Book an Appintment with Dr. Mikhail Kogan

Specialties: Pain Management, Anesthesiology.

Dr. Sekhar Upadhyayula, MD and Dr. Mikhail Kogan MD

Dr. Sekhar and Dr. Mikhail Kogan are member of American Society of Anesthesiologists.

Pain Solutions New York -

Call on 718-544-1171 or visit for Appointment.

Epidural Steroid Injection

The Epidural Steroid Injection is a procedure where numbing medicine (anesthetic) and anti- inflammatory medicine (steroid) is injected into the epidural space to treat pain caused by irritation of the spinal nerves.

Cervical Facet Joint Injection

The Cervical Facet Joint Injection is a procedure used to block or decrease pain caused by problems in the upper (neck area) spine.

Sciatica Understanding Causes & Treatment

If you have ever veteran severe pain in your buttock or back of your thigh, then you will already be painfully aware of the term "sciatica," or "sciatic nerve."

The sciatic nerve (pronounced) may be a long, thick nerve (about as thick as your thumb) that extends from the middle of the buttock, down the rear side of the higher leg. as a result of the sciatic nerve is therefore massive, once it's broken, inflamed, or irritated, it is terribly painful.

Based on the very fact that you simply are reading this text, {chances are chances are high that} that you simply are cognizant of the severe pain, numbness, and loss of operate that accompanies "sciatica."

The good news is - the physical therapists and doctors at Forest Hills Rehabilitation will help!

The sciatic nerve like all peripheral nerves, starts as nerve roots from your spinal cord. The nerve roots exit between the bones in your lower back (see low back anatomy), and eventually contribute to the large sciatic nerve that exits underneath an outsized muscle within the buttock known as the piriformis. In some patients the sciatic nerve lies directly underneath the piriformis muscle, in others it truly pierces the muscle.

If there's injury or irritation at any purpose on the sciatic nerve pathway, the nerve will become inflamed, and symptomatic.

Disc injuries (herniated disc - bulging disc), bone misalignment, swelling, ligament instability, muscle imbalances - as well as spasm, weakness, and injury, are all doable causes of sciatica.

Since there are such a large amount of potentialities that will cause sciatica, symptoms ought to be rigorously evaluated by a trained practician with years of expertise.

Although ten patients could have the precise same symptoms and ultimately diagnosed with "sciatica" there may probably be ten completely different causes, and in theory ten completely different treatments.

Signs of sciatica embody pain, numbness, tingling, weakness, or spasm within the buttock and back of the thigh, lower leg, feet and toes.

If you have got been suffering with symptoms of sciatica, like back or leg pain, symptom and tingling, burning or weakness for over 3 days you wish to consult one in all our mean clinicians these days.

For over a decade, the physical therapists, chiropractors and medical doctors at Forest Hills Rehabilitation are serving to patients similar to you, suffering with sciatica and connected symptoms.

Our skilled physical therapists work closely with supervision medical physicians to offer a range of various treatment choices for you.

We are simply accessible by public transportation, provide early morning, late evening, and weekend hours, and settle for most insurance plans.

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Surgery - Sciatica Treatment

Surgery is also an choice to treat cases of chronic sciatica when:

there is an identifiable  cause, like a slipped or herniated disc
the symptoms haven't more responsible different varieties of treatment
the symptoms have gotten progressively worse
The type of surgery that may be suggested for you'll depend on the reason behind your sciatica. Some surgical choices include:
discectomy – wherever the a part of the herniated disc pressing on your nerve is removed (this is that the commonest form of surgery required)
fusion surgery – if a bone has slipped out of place, it's going to be potential to fuse it into place employing a bone graft supported by metal rods
laminectomy – a procedure usually accustomed treat spinal stenosis, this removes or trims the arch of a bone to alleviate the pressure on the nerves
Many people have a positive result from surgery, however like all surgical procedures, spinal surgery carries some risks. there's a risk of infection and of the surgery failing, and a low risk that your spinal nerves are going to be damaged throughout surgery. this might result in muscle weakness.
Before choosing spinal surgery, your Dr. can discuss the relative risks and benefits with you.

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Injection of a adrenal cortical steroid - Sciatica Treatment

If different strategies of pain relief haven't worked, your Dr. might refer you to a specialist for associate epidural steroid injection. This delivers sturdy medicament medication on to the inflamed space round the nerves of your spine. this could release the pressure on your sciatic nerve and scale back your pain.

Exercise and physical therapy

You should additionally attempt to try to as physically active as possible with persistent sciatica as a result of this can scale back the severity of your symptoms. it's additionally suggested that you simply still work or come to figure as presently as potential.
Regular exercise can facilitate to strengthen the muscles that support your back. Exercise additionally stimulates the production of endorphins, that are natural painkilling chemicals.
Your Dr. might advocate an appropriate exercise arrange for you or refer you to a physiotherapist. A healer will teach you a variety of exercises that strengthen the muscles that support your back and improve the flexibleness of your spine. they will additionally teach you the way to enhance your posture and scale back any future strain on your back.

Cognitive behavioural medical care (CBT)

Some studies have shown that psychological feature behavioral medical care (CBT) will facilitate within the management of chronic pain that's caused by sciatica.
CBT is predicated on the principle that the approach we tend to feel is part hooked in to|keen about|captivated with|obsessed with|passionate about|addicted to|addicted to|obsessed on|smitten by} the approach we predict about things. research has shown that individuals who train themselves to react otherwise to their pain, by mistreatment relaxation techniques and maintaining a positive perspective, show a decrease within the levels of pain that they expertise.
They are additionally a lot of likely to stay active and take exercise, additional reducing the severity of their symptoms.

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Sciatica Treatment Options

If you have sciatica, it's necessary for you to stay as physically active as possible. whereas bed rest might provide some temporary pain relief, prolonged bed rest could also be spare. recommended exercises include walking and mild stretching exercises.
If you have got had to require time off work as a result of sciatica, you must aim to return to figure as shortly as possible.

Compression packs
Many people find that exploitation either hot or cold compression packs helps to reduce pain. you'll be able to create your own cold compression pack by wrapping a pack of frozen peas in a very towel. Hot compression packs are typically available from larger pharmacies. you'll find it effective to use one kind of pack followed by the other.
Treating persistent sciatica
Persistent (chronic) sciatica typically needs a mix of self-help techniques and medical treatment. Treatment choices are outlined below.

The long-run use of NSAIDs as a technique of controlling pain isn't typically recommended because they'll cause issues together with your stomach, like ulcers or internal bleeding.
If you wish pain relief over an extended time, the painkillers listed below could also be used:
Codeine (paracetamol is usually prescribed together with codeine)
A antidepressant drug, like amitriptyline hydrochloride
Gabapentin for neuropathic pain (where nerves are thought to be inflamed), or, in capsules, the same drug referred to as pregabalin
Amitriptyline was originally designed to treat depression however doctors have currently found it's also helpful for treating nerve pain.
Gabapentin was originally designed to stop seizures in individuals with brain disease. However, like amitriptyline hydrochloride, it's been found to be helpful for treating nerve pain.
Do not suddenly stop taking gabapentin as you will expertise withdrawal symptoms like anxiety, insomnia, nausea, pain and sweating. If you would like to prevent taking gabapentin or not got to take it.

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Back Pain Treatment - NYpainsolutions
Given the prevalence of back pain, you would think we'd have treatment for it down pat. Not even close. "The challenge is that you can't see injuries to tendons, ligaments, and muscles the way you can bone fractures and herniated disks," Despite diagnostic advances, doctors can't pinpoint an exact cause for as many as 85 percent of back problems, which makes them tricky to treat. Spinal manipulation, for example, is controversial -- some docs say it does more harm than good -- but it's the only remedy that got me off the couch and back on my bike. "Chiropractic care is not without concerns; then again, neither is traditional medicine, particularly when you're dealing with a problem like back pain, which has no easy, one-size-fits-all fix,"

Even exercise, which a majority of experts agree is one of the best ways to maintain a healthy back and chase away aches and pains, can be problematic. "When you're sedentary, the muscles supporting the spine get weaker, and you're more prone to injury," Dr. says. But "exercising with improper form -- rounding the back when doing dead lifts or arching it during ab work -- can place unwanted stress on the spine".

If you fall into the 80 percent of the population that regularly suffers from back pain, take heart: One-third of aches due to a strain or a sprain improve in a week without medical intervention (the remainder may take up to eight weeks). But unless you do some spine tuning -- strengthening your back through exercise and fostering healthier habits with our advice here -- your odds of a recurrence within six months are about one in three, Dr. says. Keep your back in tip-top shape by avoiding these seven spinal sins.
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Common Back Pain Causes

It began as a twinge. Then the pain began to radiate down my back when I biked. teasing became dangerous once it hurt to show my head; don't attempt cycling with impaired neck quality. however I saw no reason to switch my fitness routine. I pedaled. I kickboxed. I raised weights. And once regarding 3 weeks, I paid the value. One sleepless night, pain that felt sort of a knife in my back stapled me to the couch.

Whether you are a week­end human, an elite athlete, or somewhere in between, there is a sturdy probability that eventually you will take care of back pain, too. Here's why: Everyday activities that you simply do stupidly, slithering on a try of shoes, crawl into bed in the dead of night -- will build or break your spine health. Most aches square measure caused by strains (injured muscles or tendons) or sprains (damage to the robust animal tissue, or ligaments, situated wherever your vertebrae connect with joints). These injuries square measure usually brought on by over­use, a replacement activity, excessive lifting, or an accident. different times, a compressed (aka pinched) nerve, like in a very herniated disk, is guilty for the ache.

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Back Pain Solutions in New York Queens

The back is an complex structure of bones, muscles, and different tissues that form the posterior a part of the body’s trunk, from the neck to the pelvis. The centerpiece is that the spinal column, that not only supports the higher body’s weight however homes and protects the spinal cord — the delicate systema nervosum structure that carries signals that management the body’s movements and convey its sensations. Stacked on high of 1 another are quite thirty bones — the vertebrae — that kind the back, conjointly referred to as the spine. every of those bones contains a circular hole that, once stacked in register with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the bottom of the brain and extends within the adult to merely below the skeletal structure. little nerves ("roots") enter and emerge from the spinal column through spaces between the vertebrae. as a result of the bones of the spinal column continue growing long when the spinal column reaches its full length in babyhood, the nerve roots to the lower back and legs extend several inches down the back before exiting. this large bundle of nerve roots was dubbed by early anatomists because the complex body part equina, or horse’s tail. The areas between the vertebrae are maintained by spherical, spongy pads of animal tissue referred to as bone discs that afford flexibility within the lower back and act very similar to shock absorbers throughout the back to cushion the bones because the body moves. Bands of tissue referred to as ligaments and tendons hold the vertebrae in place and fix the muscles to the spinal column.

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Back Pain Specialist in New York Queen

Dr. Mikhail Kogan is an Interventional Pain Management Specialist with extended expertise in treating back pain and cancer pain. He currently is an Assistant Clinical Professor at Mount Sinai School of Medicine at Elmhurst Hospital Center. Dr. Kogan is board certified in anesthesiology and pain management. After completing his anesthesiology residency at St. Vincent's Medical Center in NYC, Dr. Kogan was fortunate to attend a pain management fellowship at the State University of New York in Buffalo, where he trained under two of the world’s most prominent specialists in pain management, Dr. Mark Lema and Dr. Oscar DeLeon. A significant part of his training was conducted at Roswell Park Cancer Institute. In 2000, Dr. Kogan was promoted to Director of Pain Management Service at Elmhurst Hospital. During the past six years, Dr. Kogan has developed pain management service into a premiere minimally invasive pain management practice with an emphasis on minimally invasive spinal techniques. Dr. Kogan continues to utilize the latest, most cutting edge spinal interventions including percutaneous disc decompressor, radio frequency neurolysis and spinal implantable devices. While Dr. Kogan's education and certifications attest to his knowledge, it is his patients’ satisfaction that justify his recognition in this area. Dr. Kogan is known for achieving dramatic improvement in pain without major surgery. Dr. Kogan prides himself on being a compassionate, caring physician with an excellent bedside manner. Dr. Kogan is a member of the American Society of Anesthesiologists and the American Society of Regional Anesthesia and Pain Medicine.

Back Pain Risk factors

Back pain have not only old people, even kids and youths. although excess weight, lack of exercise and improper lifting are typically blame for back pain, analysis watching these possible risk factors hasn't yet provided any clear-cut answers.

One group that does seem to have a bigger risk of back pain are people with certain psychological issues, like depression and anxiety, though the reasons why there is an increased risk are not known.

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Symptoms of Back Pain

Symptoms of Back Pain include:
  •     Muscle ache
  •     Shooting or stabbing pain
  •     Pain that radiates down your leg
  •     limited flexibility or range of motion of the back
  •     Inability to stand up straight

When to see a doctor

Most back pain step by step improves with home treatment and self-care. though the pain may take many weeks to disappear fully, you must notice some improvement within the primary seventy two hours of self-care. If not, see your doctor.

In rare cases, back pain will signal a serious medical problem. request immediate care if your back pain:
  •     Causes new bowel or bladder problems
  •     Is related to pain or throbbing (pulsation) within the abdomen, or fever
  •     Follows a fall, blow to your back or different injury

Contact a doctor if your back pain:
  •     Is constant or intense, especially at night or when you lie down
  •     Spreads down one or both legs, especially if the pain extends below the knee
  •     Causes weakness, numbness or tingling in one or both legs
  •     Is accompanied by unexplained weight loss
  •     Occurs with swelling or redness on your back

Also, see your doctor if you start having back pain for the primary time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

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Back Pain Specialist in New York Queens

Back pain is a common complaint. most of the people within the u.  s. will expertise low back pain at least of once during their lives. Back pain is one amongst the most common reasons people attend the doctor or miss work.

On the bright side, you'll be able to take measures to stop or lessen most back pain episodes. If prevention fails, simple home treatment and correct body mechanics can usually heal your back inside many weeks and keep it functional for the long-term. Surgery is rarely required to treat back pain.

Back Pain Specialist in Queens New York 11375

Nerve Block Treatment in Queens New York

In general, peripheral Nerve Blocks are a kind of procedure during which an anesthesiologist basically works on finding the nerves of the patients so on supplying a body part then, injects the numbing medicine in order to surround the nerves of the patient. once injecting the medication the body part of the person becomes numb to pain and touch and sometimes become immoveable or significant. in order to try this medical procedure you're extremely recommended to visit an professional anesthesiologist who will perform this procedure with complete care.
When it involves start this procedure the patient are offered a kind of medicine in order that he/she will relax throughout the entire procedure. once the patient gets relaxed and goes into the state of unconsciousness his or her skin is numbed so the nerve block needle is inserted through that numb skin and positioned next to the nerves additionally. And using the ultrasound technology the anesthesiologist professional see the nerves and needle and may conjointly move to look at the medicine surrounds the nerves. The peripheral truly a very important a part of nervous system that actually allows send the signals. nervous system could be a system that plays a very important role in our body since it receives and sends the signals from brain throughout the body.
Peripheral nerve blocks are a safe and highly effective procedure through that the patient will get relief from his/her suffering. and the main thing is that this medical procedure will only be possible using ultrasound technology. With this advanced and wide used technology the anesthesiologists perform this procedure and provide instant and effective relief to the patient. For a large variety of patients the peripheral nerve block is actually a boon because with this healthcare procedure they'll live their life usually. In many specific cases, an anesthesiologist may be a person who needs to employ the services of anesthesia so that patient will get relax and also the medical professionals will do the surgery. using the services of a professional Dr. with none hesitation and concern the patient will under went for this medical procedure.

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PRP, Non Surgical Cosmetic Procedures


With platelet rich Plasma therapy, or PRP Injection NYpainsolutions utilizes the healing power of isolated platelets from the patient's own blood to aid in the rejuvenation of their body's soft tissues and bones. Platelet rich Plasma (PRP) injections are accustomed heal muscle, tendon and ligament injuries, accelerating the body's natural healing method. They're a secure and natural different to surgery. A common problem with the healing process is scarring. It affects perform and is among redoubled risk of more damage. Over the previous couple of decades, medical science has recognized that Growth Factors present in specific blood components are most significant within the natural healing process. Growth factors are the foremost important biologically active substance present in blood platelets, that exhibit in depth tissue forming abilities. Throughout PRP treatment, a targeted injection of platelets derived from the very patient is injected into the injured tissue. This initiates the natural healing response of the body.

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Spinal Stenosis Solutions in Queens New York

Spinal stenosis could be a painful condition and the one who is suffering from this condition is aware of that pain has no limits. There are many treatment strategies that are followed by the doctors to cure it. However, it's not possible to fully heal the condition. the reason behind it's the fact that generally owing to this problem; nerve tissues get damaged and are irreparable. thus there's a valid question of what can be done for spinal stenosis.
A medical specialist is that the person that you visit once you start reeling under the pain of this condition. The pain because of compression of the spine is similar to rheumatic pain; moreover, the pain within the other part of body is additionally due to compression of spine. The nerve that gets pressed due to compression of spine causes you to feel pain within the specific a part of the body with that the ironed nerve is related to. However, a medical specialist help you however to not the total extent.
You can also visit a NYpainsolutions for treatment of the spinal stenosis. orthopedic surgeon also makes an accurate choice; but, the surgeons will advise you to go under the knife. however that's obviously not always good, especially just in case of patients that are suffering from this condition. For non surgical possibility you'll also consult a physical therapist, however that may not help you out with the case. Moreover, the condition is comparable to several different orthopedic and rheumatic ailments that it's exhausting to diagnose spinal stenosis........
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Endoscopic-Discectomy Treatment in Queens New York

Many patients who are suffering with serious discomfort related to the spine and back, for all such patients, specialists have many new treatments and Endoscopic Discectomy is one within the list. it's true that this treatment uses the whole technology to its advantage, however sadly, it's not the answer to all or any the conditions that cause back pain, say specialists.

In easier language, we can say that it primarily depends upon the interaction of malady with the surrounding structures and the type of complaint that's bothering the patient's health, that more determines if he's the candidate for this advance procedure or no.

During the endoscopic laser Spine Treatment, the medical experts remove the herniated material and try to achieve back the earlier access to the damaged disc. Moreover, they conjointly cauterize the disc so no any leakage of disc material happens within the body. wherever the normal discectomy needed the surgeons to form a large size incision (5-6 inch) to achieve access to the broken disc, the new to make discectomy is performed with latest technology and the incision that's currently created by the surgeons is concerning the scale of a token. it's through this gap that the sawbones insert a operating tube within the patient's body to simply insert and manipulate the special tools and perform the desired operation. This surgery is performed with associate degree medical instrument, a little video camera that displays the live video on a screen through that the sawbones is ready to find the broken disc and treat it.

Spinal Stenosis Queens

The spinal cord lies in a canal that is formed bodies, the discs, the aspect joints, the lamina, and between the lamina there are a unit ligaments. Overgrowth or movement of any of these into the spinal canal can cause stricture.
Stenosis suggests that narrowing. Narrowing will result in impingement (pressure) on the nerves and spinal cord. Pressure on nerves will cause pain, tingling or symptom, even as you'll get tingling and symptom after you hit your nervous ulnaris
As the body ages, there's extra stress, or 'wear and tear' on area unites that are attached movement, and within the spine this is often mirrored on the aspect joints, and on the ligament that lies between the lamina (bone). This ligament lies over the posterior facet of the spinal and covers the cord wherever there are not any bones. Therefore after we bend, it stretches, sort of a protecting rubber band over the neural structure.
There is gradual wear and tear on the ligament over time and it gets tears and heals repeatedly and gets calcified and eventually it gets hypertrophied (overgrown). The hypertrophied ligament currently pushes into the neural structure, inflicting pain, and this happens even a lot of withstanding and walking.
In the past, if a patient had failing conservative medical care, together with epidural steroid injections, the sole treatment left was possible a ablation surgery. The ablation is AN open, operative procedure during which the plate (bone that covers the rear of the spine) is removed and also the ligament is cleft out beneath direct visual image. This procedure is usually a really productive procedure with smart outcomes, however comes with the risks of surgery and physiological condition.
Introducing a replacement treatment for Spinal stricture secondary to ligament us hypertrophy:
The delicate decompression procedure for spinal stricture could be a safe, new therapeutic choice to relieve pressure on the spine (spinal decompression) serving to cut back lower back and leg pain and increase quality for those patients diagnosed with body part spinal stricture.
The minimally invasive spine surgery is image-guided therefore the doctor will visually see the treatment field. The procedure is performed victimization specialized delicate devices and an area anesthetic with acutely aware ('awake' or 'light' as against 'general') sedation.
The delicate procedure to treat spinal stricture restores house (relieve pressure on nerves) within the canals vertebral is whereas maintaining the natural structure of bone and muscle within the spine. This structural stability is accomplished by locating and removing solely those parts of tissue and bone that compress the spinal nerves and cause pain.

In general, the delicate procedure to alleviate body part spinal stricture takes but AN hour to perform, needs no sutures attributable to the nominal entry purpose (about the diameter of a pencil), leaves no implants behind and solely a little scar remains.

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