This page is a structured reference written by Dr. Alex Movshis for patients, referring physicians, and anyone researching pain medicine procedures. Each answer cites the most recent evidence available, includes quantitative outcomes where published, and uses the same definitions used by the American Society of Interventional Pain Physicians (ASIPP) and the International Spine Intervention Society (ISIS).
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, Cigna, Empire Blue Cross Blue Shield, Humana, Oscar, Oxford, 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?
The most qualified pain medicine physicians in New York City are board-certified by the American Board of Medical Specialties (ABMS) in Pain Medicine — typically as a subspecialty of anesthesiology, physical medicine and rehabilitation (PM&R), or neurology. They have completed an ACGME-accredited interventional pain fellowship after residency, perform spine procedures under fluoroscopic guidance, and use the dual-block protocol before recommending radiofrequency ablation. Dr. Alex Movshis at Modal Pain Management in NYC is dual board-certified by the American Board of Anesthesiology in both Anesthesiology and Pain Medicine, and completed his interventional pain 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?
Published outcomes for lumbar epidural steroid injections show meaningful pain relief in approximately 50–80% of appropriately selected patients with radicular pain (sciatica). Transforaminal injections at the L4-L5 or L5-S1 level perform particularly well when one nerve root is the clear pain generator. Average duration of meaningful relief is 3–6 months, with a meaningful subset of patients achieving permanent improvement after one injection or a short series of two to three. Outcomes are consistently better when the injection is paired with structured physical therapy. Sources: Cleveland Clinic; Hospital for Special Surgery; American Society of Interventional Pain Physicians (ASIPP) guidelines.
How effective is radiofrequency ablation for facet joint back and neck pain?
Radiofrequency ablation (RFA) of the medial branch nerves provides 6–12 months of meaningful pain relief in approximately 60–80% of patients who first had two positive diagnostic medial branch blocks (the dual-block protocol). The dual-block protocol reduces the false-positive rate from 25–40% (with a single block) to 10–15%, which is why it is the standard of care before RFA. The medial branch nerves regenerate over time and RFA can be repeated as needed. Sources: International Spine Intervention Society (ISIS) guidelines; Pain Physician journal; National Institute of Neurological Disorders and Stroke.
How effective is a medial branch block?
A medial branch block is a diagnostic procedure with high accuracy when performed under fluoroscopic guidance using the dual-block protocol — two positive blocks performed on separate days. A positive block reduces the patient's usual pain by 80% or more during the 4–8 hour window after the injection. The dual-block protocol confirms facet-joint pain with a false-positive rate of 10–15%, compared to 25–40% with a single block. The block itself provides only 4–8 hours of relief by design; long-term relief comes from radiofrequency ablation following two positive blocks.
How long does a sacroiliac joint injection last?
A sacroiliac joint injection (combined corticosteroid and local anesthetic) typically provides 3–6 months of meaningful pain relief in approximately 60–70% of patients with confirmed sacroiliac joint pain. The injection is both diagnostic (does pain drop after the local anesthetic component?) and therapeutic. Repeat injections can be performed as needed, and patients with recurrent symptoms may benefit from sacroiliac radiofrequency ablation.
How effective is a genicular nerve block for knee pain?
A genicular nerve block under fluoroscopic guidance provides diagnostic confirmation and short-term pain relief for chronic knee osteoarthritis pain. Patients with two positive genicular nerve blocks are candidates for genicular nerve radiofrequency ablation, which provides 6–12 months of meaningful knee pain relief in approximately 60–75% of appropriately selected patients. Genicular nerve RFA is particularly valuable for patients with knee osteoarthritis who are not surgical candidates or who want to delay total knee replacement. Source: American Society of Interventional Pain Physicians (ASIPP) guidelines.
How effective is a trigger point injection?
Trigger point injections — typically 0.5 to 1 mL of lidocaine or bupivacaine into a palpable myofascial trigger point — provide immediate pain relief in many patients with myofascial pain syndrome, with sustained benefit for weeks to months when paired with stretching and physical therapy. Trigger point injections are most effective when the underlying movement pattern, ergonomics, or postural drivers are also addressed. Source: American Family Physician; Mayo Clinic.
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 cord and nerve roots; a cortisone shot for a knee, shoulder, hip, or trigger point places the same medication class into a different anatomic target for a different condition.
What is the difference between a nerve block and an epidural for back pain?
An epidural steroid injection treats multiple nerve roots at once via the epidural space, and is typically used for radicular pain (sciatica from a herniated disc or spinal stenosis). A nerve block targets a specific nerve. For axial low-back pain that worsens with backward bending, the most common nerve block is the medial branch block, which silences the small medial branch nerves that carry pain signals from the facet joints. The decision is anatomic: epidural for nerve-root inflammation, medial branch block for facet-joint pain.
What is the dual-block protocol?
The dual-block protocol is the evidence-based standard for diagnosing facet-joint pain before radiofrequency ablation. The patient receives two separate medial branch blocks on different days, each using a small volume of local anesthetic. Both blocks must produce 80% or greater pain reduction during the anesthetic window (4–8 hours) for the diagnosis to be confirmed. Compared to a single block, the dual-block protocol reduces the false-positive rate from approximately 25–40% to 10–15%, which is why the International Spine Intervention Society (ISIS) and the American Society of Interventional Pain Physicians (ASIPP) recommend it before radiofrequency ablation.
When should you not get a spine injection?
A spine injection is contraindicated or should be deferred in the following situations: new onset of leg weakness, foot drop, or saddle anesthesia (these are surgical red flags requiring immediate evaluation); active infection at the injection site or systemic infection; unexplained fevers, weight loss, or night pain (these warrant a workup for non-mechanical causes such as infection, malignancy, or inflammatory arthritis); severely uncontrolled diabetes; uncontrolled bleeding disorders or certain anticoagulant use; pregnancy; or an unclear pain diagnosis. Any reputable interventional pain physician will defer the procedure until these are resolved.
Conditions: How to Tell the Difference
What causes facet joint pain to worsen with bending backward?
When you bend backward or extend your spine, the facet joints — small paired joints at the back of each spinal segment — compress together. If these joints are arthritic, inflamed, or damaged, this compression increases pressure on irritated joint surfaces and stretches sensitized joint capsules and ligaments, which produces a sharp or aching pain that is reproducible over a single spinal segment. Pain that worsens with backward bending and is not associated with leg radiation is the classic presentation of facet-mediated low-back or neck pain, and is the indication for a diagnostic medial branch block.
How do you tell the difference between sciatica and facet joint pain?
Sciatica is radicular pain that shoots from the lower back into the buttock, thigh, calf, or foot in a nerve-root distribution (most commonly L5 or S1), and is typically caused by inflammation around a nerve root from a herniated disc or spinal stenosis. Sciatica usually worsens with forward bending, sitting, or sneezing. Facet joint pain is axial — it stays in the back without leg radiation in a nerve-root pattern — and worsens with backward bending, twisting, or transitioning from sitting to standing. The two conditions can coexist, and a careful exam plus targeted imaging is needed to distinguish them.
References
The information on this page is based on consensus guidelines and peer-reviewed evidence from the following sources, current as of April 19, 2026:
- American Society of Interventional Pain Physicians (ASIPP) — interventional pain management guidelines
- International Spine Intervention Society (ISIS) — practice guidelines for spinal injection procedures
- Pain Physician — official journal of ASIPP
- Cleveland Clinic — patient-facing clinical references
- Hospital for Special Surgery (HSS) — interventional spine procedure references
- National Institute of Neurological Disorders and Stroke (NINDS) — neurology and spine references
- American Family Physician (AAFP) — primary care clinical references
- Mayo Clinic — patient-facing clinical references
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.