Changing the face of pain management. Mechanism-based treatment most likely to succeed.

A 48-year-old mechanic presented to his new primary care physician with complaints of ongoing neck and upper back pain. He had sustained a neck injury while at work 3 years earlier. Magnetic resonance imaging revealed a herniated C5-6 disk resulting in moderate spinal stenosis and right foraminal encroachment. Persistent pain in the right arm and scapula prompted physical therapy and pharmacologic treatment, neither of which was helpful. Epidural corticosteroid treatment was only transiently effective.