Transcutaneous Electrical Nerve Stimulation: Mechanisms, Clinical Application and Evidence. Rev Pain. 2007 Aug;1(1):7-11. doi: 10.1177/204946370700100103. PMID: 26526976; PMCID: PMC4589923.
Vance, C.G.T.; Dailey, D.L.; Chimenti, R.L.; Van Gorp, B.J.; Crofford, L.J.; Sluka, K.A. Using TENS for Pain Control: Update on the State of the Evidence. Medicina 2022, 58, 1332. https://doi.org/10.3390/medicina58101332
#painnyc #painbrooklyn #prpbrooklyn #prpspine #regionalanesthsia #pccwindsor #paincareclinicswindsor #painwindsorontario #paindocwindsorontarior #paincareclinics #prpwindsorontario #prp