The Vitals | Pain Management and You

Why It Matters

Understanding the non‑opioid, tiered approach to spine pain empowers patients to seek timely care, reduces unnecessary surgeries, and highlights preventive lifestyle measures that can curb chronic disability and healthcare costs.

Key Takeaways

• Pain signals travel to brain; adrenaline can temporarily suppress perception.
• Most spine pain managed non‑invasively before considering surgery.
• Opioids are limited; targeted injections address specific weak links.
• Red‑flag symptoms demand immediate specialist referral and imaging.
• Sleep, weight, smoking, and tailored exercise prevent chronic spinal pain.

Summary

The Vitals episode brings together Mount Sinai’s pain‑management specialist Dr. Houman Daneesh and neurosurgeon Dr. Tanvir Choudhri to demystify why we feel pain and how it is treated. The discussion centers on spine‑related discomfort—neck, back, shoulder, knee and even headaches that often originate from cervical facets—highlighting the typical pathway from primary‑care referral to a pain‑management evaluation before surgery is considered. Key insights include the brain’s complex pain‑signal processing, the limited role of opioids, and a diagnostic focus on identifying the weakest link in the musculoskeletal chain. For example, a weak rotator cuff can overload cervical facets, producing a crown‑like headache that may be relieved with a targeted facet injection. Red‑flag signs such as night‑time pain, fever, neurologic deficits, bowel or bladder dysfunction, or sudden foot drop trigger urgent imaging and specialist referral. The physicians underscore practical examples: Dr. Daneesh notes many patients mistake brain‑tumor headaches for migraines, when the source is often neck‑related; Dr. Choudhri stresses that emergent deficits like foot drop require rapid surgical evaluation. They also stress the gate‑keeping role of primary‑care physicians, likening them to an internal Yelp that can fast‑track appointments and prevent months‑long delays. Implications are clear for patients and providers. Early evaluation—typically within two weeks of persistent pain—can avert chronic disability, while lifestyle factors—adequate sleep, weight control, smoking cessation, and individualized exercise programs—serve as primary prevention. A coordinated, non‑invasive first line reduces opioid exposure, lowers surgical volume, and improves overall health‑system efficiency.

Original Description

Pain is one of the most common reasons people seek medical care—but what actually causes pain, and when should you seek treatment?

Two Mount Sinai experts—Drs. Tanvir Choudrhi and Houman Danesh—discuss how physicians diagnose and treat pain, particularly neck and back pain that originates in the spine. Together, they break down:

Why pain is often more complex than it seems

How signals travel between the body and brain

Why identifying the root cause is key to effective treatment.

🩺 To learn more about pain management or spine care at Mount Sinai Health System, or to schedule an appointment with a specialist, visit Mount Sinai’s website: https://www.mountsinai.org/?pk_vid=174eeee090819798177342044977c34c

🎧 Subscribe to The Vitals and explore more podcast programming from Mount Sinai for expert conversations on the biggest issues in medicine, research, and patient care: https://www.youtube.com/playlist?list=PLCT7BA-HcHliU8QIXyuk_74L_uH0gyKGt

00:00 — “What causes pain?”: Pain as a series complex signals to and from the brain.

04:09 — “When to see a specialist”: Seek evaluation if pain persists ~4–6 weeks or sooner for intolerable pain/red flags.

08:29 — “Foundations — sleep and exercise”: Sleep 7–8 hrs and correct muscle imbalances to prevent injury.

19:41 — “How injections work”: Steroid injections reduce inflammation; radio frequency ablation turns off pain nerves temporarily.

21:25 — “Goal of treatments”: Use injections/PT to enable exercise — long-term muscle stability over quick fixes.

21:49 — “Surgery as a last resort”: Avoid surgery as a quick fix; operate when nonoperative care fails or neurologic deficits exist.

28:27 — “Weight and GLP-1s”: Weight loss drugs help but watch for muscle loss — maintain resistance training and protein.