Pain management has evolved dramatically over the last two decades. 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, often without any pills at all. Dr. Patwary, our Interventional Pain Management physician, brings the full breadth of this specialty to all four Grewal Orthopedic & Spine Care 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. Consider: facet joint pathology alone accounts for 15–45% of chronic low back pain cases in the United States (ASRA Pain Medicine News, 2024) — yet is consistently underdiagnosed when clinicians rely on MRI alone without targeted diagnostic blocks. Getting the diagnosis right before choosing the procedure is the foundation of effective pain management.
Conditions We Treat
Neck Pain and Cervical Radiculopathy
Neck pain from muscle strain, degenerative disc disease, or whiplash. When pain persists beyond conservative care, cervical epidural injections or facet joint injections reduce inflammation and nerve root compression directly at the source.
Lumbar Back Pain and Sciatica
The most common pain management referral. Epidural steroid injections, transforaminal nerve root injections, and medial branch blocks address specific pain generators rather than using systemic medications. When facet joint arthritis is confirmed as the primary pain source, radiofrequency ablation provides 12–18 months of relief on average.
Facet Joint Syndrome
The small joints between vertebrae are a frequently overlooked pain source. Facet syndrome causes localized axial back or neck pain that worsens with extension. Diagnostic medial branch blocks confirm whether the facets are the source; radiofrequency ablation then provides the most durable relief available for this condition.
Spinal Stenosis
Canal narrowing that compresses nerve roots or the thecal sac. Epidural nerve blocks reduce the inflammatory component and can restore walking tolerance. For patients with severe stenosis unresponsive to injections, spinal cord stimulation offers an additional non-surgical option.
SI Joint Dysfunction
The sacroiliac joint — connecting the spine to the pelvis — is underdiagnosed as a pain source, producing significant lower back, buttock, and posterior thigh pain. SI joint injections confirm the diagnosis and provide relief. RFA of the SI joint offers more durable results.
Osteoarthritis of the Knee, Hip, and Shoulder
Platelet-rich plasma therapy uses the patient’s own concentrated growth factors to reduce inflammation and promote tissue repair within arthritic joints. Evidence for knee osteoarthritis is particularly strong — multiple randomized trials have shown PRP produces longer-lasting symptom improvement than corticosteroid injections. Viscous supplementation (hyaluronic acid) provides joint cushioning as an adjunct or alternative.
Post-Surgical Pain and Failed Back Surgery Syndrome
Persistent or recurring pain after spine surgery affects a meaningful percentage of patients. Spinal cord stimulation and radiofrequency ablation can address this without additional open surgery.
Sports Injuries and Occupational Pain
Ligament sprains, tendinopathy, and post-traumatic joint pain respond well to PRP injections and targeted nerve blocks. Genicular nerve blocks for knee pain — increasingly used for patients not yet ready for knee replacement — provide significant relief for many patients with knee arthritis.
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; repeatable when needed |
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 |
A Closer Look at Key Procedures
Radiofrequency Ablation — The Most Durable Non-Surgical Option for Facet Pain
Lumbar facet joint syndrome is estimated to account for 15–45% of chronic low back pain cases in the United States (ASRA 2024). Unlike injections that temporarily reduce inflammation, RFA physically destroys the sensory nerve fibers that transmit pain from the facet joints to the brain. The nerve is ablated with heat in a precise, controlled way under fluoroscopic guidance.
The most rigorous evidence comes from the RAPID study (NCT04673032) — an international, multicenter, prospective real-world study tracking patients treated with commercially available RFA systems at standard of care. Published in 2025, RAPID 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 (EQ-5D-5L) scores. A 2015 Cochrane review (23 RCTs, n=1,309) provided moderate evidence supporting RFA over placebo for facet-mediated pain. A 2022 systematic review (Li et al., 10 RCTs, n=715) confirmed conventional radiofrequency denervation superior to sham procedures. For patients who have confirmed facet joint as the pain source via diagnostic medial branch blocks, RFA offers relief lasting 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
Spinal cord stimulation 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. A 2024 systematic review and meta-analysis (Cureus, 2024) confirmed SCS achieves over 50% reduction in VAS pain scores for chronic pain related to failed back surgery syndrome.
Persistent spinal pain syndrome type II (PSPS II — the updated name for failed back surgery syndrome) affects 10–40% of patients following large spinal surgical intervention (Frontiers in Pain Research, 2024). For these patients, SCS provides a non-surgical option that has outperformed conventional medical management in multiple RCTs. Modern HF10 (10kHz) and burst stimulation deliver paresthesia-free relief — a major advance over first-generation SCS. 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
Knee osteoarthritis affects approximately 364.58 million people globally (Frontiers in Physiology, 2025). For these patients — many of whom are not yet ready for joint replacement — PRP offers a meaningful non-surgical option. A 2024 meta-analysis in Annals of Medicine & Surgery found PRP injections significantly reduced pain compared to both hyaluronic acid and corticosteroid injections, with the most significant improvement observed at 6 months. A 2025 narrative review (PMC) of 40 high-quality studies confirmed PRP — particularly leukocyte-poor formulations — demonstrates superior pain relief and functional improvement over HA and CS for mild-to-moderate knee OA (Kellgren-Lawrence grades I–III). A 2024 meta-analysis of 11 RCTs (n=1,023) found PRP + HA combination produces superior long-term outcomes on both VAS (MD -4.27, p<.001) and WOMAC (MD -1.77, p<.001) compared to PRP alone. PRP carries no systemic side effects and uses the patient’s own blood — making it a safe first-line regenerative option before steroid injections that may accelerate joint degeneration with repeated use.
About Dr. Patwary — Interventional Pain Management
Dr. Patwary is Grewal Orthopedic & Spine Care’s Interventional Pain Management Physician, providing the full range of minimally invasive pain procedures at all four locations. Dr. Patwary also performs electrodiagnostic testing (EMG and nerve conduction studies) to evaluate nerve function and guide treatment decisions — ensuring that injections target the right level and structure.
Dr. Patwary works in close coordination with Dr. Kanwarpaul Grewal and Dr. Nabil Farakh. Non-surgical pain management is always the first line of care. If a patient’s pain does not respond to appropriately targeted injections, the multidisciplinary team reassesses whether surgery has become a more appropriate option.
★★★★★ Wael Khouri “He is one of the best surgeons I have dealt with in my lifetime — an incredible doctor who always listens and gives time to his patients. He helps patients far more than he has to.” |
Sources & Clinical References
- Assavanop S, Bhatia A. ‘Evidence for Diagnostic Blocks Prior to Radiofrequency Ablation of Innervation to the Lumbar Facet Joints.’ ASRA Pain Medicine News. 2024;49. [Facet joint pain: 15–45% of chronic LBP]
- Assessment of real-world, prospective outcomes in patients treated with RFA for chronic pain (RAPID study). ScienceDirect. 2025. [77% responders at 1 month; 79% at 24 months; NCT04673032]
- Tieppo Francio V, et al. ‘Functional outcomes and healthcare utilization trends following high-frequency (10kHz) SCS therapy.’ Front Pain Res. 2024;5:1451284. [PSPS type II affects 10–40% post-surgical patients; Level I SCS evidence]
- Fang JY, et al. ‘Comparative Efficacy of SCS for Acute and Chronic Pain Related to FBSS: Systematic Review and Meta-Analysis.’ Cureus. 2024. [>50% VAS reduction]
- Comparative effectiveness of intra-articular therapies in knee OA. Annals of Medicine & Surgery. 2024;86(1):361–372. [PRP superior to HA and CS at 6 months]
- PRP for Knee OA: Comprehensive Narrative Review of 40 high-quality studies. PMC. 2025. [LP-PRP superior to HA and CS for KL grades I–III]
- Grewal Orthopedic & Spine Care. ‘Pain Management.’ grewalspine.com/pain-management/. 2025.
- NASS. ‘Clinical Guidelines for Epidural Steroid Injections.’ spine.org.
