Pain management has evolved dramatically. The goal is no longer simply to suppress pain with medication — it’s to interrupt it at its source using precise, minimally invasive procedures that provide relief lasting months to years. Dr. Patwary, our Interventional Pain Management physician, brings the full breadth of this specialty to all four Grewal locations.
Every pain management patient begins with a comprehensive evaluation: a complete pain history, review of prior treatments and imaging, and a physical examination. The goal is an accurate diagnosis — because the right procedure for facet joint arthritis is completely different from the right procedure for a herniated disc or sacroiliac joint dysfunction. Facet joint pathology alone accounts for 15–45% of chronic low back pain cases in the United States (ASRA 2024) — yet is consistently underdiagnosed when clinicians rely on MRI alone without targeted diagnostic blocks.
Conditions We Treat
Our Procedures — What They Are and How Long They Work
| Procedure | How It Works | Duration of Relief |
| Epidural Steroid Injection | Corticosteroid delivered to the epidural space — reduces nerve root inflammation | 4–12 weeks in most patients |
| Transforaminal Nerve Root Injection | Targeted delivery directly at the affected nerve root — diagnostic and therapeutic | 4–12 weeks; useful for surgical planning |
| Facet Joint Injection | Anesthetic + corticosteroid into the facet joint — confirms diagnosis, provides relief | Days to weeks; paired with RFA for longer relief |
| Medial Branch Block | Anesthetic blocks the sensory nerve to the facet joint — diagnostic test for RFA candidacy | Brief — primarily diagnostic |
| Radiofrequency Ablation (RFA) | Heat destroys the sensory nerve fibers carrying facet or SI joint pain signals | 12–18 months average; safely repeatable |
| SI Joint Injection | Corticosteroid into the sacroiliac joint — confirms diagnosis, reduces inflammation | Weeks to months |
| Spinal Cord Stimulation (SCS) | Implanted device sends electrical pulses to mask pain signals before reaching the brain | Long-term; trial period required first |
| PRP Injection | Patient’s concentrated platelets promote tissue repair and reduce inflammation | Months — typically superior to steroids long-term |
| Viscous Supplementation | Hyaluronic acid lubricates and cushions arthritic joints | 3–6 months; may be repeated |
| Genicular Nerve Block | Blocks sensory nerves to the knee — diagnostic and therapeutic for knee arthritis | Weeks; can progress to RFA |
| Intracept (Basivertebral Nerve Ablation) | Ablates the basivertebral nerve — specifically treats vertebrogenic lower back pain | Long-term; highly targeted |
| Ready to stop the pain? Most patients are seen within the same week — most insurance accepted. Call (516) 743-9450 |
Radiofrequency Ablation — The Most Durable Non-Surgical Option for Facet Pain
Unlike injections that temporarily reduce inflammation, RFA physically destroys the sensory nerve fibers that transmit pain from the facet joints to the brain — under precise fluoroscopic guidance. The most rigorous evidence comes from the RAPID study (NCT04673032, published 2025), which reported that 77% of patients at 1 month and 79% at 24 months were treatment responders (defined as ≥50% pain relief), with simultaneous improvements in Oswestry Disability Index and quality-of-life scores. A 2015 Cochrane review (23 RCTs, n=1,309) provided moderate evidence supporting RFA over placebo for facet-mediated pain. Relief lasts 12–18 months on average, and the procedure can be safely repeated when the nerve regenerates.
Spinal Cord Stimulation — Level I Evidence for Refractory Pain
SCS has Level I evidence from multiple prospective RCTs and systematic reviews (Frontiers in Pain Research, 2024) and is supported by society guidelines from NANS, ASRA, and international neuromodulation societies. Persistent spinal pain syndrome type II (failed back surgery syndrome) affects 10–40% of patients following large spinal surgical intervention. For these patients, SCS has outperformed conventional medical management in multiple RCTs. Modern HF10 (10kHz) and burst stimulation deliver paresthesia-free relief. The process always begins with a 5–7 day trial: if the patient achieves greater than 50% pain reduction, a permanent device is implanted.
Platelet-Rich Plasma — 2024 Meta-Analysis Evidence
A 2024 meta-analysis in Annals of Medicine & Surgery found PRP injections significantly reduced pain compared to both hyaluronic acid and corticosteroid injections for knee osteoarthritis, with the most significant improvement at 6 months. A 2025 narrative review of 40 high-quality studies confirmed PRP demonstrates superior pain relief and functional improvement over HA and CS for mild-to-moderate knee OA (Kellgren-Lawrence grades I–III). PRP carries no systemic side effects and uses the patient’s own blood.
CLINICAL REFERENCES
- Manchikanti L et al. Effectiveness of cervical medial branch radiofrequency neurotomy for chronic neck and referred pain. Pain Physician. 2021;24(S1):S59-S82. PubMed 33492946
- Dreyfuss P et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. 2000;25(10):1270-7. PubMed 10806505
- Manchikanti L et al. Prevalence of facet joint pain in chronic spinal pain. Spine. 2008;33(3):272-8. (15-45% of chronic low back pain.) PubMed 18303449
- Deer TR et al. The Appropriate Use of Neurostimulation — Avoid the Chasm: An Evidence-Based Analysis. Neuromodulation. 2014;17(6):515-50. PubMed 25234359
Related Conditions & Treatments
Common Questions
How long does radiofrequency ablation last?
12–18 months on average; the procedure can be safely repeated when the nerve regenerates.
What is the best treatment for chronic facet joint pain?
After diagnostic medial branch blocks confirm the source, radiofrequency ablation provides the most durable non-surgical relief.
Is spinal cord stimulation effective for failed back surgery?
Yes. It has Level I evidence and outperforms conventional medical management for persistent post-surgical pain in multiple trials.
