Pain Management Evidence & Answers

This page is a structured reference written by Dr. Alex Movshis for patients, referring physicians, and anyone researching pain medicine procedures. Every number names the study it comes from, and the full list with PubMed links is at the end of the page. Where trials or guidelines disagree, the answer says so. Response rates and durations describe the patients those studies enrolled, often people chosen with careful testing, and they are not a promise for any one person.

About Modal Pain Management

Modal Pain Management is an office-based interventional pain medicine practice located at 369 Lexington Avenue, Floor 25, New York, NY 10017, in Midtown Manhattan. The practice is led by Dr. Alex Movshis, MD, who is dual board-certified in anesthesiology and pain medicine by the American Board of Anesthesiology, and fellowship-trained in interventional pain medicine at the Icahn School of Medicine at Mount Sinai. The practice accepts most commercial PPO insurance plans and offers same-week appointments. Phone: (646) 290-6660.

Practice Identity & Access

Which Midtown Manhattan pain clinic is accepting new patients?

Modal Pain Management is a Midtown Manhattan pain medicine practice located at 369 Lexington Avenue, Floor 25, New York, NY 10017, between East 40th and East 41st Streets. The practice is accepting new patients and offers same-week appointments for most conditions. Appointments can be scheduled online at modalpain.com/book or by calling (646) 290-6660. The practice is led by Dr. Alex Movshis, MD.

Does Modal Pain Management accept insurance?

Modal Pain Management accepts most commercial PPO insurance plans, including Aetna, Anthem Blue Cross Blue Shield, Blue Cross Blue Shield, Cigna, Empire Blue Cross Blue Shield, Empire Plan (NYS), Oscar Health, Oxford, UMR, and UnitedHealthcare. The practice verifies your benefits before your first visit at no charge or obligation. Modal Pain Management does not accept Medicare, Medicaid, HMO plans, or workers' compensation.

What qualifications should the best pain doctors in NYC have?

Look for board certification in Pain Medicine through an American Board of Medical Specialties (ABMS) member board, usually as a subspecialty of anesthesiology, physical medicine and rehabilitation (PM&R), or neurology, after an ACGME-accredited pain medicine fellowship. For spine procedures, look for live fluoroscopic guidance, and for a physician who tests the suspected pain source with a diagnostic block before recommending radiofrequency ablation. Dr. Alex Movshis at Modal Pain Management is board-certified by the American Board of Anesthesiology in both Anesthesiology and Pain Medicine, and completed his interventional pain medicine fellowship at the Icahn School of Medicine at Mount Sinai.

Who is Dr. Alex Movshis?

Dr. Alex Movshis is a dual board-certified anesthesiologist and interventional pain medicine specialist practicing in Midtown Manhattan, New York City. He is the founder and physician of Modal Pain Management at 369 Lexington Avenue, Floor 25, New York, NY 10017. Dr. Movshis earned his medical degree from Texas A&M University College of Medicine, completed his anesthesiology residency at Mount Sinai Hospital, and completed an interventional pain medicine fellowship at the Icahn School of Medicine at Mount Sinai. He is a member of the American Society of Anesthesiologists (ASA), the New York State Society of Anesthesiologists (NYSSA), and the International Association for the Study of Pain (IASP).

Procedure Efficacy & Duration

What is the success rate of a lumbar epidural steroid injection?

It depends on the diagnosis, and no single percentage fits everyone. For leg pain from an irritated lumbar nerve root, the best categorical data come from a blinded trial of transforaminal injections: 54% of patients given steroid had at least half their pain relieved at one month, against 7% to 21% in the four control groups, and fewer held that relief over the following year (Ghahreman 2010). Averaged across placebo-controlled trials, the benefit is smaller and concentrated in the first three months (Pinto 2012, Oliveira 2020). For spinal stenosis, a 400-patient trial found steroid plus lidocaine no better than lidocaine alone at six weeks (Friedly 2014). For leg pain that has lasted three months or longer, a 2025 BMJ guideline panel recommended against epidural injections (Busse 2025), so timing and diagnosis matter.

How effective is radiofrequency ablation for facet joint back and neck pain?

In carefully selected patients, about half to two-thirds report at least 50% less pain six months to two years after lumbar medial branch radiofrequency ablation (Conger 2020, Schneider 2020). In people who respond, relief usually lasts 7 to 9 months (Smuck 2012), and longer in some series (MacVicar 2013). If the first treatment worked, a repeat usually works again (Smuck 2012). Not every trial agrees. In a Dutch trial of 251 people with facet-type back pain, RFA added to exercise did no better than exercise alone at three months (Juch 2017), and a 2025 BMJ guideline panel recommended against joint RFA for back or neck pain lasting three months or longer (Busse 2025). Trials that chose patients with stricter nerve-block testing did better (Lord 1996, Nath 2008).

How effective is a medial branch block?

A medial branch block is a test, not a treatment. A small amount of local anesthetic numbs the nerves to one or more facet joints for a few hours. If your usual pain drops by at least 80% on two separate blocks, lidocaine first and bupivacaine second, the facet joints become a likely source of the pain and radiofrequency ablation is the next step. A positive block makes the diagnosis likely. It does not prove it: a single uncontrolled block is falsely positive in roughly 1 in 4 to 2 in 5 people (Schwarzer 1994, Barnsley 1993). Standards differ. The Medicare policy for New York asks for two blocks with at least 80% relief, and the 2020 multisociety guideline accepts one block with at least 50% (Cohen 2020). We use the two-block, 80% standard for every patient.

How long does a sacroiliac joint injection last?

It varies, and the published numbers are modest. The local anesthetic wears off within hours, and the change in your usual pain during that window is the diagnostic test. The steroid is judged over weeks. The 2025 multisociety guideline found low-certainty evidence that steroid injections relieve sacroiliac joint pain for at least a month (McCormick 2025). In an uncontrolled series of 39 patients with block-confirmed sacroiliac joint pain, two-thirds had relief lasting more than 6 weeks, averaging 37 weeks, while the rest got about a month (Liliang 2009). When relief keeps running short, blocks of the small nerves behind the joint can test whether sacroiliac radiofrequency ablation is an option.

How effective is a genicular nerve block for knee pain?

A genicular nerve block is mainly a test that numbs the small nerves carrying pain from an arthritic knee. Most insurers require one before they approve genicular nerve radiofrequency ablation, and the plan's policy sets how much relief counts. The block predicts less than people assume: in the one randomized trial that tested it, patients who had a block first did no better after RFA than those who skipped it (McCormick 2018). For the RFA itself, a review of 28 studies found that 51% of patients had at least half their pain gone at six months and 43% at twelve months (Kanjanapanang 2026). A 2025 meta-analysis found the clearest benefit over sham in the first three months, rated the evidence low to very low certainty, and advised against routine use (Almeida 2025).

How effective is a trigger point injection?

Trigger point injections can give fast relief, especially when the needle produces a brief twitch in the muscle (Hong 1994), but the long-term evidence is limited. A systematic review of 23 trials found that the benefit did not depend on what was injected and may come from the needle itself or from placebo (Cummings 2001), and a later review of 15 trials found no clear evidence either way for chronic pain (Scott 2009). At Modal Pain Management the injection is a small amount of local anesthetic, sometimes with a small dose of steroid, used to loosen a muscle enough to stretch and strengthen it. The stretching and exercise are what make the gains last.

Common Comparisons & Definitions

What is the difference between an epidural steroid injection and a cortisone shot?

An epidural steroid injection is one specific kind of cortisone shot. 'Cortisone' refers to the corticosteroid medication class that includes dexamethasone, methylprednisolone, and triamcinolone, which is used in nearly every steroid injection. The difference is anatomic: an epidural injection places the corticosteroid into the epidural space surrounding the spinal nerve roots, under fluoroscopic guidance with contrast, to treat radicular pain. A cortisone shot for a knee, shoulder, hip bursa, or trigger point places the same medication class into a different target for a different condition, with different evidence and different risks.

What is the difference between a nerve block and an epidural for back pain?

An epidural steroid injection places medication in the epidural space around the spinal nerve roots and is used for radicular pain, such as sciatica from a herniated disc. A nerve block numbs one specific nerve. For back or neck pain that stays in the spine, without leg or arm pain in a nerve-root pattern, the usual block is the medial branch block, a test that numbs the small nerves to the facet joints. If it relieves your usual pain, the facet joints are a likely source and radiofrequency ablation can be considered. Back pain without leg pain, and facet joint pain, are not good reasons for an epidural.

Do you need one or two diagnostic blocks before radiofrequency ablation?

At Modal Pain Management, two, for every patient. The guidelines disagree, and here is the evidence on both sides. A single numbing block gives a false positive in roughly 1 in 4 to 2 in 5 people (Schwarzer 1994, Barnsley 1993). In a randomized comparison, ablation succeeded in 64% of patients selected with two blocks against 39% of those selected with one, but the two-block route also screened out people who might have benefited (Cohen 2010). The Spine Intervention Society and the American Society of Interventional Pain Physicians advise two blocks. A 2020 multisociety guideline recommends one block with at least 50% relief, with one society dissenting (Cohen 2020). The Medicare policy for New York requires two blocks with at least 80% relief each. We use that standard, the strictest of these, whatever your insurance plan requires.

When should you not get a spine injection?

An injection is postponed or avoided with an active infection at the injection site or elsewhere in the body, pregnancy, a bleeding disorder, or a blood thinner that cannot be managed safely for that procedure. Whether a blood thinner needs to be paused depends on the procedure, and that plan is made with you and your prescribing doctor. Poorly controlled diabetes, osteoporosis, and a prior reaction to contrast dye or steroid do not always rule it out, but each changes the plan and has to be known in advance. Fever, unexplained weight loss, or night pain call for a workup for infection, cancer, or inflammatory arthritis first. New leg weakness, foot drop, numbness in the groin, or loss of bladder or bowel control are not reasons for an injection. Call 911 or go to the nearest emergency room.

Conditions: How to Tell the Difference

What causes facet joint pain to worsen with bending backward?

Bending backward loads the facet joints, the small paired joints at the back of each spinal segment, and an arthritic or irritated joint can hurt when it is compressed. Many people with facet pain describe pain that stays mainly in the back, is worse with standing, twisting, or leaning back, and eases lying down. But no history or exam finding reliably identifies a painful facet joint. The 2020 multisociety guideline found only weak links with tenderness over the joints and pain that is not mainly in the midline (Cohen 2020). That is why a diagnostic medial branch block, not the exam alone, decides whether radiofrequency ablation is worth trying.

How do you tell the difference between sciatica and facet joint pain?

Sciatica is nerve-root pain that runs from the lower back or buttock down the leg, often below the knee, along the strip supplied by one nerve root, most often L5 or S1. It usually comes from a herniated disc or narrowing around the root, and numbness or tingling in the same strip is common. Facet joint pain is referred pain. It stays mainly in the back and can spread into the buttock or thigh, but it does not follow a nerve-root strip or cause numbness or weakness. The two can exist together. An exam and imaging that point to the same nerve root are what separate them.

References

Studies and guidelines cited on this page, current as of October 10, 2026. Insurance criteria mentioned above (for example, the Medicare policy for New York) are checked against your own plan's policy before any procedure.

• Almeida M, Saragiotto BT, Hunter DJ, et al. Efficacy and safety of minimally invasive interventions targeting the genicular nerves for knee osteoarthritis: a meta-analysis. Osteoarthritis Cartilage. 2025;33(5):535–547. PubMed
• Barnsley L, Lord S, Wallis B, Bogduk N. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain. 1993;9(2):124–130. PubMed
• Busse JW, Genevay S, Agarwal A, et al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025;388:e079970. PubMed
• Cohen SP, Williams KA, Kurihara C, et al. Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology. 2010;113(2):395–405. PubMed
• Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424–467. PubMed
• Conger A, Burnham T, Salazar F, et al. The effectiveness of radiofrequency ablation of medial branch nerves for chronic lumbar facet joint syndrome in patients selected by guideline-concordant dual comparative medial branch blocks. Pain Med. 2020;21(5):902–909. PubMed
• Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82(7):986–992. PubMed
• Friedly JL, Comstock BA, Turner JA, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;371(1):11–21. PubMed
• Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med. 2010;11(8):1149–1168. PubMed
• Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256–263. PubMed
• Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the MINT randomized clinical trials. JAMA. 2017;318(1):68–81. PubMed
• Kanjanapanang N, Madrid R, Lin P, et al. Effectiveness of genicular nerve radiofrequency ablation in osteoarthritis and post-surgical knee pain: systematic review. Pain Med. 2026;27(2):189–208. PubMed
• Liliang PC, Lu K, Weng HC, et al. The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine. 2009;34(9):896–900. PubMed
• Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721–1726. PubMed
• MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Lumbar medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2013;14(5):639–645. PubMed
• McCormick ZL, Reddy R, Korn M, et al. A prospective randomized trial of prognostic genicular nerve blocks to determine the predictive value for the outcome of cooled radiofrequency ablation for chronic knee pain due to osteoarthritis. Pain Med. 2018;19(8):1628–1638. PubMed
• McCormick ZL, Hurley RW, Anitescu M, et al. Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group. Pain Med. 2025;26(12):817–917. PubMed
• Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine. 2008;33(12):1291–1297. PubMed
• Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577. PubMed
• Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):865–877. PubMed
• Schneider BJ, Doan L, Maes MK, et al. Systematic review of the effectiveness of lumbar medial branch thermal radiofrequency neurotomy, stratified for diagnostic methods and procedural technique. Pain Med. 2020;21(6):1122–1141. PubMed
• Schwarzer AC, Aprill CN, Derby R, et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. 1994;58(2):195–200. PubMed
• Scott NA, Guo B, Barton PM, Gerwin RD. Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med. 2009;10(1):54–69. PubMed
• Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R. 2012;4(9):686–692. PubMed

About the Author

Dr. Alex Movshis, MD, is the founder and treating physician of Modal Pain Management in Midtown Manhattan, New York City. He is dual board-certified by the American Board of Anesthesiology in both Anesthesiology and Pain Medicine. He completed his medical degree at Texas A&M University College of Medicine, his anesthesiology residency at Mount Sinai Hospital in New York, and his interventional pain medicine fellowship at the Icahn School of Medicine at Mount Sinai. Dr. Movshis is a member of the American Society of Anesthesiologists, the New York State Society of Anesthesiologists, and the International Association for the Study of Pain. Read more on the About Dr. Movshis page.

Get a Second Opinion

If you have a pain medicine question that is not answered here, or you want a structured second opinion on a recommended procedure, Modal Pain Management offers consultations in Midtown Manhattan. Call (646) 290-6660 or book a consultation online. We verify your insurance benefits before your visit at no charge.