Spine pain can involve the neck, upper back, mid back, low back, sacroiliac joints, nerves, muscles, inflammation, hypermobility, or chronic pain pathways. MPM provides diagnosis-first evaluation to identify what may be driving pain before recommending treatment.
Learn how Dr. Aranguren evaluates spine pain, identifies its underlying causes, and develops personalized treatment plans to help patients reduce pain and improve function.
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. Luis Aranguren, an interventional pain management specialist here at Manhattan Pain Medicine. One of the most common reasons people come to see us is spine pain, especially pain in the neck or lower back.
Your spine is one of the most important support systems in your body. It allows you to stand, bend, twist, and move throughout the day. Because it plays such a big role in everyday movement, even small problems in the spine can lead to significant pain or limited mobility.
Spine pain can happen for many different reasons. Sometimes it’s something simple, like a muscle strain from lifting something heavy or sitting in the same position for long periods of time.
Other times, the cause may involve structures in the spine itself, such as arthritis in the joints of the spine, a herniated disc, nerve irritation, or spinal stenosis, which is a narrowing of the spinal canal.
People often experience symptoms like stiffness, sharp or dull back pain, or pain that travels into the arms or legs. Some people also notice numbness, tingling, or weakness, depending on which nerves are involved.
The first step in treating spine pain is understanding exactly where it’s coming from. That usually involves reviewing your medical history, doing a careful physical exam, and sometimes using imaging like X-rays, MRI, or ultrasound. Once we understand the source of the pain, we can build a treatment plan that fits your situation.
That plan might include targeted injections, epidurals, or facet joint injections, which can help calm irritated nerves and joints. In some cases, we may also consider treatments like spinal cord stimulation, which can help interrupt pain signals before they reach the brain.
At Manhattan Pain Medicine, our goal is to treat spine pain in a way that not only reduces pain, but also helps you move better and get back to your normal activities.
If you’re dealing with persistent neck or back pain, it’s important to get it evaluated so we can identify the cause and help you find the right treatment.
Spine pain is not one diagnosis. It can involve the neck, back, discs, nerves, facet joints, sacroiliac joints, muscles, ligaments, inflammatory conditions, hypermobility, or chronic pain sensitization. Some patients have pain that stays in the spine, while others have pain that travels into the arm, ribs, hip, pelvis, buttock, or leg.
At Manhattan Pain Medicine (MPM), spine pain evaluation begins with identifying the most likely pain generator. The goal is to determine whether symptoms are mechanical, nerve-related, inflammatory, SI joint-related, hypermobility-related, muscular, postural, postsurgical, or part of a more complex chronic pain pattern.
For patients looking for spine pain treatment in Manhattan or NYC, MPM focuses on careful diagnosis, imaging review, coordinated care, and individualized treatment planning rather than generic back pain relief.
MPM evaluates spine pain by reviewing the patient’s history, pain location, symptom pattern, prior imaging, prior injections, physical therapy response, neurologic symptoms, inflammatory features, joint mobility, and functional limitations.
Spine pain may overlap with sciatica, herniated discs, spinal stenosis, spondylosis, spondylolisthesis, facet-mediated back pain, sacroiliac joint dysfunction, inflammatory arthritis, seronegative spondyloarthropathy, hypermobility, EDS, slipping rib syndrome, thoracic outlet syndrome, and tethered cord concerns. When needed, MPM coordinates care with spine specialists, rheumatology, orthopedics, neurology, rehabilitation, physical therapy, and other clinicians.
Spine pain can continue even after rest, medication, physical therapy, chiropractic care, imaging, or injections because the true pain generator may not have been fully identified. A disc finding on MRI may not explain all symptoms. Mild imaging changes may still be painful in the right clinical context. Severe pain can also come from the SI joint, facet joints, nerve irritation, muscle guarding, inflammatory disease, or hypermobility-related instability.
MPM’s diagnosis-first approach helps determine whether pain is coming from one primary source or several overlapping contributors. This is especially important when pain travels into the leg, arm, ribs, hip, or pelvis, or when spine pain overlaps with autoimmune symptoms, morning stiffness, joint instability, or chronic pain sensitivity.
Spine pain fits 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 spine pain related to joint laxity, instability, muscle guarding, altered mechanics, recurrent sprains, or SI joint dysfunction.
Patients with autoimmune or inflammatory conditions may have pain that behaves differently from typical mechanical back pain. Morning stiffness, pain that improves with movement, SI joint inflammation, enthesitis, fatigue, or symptoms involving other joints may suggest an inflammatory pattern that requires rheumatology coordination.
MPM evaluates these patterns carefully so treatment is based on the likely source of pain, not assumptions.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
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...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
ZocDoc
This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
ZocDoc
Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
ZocDoc
Dr. Siefferman is a genius. He is very informed and listens attentively.
ZocDoc
Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
ZocDoc
Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
ZocDoc
Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
ZocDoc
Spine pain can come from many different sources, including 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. The cause is not always obvious from symptoms or imaging alone, which is why a diagnosis-first evaluation is important.
You should consider seeing a spine pain specialist when pain persists, worsens, keeps returning, travels into the arm or leg, causes numbness or tingling, limits walking or daily function, does not improve with conservative care, or overlaps with inflammatory symptoms, hypermobility, or multiple failed treatments. A specialist can help determine whether pain is coming from the spine itself, the SI joint, a nerve, muscles, inflammation, or another source.
Back pain usually describes pain felt in the upper, mid, or lower back. Spine pain is a broader term that may include neck pain, thoracic pain, low back pain, disc-related pain, nerve pain, facet joint pain, sacroiliac joint pain, and pain related to spinal structures. Some patients also feel spine-related pain in the ribs, hips, pelvis, buttock, arm, or leg.
Yes. Spine pain can cause leg pain, numbness, tingling, burning, weakness, or electric symptoms when a nerve root is irritated or compressed. This may happen with sciatica, herniated discs, spinal stenosis, spondylolisthesis, or other nerve-related spine conditions. However, similar symptoms can also come from peripheral nerve entrapment, neuropathy, hip conditions, or vascular issues, so evaluation is important.
The source of spine 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. Autoimmune and inflammatory conditions, including seronegative spondyloarthropathy and axial spondyloarthritis, can cause spine pain, sacroiliac pain, morning stiffness, enthesitis, fatigue, and joint symptoms. Inflammatory back pain may improve with movement and worsen with rest. When this pattern is suspected, MPM coordinates with rheumatology for appropriate evaluation and immune-directed treatment planning.
Hypermobility and EDS can contribute to spine 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 joint mobility, stability, symptoms, and prior history before connecting spine pain to hypermobility.
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 spine 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 spine 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.
Spine 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, rapidly worsening symptoms, or loss of function. These symptoms may indicate a serious condition that requires immediate medical attention.
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 spine 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.
Spine pain is one of the most common reasons patients seek care, but it is also one of the most commonly oversimplified. Pain in the neck, upper back, mid back, low back, or sacroiliac region can come from many different structures. It may involve discs, nerves, facet joints, sacroiliac joints, muscles, ligaments, inflammatory disease, hypermobility, spinal alignment, prior injury, or chronic pain mechanisms.
Some patients have pain that stays localized. Others have pain that travels into the arm, ribs, chest wall, hip, pelvis, buttock, or leg. Some describe burning, tingling, numbness, heaviness, weakness, stiffness, or sharp radiating pain. Others have pain that changes with sitting, standing, walking, bending, coughing, twisting, or lying down.
Spine pain treatment should not begin with a procedure or a generic exercise plan before the likely pain generator is understood. A herniated disc, spinal stenosis, facet joint irritation, SI joint dysfunction, muscle guarding, and inflammatory back pain can all feel like “back pain,” but they may require different treatment approaches.
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 the patient’s symptoms, examination, function, and prior treatment response.
Mechanical spine pain may come from muscles, ligaments, discs, joints, posture, movement patterns, arthritis, or structural changes. It may worsen with certain positions or activities and improve with rest, movement modification, strengthening, or targeted treatment. Common mechanical spine conditions include spondylosis, spondylolisthesis, facet arthropathy, disc-related pain, and sacroiliac joint dysfunction.
Mechanical pain can also be influenced by hip mechanics, pelvic alignment, thoracic mobility, scapular control, and lower extremity mechanics. This is why MPM evaluates the spine as part of a broader musculoskeletal system rather than one isolated body part.
Nerve-related spine pain can cause radiating symptoms, burning, tingling, numbness, electric pain, weakness, or pain that travels into the arm or leg. Sciatica and herniated discs are common examples. Spinal stenosis can also irritate or compress nerves, especially when walking or standing triggers leg symptoms.
Not all radiating pain comes from the spine. Peripheral nerve entrapment, neuropathy, thoracic outlet syndrome, piriformis syndrome, and pelvic nerve conditions can mimic spine-related nerve pain. MPM evaluates the nerve pathway carefully before recommending treatment.
The sacroiliac joint can cause low 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 treatment response. In selected cases, sacroiliac joint injection may help clarify or treat the pain generator. For certain structural instability patterns, sacroiliac joint fixation or fusion may require specialist evaluation.
Some spine 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 spine pain differently. Joint laxity, ligamentous instability, muscle guarding, recurrent sprains, altered proprioception, and SI joint dysfunction may contribute to pain. Some patients describe feeling 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 joint instability, muscle compensation, nerve irritation, or altered mechanics are contributing.
Spine 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 spine 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 spine 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 spine 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. It can, however, 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 spine 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, 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 spine 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 spine pain treatment in Manhattan or NYC, MPM provides coordinated pain medicine care for back pain, neck pain, sciatica, herniated discs, spinal stenosis, spondylosis, spondylolisthesis, SI joint pain, inflammatory back pain, hypermobility-related spine pain, and complex chronic pain patterns.
