PainExam Podcast

PainExam Podcast Show Notes
NAD+ Supplementation in Pain and Inflammation: Hype, Hope, or Emerging Science?
Hosted by: PainExam Podcast Presented by: NRAP Academy (Neuromodulation, Regional Anesthesia & Pain) Host: David Rosenblum, MD
Episode Overview
In this episode of the PainExam Podcast, we explore the growing interest in NAD+ (Nicotinamide Adenine Dinucleotide) supplementation and its potential role in pain management, inflammation reduction, cellular recovery, and healthy aging.
NAD+ is a naturally occurring coenzyme found in every living cell and is essential for energy production, mitochondrial function, DNA repair, and cellular resilience. As NAD+ levels decline with age, chronic stress, inflammation, and disease, researchers have begun investigating whether restoring NAD+ levels may improve outcomes in chronic pain conditions and inflammatory disorders.
We review the current science, discuss potential mechanisms of action, and examine how NAD+ therapy is being integrated into regenerative medicine, wellness programs, and pain management practices.
What is NAD+?
NAD+ is a coenzyme involved in:
✅ Cellular energy production (ATP generation)
✅ Mitochondrial health
✅ DNA repair pathways
✅ Oxidative stress reduction
✅ Neuroprotection
✅ Cellular signaling
✅ Activation of longevity-associated proteins called sirtuins
Without adequate NAD+, cells become less efficient at producing energy and managing inflammation.
Why Might NAD+ Matter in Chronic Pain?
Many chronic pain conditions involve:
Mitochondrial dysfunction
Oxidative stress
Neuroinflammation
Peripheral and central sensitization
Impaired cellular recovery
Researchers hypothesize that optimizing NAD+ levels may help address several of these pathways simultaneously.
Potential areas of interest include:
Neuropathic Pain
NAD+ may support:
Nerve repair
Axonal recovery
Mitochondrial function within neurons
Reduction of oxidative injury
Inflammatory Pain
NAD+ influences inflammatory signaling pathways and may help modulate:
Cytokine production
Immune cell activity
Cellular stress responses
Fatigue and Recovery
Patients with chronic pain frequently report:
Fatigue
Brain fog
Reduced exercise tolerance
Poor recovery
Because NAD+ plays a critical role in energy metabolism, some clinicians report improvements in energy and recovery following supplementation.
Potential Mechanisms of Action
1. Improved Mitochondrial Function
Mitochondria generate ATP, the body's energy currency.
Reduced NAD+ levels are associated with:
Cellular aging
Impaired energy production
Increased inflammation
Supplementation may help restore mitochondrial efficiency.
2. Activation of Sirtuins
Sirtuins are proteins involved in:
Cellular repair
Longevity
Metabolic regulation
Inflammation control
NAD+ serves as a critical substrate for sirtuin activity.
3. DNA Repair Support
NAD+ is required for enzymes known as PARPs (Poly ADP Ribose Polymerases), which participate in DNA repair processes following cellular injury.
4. Reduction of Oxidative Stress
Chronic inflammation often produces excessive reactive oxygen species (ROS).
NAD+ may help maintain cellular antioxidant defenses and reduce oxidative injury.
Routes of NAD+ Supplementation
Intravenous (IV) NAD+
Most commonly marketed in wellness and recovery clinics.
Potential advantages:
Direct systemic delivery
Avoids gastrointestinal absorption issues
Allows higher dosing protocols
Potential limitations:
Cost
Time commitment
Variable evidence base
Oral Precursors
Rather than NAD+ itself, many supplements provide precursors such as:
Nicotinamide Riboside (NR)
Nicotinamide Mononucleotide (NMN)
These compounds are converted into NAD+ within the body.
What Does the Evidence Show?
Current evidence remains preliminary.
While preclinical and mechanistic studies are promising, large-scale randomized controlled trials evaluating NAD+ specifically for chronic pain are still limited.
Areas under active investigation include:
Neuropathic pain
Neurodegenerative disorders
Chronic fatigue syndromes
Recovery optimization
Healthy aging
Patients should understand that NAD+ therapy remains an emerging treatment rather than a standard evidence-based pain intervention.
Safety Considerations
Reported side effects may include:
Nausea
Flushing
Chest tightness during rapid infusions
Headache
Fatigue
Lightheadedness
Most adverse effects appear infusion-rate dependent and can often be minimized through slower administration protocols.
Patients should discuss treatment with a qualified healthcare professional, especially if they have:
Cardiovascular disease
Active cancer
Significant medical comorbidities
Clinical Pearls for Pain Physicians
✔ Consider NAD+ as a potential adjunct—not a replacement—for evidence-based pain care.
✔ Continue emphasizing exercise, sleep optimization, nutrition, behavioral health, and appropriate interventional therapies.
✔ Discuss realistic expectations with patients.
✔ Recognize that evidence continues to evolve.
✔ Focus on patient-centered outcomes rather than laboratory markers alone.
Key Takeaways
NAD+ is essential for cellular energy production and repair.
Declining NAD+ levels may contribute to aging, inflammation, and chronic disease.
Early evidence suggests possible benefits in inflammation, recovery, fatigue, and nerve health.
Robust pain-specific clinical trials remain limited.
NAD+ therapy should currently be viewed as an adjunctive and investigational strategy in pain management.
Resources for Physicians
Pain Medicine Board Preparation
Prepare for the ABA Pain Medicine Boards with:
🎯 Comprehensive Question Banks 🎯 Virtual Pain Fellowship 🎯 Flashcards and Mock Exams 🎯 Weekly Board Review Content
👉 Pain Management Board Prep at NRAP Academy
Hands-On Ultrasound Courses – New York
Learn:
Peripheral nerve imaging
Ultrasound-guided injections
Regenerative medicine procedures
Diagnostic musculoskeletal ultrasound
Advanced pain intervention techniques
👉 NRAP Ultrasound Courses in New York
Ultrasound & Regenerative Medicine Training – Costa Rica
Join physicians from around the world for immersive training in:
🌴 Playa Grande, Costa Rica
☀️ Small-group hands-on instruction
🦴 Regenerative medicine applications
📡 Ultrasound-guided pain procedures
👉 Costa Rica Ultrasound Training Courses
Connect With PainExam
🌐 NRAP Academy Website
🎙️ Search PainExam Podcast on your favorite podcast platform.
📚 Explore the Virtual Pain Fellowship, Board Review Programs, Ultrasound Training, and CME opportunities.
References
Hudson Health. NAD+ Infusion Therapy: Full Clinical Review and Background Paper. 2023.
Verdin E. NAD⁺ in aging, metabolism, and neurodegeneration. Science. 2015.
Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD⁺ metabolism and its roles in cellular processes. Nature Reviews Molecular Cell Biology. 2021.
Rajman L, Chwalek K, Sinclair DA. Therapeutic potential of NAD-boosting molecules. Cell Metabolism. 2018.
Katsyuba E, Auwerx J. Modulating NAD⁺ metabolism for health and longevity. Nature Reviews Endocrinology. 2017.
Disclaimer: This podcast is intended for educational purposes only and should not be construed as medical advice. Always consult qualified healthcare professionals before initiating any treatment.

PainExam Podcast Show Notes
Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the ABA Pain Medicine Boards
In this episode of the PainExam Podcast, Dr. David Rosenblum reviews two frequently tested topics on the ABA Pain Medicine Board Examination: Occipital Neuralgia and Vertebral Compression Fractures, including the indications, techniques, complications, and evidence surrounding vertebroplasty and kyphoplasty.
Whether you are preparing for the ABA Pain Medicine Boards, ABPM, ABIPP, FIPP, or simply looking to strengthen your interventional pain knowledge, this episode covers essential board pearls, anatomy, diagnosis, imaging findings, and treatment options.
Episode Highlights
Occipital Neuralgia
Topics discussed include:
Anatomy of the greater, lesser, and third occipital nerves

C2 dorsal ramus anatomy and clinical relevance

Diagnostic criteria for occipital neuralgia

Differentiating occipital neuralgia from:
Cervicogenic headache

Migraine

Cluster headache

Tension headache


Physical examination findings

Occipital nerve blocks

Pulsed radiofrequency ablation

Cryoneurolysis

Peripheral nerve stimulation (PNS)

Board Pearl
The greater occipital nerve originates from the dorsal ramus of C2 and temporary pain relief following a diagnostic occipital nerve block strongly supports the diagnosis.
Vertebral Compression Fractures
Topics reviewed include:
Osteoporotic vertebral compression fractures

Thoracolumbar fracture patterns

MRI findings

STIR sequence interpretation

Patient selection for vertebral augmentation

Conservative treatment versus intervention

Vertebroplasty technique

Kyphoplasty technique

Cement leakage and other complications

Evidence supporting vertebral augmentation procedures

Board Pearl
Bone marrow edema on MRI STIR imaging is one of the most important findings suggesting an acute compression fracture.
Kyphoplasty vs Vertebroplasty
Vertebroplasty
Direct injection of PMMA cement into the vertebral body

Stabilizes micro-motion within the fracture

Can provide rapid pain relief

Kyphoplasty
Balloon tamp creates a cavity before cement placement

May partially restore vertebral body height

May reduce risk of cement extravasation

Often preferred in selected patients with significant vertebral collapse

Commonly Tested Complications
Cement leakage

Pulmonary cement embolism

Adjacent level fractures

Infection

Neurologic injury (rare)

High-Yield ABA Pain Medicine Keywords
Occipital Neuralgia

Greater Occipital Nerve

C2 Dorsal Ramus

Third Occipital Nerve

Cervicogenic Headache

Peripheral Nerve Stimulation

Vertebral Compression Fracture

Kyphoplasty

Vertebroplasty

PMMA Cement

STIR MRI

Osteoporosis

Cement Extravasation

Upcoming Educational Meetings & Conferences
2026 ASPN Annual Meeting – Miami
Learn more about the upcoming meeting hosted by the American Society of Pain and Neuroscience:
📍 ASPN Annual Conference & Miami Meeting Information
PainWeek 2026 – Las Vegas
Join thousands of pain physicians, APPs, nurses, and industry professionals at:
📍 PAINWeek Las Vegas 2026
Latin American Pain Society Meeting – Brazil
For information regarding the upcoming regional pain meeting in Brazil:
📍 Latin American Pain Federation (FEDELAT) Information
CME, Ultrasound & Board Review Resources
NRAP Academy
CME Courses, Virtual Pain Fellowship, Ultrasound Workshops, Regenerative Medicine Training, and Board Review Programs:
📍 NRAP Academy Website
CME Calendar
Upcoming Ultrasound Workshops, Regenerative Medicine Courses, Board Review Programs, and Conferences:
📍 NRAP Academy CME Calendar
Virtual Pain Fellowship
Comprehensive longitudinal pain management education:
📍 Virtual Pain Fellowship Program
Pain Management Board Review
Prepare for:
ABA Pain Medicine Boards

ABPM

ABIPP

FIPP

📍 PainExam Board Review Resources
Connect With Dr. David Rosenblum
Patients Seeking Care
Appointments and consultation requests:
📍 AABP Integrative Pain Care & Wellness
Physician Education
CME, Ultrasound Training, Regenerative Medicine, and Board Review:
📍 NRAP Academy
References
Margetis K, Patel A, Petrone B, et al. Percutaneous Vertebroplasty and Kyphoplasty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated April 6, 2025. Available at:
https://www.ncbi.nlm.nih.gov/books/NBK525963/

Daher M, Kreichati G, Kharrat K, Sebaaly A.
Vertebroplasty versus Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Meta-Analysis.
World Neurosurgery. 2023;171:65-71.

Masala S, Fiori R, Massari F, Simonetti G.
Kyphoplasty: Indications, Contraindications and Technique.
Radiologia Medica.
2005;110(1-2):97-105.

Headache Classification Committee of the International Headache Society (IHS).
International Classification of Headache Disorders (ICHD-3).
Cephalalgia. 2018.

Bogduk N.
The Clinical Anatomy of the Cervical Dorsal Rami.
Spine-related anatomy and occipital nerve pain syndromes.

Subscribe to the PainExam Podcast
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🎙️ PainExam Podcast Show Notes
CRPS & Intrathecal Pain Pumps — High-Yield ABA Pain Board Review
🔥 Episode Overview
In this episode of the PainExam Podcast, David Rosenblum reviews two essential ABA Pain Medicine Board topics:
Complex Regional Pain Syndrome (CRPS)
Intrathecal Drug Delivery Systems (Pain Pumps)
This episode focuses on:
High-yield board pearls
Clinical decision-making
Interventional treatment strategies
Common exam pitfalls
Whether you are preparing for the:
ABA Pain Medicine Boards
ABPM
ABIPP
FIPP
—or looking to sharpen your interventional pain knowledge—this episode delivers practical and testable concepts.
🧠 Topic 1: Complex Regional Pain Syndrome (CRPS)
🔬 What is CRPS?
CRPS is a chronic neuropathic pain condition characterized by:
Disproportionate pain
Autonomic dysfunction
Sensory abnormalities
Motor and trophic changes
📋 CRPS Types
CRPS Type I
No confirmed nerve injury
Formerly "Reflex Sympathetic Dystrophy"
CRPS Type II
Confirmed nerve injury
Formerly "Causalgia"
⚠️ Pathophysiology
CRPS involves:
Peripheral sensitization
Central sensitization
Sympathetic dysfunction
Neurogenic inflammation
Cortical reorganization
🩺 High-Yield Clinical Features
Burning pain
Allodynia
Hyperalgesia
Temperature asymmetry
Skin color changes
Edema
Weakness and trophic changes
📚 Budapest Criteria (BOARD FAVORITE)
Diagnosis requires:
Continuing pain disproportionate to injury
Symptoms in ≥3 categories
Signs in ≥2 categories
💊 Treatment
First-Line
Physical therapy (MOST important)
Early mobilization
Medications
Gabapentin
Pregabalin
TCAs
Interventional
Sympathetic blocks
Spinal cord stimulation
🚨 Board Pearls
Early treatment improves outcomes
CRPS may spread beyond the initial site
Immobilization worsens symptoms
💉 Topic 2: Intrathecal Drug Delivery Systems (Pain Pumps)
🔬 What Are Intrathecal Pumps?
Intrathecal pumps deliver medications directly into the CSF, allowing:
Lower systemic doses
Better analgesia
Reduced systemic side effects
🎯 Indications
Failed back surgery syndrome
Cancer pain
Refractory neuropathic pain
Severe chronic pain not responsive to conservative therapy
💊 Common Intrathecal Medications
Opioids
Morphine
Hydromorphone
Non-Opioid
Ziconotide
Other
Baclofen (spasticity)
⚠️ Ziconotide — HIGH-YIELD BOARD PEARL
Ziconotide:
Blocks N-type calcium channels
Does NOT cause respiratory depression
Can cause psychiatric side effects
⚠️ Major Complications
Infection
Catheter malfunction
Pump failure
Withdrawal syndromes
Catheter-tip granuloma formation
🚨 Granuloma Formation
High-dose intrathecal opioids may cause:
Catheter-tip inflammatory masses
Cord compression
Neurologic deficits
📋 Trialing
Patients typically undergo:
Bolus trial
Continuous infusion trial
before permanent implantation.
🎯 Board Pearls
Ziconotide = no respiratory depression
Pump failure can cause life-threatening withdrawal
Granulomas are associated with opioid concentration
📝 High-Yield Board Takeaways
CRPS
Budapest criteria = critical
Early PT = first-line
Autonomic dysfunction = hallmark
Intrathecal Pumps
Ziconotide is highly testable
Know granuloma risks
Understand pump complications and withdrawal
🎓 Pain Board Prep Resources
Prepare for your ABA Pain Medicine boards with:
👉 https://painexam.com 👉 https://nrappain.org
🏆 Why Physicians Choose NRAP Academy
Comprehensive board prep
High-yield MCQs
Virtual Pain Fellowship
Ultrasound-guided pain training
Interventional pain education
🎤 Upcoming Training
Join upcoming:
Ultrasound-guided procedure workshops
Regenerative medicine courses
Pain board review sessions
📢Register today!
If you're serious about:
✅ Passing your pain boards ✅ Mastering interventional pain ✅ Improving patient outcomes
Subscribe to the PainExam Podcast and join the Virtual Pain Fellowship.
👉 https://nrappain.org 👉 https://painexam.com
Reference 
https://dontforgetthebubbles.com/complex-regional-pain-syndrome/
https://www.ncbi.nlm.nih.gov/books/NBK459151/

🎙️ PainExam Podcast Show Notes
Corticosteroids & Contrast Agents in Pain Management + Evidence-Based Steroid Selection
🔥 Episode Overview
In this high-yield episode of the PainExam Podcast, David Rosenblum breaks down a must-know board topic:
👉 Injectable corticosteroids vs contrast agents in interventional pain procedures
This episode goes beyond basics and dives into:
Particulate vs non-particulate steroids
Comparative profiles of dexamethasone, betamethasone, triamcinolone, and methylprednisolone
Contrast agent selection and safety
Critical complications including embolization and neurotoxicity
A recent study comparing steroid effectiveness in transforaminal epidural injections
This is essential for physicians preparing for the ABA Pain Medicine boards and for clinicians performing spine interventions.
🧠 Core Concept
Corticosteroids = therapeutic (reduce inflammation)
Contrast agents = diagnostic + safety tools (confirm needle placement)
👉 Board pearl: Steroids treat pain — contrast prevents complications
💉 Corticosteroids — High-Yield Comparison
🔬 Mechanism
Inhibit phospholipase A2
Reduce inflammatory mediators
Decrease nerve root irritation
⚖️ Key Steroids Compared
Steroid Type Particle Profile Key Advantage Major Risk Dexamethasone Non-particulate No aggregation Safest for TFESI Possibly shorter duration Triamcinolone Particulate Large particles Longer depot effect Embolic infarction Methylprednisolone Particulate Aggregates Strong anti-inflammatory Avoid in cervical TFESI Betamethasone Mixed Depends on formulation Potent Acetate = particulate risk

🚨 Major Steroid Risks
Local:
Tissue atrophy
Depigmentation
Systemic:
Hyperglycemia
Adrenal suppression
Immunosuppression
Catastrophic (Board Tested):
Spinal cord infarction
Stroke
👉 Caused by intra-arterial injection of particulate steroids
📊 Contrast Agents — High-Yield Review
Common Agents
Iohexol (Omnipaque)
Iopamidol (Isovue)
Iodixanol (Visipaque)
🎯 Purpose
Confirm needle placement
Detect intravascular injection
Prevent intrathecal injection
⚠️ Risks
Allergic reaction
Anaphylaxis
Contrast-induced nephropathy
👉 Board pearl: Shellfish allergy ≠ contrast allergy
⚠️ Critical Safety Topic: Gadolinium
Gadolinium-based contrast agents are:
❌ NOT approved for epidural or intrathecal use ❌ NOT safe substitutes for iodinated contrast in spine procedures
🚨 Intrathecal Gadolinium Risks
Encephalopathy
Seizures
Respiratory distress
Death
👉 Extremely high-yield board concept
📚 Evidence-Based Medicine Segment
Study Review: Steroid Selection in TFESI
A recent study comparing:
Dexamethasone
Methylprednisolone
Betamethasone
🔑 Key Findings
Dexamethasone showed comparable or better outcomes
No clear advantage of particulate steroids
Similar rates of: Repeat injections
Surgical progression

🎯 Clinical Implication
👉 Efficacy differences are smaller than previously thought 👉 Safety is driving practice change
🚨 Board-Level Takeaway
Non-particulate steroids = safer
Outcomes ≈ similar
Technique matters more than steroid choice
👉 Best exam answer: dexamethasone for TFESI
🎯 Board Prep Summary
Dexamethasone = safest for transforaminal injections
Particulate steroids = embolic risk
Contrast must be used before steroid injection
Gadolinium = dangerous in neuraxial space
Clinical outcomes often similar across steroid types
🎓 Pain Board Prep Resources
Prepare for your ABA Pain Medicine boards with:
👉 https://painexam.com 👉 https://nrappain.org
🏆 Why Physicians Choose NRAP Academy
High-yield board review content
Thousands of MCQs
Virtual Pain Fellowship
Ultrasound + regenerative training
Real-world clinical integration
Register Today!
🎤 Upcoming Training
Ultrasound-guided pain procedures
Regenerative medicine courses (PRP, biologics)
Hands-on workshops
Register Today!
📢 Call to Action
If you're serious about passing your boards and practicing safer interventional pain medicine:
✅ Subscribe to the PainExam Podcast ✅ Join the Virtual Pain Fellowship ✅ Visit https://nrappain.org
 
References
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.
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.

🎙️ 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