Victoriya Brener, M.D.
   
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Dr. Frenkel Obstetrician-Gynecologist  
Pain Management
Pain management can be simple or complex, depending on the cause of the pain. An example of pain that is typically less complex would be nerve root irritation from a herniated disc with pain radiating down the leg. This condition can often be alleviated with an epidural steroid injection and physical therapy. Sometimes, however, the pain does not go away. This can require a wide variety of skills and techniques to treat the pain. These skills and techniques include:
  • Interventional procedures
  • Medication management
  • Physical therapy or chiropractic therapy
  • Psychological counseling and support
  • Acupuncture and other alternative therapies; and
  • Referral to other medical specialists

All of these skills and services are necessary because pain can involve many aspects of a person's daily life.

How is pain treatment guided?
The treatment of pain is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions, and structures involved in causing the pain. In order for a structure to cause pain, it must have a nerve supply, be susceptible to injury, and stimulation of the structure should cause pain. The concept behind most interventional procedures for treating pain is that there is a specific structure in the body with nerves of sensation that is generating the pain. Pain management has a role in identifying the precise source of the problem and isolating the optimal treatment.
What are the conditions:
Conditions commonly treated by pain management specialist:

        Musculo-Skeletal Disorders          Meurological Disorders
  • neck & shoulder pain
  • back pain, upper/lower
  • sciatic pain
  • spinal stenosis
  • disk herniation
  • pain & numbness of the extremities
  • arthritis / joint pain
  • tennis elbow / Golfer's elbow
  • carpal tunnel syndrome
  • cervical radiculopathy
  • peripheral neuropathy
  • lumbar radiculopathy
  • traumatic nerve injury

We are skilled not only to provide drug therapies, but also to use physical therapy modalities such as heat, cold, electrotherapies, ultrasound, laser, therapeutic exercise, traction, massage & manipulation, as well as to perform trigger point injections and nerve blocks.

What is a Nerve Block?
A nerve block is an anesthetic or anti-inflammatory injection targeted toward a certain nerve or group of nerves to treat pain. The purpose of the injection is to "turn off" a pain signal coming from a specific location in the body or to decrease inflammation in that area.
What are some common uses of the procedure?
People who suffer from either acute or chronic pain might have a nerve block injection to achieve temporary pain relief. Often such pain originates from the spine, but other areas commonly affected include the neck, buttocks, legs and arms. Delivering a nerve block injection allows a damaged nerve time to heal itself from a state of constant irritation. Additionally, nerve blocks can provide diagnostic information to the doctor. By performing a nerve block and then monitoring how the patient responds to the injection, the doctor can often use this information to help determine the cause or source of the pain.
How does the procedure work?

The medication delivered by the injection will be placed as close to the site of pain as possible. It will then “shut down” the pain receptors within the nerve(s) causing the problem. Imaging can help the doctor place the needle in exactly the right spot. The imaging itself is painless.

The effects of the injection are usually immediate. It only takes a short time for the medication to achieve pain relief. However, nerve blocks are only a temporary fix—they typically last for up to one or two weeks and then wear off as they are absorbed by your body. Some patients undergo several rounds of nerve blocks before they feel a more permanent sense of relief. Others may not receive any permanent pain relief from this type of injection and may require different treatment methods to manage the pain or inflammation.

Dr. Brener's pain management facility will return you to your maximum level of functional capability and independency and will help you to restore your quality of life.

  Dr. Brener is a physiatrist. She has been affiliated with Beth Israel Medical Center.
She earned her M.D. from Vinnitsa Medical Institute of N.I. Pirogova and completed her residency in physical medicine & rehabilitation at Downstate & Kings County Hospital Center.
Dr. Frenkel is an obstetrician-gynecologist at Bay OB/GYN, P.C. in Brooklyn. He has been affiliated with New York Methodist Hospital and Lenox Hill Hospital.  
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