Spine & Nerve

In this week's episode of the Spine & Nerve podcast  Dr. Nicolas Karvelas and Dr. Brian Joves review a common cause of low back pain, sacroiliac joint (SI) pain. The SI joint is a large complex joint that involves the iliac bone and sacrum. The SI joint is a critical component of the connection between the spine and lower limbs, and one of the primary functions of the SI joint is sta...

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss how pain medicine has been affected by COVID-19.  This pandemic has caused so much devastation for our patients, including some who directly experienced COVID-19 infection and those who have had to weigh seeking medical care against risking infection.  It has also impacted our practi...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves return to their Bay Area roots and mourn with Dub Nation after a devastating injury to Klay Thompson (shooting guard for the Golden State Warriors).  Klay Thompson sustained a season ending right Achilles’ tendon tear. Thompson suffered the injury during a workout... after a year of rehabbing from an ACL i...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves highlight a patient centered approach to tapering opioids. Treatment of the chronic pain disease process is challenging, but optimizing patient buy in and creating an active participant in the treatment plan can be very powerful.     In many clinical scenarios the goal of tapering / minimizing opioids is m...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves want to stay pink past October- they are continuing breast cancer awareness month and discussing one of the overlapping diagnoses: Post-Mastectomy Pain Syndrome (PMPS).     Breast cancer is the most frequently diagnosed life threatening cancer in women.  There are many different approaches to the treatment...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the recent DTM (Differential Targeted Multiplex) Spinal Cord Stimulation Randomized Controlled Trial with Dr. Michael Fishman. Dr. Fishman was one of the clinical investigators in this ground breaking study and joins our podcast to discuss the 12 month data and what it means for the future of neuro...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the relationship between diet and chronic pain.   Chronic pain including chronic spinal pain is incredibly common and difficult to treat. There are many aspects to a thorough and complete treatment plan including physical modalities, medications, procedures, and surgeries, but one often overlooked...

In this week's episode of the Spine & Nerve podcast, we sit down with Dr. Kevin Mullins. Dr. Mullins joins the podcast to discuss the journey of becoming a sports medicine physician, specifically focusing on what drove Dr. Mullins into this area of expertise and his tips to the next generation of physicians Listen in as the doctors discuss: - Why physical medicine and rehabilitation as a primary s...

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 chemothe...

In this week's episode of the Spine & Nerve Podcast, we present a recent webinar that Dr. Raman Gurai gave on the treatment options for patients living with chronic low back pain.  In this webinar, Dr. Gurai walks through the definition of pain and chronic pain, and presents his approach to helping patients.  He dives deep into three specific procedures that fill the large treatment gap between st...

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...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss one of the most commonly utilized medications, non-steroidal anti-inflammatory drugs (NSAIDs).   NSAIDs are medications with anti-inflammatory, analgesic, and anti-pyretic properties.  The mechanism of action of NSAIDs is predominantly through inhibition of cylo-oxygenase, but there are multiple ot...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss chronic pain as a disease process. Chronic pain has significant negative impacts on overall health including but not limited to: increased risk of hypertension, increased risk of cognitive decline, negative impact on sleep, and compromise of the immune system.  The key concept is that chronic pain...

In this week's episode of the Spine & Nerve podcast we present a recent webinar that Dr. Joves gave on the treatment options for patients living with chronic low back pain. In this webinar, Dr. Joves walks through his overall approach and dives deep into three specific procedures that fill the large treatment gap between steroid injections and open surgical intervention. The three main procedures...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves revisit lumbar stenosis with neurogenic claudication with a journal club of some recent literature. The studies will look at epidemiology, treatment options, and data regarding its impact on mobility / exercise.     Lumbar stenosis is defined as any type of narrowing of the spinal canal, nerve root canals,...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss one the potential complications of procedures treating the spine- post dural puncture headaches(PDPHA). Listen in as the docs discuss the typical clinical presentation and the management of PDPHA.     PDPHA is defined as a headache that occurs within 5 days of intended or accidental dural compromis...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves present journal club- therapies for cancer associated pain. They will present recent articles on established treatment modalities like intrathecal drug delivery for advanced cancer pain, as well as more emerging including peripheral nerve stimulation.   Significant pain impacting function and quality of li...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss neuromodulation of the vagus nerve as a therapy for chronic pain conditions. The vagus nerve is an incredibly complex and important nerve.  The critical and wide array of effects that the vagus nerve has on the body make it an intriguing target for treatment of a variety of different conditions. Mu...

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss preparing for an interventional pain medicine rotation. This discussion is most relevant for PGY-2 and PGY-3 residents looking to go in to a pain medicine fellowship, but is easily relatable to all levels of training. Some of the discussion points: - The bare minimum the docs expect from rotators...

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves review some key concepts regarding one of their favorite topics: buprenorphine.     Our goal as healthcare providers is to optimize diagnosis and treatment so that medications are minimized or not needed. When it is medically appropriate and indicated to utilize long term medications acting on the opioid...

In this week's episode of the Spine & Nerve podcast, we’re changing things up again and Dr. Brian Joves sits down with Dr. Nicolas Karvelas to get personal on how he progressed from a high school basketball star to a leading pain medicine physician. Listen in as the doctors discuss: - How did Dr. Karvelas sleeping with a basketball evolve into a passion for health? - Why physical medicine and reha...

In this week's episode of the Spine & Nerve podcast, Dr. Brian Joves sits down with Dr. Hunter Vincent of The Orthohealing Center in Los Angeles. Dr. Vincent joins the podcast to discuss the journey of becoming a pain medicine physician, specifically focusing on what drove Dr. Vincent into this area of expertise. Listen in as the doctors discuss: - Why physical medicine and rehabilitation as a pri...

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss the impact of epidural steroid injections on bone mineral density / risk of osteoporosis / fracture risk.   there is conflicting research/data regarding epidural steroid injections and the impact on bone mineral density and fracture risk.  We know that steroids have the potential to have an impact...

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 ba...

In this week's very special episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves had the opportunity to speak with another one of the leaders and legends in the field of pain medicine and pain research, Dr. Timothy Deer. Dr. Deer is one of the most recognizable names and faces in pain medicine. Amongst his many accolades, Dr. Deer is the President and CEO of The Center fo...