Podcast thumbnail for PainExam Podcast

PainExam Podcast

Claim This Podcast

by David Rosenblum, MD

4.0(29 reviews)
347 episodes
Updated Weekly
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87

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Quality84
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YouTube86
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Podcast Overview

David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians. Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery. Available at Amazon.com and www.MyKidsSurgery.com

Language

🇺🇲

Publishing Since

1/22/2015

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Recent Episodes

Episode thumbnail for Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the Pain Medicine Boards

May 29, 2026

Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the Pain Medicine Boards

Dr. David Rosenblum reviews occipital neuralgia and vertebral compression fractures, including vertebroplasty and kyphoplasty techniques, for pain medicine board preparation in this interview.

Episode thumbnail for CRPS and Intrathecal Pumps- ABA Pain Medicine Board Pearls and more!

May 12, 2026

CRPS and Intrathecal Pumps- ABA Pain Medicine Board Pearls and more!

<h1 data-section-id="lyirlh" data-start="0" data-end="35">🎙️ PainExam Podcast Show Notes</h1> <h2 data-section-id="1lqk82t" data-start="36" data-end="103">CRPS & Intrathecal Pain Pumps — High-Yield ABA Pain Board Review</h2> <hr data-start="105" data-end="108" /> <h2 data-section-id="nfqegv" data-start="110" data-end="132">🔥 Episode Overview</h2> <p data-start="134" data-end="266">In this episode of the PainExam Podcast, <span class="whitespace-normal">David Rosenblum</span> reviews two essential ABA Pain Medicine Board topics:</p> <ul data-start="268" data-end="368"> <li data-section-id="23spt9" data-start="268" data-end="313"> <strong data-start="270" data-end="311">Complex Regional Pain Syndrome (CRPS)</strong></li> <li data-section-id="1v6jqtp" data-start="314" data-end="368"> <strong data-start="316" data-end="366">Intrathecal Drug Delivery Systems (Pain Pumps)</strong></li> </ul> <p data-start="370" data-end="394">This episode focuses on:</p> <ul data-start="395" data-end="516"> <li data-section-id="156jf11" data-start="395" data-end="422"> High-yield board pearls</li> <li data-section-id="14q2325" data-start="423" data-end="451"> Clinical decision-making</li> <li data-section-id="1g0vlzt" data-start="452" data-end="491"> Interventional treatment strategies</li> <li data-section-id="ao54a5" data-start="492" data-end="516">Common exam pitfalls</li> </ul> <p data-start="518" data-end="552">Whether you are preparing for the:</p> <ul data-start="553" data-end="609"> <li data-section-id="1ps4lkh" data-start="553" data-end="581">ABA Pain Medicine Boards</li> <li data-section-id="1vp0p06" data-start="582" data-end="590"> ABPM</li> <li data-section-id="vkowgy" data-start="591" data-end="600"> ABIPP</li> <li data-section-id="1yof487" data-start="601" data-end="609"> FIPP</li> </ul> <p data-start="611" data-end="723">—or looking to sharpen your interventional pain knowledge—this episode delivers practical and testable concepts.</p> <hr data-start="725" data-end="728" /> <h1 data-section-id="1lzqffb" data-start="730" data-end="781">🧠 Topic 1: Complex Regional Pain Syndrome (CRPS)</h1> <h2 data-section-id="p3bg89" data-start="783" data-end="802">🔬 What is CRPS?</h2> <p data-start="804" data-end="866">CRPS is a chronic neuropathic pain condition characterized by:</p> <ul data-start="868" data-end="975"> <li data-section-id="1xjkxe4" data-start="868" data-end="893"> Disproportionate pain</li> <li data-section-id="dsiyb1" data-start="894" data-end="919"> Autonomic dysfunction</li> <li data-section-id="16zpexh" data-start="920" data-end="945"> Sensory abnormalities</li> <li data-section-id="1wvmj1i" data-start="946" data-end="975">Motor and trophic changes</li> </ul> <hr data-start="977" data-end="980" /> <h2 data-section-id="1f1m0ve" data-start="982" data-end="998">📋 CRPS Types</h2> <h3 data-section-id="1hqfhtx" data-start="1000" data-end="1015"> CRPS Type I</h3> <ul data-start="1016" data-end="1087"> <li data-section-id="ism8gz" data-start="1016" data-end="1045">No confirmed nerve injury</li> <li data-section-id="1k6fwp6" data-start="1046" data-end="1087"> Formerly "Reflex Sympathetic Dystrophy"</li> </ul> <h3 data-section-id="1whi12k" data-start="1089" data-end="1105"> CRPS Type II</h3> <ul data-start="1106" data-end="1155"> <li data-section-id="1o36siq" data-start="1106" data-end="1132"> Confirmed nerve injury</li> <li data-section-id="8ca3ln" data-start="1133" data-end="1155"> Formerly "Causalgia"</li> </ul> <hr data-start="1157" data-end="1160" /> <h2 data-section-id="1qr0541" data-start="1162" data-end="1183">⚠️ Pathophysiology</h2> <p data-start="1185" data-end="1199">CRPS involves:</p> <ul data-start="1201" data-end="1339"> <li data-section-id="18hvfy4" data-start="1201" data-end="1229"> Peripheral sensitization</li> <li data-section-id="10qzh3n" data-start="1230" data-end="1255"> Central sensitization</li> <li data-section-id="1uidn2t" data-start="1256" data-end="1283"> Sympathetic dysfunction</li> <li data-section-id="ltbhcs" data-start="1284" data-end="1311"> Neurogenic inflammation</li> <li data-section-id="h3eb49" data-start="1312" data-end="1339"> Cortical reorganization</li> </ul> <hr data-start="1341" data-end="1344" /> <h2 data-section-id="4nu1j" data-start="1346" data-end="1380">🩺 High-Yield Clinical Features</h2> <ul data-start="1382" data-end="1521"> <li data-section-id="x9kwdx" data-start="1382" data-end="1398"> Burning pain</li> <li data-section-id="1ebrmjh" data-start="1399" data-end="1412"> Allodynia</li> <li data-section-id="dklgne" data-start="1413" data-end="1429"> Hyperalgesia</li> <li data-section-id="10yxa45" data-start="1430" data-end="1455"> Temperature asymmetry</li> <li data-section-id="pyd5a7" data-start="1456" data-end="1478">Skin color changes</li> <li data-section-id="1rk2f28" data-start="1479" data-end="1488"> Edema</li> <li data-section-id="1e66mda" data-start="1489" data-end="1521"> Weakness and trophic changes</li> </ul> <hr data-start="1523" data-end="1526" /> <h2 data-section-id="oprs0u" data-start="1528" data-end="1568">📚 Budapest Criteria (BOARD FAVORITE)</h2> <p data-start="1570" data-end="1589">Diagnosis requires:</p> <ul data-start="1590" data-end="1693"> <li data-section-id="1md483k" data-start="1590" data-end="1636"> Continuing pain disproportionate to injury</li> <li data-section-id="1bdkou5" data-start="1637" data-end="1666"> Symptoms in ≥3 categories</li> <li data-section-id="197lxbi" data-start="1667" data-end="1693"> Signs in ≥2 categories</li> </ul> <hr data-start="1695" data-end="1698" /> <h2 data-section-id="eomtue" data-start="1700" data-end="1715">💊 Treatment</h2> <h3 data-section-id="8ki8pr" data-start="1717" data-end="1731"> First-Line</h3> <ul data-start="1732" data-end="1792"> <li data-section-id="kraxmk" data-start="1732" data-end="1769"> Physical therapy (MOST important)</li> <li data-section-id="1cseaio" data-start="1770" data-end="1792"> Early mobilization</li> </ul> <h3 data-section-id="1xldixa" data-start="1794" data-end="1809"> Medications</h3> <ul data-start="1810" data-end="1848"> <li data-section-id="3l8jk5" data-start="1810" data-end="1824"> Gabapentin</li> <li data-section-id="cs8og1" data-start="1825" data-end="1839"> Pregabalin</li> <li data-section-id="6go7al" data-start="1840" data-end="1848"> TCAs</li> </ul> <h3 data-section-id="1fzk3vy" data-start="1850" data-end="1868"> Interventional</h3> <ul data-start="1869" data-end="1919"> <li data-section-id="14nb6gz" data-start="1869" data-end="1891"> Sympathetic blocks</li> <li data-section-id="weshgc" data-start="1892" data-end="1919"> Spinal cord stimulation</li> </ul> <hr data-start="1921" data-end="1924" /> <h2 data-section-id="qx11f7" data-start="1926" data-end="1944">🚨 Board Pearls</h2> <ul data-start="1946" data-end="2063"> <li data-section-id="nb4wu7" data-start="1946" data-end="1983"> Early treatment improves outcomes</li> <li data-section-id="10i966h" data-start="1984" data-end="2027"> CRPS may spread beyond the initial site</li> <li data-section-id="1vpc5pw" data-start="2028" data-end="2063"> Immobilization worsens symptoms</li> </ul> <hr data-start="2065" data-end="2068" /> <h1 data-section-id="15yw56m" data-start="2070" data-end="2130">💉 Topic 2: Intrathecal Drug Delivery Systems (Pain Pumps)</h1> <h2 data-section-id="1igbaqz" data-start="2132" data-end="2165">🔬 What Are Intrathecal Pumps?</h2> <p data-start="2167" data-end="2237">Intrathecal pumps deliver medications directly into the CSF, allowing:</p> <ul data-start="2238" data-end="2317"> <li data-section-id="1ybaqei" data-start="2238" data-end="2262"> Lower systemic doses</li> <li data-section-id="1aiy65f" data-start="2263" data-end="2283"> Better analgesia</li> <li data-section-id="1mn9xoc" data-start="2284" data-end="2317"> Reduced systemic side effects</li> </ul> <hr data-start="2319" data-end="2322" /> <h2 data-section-id="1mkofw1" data-start="2324" data-end="2341">🎯 Indications</h2> <ul data-start="2343" data-end="2486"> <li data-section-id="12ujs14" data-start="2343" data-end="2375"> Failed back surgery syndrome</li> <li data-section-id="19sbpl2" data-start="2376" data-end="2391"> Cancer pain</li> <li data-section-id="1tprsnf" data-start="2392" data-end="2423"> Refractory neuropathic pain</li> <li data-section-id="pj3e1c" data-start="2424" data-end="2486"> Severe chronic pain not responsive to conservative therapy</li> </ul> <hr data-start="2488" data-end="2491" /> <h2 data-section-id="1f6wpc0" data-start="2493" data-end="2529">💊 Common Intrathecal Medications</h2> <h3 data-section-id="bv1x0h" data-start="2531" data-end="2542"> Opioids</h3> <ul data-start="2543" data-end="2573"> <li data-section-id="188wgrm" data-start="2543" data-end="2555"> Morphine</li> <li data-section-id="1ex4cto" data-start="2556" data-end="2573"> Hydromorphone</li> </ul> <h3 data-section-id="p7mfe8" data-start="2575" data-end="2589"> Non-Opioid</h3> <ul data-start="2590" data-end="2604"> <li data-section-id="1hi1aei" data-start="2590" data-end="2604"> Ziconotide</li> </ul> <h3 data-section-id="6zq5lu" data-start="2606" data-end="2615"> Other</h3> <ul data-start="2616" data-end="2639"> <li data-section-id="1vb91vw" data-start="2616" data-end="2639"> Baclofen (spasticity)</li> </ul> <hr data-start="2641" data-end="2644" /> <h2 data-section-id="1b35baq" data-start="2646" data-end="2687">⚠️ Ziconotide — HIGH-YIELD BOARD PEARL</h2> <p data-start="2689" data-end="2700">Ziconotide:</p> <ul data-start="2701" data-end="2816"> <li data-section-id="oqdoo5" data-start="2701" data-end="2735"> Blocks N-type calcium channels</li> <li data-section-id="f8qfch" data-start="2736" data-end="2777">Does NOT cause respiratory depression</li> <li data-section-id="1lf50dr" data-start="2778" data-end="2816">Can cause psychiatric side effects</li> </ul> <hr data-start="2818" data-end="2821" /> <h2 data-section-id="1nwevew" data-start="2823" data-end="2848">⚠️ Major Complications</h2> <ul data-start="2850" data-end="2967"> <li data-section-id="1p7i3n7" data-start="2850" data-end="2863"> Infection</li> <li data-section-id="1gx2qk2" data-start="2864" data-end="2888"> Catheter malfunction</li> <li data-section-id="j2ap74" data-start="2889" data-end="2905">Pump failure</li> <li data-section-id="1eypu9t" data-start="2906" data-end="2930"> Withdrawal syndromes</li> <li data-section-id="8mg75n" data-start="2931" data-end="2967"> Catheter-tip granuloma formation</li> </ul> <hr data-start="2969" data-end="2972" /> <h2 data-section-id="1q0zfq3" data-start="2974" data-end="2999">🚨 Granuloma Formation</h2> <p data-start="3001" data-end="3041">High-dose intrathecal opioids may cause:</p> <ul data-start="3042" data-end="3123"> <li data-section-id="1ig62fr" data-start="3042" data-end="3078"> Catheter-tip inflammatory masses</li> <li data-section-id="jocjjw" data-start="3079" data-end="3099">Cord compression</li> <li data-section-id="nfr8di" data-start="3100" data-end="3123"> Neurologic deficits</li> </ul> <hr data-start="3125" data-end="3128" /> <h2 data-section-id="ryqzw1" data-start="3130" data-end="3144">📋 Trialing</h2> <p data-start="3146" data-end="3173">Patients typically undergo:</p> <ul data-start="3174" data-end="3219"> <li data-section-id="5er0jx" data-start="3174" data-end="3189"> Bolus trial</li> <li data-section-id="5jdy2w" data-start="3190" data-end="3219"> Continuous infusion trial</li> </ul> <p data-start="3221" data-end="3251">before permanent implantation.</p> <hr data-start="3253" data-end="3256" /> <h2 data-section-id="1703gt1" data-start="3258" data-end="3276">🎯 Board Pearls</h2> <ul data-start="3278" data-end="3431"> <li data-section-id="8fueyu" data-start="3278" data-end="3320"> Ziconotide = no respiratory depression</li> <li data-section-id="1g8du30" data-start="3321" data-end="3375"> Pump failure can cause life-threatening withdrawal</li> <li data-section-id="x7sxa2" data-start="3376" data-end="3431"> Granulomas are associated with opioid concentration</li> </ul> <hr data-start="3433" data-end="3436" /> <h1 data-section-id="17emh38" data-start="3438" data-end="3469">📝 High-Yield Board Takeaways</h1> <h2 data-section-id="1xvzdp3" data-start="3471" data-end="3478"> CRPS</h2> <ul data-start="3479" data-end="3574"> <li data-section-id="nran8t" data-start="3479" data-end="3511"> Budapest criteria = critical</li> <li data-section-id="1lj0esr" data-start="3512" data-end="3537"> Early PT = first-line</li> <li data-section-id="z6vp4c" data-start="3538" data-end="3574"> Autonomic dysfunction = hallmark</li> </ul> <hr data-start="3576" data-end="3579" /> <h2 data-section-id="ayvvvd" data-start="3581" data-end="3601"> Intrathecal Pumps</h2> <ul data-start="3602" data-end="3709"> <li data-section-id="1ewumev" data-start="3602" data-end="3635"> Ziconotide is highly testable</li> <li data-section-id="1tefh9h" data-start="3636" data-end="3660"> Know granuloma risks</li> <li data-section-id="15j2j1l" data-start="3661" data-end="3709"> Understand pump complications and withdrawal</li> </ul> <hr data-start="3711" data-end="3714" /> <h1 data-section-id="1d3wdor" data-start="3716" data-end="3746">🎓 Pain Board Prep Resources</h1> <p data-start="3748" data-end="3795">Prepare for your ABA Pain Medicine boards with:</p> <p data-start="3797" data-end="3848">👉 <a class="decorated-link" href="https://painexam.com/" target="_new" rel="noopener" data-start="3800" data-end= "3820">https://painexam.com</a><br data-start="3820" data-end= "3823" /> 👉 <a class="decorated-link" href="https://nrappain.org/" target= "_new" rel="noopener" data-start="3826" data-end= "3846">https://nrappain.org</a></p> <hr data-start="3850" data-end="3853" /> <h1 data-section-id="1qm1w1j" data-start="3855" data-end="3919">🏆 Why Physicians Choose <span class="whitespace-normal">NRAP Academy</span></h1> <ul data-start="3921" data-end="4067"> <li data-section-id="1mod615" data-start="3921" data-end="3949"> Comprehensive board prep</li> <li data-section-id="jbiu7u" data-start="3950" data-end="3969"> High-yield MCQs</li> <li data-section-id="wwtj52" data-start="3970" data-end="3997"> Virtual Pain Fellowship</li> <li data-section-id="1h1v2j4" data-start="3998" data-end="4033"> Ultrasound-guided pain training</li> <li data-section-id="19dxiho" data-start="4034" data-end="4067"> Interventional pain education</li> </ul> <hr data-start="4069" data-end="4072" /> <h1 data-section-id="1rzucu2" data-start="4074" data-end="4096">🎤 Upcoming Training</h1> <p data-start="4098" data-end="4112">Join upcoming:</p> <ul data-start="4113" data-end="4219"> <li data-section-id="h55rwd" data-start="4113" data-end="4154"> Ultrasound-guided procedure workshops</li> <li data-section-id="z84plt" data-start="4155" data-end="4188"> Regenerative medicine courses</li> <li data-section-id="wxzdoz" data-start="4189" data-end="4219">Pain board review sessions</li> </ul> <hr data-start="4221" data-end="4224" /> <h1 data-section-id="10n2866" data-start="4226" data-end="4245"> 📢Register today!</h1> <p data-start="4247" data-end="4365">If you're serious about:<br /> ✅ Passing your pain boards<br data-start="4298" data-end="4301" /> ✅ Mastering interventional pain<br data-start="4332" data-end= "4335" /> ✅ Improving patient outcomes</p> <p data-start="4367" data-end="4438">Subscribe to the PainExam Podcast and join the Virtual Pain Fellowship.</p> <p data-start="4440" data-end="4491">👉 <a class="decorated-link" href="https://nrappain.org/" target="_new" rel="noopener" data-start="4443" data-end= "4463">https://nrappain.org</a><br data-start="4463" data-end= "4466" /> 👉 <a class="decorated-link" href="https://painexam.com/" target= "_new" rel="noopener" data-start="4469" data-end= "4489">https://painexam.com</a></p> <p>Reference </p> <p><a href= "https://dontforgetthebubbles.com/complex-regional-pain-syndrome/">https://dontforgetthebubbles.com/complex-regional-pain-syndrome/</a></p> <p>https://www.ncbi.nlm.nih.gov/books/NBK459151/</p>

Episode thumbnail for Corticosteroids & Contrast Agents for the Pain Boards

April 29, 2026

Corticosteroids & Contrast Agents for the Pain Boards

<hr data-start="318" data-end="321" /> <h1 data-section-id="lyirlh" data-start="323" data-end="358">🎙️ PainExam Podcast Show Notes</h1> <h2 data-section-id="1wgzixe" data-start="359" data-end="450"> Corticosteroids & Contrast Agents in Pain Management + Evidence-Based Steroid Selection</h2> <hr data-start="452" data-end="455" /> <h2 data-section-id="nfqegv" data-start="457" data-end="479">🔥 Episode Overview</h2> <p data-start="481" data-end="611">In this high-yield episode of the PainExam Podcast, <span class="whitespace-normal">David Rosenblum</span> breaks down a <strong data-start="585" data-end= "610">must-know board topic</strong>:</p> <p data-start="613" data-end="697">👉 Injectable corticosteroids vs contrast agents in interventional pain procedures</p> <p data-start="699" data-end="746">This episode goes beyond basics and dives into:</p> <ul data-start="748" data-end="1104"> <li data-section-id="8o8fu6" data-start="748" data-end="795"> <strong data-start="750" data-end="793">Particulate vs non-particulate steroids</strong></li> <li data-section-id="1dtj0o8" data-start="796" data-end="895"> Comparative profiles of <strong data-start="822" data-end= "893">dexamethasone, betamethasone, triamcinolone, and methylprednisolone</strong></li> <li data-section-id="1ysxnpg" data-start="896" data-end="939"> <strong data-start="898" data-end="937">Contrast agent selection and safety</strong></li> <li data-section-id="s41c1" data-start="940" data-end="1011"> Critical complications including <strong data-start="975" data-end= "1009">embolization and neurotoxicity</strong></li> <li data-section-id="1r27j71" data-start="1012" data-end="1104">A <strong data-start="1016" data-end="1102">recent study comparing steroid effectiveness in transforaminal epidural injections</strong></li> </ul> <p data-start="1106" data-end="1236">This is essential for physicians preparing for the <strong data-start="1157" data-end= "1185">ABA Pain Medicine boards</strong> and for clinicians performing spine interventions.</p> <hr data-start="1238" data-end="1241" /> <h2 data-section-id="17v1nr4" data-start="1243" data-end="1261">🧠 Core Concept</h2> <ul data-start="1263" data-end="1401"> <li data-section-id="pia4gv" data-start="1263" data-end="1322"> <strong data-start="1265" data-end="1320">Corticosteroids = therapeutic (reduce inflammation)</strong></li> <li data-section-id="sm8gsf" data-start="1323" data-end="1401"> <strong data-start="1325" data-end="1399">Contrast agents = diagnostic + safety tools (confirm needle placement)</strong></li> </ul> <p data-start="1403" data-end="1478">👉 Board pearl:<br data-start= "1418" data-end="1421" /> <strong data-start="1421" data-end="1478">Steroids treat pain — contrast prevents complications</strong></p> <hr data-start="1480" data-end="1483" /> <h2 data-section-id="1vt7oj0" data-start="1485" data-end="1530">💉 Corticosteroids — High-Yield Comparison</h2> <h3 data-section-id="165d2x8" data-start="1532" data-end="1548">🔬 Mechanism</h3> <ul data-start="1549" data-end="1646"> <li data-section-id="xdhdg3" data-start="1549" data-end="1577"> Inhibit phospholipase A2</li> <li data-section-id="1rytyej" data-start="1578" data-end="1611"> Reduce inflammatory mediators</li> <li data-section-id="uqnanj" data-start="1612" data-end="1646"> Decrease nerve root irritation</li> </ul> <hr data-start="1648" data-end="1651" /> <h3 data-section-id="1qksway" data-start="1653" data-end="1681">⚖️ Key Steroids Compared</h3> <div class="TyagGW_tableContainer"> <div class="group TyagGW_tableWrapper flex flex-col-reverse w-fit" tabindex="-1"> <table class="w-fit min-w-(--thread-content-width)" data-start= "1683" data-end="2196"> <thead data-start="1683" data-end="1749"> <tr data-start="1683" data-end="1749"> <th class="" data-start="1683" data-end="1693" data-col-size="sm"> Steroid</th> <th class="" data-start="1693" data-end="1700" data-col-size="sm"> Type</th> <th class="" data-start="1700" data-end="1719" data-col-size="sm"> Particle Profile</th> <th class="" data-start="1719" data-end="1735" data-col-size="sm"> Key Advantage</th> <th class="" data-start="1735" data-end="1749" data-col-size="sm"> Major Risk</th> </tr> </thead> <tbody data-start="1812" data-end="2196"> <tr data-start="1812" data-end="1911"> <td data-start="1812" data-end="1828" data-col-size="sm"> Dexamethasone</td> <td data-col-size="sm" data-start="1828" data-end="1846"> Non-particulate</td> <td data-col-size="sm" data-start="1846" data-end="1863">No aggregation</td> <td data-col-size="sm" data-start="1863" data-end="1882">Safest for TFESI</td> <td data-col-size="sm" data-start="1882" data-end="1911">Possibly shorter duration</td> </tr> <tr data-start="1912" data-end="2004"> <td data-start="1912" data-end="1928" data-col-size="sm"> Triamcinolone</td> <td data-col-size="sm" data-start="1928" data-end="1942"> Particulate</td> <td data-col-size="sm" data-start="1942" data-end="1960">Large particles</td> <td data-col-size="sm" data-start="1960" data-end="1982">Longer depot effect</td> <td data-col-size="sm" data-start="1982" data-end="2004">Embolic infarction</td> </tr> <tr data-start="2005" data-end="2107"> <td data-start="2005" data-end="2026" data-col-size="sm"> Methylprednisolone</td> <td data-col-size="sm" data-start="2026" data-end="2040"> Particulate</td> <td data-col-size="sm" data-start="2040" data-end="2053"> Aggregates</td> <td data-col-size="sm" data-start="2053" data-end="2080">Strong anti-inflammatory</td> <td data-col-size="sm" data-start="2080" data-end="2107">Avoid in cervical TFESI</td> </tr> <tr data-start="2108" data-end="2196"> <td data-start="2108" data-end="2124" data-col-size="sm"> Betamethasone</td> <td data-col-size="sm" data-start="2124" data-end="2132">Mixed</td> <td data-col-size="sm" data-start="2132" data-end="2157">Depends on formulation</td> <td data-col-size="sm" data-start="2157" data-end="2166"> Potent</td> <td data-col-size="sm" data-start="2166" data-end="2196">Acetate = particulate risk</td> </tr> </tbody> </table> </div> </div> <hr data-start="2198" data-end="2201" /> <h3 data-section-id="lrr3ca" data-start="2203" data-end="2229">🚨 Major Steroid Risks</h3> <p data-start="2231" data-end="2241"><strong data-start="2231" data-end="2241">Local:</strong></p> <ul data-start="2242" data-end="2279"> <li data-section-id="1svdyb0" data-start="2242" data-end="2260"> Tissue atrophy</li> <li data-section-id="1hws2yg" data-start="2261" data-end="2279"> Depigmentation</li> </ul> <p data-start="2281" data-end="2294"><strong data-start="2281" data-end="2294">Systemic:</strong></p> <ul data-start="2295" data-end="2358"> <li data-section-id="xnnt9r" data-start="2295" data-end="2312"> Hyperglycemia</li> <li data-section-id="7l1528" data-start="2313" data-end="2336"> Adrenal suppression</li> <li data-section-id="zodbpo" data-start="2337" data-end="2358"> Immunosuppression</li> </ul> <p data-start="2360" data-end="2392"><strong data-start="2360" data-end="2392">Catastrophic (Board Tested):</strong></p> <ul data-start="2393" data-end="2430"> <li data-section-id="uxiv9y" data-start="2393" data-end="2419"> Spinal cord infarction</li> <li data-section-id="1e8g6n0" data-start="2420" data-end="2430"> Stroke</li> </ul> <p data-start="2432" data-end="2497">👉 Caused by <strong data-start="2445" data-end="2497">intra-arterial injection of particulate steroids</strong></p> <hr data-start="2499" data-end="2502" /> <h2 data-section-id="d8jvvu" data-start="2504" data-end="2545">📊 Contrast Agents — High-Yield Review</h2> <h3 data-section-id="w3geap" data-start="2547" data-end="2564"> Common Agents</h3> <ul data-start="2565" data-end="2649"> <li data-section-id="de0iz0" data-start="2565" data-end="2592"> <strong data-start="2567" data-end="2590">Iohexol (Omnipaque)</strong></li> <li data-section-id="rllda" data-start="2593" data-end="2619"> <strong data-start="2595" data-end="2617">Iopamidol (Isovue)</strong></li> <li data-section-id="1aaxfxf" data-start="2620" data-end="2649"> <strong data-start="2622" data-end="2647">Iodixanol (Visipaque)</strong></li> </ul> <hr data-start="2651" data-end="2654" /> <h3 data-section-id="bkk1bf" data-start="2656" data-end="2670">🎯 Purpose</h3> <ul data-start="2672" data-end="2769"> <li data-section-id="1jrbr4g" data-start="2672" data-end="2700"> Confirm needle placement</li> <li data-section-id="1erwe8l" data-start="2701" data-end="2735"> Detect intravascular injection</li> <li data-section-id="1cngxd2" data-start="2736" data-end="2769"> Prevent intrathecal injection</li> </ul> <hr data-start="2771" data-end="2774" /> <h3 data-section-id="1arx72x" data-start="2776" data-end="2788">⚠️ Risks</h3> <ul data-start="2790" data-end="2860"> <li data-section-id="1ckjymy" data-start="2790" data-end="2811"> Allergic reaction</li> <li data-section-id="1qp3z7s" data-start="2812" data-end="2827"> Anaphylaxis</li> <li data-section-id="1p40z49" data-start="2828" data-end="2860"> Contrast-induced nephropathy</li> </ul> <p data-start="2862" data-end="2920">👉 Board pearl:<br data-start= "2877" data-end="2880" /> <strong data-start="2880" data-end="2920">Shellfish allergy ≠ contrast allergy</strong></p> <hr data-start="2922" data-end="2925" /> <h2 data-section-id="19kae1d" data-start="2927" data-end="2966">⚠️ Critical Safety Topic: Gadolinium</h2> <p data-start="2968" data-end="3005">Gadolinium-based contrast agents are:</p> <p data-start="3007" data-end="3123">❌ NOT approved for epidural or intrathecal use<br data-start="3053" data-end="3056" /> ❌ NOT safe substitutes for iodinated contrast in spine procedures</p> <hr data-start="3125" data-end="3128" /> <h3 data-section-id="i94ehv" data-start="3130" data-end="3165">🚨 Intrathecal Gadolinium Risks</h3> <ul data-start="3167" data-end="3233"> <li data-section-id="cojfe3" data-start="3167" data-end="3185"> Encephalopathy</li> <li data-section-id="2f9gkc" data-start="3186" data-end="3198"> Seizures</li> <li data-section-id="ucuvqj" data-start="3199" data-end="3223"> Respiratory distress</li> <li data-section-id="1nd295g" data-start="3224" data-end="3233"> Death</li> </ul> <p data-start="3235" data-end="3274">👉 Extremely high-yield board concept</p> <hr data-start="3276" data-end="3279" /> <h2 data-section-id="1vuhb56" data-start="3281" data-end="3318">📚 Evidence-Based Medicine Segment</h2> <h3 data-section-id="1xg59yp" data-start="3320" data-end="3364"> Study Review: Steroid Selection in TFESI</h3> <p data-start="3366" data-end="3391">A recent study comparing:</p> <ul data-start="3393" data-end="3451"> <li data-section-id="1pl4bsi" data-start="3393" data-end="3410"> Dexamethasone</li> <li data-section-id="171pyah" data-start="3411" data-end="3433"> Methylprednisolone</li> <li data-section-id="1ozkraw" data-start="3434" data-end="3451"> Betamethasone</li> </ul> <hr data-start="3453" data-end="3456" /> <h3 data-section-id="165ehez" data-start="3458" data-end="3477">🔑 Key Findings</h3> <ul data-start="3479" data-end="3655"> <li data-section-id="1t8w24" data-start="3479" data-end="3537"> <strong data-start="3481" data-end="3535">Dexamethasone showed comparable or better outcomes</strong></li> <li data-section-id="19c0err" data-start="3538" data-end="3584">No clear advantage of particulate steroids</li> <li data-section-id="166rdvd" data-start="3585" data-end="3655"> Similar rates of: <ul data-start="3607" data-end="3655"> <li data-section-id="kp0wpn" data-start="3607" data-end="3628"> Repeat injections</li> <li data-section-id="1f59nvt" data-start="3631" data-end="3655"> Surgical progression</li> </ul> </li> </ul> <hr data-start="3657" data-end="3660" /> <h3 data-section-id="15m0m0l" data-start="3662" data-end="3689">🎯 Clinical Implication</h3> <p data-start="3691" data-end="3791">👉 Efficacy differences are smaller than previously thought<br data-start="3750" data-end= "3753" /> 👉 Safety is driving practice change</p> <hr data-start="3793" data-end="3796" /> <h3 data-section-id="he8nuv" data-start="3798" data-end="3825">🚨 Board-Level Takeaway</h3> <ul data-start="3827" data-end="3933"> <li data-section-id="r2qyld" data-start="3827" data-end="3863"> Non-particulate steroids = safer</li> <li data-section-id="1s449yw" data-start="3864" data-end="3886"> Outcomes ≈ similar</li> <li data-section-id="1keda3n" data-start="3887" data-end="3933"> Technique matters more than steroid choice</li> </ul> <p data-start="3935" data-end="3983">👉 <strong data-start="3938" data-end="3983">Best exam answer: dexamethasone for TFESI</strong></p> <hr data-start="3985" data-end="3988" /> <h2 data-section-id="1l6bu9j" data-start="3990" data-end="4014">🎯 Board Prep Summary</h2> <ul data-start="4016" data-end="4266"> <li data-section-id="rbvv5t" data-start="4016" data-end="4072"> Dexamethasone = safest for transforaminal injections</li> <li data-section-id="1xx6y8w" data-start="4073" data-end="4112"> Particulate steroids = embolic risk</li> <li data-section-id="8lfgx5" data-start="4113" data-end="4163"> Contrast must be used before steroid injection</li> <li data-section-id="33trb6" data-start="4164" data-end="4209"> Gadolinium = dangerous in neuraxial space</li> <li data-section-id="19ln4nj" data-start="4210" data-end="4266"> Clinical outcomes often similar across steroid types</li> </ul> <hr data-start="4268" data-end="4271" /> <h2 data-section-id="esdsso" data-start="4273" data-end="4304">🎓 Pain Board Prep Resources</h2> <p data-start="4306" data-end="4353">Prepare for your ABA Pain Medicine boards with:</p> <p data-start="4355" data-end="4406">👉 <a class="decorated-link" href="https://painexam.com/" target="_new" rel="noopener" data-start="4358" data-end= "4378">https://painexam.com</a><br data-start="4378" data-end= "4381" /> 👉 <a class="decorated-link" href="https://nrappain.org/" target= "_new" rel="noopener" data-start="4384" data-end= "4404">https://nrappain.org</a></p> <hr data-start="4408" data-end="4411" /> <h2 data-section-id="a3t7sk" data-start="4413" data-end="4478">🏆 Why Physicians Choose <span class="whitespace-normal">NRAP Academy</span></h2> <ul data-start="4480" data-end="4640"> <li data-section-id="1q2nw8v" data-start="4480" data-end="4515"> High-yield board review content</li> <li data-section-id="6fwl4w" data-start="4516" data-end="4537"> Thousands of MCQs</li> <li data-section-id="wwtj52" data-start="4538" data-end="4565"> Virtual Pain Fellowship</li> <li data-section-id="1m8e8wt" data-start="4566" data-end="4604"> Ultrasound + regenerative training</li> <li data-section-id="8rbbcc" data-start="4605" data-end="4640"> Real-world clinical integration</li> </ul> <p><a href="https://www.nrappain.org" target="_blank" rel= "noopener">Register Today!</a></p> <hr data-start="4642" data-end="4645" /> <h2 data-section-id="1r9jgjd" data-start="4647" data-end="4670">🎤 Upcoming Training</h2> <ul data-start="4672" data-end="4783"> <li data-section-id="t5ssdq" data-start="4672" data-end="4709"> Ultrasound-guided pain procedures</li> <li data-section-id="12ok39j" data-start="4710" data-end="4760"> Regenerative medicine courses (PRP, biologics)</li> <li data-section-id="1hkksn6" data-start="4761" data-end="4783"> Hands-on workshops</li> </ul> <p><a href= "https://www.eventbrite.com/cc/ultrasound-guided-regional-anesthesia-pain-med-351559?utm-campaign=social&utm-content=creatorshare&utm-medium=discovery&utm-term=odclsxcollection&utm-source=cp&aff=escb" target="_blank" rel="noopener">Register Today!</a></p> <hr data-start="4785" data-end="4788" /> <h2 data-section-id="ymhwsd" data-start="4790" data-end="4810">📢 Call to Action</h2> <p data-start="4812" data-end="4906">If you're serious about passing your boards and practicing safer interventional pain medicine:</p> <p data-start="4908" data-end="5013">✅ Subscribe to the PainExam Podcast<br data-start="4943" data-end="4946" /> ✅ Join the Virtual Pain Fellowship<br data-start="4980" data-end= "4983" /> ✅ Visit <a class="decorated-link" href="https://nrappain.org/" target="_new" rel="noopener" data-start="4991" data-end= "5011">https://nrappain.org</a></p> <p data-start="5040" data-end="5238"> </p> <p>References</p> <p>Calvo N, Jamil M, Feldman S, Shah A, Nauman F, Ferrara J. Neurotoxicity from intrathecal gadolinium administration: Case presentation and brief review. Neurol Clin Pract. 2020 Feb;10(1):e7-e10. doi: 10.1212/CPJ.0000000000000696. PMID: 32190427; PMCID: PMC7057078.</p> <p>Moreira, Alexandra M., et al. "Comparing the effectiveness and safety of dexamethasone, methylprednisolone and betamethasone in lumbar transforaminal epidural steroid injections." Pain physician 27.5 (2024): 341.</p>

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David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians.

Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com

Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery.

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