Frequently Asked Questions

What is QEEG?

Quantitative Electroencephalography (QEEG) is the use of digital signal analysis to extend the analysis of electroencephalography (EEG). Electroencephalography (EEG) is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain.(1) In clinical contexts, EEG refers to the recording of the brain’s spontaneous electrical activity over a short period of time, usually 20-40 minutes, as recorded from multiple electrodes placed on the scalp.  We are currently using this non-invasive technology to measure a patient’s pain level on an experimental basis.

What is an EEG?

An EEG involves the recording of a standard clinical EEG and shows the electrical activity of your brain,  just like the EKG shows the electrical activity of your heart.  Both are non-invasive and there are no risks to you.

What is Neurofeedback (NFB)? 

Neurofeedback (NFB) is a process whereby you learn to decrease your pain level based on feedback from your own brain waves while watching a movie or listening to music. If your referring doctor thinks you are a candidate for this procedure, you will be asked to participate in a trial study to investigate the treatment of pain through NFB. If the initial trial shows a positive response, you will be eligible for a course of NFB treatment.

Why I use CT Guidance vs Fluoroscopy?

I utilize a CT Scanner for most procedures which increases safety and accuracy, as well as minimizes patient discomfort, compared to the fluoroscopy guided techniques. CT allows me to use a postero-lateral approach to lesion the medial articular branches in the neck, with the apparent result of creating a longer lasting lesion than is obtained with the conventional lateral cervical approach. The use of CT minimizes the risk of pneumothorax in the thoracic area, allows for better imaging in patients who have undergone fusions, provides direct visualization of the ganglia in percutaneous partial rhizotomies, minimizes pain in trauma to the roots during discography, and allows for rapid anatomical interpretation of the discogram. CT also gives more sensitive radiological control during vertebroplasties.
Some nerves are difficult to visualize on routine CT or MR imaging.

Under CT guidance, a needle may be placed adjacent to the nerve site. Contrast (X-ray dye) is then injected, highlighting the nerve and confirming correct needle placement. The nerve may then be injected with cortisone and local anaesthetic to confirm and also treat chronic pain. In some cases the nerve may be destroyed with either alcoholic or radiofrequency ablation.

Why can’t someone help me?

Because no one can determine what another person feels, diagnosing and treating pain is a challenge, making it difficult for family members, friends, the medical profession, and insurance companies to understand. Still, pain can be managed even when the underlying causes of it — such as cancer, osteoporosis or injury — cannot.  I believe that patients who continue to be in serious pain for six months after receiving adequate care by local, “affordable” physicians, should look elsewhere for treatment and seek a second opinion.

Why a pain specialist?

Most doctors under-treat pain, either through ignorance of the specifics of pain management, or possibly fear of prescribing narcotics. If you come to me, a neurologist, asking about drugs for your heart, I’ll tell you about 10. A cardiologist could tell you about 27. It’s the same in pain management. Doctors who treat pain know more about how to alleviate pain than those who specialize in diseases that cause pain, including oncologists who treat cancer, among others.

What is a Patient Advocate?

It’s not at all surprising that you ask this question… because almost no one else has one.  Our Advocate helps you recover whatever you may be due from your managed care program or your private insurance carrier.  At times like these – when you’re anxious and in pain – we think it’s important to have someone in your corner to help deal with your healthcare reimbursement while you deal with your recovery.

Is it just my imagination?

Despite notions current in pop psychology, in most cases, whether or not the source of pain can be identified, pain really is physical. It is not about anger. It is not about stress. When a patient complains of pain and their medical tests reveal no physical cause, it is usually improper for doctors to tell them that the problem is “in their head.” A few nerve problems are clearly related to stress and do warrant psychological help. For the most part, I believe my patients’ pain is real, even when the causes of the pain may not show up on an x-ray or other tests.

What are the consequences of untreated pain?

All pain comes from injury to or irritation of nerves. Pain ultimately is perceived by and reacted to by the brain. When nerves send signals of pain over a prolonged period of time, these pain impulses literally become part of us, influencing everything we do. They won’t show up as part of the body’s physical structure, but they can lead to significant related psychiatric symptoms. The earlier you treat pain effectively, the easier it will be to control it and prevent it from becoming chronic and endless. Otherwise we, the medical community, may actually help drive some patients with chronic, poorly understood pain syndromes “crazy.”  Untreated pain has been shown to cause brain damage which may be reversed if the pain can be eliminated.

Am I crazy?

No. You’re not. Pain is not in your imagination. It is in the pain processing system of your brain.


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Emile M. Hiesiger, M.D.

The Corinthian
345 East 37th Street
Suite 320
New York, NY 10016
• Phone (212) 697-1411 or
• Phone (212) 263-6123
• Fax (212) 697-1399

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