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.

Neuropathy
Conditions & Treatment Options

Neuropathy is defined as a group of disease that can result from malfunctioning of nerves that can cause pain in all different parts of the body, but most commonly, the feet and hands. Neuropathy can come in several forms, numbness, tingling, weakness, and in some cases they may cause pain.
As physicans trained in the management and treatment of chronic pain pain management physicians are uniquely able to treat painful neuropathy. Medications can be used to try to manage this unique pain category, but more recently, interventional pain management procedures and interventions have been developed which can greatly reduce the burden that comes with neuropathic pain.

Depending on the location, the type of neuropathy, the severity of the pain, a diagnostic and theraputic approach is tailored to the patient to determine the best possible treatment option to decrease pain and increase a patient’s quality of life. Common forms of neuropathy which can be treated include diabetic neuropathy, radiation induced neuropathy, chemotherapy induce neuropathy, to name a few.

Approximately 30-40 % of peripheral neuropathy cases are idiopathic (due to unknown causes). Well-defined causes or risk factors for developing peripheral neuropathies include:

  • Diabetes Mellitus – most common cause, ~30% of peripheral neuropathies. ~60% percent of all people with diabetes suffer from peripheral neuropathy (1)
  • Alcoholism
  • Autoimmune disorders, such as Guillain-Barre syndrome
  • Cancer related, or cancer treatment related (Chemotherapy-induced neuropathy)
  • Chronic kidney failure
  • Connective tissue/autoimmune disease, such as rheumatoid arthritis, lupus, amyloidosis, Guillain-Barre syndrome, Lyme’s disease, and sarcoidosis
  • Infectious disease, such as Lyme disease, HIV/AIDS, and Hepatitis B
  • Nerve impingements such as Carpal or Tarsal tunnel syndrome
  • Vitamin deficiencies

Peripheral neuropathy usually affects both sides of the body. Symptoms are usually noticed first in the toes. If the disease progresses, symptoms may gradually move up the legs; if the mid-calves are affected, symptoms may develop in the hands as well.

Symptoms typically include pain which can vary from dull, aching, and throbbing to sharp, stabbing, and burning. Pain is often accompanied by tingling and numbness and hypersensitivity to light touch. Any of these painful sensations can greatly reduce physical function and limit the ability to walk. When motor nerves become involved in the neuropathy, muscle weakness, cramps, twitching, and muscle atrophy or wasting can occur. As nerve damage progresses over time, there is loss of sensation. The ability to sense pain and the sense of balance may be partially or completely lost, which greatly increases the risk of falls and injury.

Peripheral neuropathy is diagnosed based upon a medical history and physical examination of the feet. During an examination, there may be signs of nerve injury, including:

  • Loss of the ability to sense vibration and movement in the toes or feet (eg, when the toe is moved up or down)
  • Loss of the ability to sense pain, light touch, and temperature in the toes or feet
  • Loss or reduction of the Achilles tendon reflex

More extensive testing, including nerve conduction studies, nerve biopsy, or imaging tests (eg, X-ray or computed tomography [CT] scan), is not usually needed to diagnose peripheral neuropathy.

There are four main components of peripheral neuropathy treatment:

  • Control of blood sugar levels (for diabetics)
  • Lifestyle interventions, specifically diet and exercise
  • Care for the feet to prevent complications
  • Control of pain caused by neuropathy — Neuropathic pain can be difficult to control and can seriously affect your quality of life. Neuropathic pain is often worse at night, seriously disrupting sleep.

There are several medications that are useful for the treatment of diabetic neuropathy and have been approved by the US Food and Drug Administration (FDA), including duloxetine and pregabalin. Other medications are also useful, including tricyclic medications (eg, amitriptyline), gabapentin, tramadol, and alpha-lipoic acid.

Unfortunately, many of the peripheral neuropathies are progressive, and systemic oral medication or local topicals can become less effective over time. If the pain or disability of peripheral neuropathic pain is severe and traditional medical management is not providing effective relief, spinal cord stimulation (SCS) may be an option. In fact, one of the most common studied diagnoses utilizing SCS for pain is diabetic peripheral neuropathy (DPN). A systematic review of traditional spinal cord stimulation (SCS) studies used to treat DPN reported >50% relief in 63% of patients (2). However, SCS has its shortcomings in treating peripheral neuropathy. Stimulation is applied to the spinal cord but does not target individual nerves, making it difficult for treatment effects to cover specific body parts like the distal legs and feet, which are affected most in peripheral neuropathies.

We published two case reports on the treatment of peripheral neuropathies with DRG-S, one detailing improvements in diabetic neuropathy and one in chemotherapy-induced neuropathy (3,4) (have images of papers on screen to click and take patient to article). DRG-S likely improves the symptoms of peripheral neuropathy through multiple mechanisms, giving it several advantages over SCS when treating peripheral neuropathies.

DRG-S may provide better coverage for peripheral neuropathies because it directly targets the individual nerve fibers innervating the feet and legs to block pain signal transmission (5–7). Additionally, stimulation reaches the spinal cord to further disrupt incoming pain signals. Stimulation can also spread in the opposite direction, towards the small nerve fibers of the sympathetic nervous system which are typically damaged the most in peripheral neuropathies. DRG-S has a direct effect on these small nerve fibers (Aδ and C fibers), which not only transmit pain, but also control local blood flow and inflammation. Stimulation effectively disrupts signaling from these fibers, thereby reducing local inflammation and blocking constriction of blood vessels to increase local blood flow and tissue oxygenation. This is an important consideration for peripheral neuropathy patients as the increased blood flow often improves the symptoms of peripheral neuropathy.

  1. Kaur S, Pandhi P, Dutta P. Painful diabetic neuropathy: an update. Ann Neurosci [Internet]. 2011 Oct [cited 2020 Mar 27];18(4):168–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25205950
  2. Pluijms WA, Slangen R, Joosten EA, Kessels AG, Merkies ISJ, Schaper NC, et al. Electrical spinal cord stimulation in painful diabetic polyneuropathy, a systematic review on treatment efficacy and safety. Eur J Pain [Internet]. 2011;15(8):783–8. Available from: http://dx.doi.org/10.1016/j.ejpain.2011.01.010
  3. Chapman KB, van Roosendaal B-K, van Helmond N, Yousef TA. Unilateral Dorsal Root Ganglion Stimulation Lead Placement with Resolution of Bilateral Lower Extremity Symptoms in Diabetic Peripheral Neuropathy: A Case Report. Cureus. 2020;
  4. Groenen PS, Van Helmond N, Chapman KB, Helmond N Van, Chapman KB, Van Helmond N, et al. Chemotherapy-Induced Peripheral Neuropathy Treated with Dorsal Root Ganglion Stimulation. Pain Med. 2019;20(4):857–9.
  5. Deer TR, Levy RM, Kramer J, Poree L, Amirdelfan K, Grigsby E, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. J P [Internet]. 2017 Apr 1 [cited 2019 Aug 9];158(4):669–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28030470
  6. Van Buyten J-P, Smet I, Liem L, Russo M, Huygen F. Stimulation of Dorsal Root Ganglia for the Management of Complex Regional Pain Syndrome: A Prospective Case Series. Pain Pract [Internet]. 2015 Mar;15(3):208–16. Available from: http://doi.wiley.com/10.1111/papr.12170
  7. Deer TR, Levy RM, Kramer J, Poree L, Amirdelfan K, Grigsby E, et al. Comparison of Paresthesia Coverage of Patient’s Pain: Dorsal Root Ganglion vs. Spinal Cord Stimulation. An ACCURATE Study Sub-Analysis. Neuromodulation. 2019;2018.

EDUCATIONAL 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.





EDUCATIONAL RESOURCES

Trigeminal Neuralgia

This chronic condition is caused by a misfiring of the trigeminal nerve. An attack causes brief episodes of extreme, shooting pain.

EDUCATIONAL RESOURCES

Occipital Neuralgia

This condition is a distinct type of headache caused by irritation or injury of the occipital nerves. These nerves travel from the base of the skull through the scalp. This condition can result in severe pain and muscle spasms.





EDUCATIONAL RESOURCES

BOTOX® Injections for Pain

When we think of BOTOX, we often think of wrinkle reduction. But these injections have other uses. They also treat pain. Let's learn about BOTOX and what types of pain it treats.

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.