Introduction
Chronic pain (any pain that persists for three months or longer that limits what you can do, doesn’t resolve with rest or standard treatment) requires a different kind of medical approach than an acute injury. It requires a specialist who understands the anatomy of pain: which structures are generating the signals, which neural pathways are carrying them, and which interventions can interrupt those signals precisely enough to restore your quality of life. [1]
Interventional pain management is that specialty. At New York Bone & Joint Specialists, it’s practiced within an orthopedic surgical practice by design. When Dr. Leon Popovitz founded New York Bone & Joint on the principle that preserving your body’s own tissue is the foundation of long-term health, he built the practice to exhaust every appropriate non-surgical option before a surgical recommendation is ever made. Interventional pain management performed by a dedicated specialist with subspecialty depth, integrated with the orthopedic team is how that principle is practiced.
Dr. Efime Popovitz brings dual board certification in Anesthesiology and Pain Medicine, fellowship training at Yale School of Medicine, and fluency in both fluoroscopic and ultrasound-guided procedures to every patient he sees at New York Bone & Joint. His approach is individualized, multimodal, and built around two critical questions: what’s actually causing your pain, and what’s the most precise, least invasive way to address it?
What is Interventional Pain Management?
Interventional pain management is the subspecialty of medicine focused on diagnosing and treating pain through minimally invasive procedures (such as injections, nerve blocks, radiofrequency ablation, and neuromodulation) that target the specific anatomical source of pain with a precision that oral medications and physical therapy alone can’t achieve.
The discipline is grounded in a fundamental principle: pain has a source. A herniated disc compressing a nerve root is a different source than inflamed facet joints or a dysfunctional sacroiliac joint or a peripheral nerve injured by trauma. Each source has a different treatment. Identifying which source is generating your pain, and sometimes using a diagnostic injection as the tool to confirm it, is the first clinical task. Treatment follows diagnosis. Not the other way around.
“One of the most common patterns I see is a patient who has been treated for back pain for months without meaningful improvement because the treatment was directed at a category (‘back pain’) rather than a specific generator. Back pain from lumbar facet arthropathy responds to medial branch blocks and potentially radiofrequency ablation. Back pain from a compressed nerve root responds to epidural steroid injection near that root. Back pain from sacroiliac joint dysfunction responds to SI joint intervention. The treatments are different because the sources are different. Getting to the right treatment requires getting to the right diagnosis first.” — Dr. Efime Popovitz
Conditions We Treat
Dr. Efime Popovitz treats chronic pain conditions affecting the spine, joints, and peripheral nervous system. The following conditions are among the most commonly treated at New York Bone & Joint:
| Condition | Primary Source of Pain | First-Line Interventional Approach | Notes |
| Lumbar Radiculopathy (Sciatica) | Compressed or irritated lumbar nerve root, typically from herniated disc or stenosis | Lumbar epidural steroid injection (interlaminar or transforaminal) | Targets the nerve root directly. Provides anti-inflammatory relief to allow function and physical therapy to proceed. [3] |
| Cervical Radiculopathy (Pinched Nerve) | Compressed cervical nerve root from disc herniation or foraminal stenosis | Cervical epidural steroid injection or cervical selective nerve root block | Precision placement essential in the cervical spine. Fluoroscopic guidance required. [1] |
| Spinal Stenosis (Lumbar or Cervical) | Narrowed spinal canal compressing multiple nerve roots | Epidural steroid injection (lumbar or cervical) to reduce nerve inflammation | Can provide significant functional improvement allowing activity and physical therapy. [6] |
| Herniated Disc | Disc material pressing on nerve root or spinal cord | Epidural steroid injection at or near the affected level | Most effective when combined with structured physical therapy. Imaging-confirmed level targeted. |
| Facet Joint Arthritis | Degenerated facet joints on posterior spine: cervical, thoracic, or lumbar | Medial branch block (diagnostic) → Radiofrequency Ablation if confirmed facet-mediated pain | RFA can provide 6–24 months of relief when facet joint is confirmed as the pain generator. [4] [9] |
| Sacroiliac Joint Dysfunction | Inflamed or hypermobile SI joint; common source of low back and buttock pain | SI joint diagnostic injection → therapeutic SI joint injection if confirmed | Up to 30% of low back pain may originate from the SI joint. [5] Often misattributed to lumbar pathology. |
| Degenerative Disc Disease | Loss of disc height and hydration causing nerve and joint irritation | Epidural steroid injection for acute flares; medial branch block if facet component | Multimodal approach required: injection is one component alongside physical therapy and activity modification. |
| Post-Surgical Pain | Residual nerve inflammation, scar tissue, or altered pain signaling after spine or joint surgery | Epidural steroid injection, selective nerve root block, or PNS depending on pattern | Post-surgical pain requires careful evaluation to distinguish structural recurrence from nerve sensitization. |
| Peripheral Nerve Pain (chronic) | Injured or sensitized peripheral nerve from trauma, compression, or neuropathy | Peripheral Nerve Stimulation (PNS) using SPRINT system for refractory cases | PNS targets the specific nerve with electrical stimulation rather than pharmacological intervention. [7] [10] |
| Chronic Joint Pain (shoulder, knee, hip) | Inflammatory arthritis, synovitis, osteoarthritis of peripheral joints | Ultrasound-guided joint injection, trigger point injection | Coordinated with NYBJ orthopedic team; injection may be prelude to surgical evaluation or primary treatment. |
| Myofascial Pain & Trigger Points | Hypersensitive muscle knots causing local and referred pain | Trigger point injection with local anesthetic ± steroid | Useful for myofascial pain syndrome, tension headaches, and chronic muscle pain syndromes. |
| Chronic Migraine | Sensitized trigeminal pathways and occipital nerve involvement | Occipital nerve block, botulinum toxin injections for chronic migraine | Coordinate with neurology; New York Bone & Joint treats the interventional component. |
Procedures: What We Do and How
Every procedure at New York Bone & Joint is performed by Dr. Efime Popovitz using fluoroscopic or ultrasound guidance where accuracy requires it. The following describes the most commonly performed procedures at New York Bone & Joint.
Epidural Steroid Injections (ESI)
The most commonly performed spinal interventional procedure. Corticosteroid is delivered into the epidural space (that’s the space surrounding the spinal cord’s protective covering) reducing inflammation around compressed or irritated nerve roots. [1] [3]
Three approach types are used depending on the location and nature of the pathology:
- Interlaminar: Needle placed between the laminae, delivering medication broadly to the epidural space. Useful for bilateral or widespread nerve root irritation.
- Transforaminal (selective nerve root injection): Needle placed adjacent to a specific exiting nerve root at the foramen. Most targeted approach for single nerve root compression. Preferred when imaging clearly identifies a single-level pathology.
- Caudal: Needle placed through the sacral hiatus, delivering medication to the lower lumbar epidural space. Useful for lower lumbar and sacral nerve root conditions.
“A nuance about ESI that I explain to every patient: the injection is anti-inflammatory, not curative. If a disc herniation is compressing a nerve root, the steroid reduces the inflammation that’s amplifying the nerve’s pain signal, but the disc is still there. The value of the injection is that it can quiet the nerve response enough to allow physical therapy to proceed and the disc to resorb over time. That’s the goal: create a window of reduced pain that allows the body’s own healing process to work.” — Dr. Efime Popovitz
Medial Branch Blocks & Radiofrequency Ablation (RFA)
Facet joints are small joints on the posterior spine, one at each vertebral level on each side, that guide spinal movement. When they become arthritic (a very common source of cervical and lumbar pain, particularly in patients with degenerative changes), they generate pain signals through the medial branch nerves.
Medial branch block: A diagnostic injection of local anesthetic to the medial branch nerves supplying a facet joint. If the patient experiences significant temporary pain relief, facet joint arthropathy is confirmed as the primary pain generator. This distinction matters: facet-mediated pain responds to RFA; nerve root pain does not.
Radiofrequency ablation (RFA): Once the facet joint is confirmed as the pain source, RFA uses heat generated by radiofrequency energy to interrupt the medial branch nerves that transmit facet joint pain. The nerve isn’t destroyed permanently (it will regenerate over time), but RFA typically provides 6–24 months of meaningful pain relief, after which the procedure can be repeated. [4] [9]
Sacroiliac Joint Injections
The sacroiliac joints connect the sacrum to the iliac bones of the pelvis and are a frequently overlooked source of low back and buttock pain. Studies suggest that SI joint dysfunction accounts for up to 30% of low back pain cases, a proportion that is often underdiagnosed because SI joint pain can radiate in patterns similar to lumbar radiculopathy or facet pain. [5]
A diagnostic injection of local anesthetic into the SI joint under fluoroscopic guidance confirms whether the SI joint is the pain generator. If confirmed, a therapeutic injection with corticosteroid can provide meaningful relief. For refractory SI joint pain, RFA of the lateral branch nerves is an option for longer-term relief.
Peripheral Nerve Stimulation (PNS): SPRINT System
For patients with chronic pain that has not responded adequately to injections, medications, or physical therapy (and for whom surgery isn’t the appropriate or desired next step), peripheral nerve stimulation represents a meaningful advance in non-surgical pain management. [7] [10]
PNS delivers gentle electrical stimulation directly to the peripheral nerve responsible for pain, interrupting the pain signal before it reaches the brain. At New York Bone & Joint, Dr. Efime Popovitz uses the SPRINT PNS System, which delivers stimulation through a thin, flexible lead placed near the target nerve under ultrasound guidance in the office. The lead connects to a small external device. No permanent implant is required.
The treatment period is 60 days, after which the lead is removed. Clinical studies show that many patients achieve sustained pain relief beyond the treatment period, consistent with neuroplasticity effects, the nervous system’s restoration of normal signaling pathways during the stimulation period. [10]
PNS is appropriate for:
- Chronic pain from peripheral nerve injury or neuropathy that has failed conservative management
- Post-surgical pain where structural recurrence has been ruled out
- Chronic shoulder, knee, or limb pain from nerve-mediated sources
- Patients who want to avoid permanent implants or major surgery
“I am passionate about integrating PNS into the spectrum of treatment options available to patients. Part of the reason is that PNS merges my background in anesthesiology and pain medicine. As an anesthesiologist, I routinely “block” or numb nerves for anesthesia and pain control such as for shoulder or knee surgery. As a pain physician, I can apply those same techniques to patients with a chronic pain issue. Instead of blocking these nerves, we stimulate them and change the way they transmit pain signals.” — Dr. Efime Popovitz
Other Procedures Performed at New York Bone & Joint
- Trigger point injections: Local anesthetic injected into hyperirritable muscle knots for myofascial pain syndrome, chronic muscle tension, and referred pain patterns.
- Occipital nerve blocks: Local anesthetic and corticosteroid injected near the greater and lesser occipital nerves for occipital neuralgia and certain chronic headache patterns.
- Botulinum toxin injections for chronic migraine: BOTOX administered at standardized injection sites for patients meeting criteria for chronic migraine (15+ headache days per month). Typically repeated every 12 weeks.
- Ultrasound-guided joint injections: Shoulder, knee, and hip joint injections with corticosteroid or hyaluronic acid, performed with ultrasound guidance for accurate placement. Coordinated with the New York Bone & Joint orthopedic team.
- EMG / Nerve Conduction Studies: Electrophysiological testing to diagnose nerve damage, radiculopathy, neuropathy, and nerve entrapment syndromes. Guides treatment planning.
How We Diagnose Before We Treat
The most consequential step in interventional pain management isn’t the procedure but rather the diagnosis that determines whether the procedure is the right answer and where it should be directed.
At New York Bone & Joint, every new patient with chronic pain receives a structured evaluation: a thorough history of the pain’s character, location, aggravating factors, and prior treatments; a physical examination including provocative and neurological testing; and review of all available imaging. In many cases, existing MRI or X-ray tells us what we need to know. In some cases, we order additional imaging, including EMG/NCS when nerve function needs to be directly assessed.
“Imaging shows anatomy. It doesn’t always tell us which anatomical finding is the pain source. A patient can have three levels of disc bulge on MRI and still have pain that is coming entirely from the facet joints. A patient can have an MRI that looks relatively benign and have severe radiculopathy from a small, contained disc herniation that’s compressing a specific nerve root. The imaging guides the evaluation. The diagnostic injection (when we place local anesthetic at a specific target and ask whether the pain changes) gives us physiological information that the MRI can’t. It tells us whether that structure is the one that is causing the problem. That’s how we know where to aim.” — Dr. Efime Popovitz
| From Dr. Efime Popovitz: A Case That Shows How the Right Sequence Changes Everything A 38-year-old electrician came to see me with over 15 years of chronic low back pain likely related to both current occupation and prior mason work. He described pain across his low back that radiates to the buttock and lateral thigh and typically stops at the level of the knee. He used to have numbness and tingling going down to his feet, but he more recently endorsed pure pain. Symptoms are worse on the left side but do occur bilaterally. He says the symptoms are worst with spinal extension, bending and twisting motions and particularly with activities such as sprinting for prolonged periods. He says he had undergone several epidural injections over the last few years, but his last 2 epidurals only provided relief for a few weeks at a time. He had performed several rounds of physical therapy along with home exercises without noticeable improvement in his pain. He had also taken anti-inflammatories including meloxicam for the pain without noticeable benefit. When I reviewed his MRI, I saw a moderate disc herniation with left-sided foraminal narrowing at L4-L5 and L5-S1. There was a separate finding of facet arthropathy at these same levels. The question was which of these was generating his back and leg pain. His symptoms (pain down the leg but stopping at the knee, the worsened pain with bending and twisting) were consistent with facet arthropathy. I addressed this by performing medial branch blocks at L4-L5, L5-S1 on both sides, which effectively “numbs” the nerves which supply the arthritic joints at these levels. These two sets of diagnostic blocks resulted in 85% relief of his back and leg pain for the duration of the local anesthetic. That confirmed the facet joints as the pain source and that proceeding with radiofrequency ablation or “burning” of the nerves would provide effective pain relief for at least 6 months. This is the case that illustrates the value of sequencing. The last few cortisone injections weren’t working because they were treating the wrong source of pain. While initial epidural injections may have helped his leg pain and numbness, his new pain generator was arthritis and inflammation of facet joints. Facet arthropathy mainly causes low back symptoms, but it can certainly radiate to the lower extremities and mimic pain from a disc herniation. The right answer was available all along. It just required the right diagnosis first. — Dr. Efime Popovitz |
Why Choose New York Bone & Joint for Interventional Pain Management?
| The New York Bone & Joint Advantage | What It Means for You |
| Dual board-certified specialist in Anesthesiology and Pain Medicine | Dr. Efime Popovitz holds dual board certification through the American Board of Anesthesiology, with fellowship training specifically in pain medicine at Yale School of Medicine. He isn’t a generalist offering interventional procedures: he’s a dedicated subspecialist. |
| Integrated with orthopedic surgeons | Pain management within an orthopedic practice means Dr. Efime Popovitz and the New York Bone & Joint surgical team communicate directly about your case. If your condition requires surgical evaluation, it happens within the same practice. If it doesn’t, that is confirmed by the same team. |
| Fluoroscopic and ultrasound guidance as standard | Both imaging modalities available and used where accuracy demands them. [8] Blind or landmark-guided injections are not our standard. |
| Diagnosis before treatment | Every patient receives a structured evaluation before any procedure is recommended. We identify the pain source first. Treatment follows diagnosis. |
| Full spectrum of interventional procedures | From diagnostic medial branch blocks to RFA to PNS: the full evidence-based procedural toolkit is available at New York Bone & Joint. No referral to a separate facility for interventional care. |
| SPRINT PNS system for refractory cases | For patients who have exhausted injections and are not surgical candidates, PNS offers a proven, reversible, non-implant option. Dr. Efime Popovitz is experienced with the SPRINT system and evaluates candidacy carefully. [7] |
| Honest escalation guidance | When interventional care doesn’t provide adequate relief and surgical evaluation is warranted, we say so. Our orthopedic team is in the same building. We don’t repeat procedures that aren’t working. |
| No hospital visit required | All procedures performed in-office at our Upper East Side and Midtown locations. Same-day return home. |
| The bottom line Chronic pain deserves the same level of clinical precision as any other medical condition. At New York Bone & Joint, that means a dual board-certified specialist with Yale fellowship training, fluoroscopic and ultrasound guidance, a diagnostic-first approach, and direct coordination with the orthopedic surgeons in the same practice. That’s what Dr. Efime Popovitz brings to every patient. |
Risks and Considerations
Interventional pain procedures are generally very safe when performed by an experienced, board-certified physician under image guidance. The following risks apply across most procedures: [1]
- Post-procedure soreness: Temporary discomfort at the injection site for 24–48 hours after most spinal or joint injections. Resolves without intervention.
- Steroid-related effects: Temporary blood glucose elevation (significant for diabetic patients), transient flushing, and very rarely systemic effects from absorbed corticosteroid. Your physician will advise on monitoring if relevant to your profile.
- Injection frequency limits: Repeated corticosteroid injections in the same location carry cumulative risks. At New York Bone & Joint, we adhere to evidence-based frequency limits and re-evaluate the treatment plan if relief isn’t sustained.
- Infection: Rare with standard sterile technique. Less than 1 in 10,000 procedures in experienced hands.
- Incomplete relief: Not every patient responds to every procedure. Diagnostic injections are designed to provide information when they do not provide full relief. If a procedure doesn’t produce the expected result, that information changes the diagnostic picture and guides the next step.
- PNS-specific risks: Minor skin irritation at the dressing site, temporary lead-site discomfort, and rare lead displacement. No permanent implant means no long-term device-related risk. The device can be removed at any time if treatment is unsuccessful or unwanted.
At your consultation, Dr. Efime Popovitz will review the specific risks relevant to your planned procedure and individual health profile.
References
- American Academy of Orthopaedic Surgeons. Epidural Steroid Injections. OrthoInfo. orthoinfo.aaos.org/en/treatment/spinal-injections
- Chou R et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain. Spine. 2009. pubmed.ncbi.nlm.nih.gov/19363457
- Cohen SP et al. Epidural steroid injections: a comprehensive evidence-based review. Pain. 2013. pubmed.ncbi.nlm.nih.gov/23598728
- Manchikanti L et al. Comprehensive review of radiofrequency ablation for spinal pain. Pain Physician. 2012. pubmed.ncbi.nlm.nih.gov/32503359
- Simopoulos TT et al. Systematic assessment of diagnostic accuracy of sacroiliac joint interventions. Pain Physician. 2015. pubmed.ncbi.nlm.nih.gov/26431129
- Soin A et al. Lumbar Epidural Steroid Injections for Chronic Spinal Pain: A Clinical Review of Efficacy and Evidence. Cureus. 2025. pubmed.ncbi.nlm.nih.gov/41487815
- Huntoon MA et al. A Retrospective Review of Real-world Outcomes Following 60-day Peripheral Nerve Stimulation for the Treatment of Chronic Pain. Pain Physician. 2023. pubmed.ncbi.nlm.nih.gov/37192232
- American Society of Regional Anesthesia and Pain Medicine (ASRA). Practice guidelines for ultrasound-guided procedures. asra.com/guidelines-articles
- van Kleef M et al. Randomized trial of radiofrequency lumbar facet denervation. Pain. 1999. pubmed.ncbi.nlm.nih.gov/10515020
- Ong Sio LC et al. Mechanism of Action of Peripheral Nerve Stimulation for Chronic Pain: A Narrative Review. Int J Mol Sci. 2023. pubmed.ncbi.nlm.nih.gov/36901970
