PainExam Podcast

🎙️ PainExam Podcast & Video Show Notes
Facet-Mediated Pain, RFA, and Advanced Interventional Strategies
🔥 Episode Overview
In this episode of the PainExam Podcast, David Rosenblum delivers a high-yield, board-focused deep dive into:
Lumbar, cervical, and thoracic facet-mediated pain
Medial branch blocks (MBB) and radiofrequency ablation (RFA)
Key Medicare / LCD criteria for performing procedures
Advanced therapies including multifidus stimulation and regenerative medicine (PRP)
This episode is essential for pain physicians preparing for the ABA, ABPM, ABIPP, and FIPP board exams — and for those looking to refine their interventional practice.
🧠 Key Topics Covered
🦴 Facet-Mediated Pain (Lumbar, Cervical, Thoracic)
Axial, non-radicular pain
Worse with extension and rotation
Cervical facet pain → often post-whiplash
Thoracic facet pain → underdiagnosed
🔬 High-Yield Anatomy & Innervation
Dual innervation of facet joints
L5–S1 facet → L5 dorsal ramus (board favorite)
C2–3 facet → third occipital nerve
💉 Diagnosis & Medicare Criteria
Gold standard: Medial branch blocks (NOT imaging)
Medicare requires: Chronic pain ≥ 3 months
Failed conservative therapy
Two diagnostic blocks with ≥80% relief

⚡ Interventional Treatment
Radiofrequency ablation (RFA) 6–12 month relief
Repeatable

Proper needle placement and stimulation techniques
🚀 Advanced & Emerging Therapies
Multifidus stimulation Restores spinal stability
Treats underlying dysfunction

PRP / Regenerative Medicine Targets inflammation and tissue healing
Growing role in pain management

🎯 Board Prep Takeaways
Facet pain = axial + extension-based
Diagnosis = medial branch blocks
Know cervical vs lumbar differences
Medicare requires dual blocks before RFA
L5 dorsal ramus = high-yield exam concept
🎓 Pain Board Prep & CME Resources
If you're preparing for your boards or want to advance your clinical skills:
👉 Start your Pain Board Review: https://nrappain.org
👉 Access Question Banks, Lectures & Virtual Fellowship: https://nrappain.org
👉 PainExam Platform: https://painexam.com
🏆 Why Pain Physicians Choose NRAP Academy
Comprehensive ABA / ABPM / ABIPP / FIPP board prep
High-yield lectures + MCQs
Ultrasound-guided procedure training
Regenerative medicine education
Virtual Pain Fellowship curriculum
🎤 Upcoming Live Training & Conferences
Join Dr. Rosenblum at upcoming events:
ASPN 2026 Annual Meeting — Ultrasound & regenerative medicine labs
PainWeek 2026 — Lectures on: Image-guided interventions
Ultrasound integration
Regenerative pain therapies
AI in pain management

🔗 Connect & Learn More
🌐 NRAP Academy: https://nrappain.org
📚 PainExam Board Prep: https://painexam.com
🎥 YouTube: NRAP Academy
🎓 Courses: Ultrasound & Regenerative Medicine Training
📢 Call to Action
If you're serious about passing your pain boards and mastering interventional pain:
✅ Subscribe to the PainExam Podcast ✅ Join the Virtual Pain Fellowship ✅ Attend a live ultrasound or regenerative medicine course

🎙️ PainExam Podcast Show Notes
Phantom Limb Pain & Sacroiliac Joint Dysfunction — High-Yield Pain Board Review
🔥 Episode Overview
In this episode of the PainExam Podcast, David Rosenblum delivers a high-yield review of two must-know topics for the ABA Pain Medicine Board Certification exam:
Phantom Limb Pain — mechanisms, risk factors, and advanced treatment strategies
Sacroiliac (SI) Joint Dysfunction — diagnosis, provocative testing, and interventional management
Whether you're preparing for the ABA, ABPM, ABIPP, or FIPP boards, or looking to sharpen your clinical practice, this episode focuses on testable concepts, real-world applications, and interventional pearls.
👉 Explore full board prep and CME: PainExam.com
🧠 Topic 1: Phantom Limb Pain — Key Points
Phantom limb pain is a neuropathic pain syndrome following amputation, driven by both peripheral and central mechanisms.
High-Yield Pearls
Caused by cortical reorganization + central sensitization
Strongly associated with pre-amputation pain
Distinct from: Phantom sensation (non-painful)
Stump pain (localized)

Clinical Features
Burning, cramping, or electric pain
Perceived in the missing limb
May be triggered by stress or environmental factors
Treatment Strategies
First-line: gabapentinoids, TCAs
Advanced: ketamine, neuromodulation
Key non-pharmacologic therapy: mirror therapy
🚨 Board Pearl
Preemptive analgesia reduces the risk of phantom limb pain
🦴 Topic 2: Sacroiliac Joint Dysfunction — Key Points
SI joint dysfunction is a major cause of axial low back pain, accounting for up to 25% of cases.
High-Yield Pearls
Pain is typically: Unilateral
Buttock-dominant
Radiates to posterior thigh (rarely below knee)

Physical Exam
Positive provocative tests: FABER
Gaenslen
Thigh thrust
Compression

👉 3 or more positive tests = high diagnostic accuracy
Diagnosis
Confirmed with image-guided intra-articular injection
Imaging alone is NOT diagnostic
Treatment
Physical therapy
SI joint injections
Lateral branch RFA
SI joint fusion (refractory cases)
🚨 Board Pearl
Diagnostic SI joint injection is the gold standard
🎯 Board Prep Takeaways
Always distinguish central vs peripheral mechanisms in neuropathic pain
Know diagnostic confirmation strategies (blocks vs imaging)
Focus on first-line vs interventional escalation pathways
Understand procedure indications for boards
🎓 Upcoming Events & Live Training
🏆 ASPN 2026 Annual Meeting
Join Dr. Rosenblum for:
Ultrasound-guided peripheral nerve blocks
Spine interventions
Regenerative medicine techniques (PRP, biologics)
Hands-on procedural training
💉 Ultrasound-Guided Regenerative Medicine Course
Learn:
PRP injection techniques
Ultrasound-guided joint and nerve procedures
Real-world workflows for integrating regenerative medicine into your practice
👉 Hosted through NRAP Academy
🎤 PainWeek 2026 Lectures
Dr. Rosenblum will be presenting on:
Precision image-guided pain procedures
Ultrasound integration in clinical practice
Regenerative medicine in interventional pain
Future directions: AI and neuromodulation
🔗 Resources
🌐 Pain Board Review: PainExam.com
🎓 Courses & CME: NRAPPain.org
📺 YouTube: NRAP Academy
🧠 Question Bank + Virtual Fellowship: Available now
📢 Call to Action
If you're preparing for the pain boards or want to elevate your clinical skillset:
✅ Subscribe to the PainExam Podcast ✅ Join our Virtual Pain Fellowship ✅ Attend a live ultrasound or regenerative medicine course

PainExam Podcast Show Notes
Red Light Therapy (Photobiomodulation) for Pain
Evidence, Mechanisms, and Clinical Applications
Host: Dr. David Rosenblum
Red light therapy, also known as photobiomodulation (PBM) or low-level laser therapy (LLLT), is an emerging non-invasive treatment modality increasingly used in pain medicine, rehabilitation, and regenerative medicine practices.
In this episode of the PainExam Podcast, Dr. Rosenblum reviews the mechanisms, clinical evidence, indications, and safety considerations surrounding photobiomodulation therapy for pain.
Red and near-infrared wavelengths stimulate mitochondrial activity, increase ATP production, reduce inflammatory mediators, and promote tissue healing. These physiologic effects may translate into analgesic benefits for a variety of musculoskeletal and neuropathic pain conditions.
Clinical research suggests potential benefit in temporomandibular disorders, chronic neck pain, and inflammatory oral conditions, though results vary due to differences in dosing parameters and treatment protocols.
Despite these limitations, PBM has a favorable safety profile and is increasingly being integrated into multimodal pain management strategies.
Key Topics Covered
• What is photobiomodulation therapy (PBM) • How red and near-infrared light interact with mitochondria • Mechanisms of analgesia and tissue repair • Evidence from clinical trials in TMD, neck pain, and oral inflammatory pain • The biphasic dose response (Arndt-Schulz law) • Safety profile and contraindications • How PBM may integrate with regenerative pain medicine
Mechanism of Action
Photobiomodulation works primarily through stimulation of mitochondrial chromophores, particularly cytochrome c oxidase.
This leads to:
• Increased ATP production • Modulation of inflammatory cytokines • Increased angiogenesis and tissue repair • Reduced oxidative stress
These effects may improve pain, inflammation, and healing in certain musculoskeletal conditions.
Evidence Discussed in This Episode
Temporomandibular Disorders
Randomized trial demonstrating improvements in pain and mandibular function with red light therapy.
De Carvalho et al., Pain Research and Treatment (2019) https://onlinelibrary.wiley.com/doi/full/10.1155/2019/8578703
Chronic Neck Pain
Clinical trial demonstrating improvements in pain scores and pressure pain thresholds after photobiomodulation therapy.
Chen et al., Lasers in Medical Science (2022) https://link.springer.com/article/10.1007/s10103-022-03540-0
Oral Pain and Dental Inflammation
Randomized study demonstrating reduced pain and improved healing following PBM treatment.
Almeida et al., BMC Oral Health (2023) https://link.springer.com/article/10.1186/s12903-023-02784-8
Who May Benefit From Photobiomodulation?
Red light therapy may be considered as an adjunct treatment for:
• myofascial pain • cervical spine pain • temporomandibular disorder • tendinopathy • peripheral neuropathy • musculoskeletal injury recovery
Safety and Contraindications
Photobiomodulation has a very favorable safety profile.
Reported adverse effects are rare and usually mild:
• transient erythema • warmth at treatment site • headache • eye irritation without proper protection
Precautions include:
• avoiding direct retinal exposure • avoiding treatment over malignancy • avoiding application over the uterus during pregnancy • caution in photosensitive disorders
Resources
For Patients Seeking Treatment
Learn more about integrative and regenerative pain treatments including PRP, ultrasound-guided injections, and advanced pain therapies:
AABP Integrative Pain Care & Wellness https://www.AABPpain.com
For Pain Physicians and Advanced Practice Providers
Training in ultrasound, interventional pain procedures, and pain board preparation:
NRAP Academy CME Education https://www.NRAPpain.org

Dr. Rosenblum from NRAP Academy presented a webinar on the integration of regenerative medicine into pain practices, highlighting its benefits and applications. He discussed the evolution of treating pain, emphasizing the shift from neural blockade to addressing tissue health. Dave explained the use of PRP and BMAC in treating conditions like knee pain, and shared patient success stories. He addressed common misconceptions about regenerative medicine, including its cost and effectiveness. Dave also mentioned upcoming events and training opportunities in regenerative medicine.
 
Regenerative Medicine Pain Management Events
Dr. Rosenblum  announced his upcoming involvement in two significant events: a webinar on regenerative medicine for ASIPP and co-directing the ASPN Ultrasound and Regenerative Medicine Pain Workshop in Miami with Dr. Ali Valimoed. He encouraged attendees to register for these events, emphasizing their importance in the field of pain management. He also mentioned a previous lecture he gave on the integration of regenerative medicine into pain practices, though the recording was not successful.

Regenerative Medicine in Pain Practices
Dr. Rosenblum  discussed the integration of regenerative medicine into pain practices, emphasizing its importance in 2026 and beyond. He explained that traditional approaches like steroids and RFA only manage pain without addressing tissue health, using the knee as an example. He suggested combining visco supplements with regenerative techniques like PRP or BMAC to preserve joints in patients seeking alternatives to knee replacement. He noted that while other stem cell products are promising, more research is needed for wider adoption, and he plans to focus on PRP and BMAC for now.
Regenerative Medicine Patient Education
Dr. Rosenblum  discussed the importance of educating patients about regenerative medicine and pain treatment options. He explained that while regenerative treatments cannot fully reverse severe issues like meniscus damage, they can help heal and repair tissues, reduce inflammation, and improve function. He highlighted the growing demand for non-surgical, opiate-sparing solutions and mentioned the role of government and physician-led campaigns in addressing the opiate crisis.
PRP's Role in Chronic Pain Management
Dr. Rosenblum discussed the growing demand for alternative treatments to opioids and surgeries, highlighting the role of Platelet-Rich Plasma (PRP) in addressing chronic pain by modulating inflammation and stimulating tissue repair. He emphasized the importance of using high-quality PRP preparation methods, such as a double-spin kit, to achieve optimal results, and criticized studies claiming PRP's ineffectiveness, often due to poor preparation techniques. David also noted that effective PRP treatments can improve pain and function better than corticosteroids, and he expressed hope that patients would refer others, leading to business growth.
PRP Therapy: A Promising Alternative
Dr. Rosenblum discussed the effectiveness of PRP (platelet-rich plasma) therapy compared to steroids and viscosupplements in treating various musculoskeletal conditions. He cited a meta-analysis showing that PRP provided better relief than steroid and viscosupplement treatments for patients with moderate arthritis after one year. David also shared a recent case where he used PRP to treat coccydynia, a condition involving pain in the coccyx, and mentioned its potential use in treating other conditions such as radiculopathy and foraminal stenosis.
PRP Injection Treatment Flexibility
Dr. Rosenblum discussed a medical procedure involving PRP and lidocaine injections in various areas of the body, including the coccygeal ligaments, caudal space, and transforaminal spaces, to address pain and inflammation. He emphasized the importance of tailoring treatment to individual patients rather than adhering to insurance company guidelines, which can limit the number of injections given in a single session. David highlighted that when patients pay out-of-pocket, practitioners have more flexibility to effectively treat their conditions, potentially avoiding surgery or improving post-surgical outcomes.
PRP in Orthopedic Practice
Dr. Rosenblum shared his experience treating a patient with PRP for post-operative knee surgery, despite the orthopedic surgeon's skepticism. He discussed how regenerative medicine can enhance a practice by positioning it as innovative and attracting younger patients who prefer non-surgical treatments. David noted that while some orthopedic surgeons may refer patients for PRP, others might be hesitant due to potential decreases in surgical procedures. He also mentioned that primary care doctors may not be aware of the growing evidence supporting PRP's effectiveness and safety.
PRP: A Cost-Effective Alternative
Dr. Rosenblum discussed regenerative medicine, particularly PRP, highlighting its potential to avoid surgeries and improve patient satisfaction with an estimated 70% success rate. He emphasized the financial benefits for physicians, as it provides a cash stream with no need for prior authorizations or denials. David also addressed patient responsibility in healthcare costs, comparing the cost of regenerative treatments to other lifestyle expenses. He noted that while training is necessary, most interventional pain physicians possess the skills to administer PRP treatments.
PRP Treatment Success Stories
Dr. Rosenblum shared patient testimonials highlighting successful outcomes from PRP (platelet-rich plasma) treatments for various pain conditions, including shoulder, back, and neck issues. Patients reported significant improvements in pain relief and mobility, with some noting long-lasting effects beyond cortisone shots or surgery. David emphasized the importance of individualized treatment approaches and quality care, encouraging both patients and physicians to reach out for training and consultations. He concluded by inviting listeners to share the content with colleagues and patients, emphasizing the value of PRP treatments when done correctly.

Peptides in Pain Management: BPC-157, Risks, Reality, and the Business of Regenerative Medicine
Episode Length: ~12–15 minutes Target Audience: Pain physicians, anesthesiologists, PM&R, sports medicine, and regenerative medicine clinicians Hosted by: Dr. David Rosenblum, MD Produced by: PainExam | NRAP Academy
🧠 Episode Overview
Peptides like BPC-157 have exploded in popularity across regenerative medicine, sports medicine, and cash-based pain practices — but does the science support the hype?
In this episode of PainExam, Dr. David Rosenblum takes a critical, evidence-based look at BPC-157 and other peptidesin pain management, examining:
The biological rationale behind peptide therapy

Preclinical and early human evidence for pain and tissue healing

Regulatory status and safety concerns

Ethical, legal, and marketing risks for physicians

How peptides are currently being incorporated — and monetized — in pain practices

This episode is designed to help clinicians separate science from marketing, and to approach peptide therapies with appropriate caution and professionalism.
⏱️ Episode Breakdown
🔹 00:00–01:30 — Introduction
Why peptides are trending in pain and regenerative medicine

What patients are asking — and what physicians need to know

🔹 01:30–04:30 — What Is BPC-157?
Origins of Body Protection Compound-157

Mechanisms: angiogenesis, inflammation modulation, tissue repair

Summary of preclinical data and animal pain models

🔹 04:30–07:00 — Evidence for Pain Relief & Healing
Early inflammatory and non-inflammatory pain studies

Intra-articular BPC-157 for knee pain: what the case series showed

Why current human data are hypothesis-generating, not definitive

🔹 07:00–09:30 — Risks, Unknowns & Regulatory Issues
FDA status and investigational use

Quality, purity, and dosing variability

Theoretical biologic risks and drug interactions

🔹 09:30–12:30 — The Business of Peptides in Pain Practice
How peptides are marketed in regenerative clinics

Cash-based models and patient demand

Ethical marketing, informed consent, and medicolegal exposure

🔹 12:30–End — Clinical Takeaways
Where peptides fit — and don't fit — in current pain practice

Why evidence still matters in regenerative medicine

⚠️ Key Clinical Takeaways
BPC-157 shows promising preclinical data, but human evidence remains limited

Current studies lack randomization, controls, and long-term outcomes

Peptides are not FDA-approved for pain or musculoskeletal indications

Marketing peptides without transparency poses ethical and legal risk

Physicians must clearly distinguish experimental therapies from standard of care

📚 Key References Discussed
Józwiak et al. Multifunctionality and Possible Medical Application of BPC-157 — MDPI Pharmaceuticals (2025)

McGuire et al. Regeneration or Risk? A Narrative Review of BPC-157 — Current Reviews in Musculoskeletal Medicine (2025)

Sikirić et al. Effects of BPC-157 on Inflammatory and Non-Inflammatory Pain — Inflammopharmacology (1993)

Lee & Padgett. Intra-Articular Injection of BPC-157 for Knee Pain — Alternative Therapies in Health and Medicine (2021)

📢 Sponsored Message / Advertisement
🔔 Ready to Master Evidence-Based Pain Medicine?
If you're preparing for Pain Medicine boards or looking to strengthen your foundation in interventional and regenerative pain management, check out the educational resources at:
👉 https://www.nrappain.org
🎓 Offered through NRAP Academy:
✅ PainExam® Pain Management Board Review

✅ ABA, ABPM, FIPP, and ABIPP exam preparation

✅ Ultrasound-guided pain procedure training

✅ Regenerative pain medicine education — grounded in evidence, not hype

✅ Virtual Pain Fellowship curriculum

All content is designed by practicing pain physicians, for practicing pain physicians.
🎯 Why Learn with NRAP Academy?
Evidence-driven, board-relevant education

Practical clinical insights you can apply immediately

Trusted by physicians nationwide

Focused on ethical, safe, and effective pain care

👉 Explore courses and upcoming programs at https://www.nrappain.org
🎧 Subscribe & Stay Sharp
If you found this episode helpful:
Subscribe to the PainExam Podcast

Share it with a colleague

Leave a review to help other pain physicians find evidence-based content

Disclaimer: This podcast is for educational purposes only. Discussion of investigational therapies does not constitute endorsement or clinical recommendation. Physicians should follow applicable laws, regulations, and professional guidelines when considering experimental treatments.
 
References
Lee, Edwin, and Blake Padgett. "Intra-Articular Injection of BPC 157 for Multiple Types of Knee Pain." Alternative Therapies in Health & Medicine 27.4 (2021).
Józwiak, Michalina, et al. "Multifunctionality and Possible Medical Application of the BPC 157 Peptide—Literature and Patent Review." Pharmaceuticals 18.2 (2025): 185.
McGuire, F. P., Martinez, R., Lenz, A., Skinner, L., & Cushman, D. M. (2025). Regeneration or risk? A narrative review of BPC-157 for musculoskeletal healing. Current Reviews in Musculoskeletal Medicine, 18(12), 611-619.