Pain Management

Treating Back Pain Without Surgery

Treating Back Pain Without Surgery

If you are considering back surgery because of a pain issue, it might not even be the most expedient treatment for you as it will not always alleviate or mitigate pain. Unless your back issue is neurological or an instance of instability of the spine, surgery simply is not your best course of treatment. If you suffer from muscular or myofascial pain, lumbar facet arthropathy or lumbar disc herniation, amongst other back pain issues, your best bet is to treat your back pain without surgery. Read my blog for the full details of the non-surgical treatments I recommend.

Musculoskeletal Ultrasound – An X-Ray in Motion

Musculoskeletal Ultrasound – An X-Ray in Motion

Musculoskeletal Ultrasounds (MSUs) are my go-to when attempting to pin down an issue that we don’t believe to be bone related. That means they are perfect for diagnosing muscle, tendon, and ligament injury – as this dynamic investigative and explorable procedure tells us in seconds the make-up of your musculoskeletal system. We have found that MSU has been pivotal in helping diagnose sports injuries and others who find they are in pain when they move a joint. Traditional analysis like x-rays and MRIs take static images where MSUs create dynamic images in motion. Let’s explore that some more.

Using Nerve Blocks to Extinguish Headaches and Migraines

Dealing With Migraines So You Can Relax This Weekend

Migraines – they’re a real headache. After a long week of working we deserve to have some time off; and whether that’s having a lie in, a series binge on Netflix, or jumping into your overgrown garden and getting stuck into some horticulture – we all need to switch off a bit at the end of the week. We should have some escapism. But there’s nothing worse than your tranquillity being intruded on by a throbbing head pain that gets gradually worse. There’s a banging on one side of your head, like a nail been driven by a hammer and you feel a slight nausea. So much for your down time. Again, migraines, they can be real headaches. But not to worry, I can sort that for you.


Enter: Nerve Blocks

Medical science has transformed the usage of Nerve Blocks, which work a type of local anaesthetic, to treat migraines and headaches. The procedure is usually used for the treatment of pain, chronic pain, and complicated dental work. 

Peripheral Nerve Blocks are a reasonable option for many patients with headache disorders. The injection is administered with a syringe and needle that is utilized to inject nerves on the outside of the skull. Alternatively, a soft and minimally invasive catheter will deliver numbing medicine to a target bundle of nerves via the nasal passages.

The goal of this procedure is to temporarily numb the nerves in the periphery and consequently reduce the pain signals travelling to and from the central nervous system, and of course –allow you to watch Netflix and drift off in peace.

How Does the Procedure Work?


Your physician will usually take a few minutes to administer the entire procedure. Depending on your physician and the location of the migraine the anaesthetic may be injected directly to where the pain is manifesting itself. 

Thanks to this breakthrough procedure, no hair needs to be shaved – and all you will experience is a slight discomfort before your migraine completely breaks and you can enjoy the weekend you deserve. This procedure is especially beneficial for rescuing patients whose home medication has failed them.

If you are interested in Nerve Blocks to help you overcome a migraine, especially if your home medication is failing you, then make sure you contact your local physician. Alternatively, if you are local, you can find me at Mount Sinai’s Department of Rehabilitative Medicine’s Downtown office.

Spine Care: Strengthening the Core of Your Body

Strengthen Your Supporting Arch

If the body is a temple the spine is the supporting arch, but it should be treated like the sanctuary. That’s because the spine has more than a duty to keep the body upright. It’s more than just a bunch of bones as it homes the pathways of our central nervous system which allows our brain to communicate with everything else in our body. We should prioritize our spine’s health in our day-to-day life as lack of care can lead to physical discomfort and make us susceptible to future complications. Spine care is an everyday task that can be optimized with a few careful steps. This leads us straight into the crux and goal of this blog entry: keeping a good posture.

Keeping correct posture is the most difficult aspect of spine care, and it won’t happen overnight - although, you can get the process going immediately. Your spine wants to be in a slight S shape with your shoulders squared and your hip tucked in. Often, achieving this position is relatively easy, making it a subconscious and natural stance is where the difficulty lies.


·        For starters, imagine a string tied to the back of your head. Now imagine someone lightly tugging it back as if you were a marionette. Your head should be lifted and held high and proud.

·        Then, tighten your shoulders by pulling them back slightly (without puffing your chest out like a bird). They should be squared and back, not rounded and hunched.

·        Tuck your pelvis in using your gluts. Stand up straight and distribute weight evenly between both your feet.

At this stage, you may feel slight discomfort – if not – great, just keep practicing until it becomes your natural stance. If you are feeling discomfort, then read on.

I frequently explain to patients who visit me about posture and back pain at the Mount Sinai Center of Rehabilitative Medicine that their discomfort in standing straight usually stems from underdeveloped supporting muscles. Either this, or the pain they are experiencing is due to their body weight – and I’ll explain why.

For every kilo you lose, your spine frees 8 kilos worth of tension, which means that thinner people put less strain on their spine and heavier people put on more. But an exercise regime isn’t just about losing weight, in fact, that is just a bonus. The real benefit comes from strengthening the muscles that support the skeletal structure.

Think about it, there are plenty of athletes who would score high on the BMI scale for being overweight, consequently meaning their back should be under high levels of pressure, but do not suffer from back problems as their muscles are sufficiently developed to handle the extra stress. Once your muscles have been adequately strengthened, holding the aforementioned posture will no longer be uncomfortable.

The balancing act lies between being at a suitable weight comparative to your core strength. That’s why a focus on exercising the abdominals and lower back muscles will immediately reduce the impact the spine sustains throughout everyday life.

But of course, make sure your lifting technique is spot-on. There would be nothing worse than damaging your spine in your attempt to strengthen it. 


How Can You Cope With Male Pelvic Pain?

Dealing with Male Pelvic Pain

 Male Pelvic Pain is a generic term given to chronic pain in the groin, the prostate and surrounding areas of the pelvis. Its genesis varies and is generally considered a symptom. The pain can be a symptom of orchialgia, from a prior surgery around the testicles and penis, and patients who have recently had penile implants. Using neuromodulation and nerve blocks we can sever the ties between the pain receptors and the brain which will numb the pain. Let’s take a deeper look into the more common manifestations briefly aforementioned before delving into medical science’s response to it.




What is Male Pelvic Pain?


The prostate is a walnut sized gland that sits in front of the rectum – just below the bladder. It has the responsibility of making a part of the fluid required for semen. Prostatitis is an infection or inflammation of the prostate and is the most common urologic problem in men younger than 50. It can cause painful urination and ejaculation – and is commonly conflated or confused with other urinary tract infections. Prostatitis may not be associated with bacterial infections of the prostate.


Orchialgia is the name given to long-term pain of the testes considered chronic if the pain persists over three months. It could be caused by injury, surgery, cancer, or testicular torsion – and is a possible complication of a vasectomy.

Inguinal Hernia

A hernia occurs when an internal organ pushes blood through an area that has damaged or weak muscle. Muscles are usually strong enough to keep organs in place, a hernia develops when there are weak spots. An inguinal hernia is the most common type of hernia – and appears as a swelling or lump in the groin. The swelling can be incredibly painful and will often protrude when lifting something and retract when sitting or lying down.

Surgery hopes to push the bulge back into place and strengthen the weakness in the abdominal wall, however, can cause serious pain to the pelvic area.

Penile Implants

A penile prosthesis is an optional treatment for men with erectile dysfunction. There is a myriad of distinct types of prosthetic from malleable rods to a pump connected to the system, connected under the loose skin of the scrotal sac between the testicles. This surgery can sometimes lead to chronic pain in the penis area.




A Solution to Male Pelvic Pain

Advances in medical science have meant we can deal with acute and chronic localized pain in Male Pelvic Pain regardless of the cause. 

Nerve Blocks

During an episode of chronic pain, a group of nerves called a plexus or ganglion sends pain signals to the brain. This pathway can be blocked using Nerve Blocks – an injection of medication that numbs a specific region of the body from picking up pain signals. The brain will not receive signals that the area is in pain which stops pain.

Therapeutic Nerves Blocks can be used to treat more painful conditions. These blocks contain local anaesthetic than can control and relieve a localized pain.

Sympathetic Nerves Blocks can be used to determine if there is damage to the sympathetic nerve chain which serves as a diagnostic.

These can be used after, or in lieu of, surgery.




Neuromodulation is the process by which an implantable wire is placed onto the nerves carrying the electrical transmission of pain and thereby reducing the painful firing of those nerves.  This is a very common approach to alter the nerve activity.  The process normalizes or modulates nervous tissue function. Subsequently, neuromodulation minimizes symptoms of Male Chronic Pelvic Pain by lessening the number of painful neurons fired. 

If you are interested in tackling Male Pelvic Pain with one of these minimally interventional methods, contact us to discuss a plan.




Pregnancy Related Musculoskeletal Pain

How To Deal With Pregnancy Related Muscle Pain

Pregnancy is an exciting time for any woman or family, but it brings with it many anatomic and physiological changes that can hinder a woman’s quality of life. During pregnancy, many women suffer from musculoskeletal pain due to the intense changes the body endures throughout the process, this includes but is not limited to: arthralgias, back pain, separation of the pelvis, transient osteoporosis, and tendonitis. This month, we’ll explore how we can manage the pregnancy-related pain while limiting the use of oral medications.




Women usually gain in the range of 25-35 pounds during pregnancy. A shift occurs in the woman’s centre of gravity. Hormonal and biomechanical alterations strain the axial skeleton and the pelvis which are pivotal in maintaining good posture. The body’s adaptions can overload a normally well-designed system, which causes acute pain and possibly chronic pain.  Symptoms vary from person to person, but commonly patients experience pain, fatigue, and sleep disturbances.



Traditionally, treatment includes some oral medications including nonsteroidal anti-inflammatories (NSAIDs).   Patients who have trouble sleeping are often provided medications that modulate sleep and pain.   However, during pregnancy, the uses of oral medications is often limited as many medications can cross the blood-brain barrier and affect the foetus. 

Specialized physical therapy programs can focus on stretching, strengthening, bracing and the use of modalities such as heat, ice and massage to ease the pain.  We can also use the same ultrasound technology your obstetrician uses to see the baby to diagnose many of musculoskeletal disorders that arise during pregnancy.  We also utilize this same technology to provide accurate guided injections to provide relief for moderate to severe pain.   

We’ll focus treatment on limiting oral medications, working mainly with the right physical therapy and offering an ultrasound-guided (non-radiation) approach to interventions when necessary.

How To Cope With Spinal Cord Injury Pain

Using A Dorsal Column Stimulation For Spinal Cord Injury Associated Pain


Back pain is extremely common, it affects most people; fortunately, it usually goes away on its own accord after around six to twelve months. But for some people, chronic back pain is a lifelong struggle, and severely hinders lifestyle choices. We have a solution, one that means you will no longer wake up and realize you will not be able to attend your kids band rehearsal, make that perfect that golf swing, or make a coffee appointment with an old friend. With Dorsal Column Stimulation (DCS), we can squash these problems for you. Say hello to your new life.

DCS is a neurostimulation transmitter that works by intercepting nerve endings’ pain signals before they reach the brain. In more simple terms, pain originates in transmitted signals from nerve endings that pass up your spinal column - DCS intercepts these signals and transposes them. The brain receives a more pleasant signal in lieu of pain. Patients describe this feeling as a gentle massaging, and others as the absence of pain.  


shoulder 2.jpg


The minimally invasive surgery works firstly by making a small incision in you back, and placing the medical wires (leads) that deliver stimulation into the epidural space of your spinal cord. The second incision creates a tiny pocket under the skin that is large enough to hold the neurostimulator. Finally, the physician will connect the leads to the neurotransmitter. The parts are designed to work together to manage pain, and come with chargeable and non-chargeable batteries, usually placed inside the buttock or abdomen. You will be handed a small handheld device to give you full control over the pain signals, and allow you to manipulate the sensation. And with this, the surgery is complete; and you can begin planning your new life.

During the first few months, it is advised to not lift heavy objects, involve yourself in physical activity – or any movements that involve twisting, climbing, bending etc. You should look at this  as a recovery time, or better still, a space to plan your new life. Most patients report that their lives have never been better.

DCS has helped thousands reclaim their lives.

Dr Spinner can perform the surgery at Mount Sinai, NYC. With all that has been said, only your doctor can tell you if it right for you. There are some conditions where this surgery will not work. If you wish to see Dr Spinner, or would like to learn more, please contact our switch board at: (212) 724-6362


Dr David Spinner, Mount Sinai

Dr David Spinner, Mount Sinai

Revolutionizing Post-Stroke Pain Management Methods

Revolutionizing Post-Stroke Pain Management Methods

Strokes can effect patients in a variety of ways depending on which area of the brain is damaged. 85% of all stroke survivors report developing pains in the arms and, more specifically, the shoulder. This pain tends to be on the side of the body effected during the stroke and can be caused by a weakening of the muscles that control the shoulder joints. Traditionally this pain is controlled with painkillers or steroid injections if the area is inflamed. These methods are only short term solutions as long-term use of painkillers can introduce new problems to the patient, however, a new technology has been developed that can control chronic shoulder pain in a more long term, drug-free way.