Neck and back pain can come from discs, nerves, facet joints, sacroiliac joints, muscles, ligaments, inflammation, hypermobility, or chronic pain pathways. MPM provides diagnosis-first evaluation to identify what may be driving symptoms before recommending treatment.
Neck and back pain can result from injuries to the spine, nerves, joints, muscles, or surrounding soft tissues. Dr. Siefferman explains how identifying the true source of pain leads to more targeted treatment options and long-lasting relief.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman, interventional pain specialist and medical director at Manhattan Pain Medicine. Peripheral nerve stimulation is a mode of neuromodulation where we use an electrode on a nerve outside the spine, which is why it’s called peripheral nerve stimulation.
This can be done with a fully implanted medical device or a temporarily implanted or partially implanted medical device. Generally, if this is a mode we are considering, we start with a trial of TENS—so, transcutaneous electrical nerve stimulation.
Many physical therapists offer this; you can buy one yourself online. We will trial this extensively and if it seems helpful, or if it’s in an area where it can’t practically be used, then we will talk about a temporary peripheral nerve stimulator. Generally in this situation, there is a hairlike electrode—super thin, .3 mm—which we place through the skin next to the nerve. It gets taped down, there’s a battery pack, and then there’s a remote control. That can stay in for 60 days, and we program it and we use that to block the pain signaling.
Now, it will help decrease the pain signaling and it will also decrease the sensitization of the nervous system. In other words, it’ll help the brain remember what normal feels like. This is something that we may consider; there’s a role for it. It’s just one option in a spectrum of treatments.
If this is something that interests you, if you’d like to discuss it more, please, we’re happy to speak about this and also talk about the range of other treatment options that might be appropriate for your situation.
Neck and back pain are common, but persistent symptoms are not always simple. Pain may come from the spine, discs, nerves, facet joints, sacroiliac joints, muscles, ligaments, inflammatory disease, hypermobility, posture, movement patterns, prior injury, or chronic pain sensitization.
Some patients feel pain only in the neck or lower back. Others have pain that travels into the head, shoulder, arm, ribs, hip, pelvis, buttock, or leg. Symptoms may include stiffness, aching, sharp pain, burning, numbness, tingling, weakness, headaches, or pain that worsens with sitting, standing, walking, bending, lifting, or sleeping.
At Manhattan Pain Medicine (MPM), evaluation begins with identifying the most likely pain generator. For patients looking for neck and back pain treatment in Manhattan or NYC, MPM focuses on careful diagnosis, imaging review, functional assessment, coordinated care, and individualized treatment planning.
MPM evaluates neck and back pain by reviewing the patient’s history, pain location, symptom pattern, prior imaging, prior treatments, neurologic symptoms, inflammatory features, joint mobility, and functional limitations.
Neck and back pain may overlap with sciatica, herniated discs, spinal stenosis, spondylosis, spondylolisthesis, facet-mediated pain, sacroiliac joint dysfunction, seronegative spondyloarthropathy, autoimmune-related pain, EDS, hypermobility spectrum disorder, thoracic outlet syndrome, scapular dyskinesia, slipping rib syndrome, and tethered cord concerns. When needed, MPM coordinates care with spine specialists, rheumatology, neurology, orthopedics, rehabilitation, physical therapy, and other clinicians.
Neck and back pain can persist or return when the underlying driver has not been fully identified. A patient may have an MRI finding that does not explain the full pain pattern, or they may have significant pain even when imaging looks mild. Pain may also come from the SI joint, facet joints, irritated nerves, muscle guarding, inflammatory disease, joint instability, or chronic pain sensitivity.
MPM’s diagnosis-first approach helps determine whether symptoms are mechanical, nerve-related, inflammatory, hypermobility-related, SI joint-related, muscular, or mixed. This is especially important when neck pain overlaps with headaches or shoulder pain, or when back pain travels into the hip, pelvis, buttock, or leg.
Neck and back pain fit within MPM’s Musculoskeletal issues Zone of Expertise, with important overlap in Hypermobility and Autoimmune and Inflammatory care.
Patients with EDS or hypermobility spectrum disorder may experience neck or back pain related to joint laxity, instability, altered mechanics, muscle guarding, recurrent sprains, or SI joint dysfunction. Patients with autoimmune or inflammatory conditions may have pain that behaves differently from typical mechanical pain, including morning stiffness, pain that improves with movement, SI joint inflammation, enthesitis, fatigue, or symptoms in other joints.
MPM evaluates these patterns carefully so treatment is based on the likely source of pain, not assumptions.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Chronic neck and back pain can come from discs, nerves, facet joints, sacroiliac joints, muscles, ligaments, spinal stenosis, spondylosis, spondylolisthesis, arthritis, inflammatory disease, hypermobility, EDS, prior injury, postsurgical changes, or chronic pain sensitization. Because several causes can overlap, diagnosis-first evaluation is important before selecting treatment.
You should consider seeing a specialist when neck or back pain persists, worsens, keeps returning, travels into the arm or leg, causes numbness or tingling, limits walking or daily function, interferes with sleep, does not improve with conservative care, or overlaps with inflammatory symptoms, hypermobility, or multiple failed treatments.
The source of pain is identified through history, physical examination, neurologic assessment, movement testing, imaging review, and sometimes diagnostic injections. Disc pain, nerve pain, facet joint pain, SI joint pain, muscle pain, and inflammatory pain can overlap. MPM evaluates the full pain pattern before recommending treatment.
Yes. Neck pain can overlap with headaches when cervical joints, muscles, nerves, posture, dystonia, or upper cervical mechanics contribute to pain. However, headaches can also come from migraine, tension headache, TACs, intracranial pressure concerns, TMJ disorders, or other neurologic conditions. MPM evaluates the headache and neck pattern together when symptoms overlap.
Yes. Back pain can cause leg pain, numbness, tingling, burning, or weakness when a spinal nerve root is irritated or compressed. This may happen with herniated discs, spinal stenosis, spondylolisthesis, or other nerve-related spine conditions. Similar symptoms can also come from peripheral nerve entrapment, neuropathy, hip conditions, or vascular issues, so evaluation is important.
Yes. Autoimmune and inflammatory conditions can cause spine pain, sacroiliac pain, morning stiffness, enthesitis, fatigue, and symptoms in other joints. Inflammatory back pain may improve with movement and worsen with rest. When this pattern is suspected, MPM coordinates with rheumatology for appropriate evaluation and treatment planning.
Hypermobility and EDS can contribute to neck and back pain in some patients through joint laxity, instability, altered mechanics, muscle guarding, recurrent sprains, SI joint dysfunction, and increased demand on stabilizing muscles. Not every patient with spine pain has hypermobility, and not every hypermobile patient has EDS. MPM evaluates the full pattern before making that connection.
Treatment depends on the pain generator. Options may include physical rehabilitation coordination, medication management, acupuncture, Feldenkrais, biofeedback, pain psychology, diagnostic ultrasound when relevant, ultrasound-guided injections, spine injections, epidural injections, steroid injections, SI joint injections, regenerative options in selected cases, neuromodulation for selected chronic nerve pain, or referral to rheumatology, neurology, spine surgery, or rehabilitation when needed.
Epidural injections may be considered when symptoms suggest irritated or inflamed spinal nerve roots, such as radiating arm or leg pain related to a herniated disc, spinal stenosis, or radicular pain pattern. They are not appropriate for every type of neck or back pain. MPM evaluates the diagnosis, imaging, symptoms, risks, and prior treatment response before recommending an epidural injection.
Spinal cord stimulation may be considered for selected chronic neuropathic pain patterns when conservative care, medications, injections, or other treatments have not provided adequate relief. It may be considered for certain persistent spine-related nerve pain conditions, including some postsurgical or refractory neuropathic pain patterns. It is not a first-line treatment and requires careful evaluation, trialing, and risk discussion.
Regenerative medicine options such as PRP, prolotherapy, or other orthobiologic approaches may be considered in selected musculoskeletal pain patterns, but they are not appropriate for every neck or back condition. They should not be presented as a way to reverse arthritis, repair all disc problems, or replace surgery when surgery is medically indicated. MPM evaluates anatomy, diagnosis, severity, evidence, goals, and risk profile before discussing these options.
Neck or back pain should be evaluated urgently when it is associated with new weakness, progressive numbness, bowel or bladder dysfunction, saddle anesthesia, fever, unexplained weight loss, history of cancer, major trauma, severe night pain, chest pain, shortness of breath, sudden severe headache, vision changes, trouble walking, rapidly worsening symptoms, or loss of function.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If neck or back pain is affecting your movement, sleep, work, or daily life, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers discs, nerves, facet joints, SI joints, muscles, inflammation, hypermobility, EDS, arthritis, and complex chronic pain patterns. Request an appointment to discuss your symptoms, prior imaging, and care options.
Neck and back pain are often described as simple mechanical problems, but persistent pain is usually more complex. Pain in the neck, upper back, mid back, lower back, or sacroiliac region may involve discs, nerves, joints, muscles, ligaments, inflammatory disease, hypermobility, spinal alignment, prior injury, or chronic pain mechanisms.
Some patients experience localized aching or stiffness. Others have pain that travels into the head, jaw, shoulder, arm, ribs, chest wall, hip, pelvis, buttock, or leg. Symptoms may include burning, tingling, numbness, weakness, stiffness, muscle guarding, headaches, or pain that changes with movement, posture, lifting, sitting, standing, walking, or sleep position.
Neck and back pain treatment should not begin with a procedure, medication, or exercise plan before the likely pain generator is understood. A herniated disc, irritated nerve root, facet joint, SI joint, muscle trigger point, inflammatory arthritis, and hypermobility-related instability can all create pain, but they may require different treatment plans.
Imaging can be useful, but it does not always tell the full story. Some patients have significant MRI findings that are not the main source of pain. Others have severe pain with relatively mild imaging changes. MPM reviews imaging in the context of symptoms, examination, function, and prior treatment response.
Neck pain may overlap with headaches, shoulder pain, arm symptoms, scapular dyskinesia, thoracic outlet syndrome, cervical dystonia, or nerve irritation. Some patients feel pain at the base of the skull, behind the eyes, across the shoulders, between the shoulder blades, or down the arm.
The goal is to determine whether symptoms are coming from cervical joints, muscles, nerves, discs, posture, shoulder mechanics, headache biology, TMJ overlap, or another source. This distinction matters because headache-related neck pain, nerve-related neck pain, and musculoskeletal neck pain may need different treatment strategies.
Back pain may stay in the lower back or travel into the buttock, hip, pelvis, thigh, calf, or foot. Radiating pain, numbness, tingling, burning, or weakness may suggest nerve irritation. Sciatica and herniated discs are common causes, but similar symptoms may also come from spinal stenosis, spondylolisthesis, peripheral nerve entrapment, piriformis syndrome, hip pathology, SI joint dysfunction, or neuropathy.
MPM evaluates the full pathway of pain rather than assuming that every leg symptom is sciatica or every MRI finding is the main problem.
Facet joints are small joints in the spine that can contribute to neck or back pain, especially with extension, rotation, arthritis, or degenerative change. Disc-related pain may involve local spine pain or nerve root irritation. Spinal stenosis can narrow the space around spinal nerves and may cause pain, cramping, heaviness, numbness, or weakness with standing or walking.
Each of these conditions requires careful clinical correlation. Treatment may include rehabilitation coordination, medication management, image-guided injections, or specialist referral depending on the pattern.
The sacroiliac joint can cause lower back, buttock, hip, groin, pelvic, or leg-like pain. SI joint pain may be mistaken for lumbar spine pain, hip pain, or sciatica. It can be influenced by injury, pregnancy, altered mechanics, inflammatory disease, hypermobility, EDS, or prior spine surgery.
When SI joint dysfunction is suspected, MPM may evaluate movement, tenderness, provocative testing, imaging, and prior response to treatment. In selected cases, sacroiliac joint injection may help clarify or treat the pain generator. Certain structural instability patterns may require referral for additional specialist evaluation.
Some neck and back pain is inflammatory rather than primarily mechanical. Inflammatory back pain may involve morning stiffness, improvement with movement, worsening with rest, sacroiliac pain, fatigue, enthesitis, and symptoms in other joints. Conditions such as seronegative spondyloarthropathy, rheumatoid arthritis, Sjogren’s, autoimmune-related pain, and arthritis-related joint pain may contribute to spine symptoms.
MPM does not replace rheumatology. Instead, MPM helps identify when pain may have an inflammatory pattern and coordinates with rheumatology when DMARDs, biologics, infusions, or immune-directed treatment may be appropriate. Pain-focused care may still be useful when inflammatory disease overlaps with mechanical pain, nerve pain, SI joint dysfunction, or chronic pain sensitization.
Patients with EDS or hypermobility spectrum disorder may experience neck and back pain related to joint laxity, ligamentous instability, muscle guarding, recurrent sprains, altered proprioception, and SI joint dysfunction. Some patients feel unstable, overworked, or unable to tolerate aggressive stretching or manipulation.
Hypermobility-related spine pain should be evaluated carefully. The goal is not to assume every symptom is caused by EDS or HSD, but to understand whether instability, muscle compensation, nerve irritation, or altered mechanics are contributing.
Neck and back pain can become chronic when the original pain generator persists, when several contributors overlap, or when the nervous system becomes more sensitive over time. Chronic pain may involve mechanical irritation, nerve pain, inflammation, muscle guarding, sleep disruption, fear of movement, stress physiology, and reduced activity tolerance.
Pain psychology, biofeedback, acupuncture, Feldenkrais, medication management, and rehabilitation coordination may support patients whose pain has become part of a broader chronic pain pattern. These approaches do not mean the pain is imagined. They help address how the nervous system, movement, and daily function interact with pain.
Treatment at MPM depends on the diagnosis and clinical pattern. Options may include medication management, physical rehabilitation coordination, acupuncture, Feldenkrais, weight-related support when relevant, biofeedback, pain psychology, diagnostic ultrasound when appropriate, ultrasound-guided injections, spine injections, epidural injections, epidural lysis of adhesions or Racz catheter procedures in selected cases, steroid injections, sacroiliac joint injection, regenerative medicine, PRP, prolotherapy, ketamine therapy, biologics or infusions through appropriate specialist coordination, spinal cord stimulation, dorsal root ganglion stimulation, and sacroiliac joint fixation or fusion referral when appropriate.
These treatments are not interchangeable. Epidural injections may be considered for selected nerve root pain patterns. SI joint injections may be considered when the SI joint is suspected as a pain generator. Neuromodulation may be considered for selected persistent neuropathic pain. Biologics and DMARDs belong to rheumatology-directed inflammatory disease care. Regenerative options require careful patient selection and should not be presented as universal spine treatments.
Some neck and back conditions require surgical evaluation, especially when there is progressive neurologic deficit, severe structural compression, instability, significant spinal stenosis, certain spondylolisthesis patterns, persistent disabling radicular pain, or failure of appropriate nonsurgical care.
MPM can help evaluate pain generators and coordinate referral when surgical input is needed. Pain medicine does not replace spine surgery when surgery is medically indicated, but it can help patients understand whether pain appears to be mechanical, nerve-related, inflammatory, SI joint-related, hypermobility-related, or mixed before moving forward with more invasive decisions.
Patients should seek urgent evaluation for neck or back pain associated with new weakness, progressive numbness, bowel or bladder dysfunction, saddle anesthesia, fever, unexplained weight loss, history of cancer, major trauma, severe night pain, chest pain, shortness of breath, sudden severe headache, vision changes, trouble walking, or rapidly worsening symptoms.
These symptoms may indicate infection, fracture, malignancy, spinal cord compression, vascular conditions, neurologic disease, or other serious medical problems that require immediate attention.
MPM approaches neck and back pain through a diagnosis-first model. The goal is to identify the source of pain, understand overlapping contributors, interpret imaging carefully, and build a treatment plan that fits the patient’s symptoms, goals, and risk profile.
For patients looking for neck and back pain treatment in Manhattan or NYC, MPM provides coordinated pain medicine care for neck pain, back pain, sciatica, herniated discs, spinal stenosis, spondylosis, spondylolisthesis, SI joint pain, inflammatory back pain, hypermobility-related spine pain, and complex chronic pain patterns.
