At Manhattan Pain Medicine, each provider brings specialized expertise. This lets us collaborate around clusters of related conditions. We treat all pain, but certain Zones of Expertise show particular synergy in our practice. Some affect the whole body; others are anatomically focused; some sit within trauma frameworks and pain psychology.
Chronic Pain
Pain is a distress signal to the brain. New pain is straightforward; chronic or recurrent pain becomes layered and complex. Most patients have lived with it for years. Diagnosing and treating complex chronic pain is a journey.
This journey is iterative: Discovery → Treatment → Maintenance, and rarely complete after one visit. We reverse-engineer the problem: what causes pain, how it started, and why it persists. We look at the whole body, how systems relate, and which thread to untie first.For Chronic Pain, we work on two paths at once:
• Get the patient comfortable.
• Confirm the what, how, and why of pain generation.
Hypermobility
Hypermobility is structural laxity or instability of joints/ligaments due to insufficient tensile strength or capsular support. It can be localized after injury or systemic in Hypermobility Spectrum Disorder (HSD), Ehlers-Danlos Syndrome (EDS), or certain autoimmune diseases.
Laxity and capsular instability alter biomechanics. The body adopts protective postures; muscles shift from coordinating motion to stabilizing joints, leading to:
• gravity-favored compensations
• suboptimal mechanics
• joint injury
• soft-tissue overuse/misuse
• pain
We determine whether laxity is global or patterned, and screen for systemic drivers (autoimmune/inflammatory disease, EDS, related conditions) using genetic tests, bloodwork, and imaging.
Treatment involves:
• addressing underlying conditions
• regenerative medicine to tighten specific ligaments
• physical therapy to unwind maladaptive synergy patterns
Presentations vary widely. We re-evaluate stepwise and collaboratively to restore structural integrity, biomechanics, and function.
Autoimmune and Inflammatory Disorders
Inflammation is essential for healing, but dysregulation can drive destructive, excessive responses—seen in autoimmune disease (e.g., lupus, psoriasis), post-infectious states (Lyme, EBV, COVID), and immune dysfunction (immunodeficiency, MCAS).
Excess inflammation sensitizes tissues and the nervous system, causing diffuse pain, and can impair joint stability—contributing to hypermobility. Our Discovery–Treatment–Maintenance framework identifies the what and why, controls the exaggerated response, treats ongoing pain, and then addresses the cause.
Autonomic dysfunction
The autonomic nervous system (ANS) balances sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) control of heart rate, temperature, gut motility, sweating, blood pressure, mood, and more. Autonomic dysfunction is an imbalance that disrupts these automatic functions.
It commonly accompanies hypermobility, autoimmune disease, SIBO, migraine, post-COVID states, small fiber neuropathy (SFN), and others. We treat the underlying driver while bridging symptoms with medications, sympathetic blocks, infusions, biofeedback, and physical therapy. Often, a team, including pain psychology, interventional pain, rheumatology, acupuncture, PT, gastroenterology, and cardiology, works together to realign the system.
Psychology of Pain
Chronic pain has time to reshape life, self-image, relationships, work, and hope. The long, costly search for the right providers, correct diagnoses, and effective treatments can amplify the burden.
Pain psychologists help identify core feelings and their sources, regulate emotions, and rebuild self-structure and life plans. Their expertise in pain neurobiology improves engagement with the medical journey of Diagnosis, Treatment, and Maintenance. Practical tools include naming and tracking pains, recording triggers and benefits of therapies, and coordinating multi-provider care. This coaching empowers patients who feel stuck.With or without a psychologist, active participation, understanding the how/why, making intentional choices, and tracking progress, returns the locus of control to the patient.
Musculoskeletal issues (Spine/Joint/muscle/tendon/Ligament/nerve)
Most pain arises from mechanical dysfunction of muscles, joints, tendons, ligaments, and their nerves. One stressed area leads to compensations and new stress elsewhere.
We identify the pain-signaling structures and then address why they’re overloaded. Durable relief requires treating causes, not just symptoms. For example, knee pain is more than “osteoarthritis”; it reflects cumulative biomechanical stress from injury, instability, or overuse. We reverse-engineer mechanics to offload painful tissues and restore function.
Disc herniations are rarely isolated; posture, facet joints, and spinal ligaments often contribute. Treatment starts with a precise mechanical understanding, then uses medications, injections, and guided physical therapy to get you back on track.
Headache (Including Facial Pain & TMJ dysfunction)
“Headache” includes all head and facial pain. Because headaches disrupt cognition, we often treat them first; if the brain isn’t well, nothing feels well.
We inventory head pains to distinguish primary from secondary headaches and identify contributors. Neck–head–TMJ relationships are often bidirectional. Whether migraine, craniocervical instability, inflammatory arthritis, or orofacial dystonia, our team, led by a board-certified headache specialist, guides diagnosis and treatment.
Pelvic Pain
The pelvis is anatomically complex and influenced by multiple body systems; pelvic pain can also originate outside the pelvis. Our pelvic pain physiatrists use a structured discovery process to identify which structures generate pain, how and why they do, and how to treat root causes.
We evaluate and coordinate care for the full spectrum: hernias, pelvic ring instability, pelvic dystonia, hip dysplasia, transitional vertebra (Bertolotti syndrome), sacroiliac joint issues, Tarlov cysts, pudendal neuralgia, Endometriosis, pelvic congestion syndrome, and more; diagnosing what we can treat directly and organizing specialty care when needed.