Our Philosophy

Pain is a complex problem that requires treatment and management by a pain medicine specialist. Millions of people suffer from headaches and nerve pain at great personal cost. If you find that you cannot safely control your pain with over-the-counter medications, or have failed to find relief from other treatments or practitioners, you should consider consulting with our pain management physicians. For most patients, interventional pain management procedures can treat or reduce pain, allowing the patients to regain function, and thereby improving their quality of life.

Hip, Knee, Leg & Foot Pain
Conditions & Treatment Options

Joint pain is common, and it can be caused by osteoarthritis of aging, trauma, or inflammatory conditions like Rheumatoid arthritis. If you have tried hot and cold packs, physical therapy, and medications but find yourself still struggling with pain, it may be time to consider the next level of therapy with an image-guided joint injection.

Synthetic steroids are similar to the natural steroidal hormones that are produced by the body. Steroids help to reduce inflammation from arthritis which in turn can reduce pain and swelling for several months at a time. Steroid injections can be performed for pain in almost any joint and be repeated if necessary.

Hyaluronic acid injections are also referred to as gel injections because of the thick lubricating consistency of the medication. Arthritis and age cause the natural cushion of the knee joint to wear down. Gel injections are performed in a series and help to replace that cushion providing pain relief for up to 12 months.

Platelet rich plasma, or PRP, injections are a form of Regenerative Medicine that harnesses the healing power of your own body to improve pain. A small amount of your own blood is taken to prepare an injection that is rich in platelets. Platelets contain clotting factors and growth factors which promote healing of joints, ligaments, and tissues. PRP is most effective when it is performed as a series of injections. These injections can relieve pain for months, years, or even indefinitely.

Osteoarthritis is a common cause of hip and hip joint pain. Hip arthritis (osteoarthritis) usually presents symptoms in the groin and buttocks. The pain is often described as aching and throbbing and may become sharp or severe with hip movement.

The hip joint is a ball and socket synovial joint, formed by an articulation between the pelvic acetabulum (the socket) and the head of the femur (the ball). The joint and neck of the femur is covered by the hip joint capsule. Pain from the hip joint typically presents with pain in the groin. This is not to be confused with trochanteric bursitis, which presents as pain on the lateral aspect of the femur.

Intra-articular Hip Joint Injection

An intra-articular hip joint injection is a low risk, fast procedure that can be used to diagnose the hip as a pain generator, and may be therapeutic if a small amount of steroid is placed. Quite often patients are referred to the Spine and Pain Institute of New York by their orthopedic surgeon for this injection to determine if the pain is coming from the hip. It is also often that hip/groin pain from osteoarthritis can be confused with pain stemming from the low back or sacroiliac joint and this procedure can be used to differentiate between the two.

The procedure is performed using fluoroscopy (real time x-ray) that enables the pain management specialist to visualize the hip joint. A thin needle is guided to the joint and a small amount of contrast dye is injected to see inside the joint space followed by a local anesthetic. If the local anesthetic relieves hip pain, then the hip socket is the likely pain source. An injection of a steroid medication may provide prolonged pain relief. Intra-articular hip joint injections are a low risk, quick and effective treatment to relieve pain. The duration of pain relief depends on many things including the degree of underlying structural damage (i.e. osteoarthritis) and its susceptibility to the effects of the injection. An intra-articular hip joint injection may be performed to delay hip replacement surgery, as an alternative to surgical repair of labral – hip cartilage tears, and treat sprains or strains caused by sports or trauma. Sometimes the cause of hip pain is unknown and is termed idiopathic. It is a low risk and fast method of obtaining pain relief. The duration of relief depends on the degree of underlying damage, but typically cannot be estimated as patients respond differently to treatments.

Additional Information

An intra-articular hip injection is not the same as a trochanteric bursa injection, often performed to treat hip bursitis. The trochanteric bursa injection can be performed without fluoroscopic guidance (blindly) by palpating the greater trochanter and injecting medicine through a needle into the bursa. The intra-articular hip injection is specific, and the needle is accurately guided using real time x-ray (fluoroscopy).

The lateral femoral cutaneous nerve (skin nerve located on the side of your thigh) is a branch of the lumbar (low back) spinal nerves that travel under the inguinal ligament (groin area) and provides sensation to the side of the thigh. Because the nerve travels under the inguinal ligament, it is susceptible to impingement at the inguinal ligament. This is similar to carpal tunnel wherein the wrist’s median nerve becomes trapped.

Symptoms may include:

  • Numbness in the lateral thigh
  • Neuropathic pain, sometimes severe

When pain does not respond to medical management, a nerve injection block at the site of impingement can provide both diagnostic and therapeutic advantages.

Cryoablation (cold therapy) may provide pain relief as well as dorsal root ganglion stimulation.

VIEW IMAGE

Peripheral Neuropathy

Neuropathy is the medical term for nerve damage. A generalized type of neuropathy, known as polyneuropathy, is the most common type of peripheral neuropathy. Signs and symptoms of peripheral neuropathy include loss of sensation and/or burning pain in the hands or feet. Treatments for peripheral neuropathy are available and include several elements: diet and exercise, control of blood glucose levels for diabetics, prevention of injury, and control of painful symptoms.

LEARN MORE ABOUT NEUROPATHY

DRG-S for Low Back Pain and Leg Pain

Effective treatment for chronic low back pain (LBP) is considered the ‘holy grail’ of neuromodulation. Spinal Cord Stimulation (SCS) was introduced in 1967 to treat chronic pain. Over the years it has shown mixed results for LBP, with limited improvements in pain and function, and loss of efficacy over time. Dorsal root ganglion stimulation (DRG-S) was developed as a treatment for nerve-related pain syndromes and has proven to be superior to SCS for complex regional pain syndrome (CRPS), which typically affects the hands or feet.

As utilization of DRG-S increased, so did our understanding of its underlying mechanisms of action. One such mechanism of action is a result of the stimulator device sending inhibitory signals into the spinal cord. Based on this principle, the team at the Spine & Pain Institute of NY pioneered the treatment of low back pain with DRG-S at the T12 spinal level1. Their publication on a case series of patients using DRG-S at the T12 level for intractable low back pain was better than previous studies with other forms of neurostimulation for low back pain.

The study included patients who had failed extensive treatments and included several patients who had multiple spinal surgeries. They reported not only excellent pain relief, but also great improvements in physical function and psychological testing that were not previously seen with neuromodulation therapy. The results of the study are shown on the right, here, and below. In our clinical experience, these results are readily reproducible and have been maintained over time.

After experiencing continued impressive results with DRG-S for low back pain, we decided to dive deeper into exactly why and how this device works in this manner. After a year’s long quest and an exhaustive review of the published literature relating to nerve transmission and back pain, the team authored ‘The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations from Dorsal Root Ganglion Stimulation Treatment’. This evidence based paper details our theory on why DRG-S works at T12 for low back pain, and more importantly outlines how low back pain is transmitted in the spinal cord2.

VIEW PAPER

After experiencing continued impressive results with DRG-S for low back pain, we decided to dive deeper into exactly why and how this device works in this manner. After a year’s long quest and an exhaustive review of the published literature relating to nerve transmission and back pain, the team authored ‘The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations from Dorsal Root Ganglion Stimulation Treatment’. This evidence based paper details our theory on why DRG-S works at T12 for low back pain, and more importantly outlines how low back pain is transmitted in the spinal cord2.

To better understand this complex subject, which for many may be challenging to fully grasp, the major points have been illustrated in this animated graphic. Since that time, the team has expanded the use of DRG-S by placing additional leads at S1 along with T12 as an off-label treatment for low back and associated leg pain. Our results continue be superior to our doctor’s experiences with other forms of neurostimulation for similar pain conditions. Our doctors have collectively published over 20 articles in peer reviewed medical journals on DRG-S and are considered thought leaders and pioneers of DRG-S therapy. While results from our practice with DRG-S are quite impressive and have been published and shared with the medical community, the team also recorded patient testimonials to further illustrate the great improvements seen with this therapy. The testimonials can be accessed on our Youtube page.

DRG-S Low Back Pain OutcomesDRG-S Compared to SCS for LBP

Multiple studies have published positive results using DRG-S therapy for low back pain. For instance, DRG-S was utilized at the L2 level to treat discogenic low back pain following failed back surgery. The graphic below shows the changes in patient reported survey scores used to measure treatment response before and after DRG-S therapy in each study. Collectively, improvements with DRG-S therapy in VAS (visual analog scale) which measures pain severity, ODI (Oswestry disability index) and SF-36 Physical which measure physical function, EQ-5 which measures quality of life, and SF-36 Mental which measures psychological improvements were consistent with or superior to prior spinal cord stimulation studies. If you are interested in learning more about DRG stimulation for low back pain and leg pain, or have failed other forms of neuromodulation, please feel free to reach out to our physicians at the Spine and Pain Institute of NY to learn more.

1. Chapman KB, Groenen PS, Patel K V., Vissers KC, van Helmond N. T12 Dorsal Root Ganglion Stimulation to Treat Chronic Low Back Pain: A Case Series. Neuromodulation Technol Neural Interface. 2020;23(2):203-212. doi:10.1111/ner.13047

2. Chapman KB, Groenen PS, Vissers KC, van Helmond N, Stanton‐Hicks MD. The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations From Dorsal Root Ganglion Stimulation Treatment. Neuromodulation Technol Neural Interface. Published online April 23, 2020:ner.13150. doi:10.1111/ner.13150

VIEW ON YOUTUBELEARN MORE ABOUT SPINAL CORD STIMULATION (SCS)
HIP PAIN RESOURCES

Piriformis Syndrome

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.





HIP PAIN RESOURCES

Hip Joint Injection

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.

HIP PAIN RESOURCES

Sacroiliac Joint Injection

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.





KNEE PAIN RESOURCES

Knee Viscosupplementation

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.

KNEE PAIN RESOURCES

Osteoarthritis of the Knee

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.





FOOT, ANKLE & KNEE RESOURCES

PRP Therapy

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.

FOOT & ANKLE RESOURCES

Rheumatoid Arthritis

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.





FOOT & ANKLE RESOURCES

Peripheral Neuropathy

This injection treats the pain of an inflamed nerve in your cervical spine. It relieves nerve swelling. If you have a herniated disc, spinal stenosis or some other problem that's pressing on a nerve, it may help you.

Types Of Pain

Let's live pain free.

Is Pain Management Right for You?

Depending on many factors, such as the type of pain and your general health, there are numerous options for treating your pain. Some patients are surprised to learn that a treatment that previously failed to provide relief may be effective when combined with a multi-treatment approach.

Our specialists treat complex pain issues. There are many different physical and neurological disorders that contribute to pain, and we treat all types of pain including:

HEAD & FACIAL PAINNECK PAINHAND, ARM, CHEST & SHOULDER PAINLOWER & UPPER BACK PAINPELVIC & ABDOMINAL PAINHIP, KNEE, LEG & FOOT PAINNEUROPATHYSPINAL CORD STIMULATIONCANCER PAIN
LEARN MORE ABOUT PAIN MANAGEMENT

Practice Policies

We are pleased you chose The Spine and Pain Institute of New York for the diagnosis, treatment and management of your pain. To acquaint you with our office policies, we provide the following information.

PRIOR TO PROCEDURE FORMS

*If your insurance requires a referral for a visit to a specialist, you must obtain this referral from your Primary Care Physician prior to your visit.

INITIAL CONSULTATIONS

Please bring the following relevant information to your consultation.

Photo ID
Insurance Information
Referral*
Diagnostic Studies & Reports (MRI/X-Rays)
List of Medications

INSURANCE & BILLING

We accept most insurance programs and their subsidiaries. If we do not participate in your insurance plan, please contact Billing to find out if other arrangements are possible. Text us via Klara using the messaging option to the bottom right of this page! Just detail your concern or question, and a member of the team will reply via return text message or phone call. Insurance co-payments are due at the time of arrival. We accept cash, checks and credit cards.

APPOINTMENTS

If you are a new patient, please arrive 15 minutes prior to your appointment to allow time to register. If you are running late or need to reschedule, please contact us as soon as possible to make us aware. Unfortunately, if you are more than 30 minutes late for your appointment time, we will have to reschedule.

PROCEDURES

If you are scheduled for a procedure or plan on having one in the future, please read the attached important instructions to follow prior to a procedure.You will be called prior to your procedure and notified about the following information as well.

MEDICATIONS & REFILL REQUESTS

Please discuss your medication needs, including refill requests, with your provider at the time of your appointment. Medications should be taken only as prescribed. Please do not request early refills of your medications. Patients are responsible for lost or stolen medications and prescriptions once they leave the office.

AFTER HOURS EMERGENCIES

Our regular phone lines are transferred to an answering service after normal business hours. Please proceed to the nearest emergency room for after-hours emergencies.