Introduction to Neuromodulation
Neuromodulation is a term used to describe a rapidly developing technology utilized by physicians to manipulate the human nervous system to achieve a desired outcome. The human body communicates with itself in several ways, with the nervous system being responsible for the conveying and processing information to and from our external environment to our brain.
The nervous system transmits signals along nerve fibers. A nerve fiber typically has specific receptors at one end which receive a stimulus and transmit the signal down a long stem called an axon. The axon relays the information to branches at the other end of the nerve, called the terminal, which releases. At transmitters to the next nerve. The manner in which these messages are sent along the nerve is similar to other electrical transactions.
The cells in our body are maintained by an electrical gradient, maintained for the most part by Na+/K+ levels inside the cell compared to outside the cell. This electrical balance can be manipulated to with block or send signals along these nerve fibers. Local anesthetics such as lidocaine can block these channels and stop nerve transmission. We can also modulate the firing of these nerves, with the most common example using this technology being a cardiac pacemaker.
When we suffer an injury, the human body has a remarkable ability to heal itself, to the best of its ability. When a condition gets to a point where further healing is unlikely, the injury can become chronic. Interventions such as medications, injections, and surgery are options specific for each case, however the underlying injury may not be amenable to these options.
Spinal cord stimulation has been a treatment option for nerve pain syndromes for several decades, and recent advances have yielded better outcomes than previously recorded. There is a defined role for spinal cord stimulation in the treatment of chronic neuropathic pain syndromes. A recent form of neuromodulation applies an electrical stimulus to the dorsal root ganglion, the bundle of cell bodies of incoming sensory nerve tissue to modulate nerve function. Applying neural stimulation to the incoming nerve fibers has yielded very promising results that have demonstrated results that have not been seen with traditional spinal cord stimulation.
What is Dorsal Root Ganglion Stimulation?
The doctors at the Spine and Pain Institute of New York are considered thought leaders with dorsal root ganglion stimulation and have pioneered much of the research around the therapy. Our physicians have performed hundreds of DRG-S trial and implant procedures, among the most in the US and the world. This extensive experience has led to our physician’s role in the establishment of guidelines and treatment protocols with DRG-S.
Along with our extensive experience, we have a dedicated research team conducting studies in DRG-S to perfect the procedure technique and continue to improve the safety and efficacy of this therapy as well as expand its use in chronic pain treatment.
For a list of our study-related publications in peer-reviewed medical journals and conferences, and to learn more about ground-breaking research into DRG-S, please click here.
Our expertise in DRG-S has resulted in hundreds of success stories for our patients, many of whom have experienced near-miraculous improvements in their pain. Some of our patient testimonials to the success DRG-S therapy at SPNY can be found here.
With each success story and the variety of conditions we have been able to treat with DRG-S, we believe the potential uses for this therapy have only begun to scratch the surface. At SPNY, we take a more aggressive approach with DRG-S and consider it a front-line therapy for the treatment of chronic pain in many cases. If you are experiencing chronic pain that has failed conventional therapies, make an appointment today to meet with one of our DRG-S expert physicians to discuss if you are a candidate for this promising and exciting new therapy.
Neuromodulation is a therapeutic treatment for patients where electrical energy is used to alter, or change, our nervous system’s signaling to achieve a desired outcome. Spinal cord stimulation (SCS) has been the mainstay form of neuromodulation since its first application in 1967. SCS as a therapy has matured over the years with greater utilization and better outcomes. Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation where an electrical field is placed over the DRG and was designed to meet some of the shortcomings with SCS.
The dorsal root ganglion is a cluster of cell bodies of the nerves that travel from the extremities into the brain. This collection of cell bodies forms a bulge within the nerve just before or as it enters the spinal canal. The cell bodies can be looked at as the processing units of the nerves.
Nerves transmit signals from the extremities to the spinal cord. A sensation received at a nerve terminal transmits the signal along the axon to the nerve ending to the spinal cord. These nerves typically connect, or synapse, in the dorsal horn of the spinal cord. The input is processed, and the nerve messages are then sent up the spinal cord to the brain.
We now know that within the DRG, the cell bodies communicate and can downregulate (slow down) or up regulate (speed up) the nerve transmission. This ‘processing unit’ of the nerves prior to the entrance is an optimal place to intervene with the transmission of pain from the extremities or nerves along the trunk to the brain. DRG Stimulation has demonstrated superior pain relief when compared to traditional SCS for treating Complex Regional Pain Syndrome (CRPS) and post-surgical nerve pain in the ACCURATE randomized controlled trial.
In traditional SCS, electrical stimulation is provided by a battery-powered pulse generator connected to implanted lead wires placed approximately to the posterior portion of the spinal cord known as the dorsal columns. The dorsal columns are comprised of sensory nerve fibers that transmit only position and fine touch sensation separate from pain to the brain. Stimulating these fibers causes a constant tingling sensation known as a paresthesia in the region of the body that the fibers are transmitting sensation from. By creating a paresthesia in a painful area, pain signaling can be masked and reduced, leading to pain relief.
While this was the earliest form of neuromodulation used to treat chronic pain, it had its shortcomings. First, most patients are not comfortable with the constant tingling sensation SCS creates. Second, tolerance to the stimulation builds over time with loss of efficacy within 1-3 years in many cases. As a result, newer forms of paresthesia-free SCS were introduced with better results, including Burst DR-SCS and High frequency SCS. However, limitations in pain coverage and efficacy with certain conditions like axial low back pain and joint pain remain.
To address these shortcomings, DRG-S was developed as a novel therapy that differs from traditional SCS in its location and use of paresthesia-free stimulation. The dorsal root ganglion (DRG) is a relatively small structure composed of cell bodies of the sensory portion of each spinal nerve, located adjacent to the spinal cord at every spinal level on both the right and left sides. All incoming sensory signals traveling to the spine pass through here. In contrast to SCS, stimulation at this site can target every type of sensory nerve. This gives the advantage of stimulating pain-transmitting nerves directly to block and disrupt pain signaling. In addition, fine touch and other types of sensory nerves can be stimulated to mask and reduce pain signaling indirectly in the spinal cord through a variety of mechanisms, some that are similar to SCS.
Unique anatomical features of the DRG also make it optimal for neuromodulation therapy:
1. All sensory nerve cell bodies at a given spinal level are housed here, allowing for focal stimulation to cover a specific body region, resulting in better and more precise pain coverage.
2. There is a minimal barrier of connective tissue and fluid surrounding the DRG compared to the spinal cord, which allows for much closer lead wire placement to the target nerve tissue. Therefore, significantly lower electrical stimulation is needed to reach the nerves compared to SCS, resulting in potentially less collateral damage to surrounding tissue.
3. The DRG is an immobile structure situated in a bony case outside of the spinal canal. Unlike the spinal cord, it is not prone to shifting and movement, meaning the lead wires remain in the same position relative to the nerve tissue. The amount of stimulation that reaches the nerves and the precise location it is directed towards remain stable, resulting in less fluctuation of pain relief than SCS.
As with SCS, electrical stimulation is provided by a battery-powered pulse generator connected to implanted lead wires placed approximate to the DRG structure. Depending on the location and area of pain, up to 4 leads may be placed at different spinal levels and/or on both sides of the spine to cover the painful region involved.
To learn more about DRG-S technology and the DRG-S trial and implant procedures, watch this video.
The placement of the electrical field at the DRG allows us to apply electrical energy to directly modulate pain fibers and also activate pain-relieving nerves to block pain.
From a basic science level, there are special characteristics about the DRG that makes it so appealing as a target. In the natural state, the DRG can serve as a ‘filter’ of sensory input. Thus, the DRG already serves as a ‘gatekeeper’ for sensation from the external environment, and our body, to the central nervous system. Applying stimulation to this site increases this filtering ability to decrease the amount of pain signals that pass through the gate in addition to other distinct mechanisms.
An additional effect of DRG-S is to activate nerve fiber lines as well. So, at the settings used, we can activate the nerve fibers that our body naturally has to block pain. This can be thought of as the way a pacemaker is able to make the heart beat at a certain rhythm. But rather than activating cardiac fibers, we are activating inhibitory fibers.
There are several types of sensory nerves. Aδ and C fibers are the smallest nerve fibers that transmit pain but are also responsible for sending light touch related sensations. These fibers surround our hair follicles and use endorphins as a messenger to transmit signals. Endorphins are inhibitory and act on our body’s opioid receptors to block pain. We currently have several research projects running to try to prove this is part of the mechanism of how DRG-S works.
After a patient decides to proceed with a DRG stimulator, there are several steps which must be completed. As with a traditional stimulator, there is first a 7-day trial period with the device. The leads are placed through the skin over the target levels. This trial period involves no incisions and the generator is taped to the skin on the outside of the body. An Apple device is provided to the patient and it is used to communicate with the device through an app. All patients are required to have a psychological clearance performed, a MRSA nasal swab, a medical clearance, among other paperwork.
After the trial, you will return to the office and the leads are removed. The lead removal is a relatively benign and performed in the exam room. At that time, you will decide whether or not to proceed with the implant of the device.
A randomized controlled trial, the ACCURATE study (A Safety and Effectiveness Trial of Spinal Cord Stimulation of the Dorsal Root Ganglion for Chronic Lower Limb Pain) was launched in the US, leading to FDA approval in 2016. In this landmark study, DRG-S demonstrated superiority over standard neuromodulation therapy, spinal cord stimulation (SCS), in a head-to-head comparison for the treatment of chronic pain related to a nerve condition called complex regional pain syndrome (CRPS).1 Sub-analysis studies from this trial also showed that DRG-S provided better and more stable pain coverage to specific body regions such as the distal feet and legs than SCS. 2,3 Today, DRG-S is considered a front-line therapy for the treatment of chronic pain from specific body regions such as the lower back, groin, hip, knee, and foot.
Learn more about the treatment options
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.
Energy Delivered to the Neural Structures
DRG-S uses far less electrical energy for effect when compared to other forms of spinal cord stimulation (SCS). Research performed by the physician researchers at the Spine & Pain Institute of NY on programming optimization have substantially reduced the amount of electricity delivered to the nerve tissue.
There are inherent anatomic and physiologic advantages to stimulation at the DRG rather than on the dorsal columns. Newer types of SCS have been introduced recently which have led to better outcomes, including Burst DR-SCS and High frequency SCS. With these systems, the leads are placed on the dorsal columns, but it is believed the effects are through alternative mechanisms potentially independent of the dorsal columns. These newer methods of SCS provide subthreshold stimulation, or in other words they do not require the tingling sensation to block pain sensation. Patients tend to prefer the subthreshold, paresthesia-free stimulation when compared to traditional, tonic SCS.1,3,4 When the electrical energy is delivered to the patient, it is not delivered in a constant manner. There are three parameters that can be manipulated:
The frequency measured in Hertz (Hz)- This is the number of times per second the electrical energy is activated.
The pulse width (pw)- This is how long each individual pulse is delivered for.
And, the amplitude measured in milliamps (mA)- This is the strength of the electrical energy.
The cumulative amount delivered to the patient is measured in a unit called microcouloumbs per second (uC/s) which is the product of frequency (Hz)*pulse width(pw)*amplitude (mA).5 Our research team performed studies demonstrating maintained efficacy with DRG-S at settings that were 4 times lower than previously reported. Additionally the SPNY team performed further research using cyclic ‘on’ ‘off’ paradigms to further decrease the necessary electrical charge to our nervous tissue by 2/3.6 In essence, although demonstrated in small studies, DRG-S has vast improvements not only in pain, but in function, quality of life, and psychological status. The physicians of the Spine & Pain Institute of NY have seen the clinical improvements and use Dorsal Root Ganglion Stimulation as a primary method of neuromodulatory therapy for pain.
Dorsal Root Ganglions Stimulation
for Peripheral Vascular Disease
Peripheral vascular disease, or PVD, is a systemic disorder that involves the narrowing of peripheral blood vessels, most commonly caused by atherosclerosis. Peripheral Vascular Disease (PVD) is a major cause of morbidity and mortality globally, with significant financial burdens on healthcare resources 1. Peripheral Arterial Disease (PAD) affects 10-15% of the population and ~20% of people >60 years old, and a 2010 estimate was over 200 million affected globally 2.
In PVD, the diameter of the blood vessel is reduced, limiting the amount of oxygen that circulates to the arms and legs. Symptoms typically start with pain and discomfort while walking, and in severe cases, it may progress into critical limb ischemia, a severe stage of PVD that can result in ulcerations or potentially amputation.
Peripheral vascular disease is most commonly caused by smoking, high blood pressure, elevated cholesterol levels, and/or type 2 diabetes. Patients with PVD may experience no symptoms at first, and when symptoms begin to appear, they tend to be irregular and occur more often when a patient is active—especially when walking.
A patient may experience pain, cramping, and/or discomfort in their legs and feet. Other symptoms can range from achiness, to burning and fatigue, to cold, painful feet, to presenting with non-healing ulcers. If a patient’s peripheral vascular disease continues to progress, symptoms will probably occur with greater frequency and may manifest even when the patient is not walking or otherwise being active.
Other signs to watch for include
• Changes to the skin on the legs and feet, which can become thin and/or shiny
• A purplish tinge to arms and legs, or toes that become blue
• Wounds and ulcers appearing on the feet and legs
• Thinning of hair on the legs
Therapy typically includes changes to diet and exercise, smoking cessation, and, if appropriate, medications including blood thinners to dissolve clots, statins to reduce cholesterol, and vasodilators, which widen the blood vessels.
In the majority of cases, lifestyle changes, medical management, and intravascular based procedures such as stents can treat the majority of cases. However, critical limb ischemia leads to the final step in treatment, amputation.
Prior to this point, after thorough intravascular and comorbidity optimization, neurostimulation should be considered to treat symptoms, improve quality of life, and prevent limb amputation.
Dorsal Root Ganglion Stimulation (DRG-S) is a newer mode of neuromodulation where the lead and electrodes are placed over the dorsal root ganglion. The dorsal root ganglion is positioned at the entry if peripheral nerves into the spinal cord and houses the cell bodies of nerves responsible for incoming sensations. These factors make it is an optimal location to modulate all afferent nerve fiber types, including the nerves of the sympathetic nervous system. The sympathetic nervous system is responsible for the ‘fight or flight’ response. The sympathetic nervous system is responsible for increasing our heart rate, dilating our pupils, raises the hair on our skin, and vasoconstricts our blood vessels.
Our vascular system is controlled by our sympathetic nervous system. Sympathetic nerves leave our spinal column from the levels of T1 to L2 and enter a group of nerves on the side of our spine called the sympathetic chain. The DRG sits at the entry/exit of nerves from the spine and gives branches directly into the sympathetic chain to control its function. By applying stimulation at the DRG, signals are sent into the sympathetic chain that mimic the signals to cause decrease sympathetic outflow, and cause vasodilation.
Additional benefit may be decreasing inflammation spread through the nervous system3. As diabetic peripheral neuropathies are related to the microvasculature, we have seen profound improvements with DRG-S, in addition to chemotherapy induced peripheral neuropathy4–6. Click here to learn more about peripheral neuropathy treated with DRG-S.
There are several objective measures to determine blood flow for the distal extremities, and they include ankle/brachial index (ABI), doppler ultrasound, and PTc027. These tests are used to means to measure blood flow to the extremities8.
Our team published an impressive case series on the use of DRG-S for peripheral vascular disease. In one case we applied DRG-S for a 48 year old lawyer who was planning to have her finger tips amputated secondary to tissue death from lack of blood flow. DRG-S was used to treat her symptoms, her testing improved, and ultimately her fingers healed completely. The second case was an elderly patient who had peripheral vascular disease which was going to require her foot to be amputated. The patient was trialed with both systems, SCS and DRG-S and compared in terms of improvements in PtCO2. SCS performed as it did in literature, which was barely enough to prevent amputation. DRG-S improved blood flow to near normal levels. The third case demonstrated long term benefit with the treatment.
The researchers at the Spine & Pain Institute of NY believe that DRG-S will show superior results compared to SCS in the treatment of peripheral vascular disease if compared head to head. We believe in the science our experience with DRG-S for the treatment of peripheral vascular disease. Ask your physician at the Spine & Pain Institute of NY about DRG-S for PVD.
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.
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.
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.
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
EDUCATIONAL RESOURCES
How DRG stimulation at T12 reveals the transmission of low back pain in the spinal cord
EDUCATIONAL RESOURCES
Dorsal Root Ganglion Stimulation
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
Spinal Cord Stimulator
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.
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.
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:
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.
*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.