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Practice Brochure - Text only
Practice Brochure - Text only
By Sireen Gopal, MD

Advanced Non Surgical Spine Care:

Advanced Pain Management Interventions

A New Era in Non-operative Spine & Musculoskeletal Care

Sireen Gopal, M.D.

Diplomate American Board Phyiscal Medicine & Rehabilitation
Board Certified in Pain Management (ABMS)- American Board of PM&R/ Anesthesiology
Diplomate American Board of Pain Medicine
Diplomate American Board of Electrodiagnostic Medicine

¡§New York Spine & Sport Rehabilitation Medicine Center is dedicated in bringing patients to their fullest possible level of function through a multi-disciplinary approach of providing individualized management options. Focus is on quality and outcome of patient care with emphasis on communication with the patient and the patient¡¦s primary provider to facilitate continuation of care in the patient¡¦s home community¡¨

There is widespread recognition that spine and musculosketal pain conditions if not treated early and aggressively can lead to chronic disuse, disability, drug dependence, depression and dissatisfaction with the medical profession. The reason is not a lack of sufficiently potent painkillers, nor is it undiagnosed or untreatable pathology, but rather an over-reliance on analgesic, passive symptomatic care and a failure to make specific source-of- pain diagnoses.

The minority of patients that do not recover within 6 weeks from passive care (oral medications, passive physical therapy, spinal manipulations etc.) account for up to 75-90% of the total expenses related to this health care problem. The incidence rate, cost of chronicity, disability and high recurrence rate add up to a problem of epidemic proportions.

Quality care & cost containment strategies for managing benign spine and musculosketal pain:

Comprehensive Non-Operative Spine and Musuclosketal care:

Early clinical diagnosis and treatment of musculoskeletal pain
Targeted & goal oriented Physical therapy
Therapeutic exercises, Functional Restoration,Ergonomic modification, Injury Prevention
Local injections including Joint, Bursa, Tendon sheath, Nerve Blocks and Trigger point
Fluoroscopic guided Interventional pain procedures

Primary Prevention: In the first few episodes of back or joint pain in patients involved in activities with prolonged sitting, repetitive bending, twisting or lifting activities, patient education for body mechanics, skill training at work, ergonomic modifications and improved fitness with therapeutic exercises is provided. Often it may be beneficial to include an on site work analysis and a continued maintainence program.

Often it is tacitly assumed that the vast majority of patients recover from back pain whether or not they are treated. If the acute episodes last longer than 6 weeks or recur our pro-active management program aggressively treats acute pain episodes with all non-surgical options. Often advanced imaging (MRIs,CTs etc.) may not be indicated if treatment is initiated. Early return to function or work is the key that can help prevent the emergence of chronic pain syndromes, with their enormous human and monetary costs. Targeted active physical rehabilitation, spinal mobilization techniques and if necessary early interventional pain diagnostics and therapeutics are provided with an emphasis on communication between patient and health care provider. It is the standard of care at our center to treat acute pain aggressively, as it may often lead to chronic pain syndromes and behavior.

Active, problem targeted physical therapy
Spinal Stabilization, Mckenzie, Maitland¡¦s techniques using the muscle system to treat and protect spinal structures from recurrent pain, repetitive microtrauma and degenerative change
Emphasis on scientific basis for therapeutic exercises tailored to each patient
Recommendations for lifestyle changes for improving and maximizing functional status
Injury prevention, Ergonomics, Body mechanics
Get the best functional results with the least number of therapy sessions!!

This group of patients may require the most judicious use of health care resources as majority of these cases account for up to 90% of the expenses related to this health care problem. Structural conditions of the spine such as Disc herniations, Spondylosis, Stenosis, Spondylolisthesis may need along with physical rehabilitation, interventional diagnostic and therapeutic pain management and/or surgery as indicated.

Indications for Interventional Management for Benign Spine Pain:
Radicular or axial back pain of structural origin not responding to an 6-8 week (maximum) active supervised physical rehabilitation program
Increasing limitations in patient¡¦s physical activity scales secondary to pain
Increasing need for pain medications, side effects or contraindications
Prior to use of narcotics for pain management
Prior to surgery in degenerative or injury related spine pain
To break the ¡§pain cycle¡¨, facilitate rehabilitation, return to prior functioning status and avoid chronic pain syndromes

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These Spinal injections performed under fluoroscopic guidance offer the advantages of low cost, low dose precise placement of steroid at the target of interest. Use of these injections delivers potent medications precisely to the abnormal spinal interface making it more effective than blind epidural injections. It also allows useful diagnostic information to be gathered from the degree of symptom relief afforded by the nerve block. This can be of value to our surgeon, if pain cannot be controlled and surgery becomes necessary, particularly in those patients with multiple spine abnormalities. These injections are safe and no serious complications to date have been reported in our practice in several hundred procedures.

Different procedures and types of pain


Transforaminal Selective Epidural/ radiculography:- Persistent radiating back, leg, neck or arm pain from the spine, one or two level
Interlaminar/Caudal Epidural/ epidurography:- Persistent radiating back, leg, neck or arm pain, multiple level
Facet Injection/Nerve Blocks:-Persistent central back or neck pain
Discography/Intradiscal thermal therapy:- Persistent central back pain of disc origin
Sacroiliac joint injection:- Persistent lower back/buttock pain from sacroiliac joint
Hip joint injection:-Persistent hip pain

Secondary functional restoration focuses on specific functional goals for comprehensive rehabilitation including pain control, functional capacity testing, physical training, education about biomechanics and ergonomics, and identification of psychosocial predictors of disability.

Patients with psychosocial overlay need early identification and management. This often needs close communication with the patient and related social support systems.

Finally, tertiary pain management needs a multidisciplinary approach. If patients have conditions (such as failed back syndromes, chronic spinal arachnoiditis etc.) that need chronic pain management, long term oral narcotic medications they are referred to a Chronic Pain Center for multidisciplinary team management. This has been shown to be the most cost effective approach.

Areas of expertise:

Advanced Non-operative treatment of Benign Spine pain
Occupational Medicine
Sports Medicine
Physical rehabilitation and therapeutic exercises
Functional restoration, injury prevention
Interventional Pain Management

Common diagnoses treated:

Axial & Radiating Spine Pain
Disc herniations/discogenic pain, Sciatica
Degenerative disc disease, Spondylosis, Stenosis
Rotator cuff injury
Tendinitis, Bursitis, Strains, Sprains
Arthritis and degenerative conditions
Carpal tunnel syndrome & overuse injuries
Reflex Sympathetic Dystrophy

2008 Eastchester Road, 2nd level
Bronx, New York 10461
Tel: (718) 794 0600
Fax:(718) 794

This is the Text only, for further information and actual Brochure please contact the office.