Back Pain Relief | Chronic Pain Treatment

Introduction To

Understanding Back Pain: A Four-Bucket Approach for Long Island & Nassau County Patients

At Mosaic Pain Medicine & Rehabilitation in Cedarhurst, NY—serving patients throughout Nassau County and the Five Towns of Long Island—we believe that the first step toward lasting back-pain relief is education. Research shows that up to 84 percent of adults will experience back pain during their lifetime, and while most acute episodes of back pain subside within 12 weeks, chronic lower-back pain can dramatically limit work, family life, and recreation if left untreated.

To help our Long Island neighbors understand what’s happening inside their bodies, Dr. Brian Singer teaches every patient a simple, four-bucket model of spinal anatomy and pain generators:

By pinpointing which “bucket” is driving your discomfort, we can pair targeted therapies such as epidural steroid injections, trigger-point injections, or radiofrequency ablation with a personalized rehabilitation plan.

Bones of the Spine (Vertebrae)

The spine (vertebral column) is a complex structure that provides support, movement, and protection for the spinal cord. The bones of the spine include 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 coccyx bones. Most of these bones stack on one another as vertebrae, disk, vertebrae with nerves diving out to innervate the body. These bones are

Cervical Spine (Neck) – These support the head and allow for movements like nodding and turning.
Thoracic Spine (Mid-Back) – These vertebrae are unique that they are attached to the ribs
Lumbar Spine (Lower Back) – There are five vertebrae (L1-L5) in this region and are the largest and bear most of the body’s weight. These are the most affected bones that cause most of the back pain.
Sacrum and Coccyx (Pelvic Area) – The sacrum consists of five fused vertebrae (S1-S5) that connect the spine to the pelvis, while the coccyx (tailbone) is made of three to five fused bones, providing support when sitting.

Conditions like lumbar spondylosis, scoliosis, compression fracture, and facet joint arthritis can significantly impact these structures, causing chronic pain.

Nerves of the Spine (Spinal Cord and Peripheral Nerves)

The spinal cord is a bundle of nerves that runs through the spinal canal, transmitting messages between the brain and the body.

Cervical Nerves (C1-C8) – Control movement and sensation in the head, neck, shoulders, arms, and hands.
Thoracic Nerves (T1-T12) – Control the chest and upper abdominal muscles.
Lumbar Nerves (L1-L5) – Control the lower abdomen, legs, and parts of the feet.
Sacral Nerves (S1-S5) – Affect the hips, buttocks, legs, and bladder control.

These spinal nerves branch out from the spinal cord through small openings between the vertebrae called foramina, allowing communication between the brain and different parts of the body. Nerves can be pinched due to herniated disks, facet arthritis, foraminal narrowing etc which will lead to significant pain. These conditions are best treated by our back specialist usually with epidural steroid injection .

Muscles of the Spine

Muscles around the spine help with movement, stability, and posture and can be approached as deep and superficial muscles.

Strong spinal muscles help protect the spine from injury, offload painful pressure to the bones and nerves and support your activities of daily living. Back spasms are common and treated effectively with therapy and muscle relaxant medications. Trigger points can develop in any muscle and oftentimes a trigger point injection can be a useful procedure in relieving pain.

Tissues of the Spine (Discs, Ligaments, and Cartilage)

Several soft tissues help keep the spine flexible and cushioned:

Intervertebral Discs – These cartilage cushions sit between the vertebrae, absorbing shock and preventing bone-on-bone contact. Each disc has a tough outer layer (annulus fibrosus) and a gel-like inner core (nucleus pulposus).
Ligaments – These tough bands hold the vertebrae together and maintain spinal stability. Two major structures include anterior longitudinal ligament (which prevents excessive backward bending) and the posterior longitudinal ligament (which limits forward bending).
Cartilage and Facet Joints – Cartilage lines the small facet joints, allowing smooth movement between vertebrae while preventing excessive twisting or bending.

Discs when weak or damaged can herniate. There are many different types of disc herniation which we will evaluate with MRI imaging. A disc herniation can push on nerves causing significant pain and discomfort. Oftentimes patients will have tremendous benefit from epidural steroid injection to help decrease the swelling and inflammation caused by the disc herniation.

Our Treatment Approach

At Mosaic Pain and Medicine Rehabilitation, we take a multidisciplinary approach to back pain treatment, combining diagnostic expertise, interventional pain procedures, and rehabilitation strategies to provide lasting relief.

Comprehensive Lifestyle
Lifestyle Modification Combined with patient tailored cognitive behavioral therapy referral, nutrition, vitamin supplementation
Physical and Occupational Therapy
Physical and Occupational Therapy for Functional Improvement
Non-Opioid Medication Management
Medications non opioids oral medications
Targeted Injections for Pain Relief
Injections; targeting muscle, nerve, bone or sympathetic
Neuromodulation Techniques for Pain Management
Neuromodulation; spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation
Specialist Referrals for Advanced Care
Referral to my colleagues specialized in orthopedic surgery, neurosurgery or neuropsychology.