Overview
Chronic back and neck pain affects millions of Americans and is one of the leading causes of disability and reduced quality of life. Unlike acute pain that resolves as an injury heals, chronic pain persists for weeks, months, or years — often outlasting the original injury and taking on a life of its own in the nervous system. Dr. Roslyn Migdale brings a uniquely comprehensive perspective to spinal pain: over 6,000 chiropractic patients, a PM&R residency, and fellowship-level interventional training all inform how she evaluates and treats each individual.
What Causes Chronic Back and Neck Pain?
Chronic spinal pain can stem from many sources: degenerative disc disease, facet joint arthritis, muscle and ligament strain, nerve irritation or compression, or a combination of factors. In many cases, the original structural cause has healed but the nervous system has become sensitized — a phenomenon called central sensitization — where the pain signal itself has become amplified and self-sustaining. Understanding whether pain is primarily structural, neuropathic, or centrally mediated guides the entire treatment approach.
How Dr. Migdale Approaches Spinal Pain
Dr. Migdale evaluates chronic back and neck pain through both an interventional medicine lens and a hands-on musculoskeletal lens developed over more than 15 years of clinical practice. She performs a thorough history and physical examination, reviews imaging, and considers the full picture — structural, neurological, functional, and psychosocial — before recommending a treatment pathway. For many patients, a combination of image-guided procedures and functional restoration achieves the best outcomes.
Treatment Options
Depending on the diagnosis, treatment may include: medial branch blocks and radiofrequency ablation for facet-mediated pain; epidural steroid injections for disc-related nerve irritation; trigger point injections for myofascial components; spinal cord stimulation for refractory cases; and manual therapies including medical acupuncture, Active Release Technique, and Graston for soft-tissue components. Dr. Migdale's dual background means she can offer this full range — surgical to hands-on — in a single practice.