Hip, Knee, Leg & Foot Pain Management 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 CAUSE OF JOINT PAIN INTRA-ARTICULAR STEROID INJECTIONS HYALURONIC ACID INJECTIONS PLATELET RICH PLASMA INJECTIONS HIP PAIN AND OSTEOARTHRITIS MERALGIA PARESTHETICA (MP): OUTER THIGH PAIN 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. 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 OUTCOMES DRG-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 YOUTUBE LEARN MORE ABOUT SPINAL CORD STIMULATION (SCS) HIP PAIN RESOURCES HIP PAIN RESOURCES HIP PAIN RESOURCES KNEE PAIN RESOURCES KNEE PAIN RESOURCES FOOT, ANKLE & KNEE RESOURCES FOOT & ANKLE RESOURCES FOOT & ANKLE RESOURCES 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: 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. MANHATTAN 860 Fifth Ave New York, NY 10065 212.724.7246 NEW JERSEY 1 Bay Ave. 2nd Fl. Suite 1 Montclair, NJ 07042 718.667.3577 STATEN ISLAND 1360 Hylan Blvd. Staten Island, NY 10305 718.667.3577 STATEN ISLAND 1534 Victory Blvd. Staten Island, NY 10314 718.667.3577 BROOKLYN 1513 Voorhies Ave. Brooklyn, NY 11235 718.427.2110 DOWNTOWN BROOKLYN 188 Montague St. 3rd Fl. 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