Treating Pain from the Top Down: Advice from a Neurologist

Many people would not think a neurologist the best specialist to see for treating back pain, but Dr. Naomi Feuer will convince them otherwise. An Assistant Professor of Neurology at Weill Cornell Medical College, Dr. Feuer evaluates and treats patients with back and neck pain at the Weill Cornell Medicine Center for Comprehensive Spine Care.

“The role of a neurologist is fundamental because it involves a comprehensive diagnostic analysis with the goal of isolating the underlying etiology of the patient’s symptom constellation. If we don’t know what we are treating, we have no path towards an appropriate and successful treatment plan. First, we must localize the cause of the symptom and then we can focus on management,” explained Dr. Feuer.

Grateful pain patient

This was certainly the case for 70-year-old Thomas Petillo, who suffered from chronic back pain and was debilitated by diffuse pain, muscle spasms numbness, and weakness in his arm and legs for nearly 20 years. Numerous surgeries and procedures had done little to alleviate the problem. Moreover, the constant pain medication Thomas was using had damaged his intestines.

Dr. Feuer conducted a thorough diagnostic evaluation of Thomas’s central and peripheral nervous system. Her first instinct was that many of his neuromuscular symptoms emanated from the structural abnormalities in his neck, which tests eventually confirmed. After she recommended a spinal surgeon, Thomas soon underwent surgery and felt an immediate difference. His pain subsided significantly, and he regained the quality of life he wanted. 

After all his years of pain, he could not be more grateful for the care he received from Dr. Feuer and Weill Cornell Medicine. “Dr. Feuer has been so attentive. She really is on a different level of physicians,” he gushed. “She’s very clear that her intention is to get her patients moving forward. She is all about giving her patients the best options available.”

When to see a specialist

For many, pain subsides with time. Certain symptoms, however, should never be ignored, such as:

• Severe, unremitting pain
• Numbness and tingling
• Weakness in one or more extremities
• Bowel or bladder incontinence
• Unexplained falling and incoordination
• Inability to perform prior activities of daily living due to neuromuscular limitations

“This list is not comprehensive, and these types of symptoms do not necessarily mean that the spine or nervous system is damaged or in danger. But if you are experiencing symptoms of this nature, whether they are new or progressing, you must have a diagnostic evaluation,” asserted Dr. Feuer.

She also relayed that patients may frequently presume that they have pain and associated symptoms because of something they did or didn’t do. She hopes that all patients understand that pain is never their own fault, and that the best way to experience relief is to see a specialist as soon as possible.

Targeted, successful treatment

Pain can be incredibly frustrating and difficult to cope with. To have the best chances for successful treatment, Dr. Feuer suggests seeking out a highly qualified and compassionate specialist for a thorough diagnostic evaluation using a multidisciplinary approach towards the workup and management, as well as making appropriate lifestyle changes.

Comprehensive evaluation: Believing that a correct diagnosis is the best tool for treating pain, Dr. Feuer suggests that anyone experiencing back or neck pain first receive a comprehensive evaluation. She cautions against receiving any treatment or intervention before a careful, holistic workup—which sometimes includes an MRI and neurophysiologic testing.

Though some patients may not receive a clear or straightforward diagnosis, the evaluation is still important because it helps guide treatments and additionally prevents any unnecessary or potentially harmful invasive procedures. “It’s best to first see a diagnostician,” she explained, “such as a neurologist, physiatrist, or pain management specialist. After an evaluation, he or she can recommend appropriate specialists. Though we may not have all the answers at times, we never stop overseeing health and safely improving the quality of life.” 

Lifestyle adjustments: Dr. Feuer maintains that we should not underestimate simple lifestyle adjustments, including:

• Modifying a work environment to make it more ergonomic (changing chairs, adjusting desk height, taking more breaks)
• Improving posture and core strength
• Attaining and maintaining a healthy weight
• Reducing stress and learning healthy coping modalities (i.e., mindfulness)

“Pain plays an essential role in our nervous system as it can inform the body as a warning sign of impending or actual injury. Many of the pathways in our nervous system responsible for carrying pain signals also involve emotion. Pain causes emotional distress, and emotional distress may cause pain. Modifying one of these perceptions can potentially improve both,” Dr. Feurer explained.

Multidisciplinary treatment: “At the Center, we don’t just treat an MRI, we treat a patient,” affirmed Dr. Feuer. “Often patients will come in with multiple conditions. We take all possible steps to improve their quality of life in the least invasive way possible. The goals of treatment typically are tailored to the patient’s test results and symptoms. Traditional medical treatments are used with mind-body therapies to create an integrative approach towards health and wellness. We are careful to recommend surgery only when clinically appropriate, safe, and medically necessary.”

If you are suffering from debilitating pain or some minor concerns, Dr. Feuer and the Weill Cornell Center for Comprehensive Spine Care are here to help. 

Learn more about the many conditions treated at the Center for Comprehensive Spine Care.