Pain Condition
Chronic and Refractory Pain
By Dr. Anthony J. Gordon, Doctor of Acupuncture | Last reviewed September 2026
You have seen several specialists, had the imaging, tried the medications, done the physical therapy, and maybe had injections or surgery. The pain is still here. Pain that does not respond to standard care is called refractory pain. It usually means something has not been found or treated yet. Dr. Gordon starts by looking for muscle, nerve and nervous system sources of pain that have not been examined yet.
Prefer to talk it through? Call (516) 597-5400. Most new patients are seen within one to two weeks.
Overview
Understanding Chronic and Refractory Pain
Chronic pain is pain that lasts longer than three months. Refractory pain is chronic pain that has not improved enough with standard treatments such as medication, injections, physical therapy or surgery. It is common, and it is one of the main reasons patients come to the clinic.
Refractory pain rarely has a single cause. Often a muscle or nerve source was never examined because imaging looked normal or explained only part of the picture. Over time, the nervous system can become more sensitive, so pain spreads, flares more easily and responds less to treatment. Sleep, stress and months of guarding and avoiding movement add to the load. Conditions such as fibromyalgia, neuropathy, central sensitization, chronic pelvic pain and lingering pain after surgery often fall into this group.
Your physicians rule out conditions that need medical or surgical care. Dr. Gordon looks for the muscle, nerve and nervous system factors that keep pain going, and builds your plan around them.
Chronic and Refractory Pain at a Glance
Also called
Chronic pain, treatment-resistant pain, persistent pain
Definition
Pain lasting three months or longer that has not improved enough with standard care
Common examples
Fibromyalgia, neuropathy, central sensitization, chronic pelvic pain, pain after surgery
Why it persists
Missed muscle or nerve sources, a sensitized nervous system, and months of guarding
What Dr. Gordon addresses
Trigger points, irritated nerves, nervous system sensitivity, movement and pacing
The Gap in Care
What Tests Check, and What They Can Miss
Standard pain care is good at finding structural problems and managing symptoms. The muscle, nerve and nervous system drivers of long-standing pain are often never examined directly.
What routine testing is looking for
- Fractures, tears and disc problems on imaging
- Inflammatory and autoimmune disease
- Infection and other serious causes
- Candidates for injections or surgery
What often keeps symptoms going
- Trigger points that refer pain to other areas
- Small nerves irritated by tight muscles or scar tissue
- A nervous system that has become sensitized
- Protective guarding and movement avoidance
- Poor sleep and stress that lower pain tolerance
These are assessed with a detailed history, hands-on examination and nerve testing, not imaging alone.
Signs & Symptoms
Does This Sound Like You?
These are the patterns Dr. Gordon sees most often.
Pain that has lasted months or years
Pain that has not gone away despite time and treatment.
Several treatments that did not help
Medication, injections, therapy or surgery with little or short-lived relief.
Pain that spreads or moves
Pain that has expanded beyond where it started.
Flares from small triggers
Light activity, stress or poor sleep setting off a flare.
Normal or unclear test results
Imaging and labs that do not explain how much you hurt.
Fatigue and poor sleep
Pain that disrupts sleep, and poor sleep that worsens pain.
Root Causes
The Four Drivers Dr. Gordon Looks For
Most people have more than one of these in play. Finding which one leads makes treatment more efficient.
Missed muscle sources
Trigger points can refer pain far from where they sit and are not visible on imaging.
Irritated nerves
Small nerves irritated by tight muscles, scar tissue or old injuries cause burning, zinging or aching pain.
Nervous system sensitivity
After months of pain, the nervous system can amplify signals, so pain spreads and flares more easily.
Guarding and deconditioning
Protective tension and avoiding movement keep tissues tight and sensitive.
Your First Visit
How Dr. Gordon Evaluates Chronic and Refractory Pain
The initial evaluation runs 60 to 75 minutes. With complex pain, the history matters as much as the exam, so Dr. Gordon takes the time to understand everything that has been tried.
Records and history review
Dr. Gordon reviews your records, imaging, medications, injections, surgeries and therapies so he knows what has been ruled out and what has already been tried.
Pain mapping
Dr. Gordon maps where the pain started, where it has spread, what triggers flares and what helps.
Muscle and nerve examination
Hands-on assessment for trigger points and irritated nerves, plus a neurological screen of strength, sensation and reflexes.
Sensitivity and lifestyle assessment
Dr. Gordon looks at signs of nervous system sensitization along with sleep, stress and activity patterns.
Plan and coordination
A clear plan, plus communication with your physician, orthopedist or physical therapist when that helps your care.
When to see a physician first
- Unexplained weight loss, fever or night sweats with your pain
- Pain that steadily worsens over weeks despite rest and treatment
- New weakness, numbness or trouble walking
- Numbness in the saddle area or loss of bladder or bowel control
- Severe pain at night that does not change with position
- A history of cancer with new or changing pain
If you have any of these, contact your doctor or go to the nearest emergency department.
Bring to your first visit
Records
Recent lab results, imaging reports and specialist notes. These can also be faxed ahead.
Treatment history
A short list of what you have tried and what did or did not help.
Clothing
Something comfortable and loose fitting.
Treatment
How Dr. Gordon Treats It
These are the tools Dr. Gordon uses most often for complex, long-standing pain, chosen from your exam findings.
Primary approach
Orthopedic Dry Needling
Dr. Gordon has used dry needling for more than 18 years. For refractory pain, treatment targets the trigger points and guarded muscles that keep feeding pain signals, starting gently and building as your system tolerates it.
See all servicesNerve focus
Neuro-Functional Acupuncture
Electro-acupuncture along nerve pathways to calm irritated nerves and help turn down nervous system sensitivity.
See all servicesBetween visits
Pacing Plan & Team Coordination
Pacing, sleep and activity strategies, coordinated with your physician, pain specialist or physical therapist.
Referring provider? Contact the clinicWhat to Expect
A Typical Recovery Arc
Visits 1 to 3
Find the main driver
Dr. Gordon confirms which muscles and nerves are behind your symptoms and starts calming the most reactive areas. Many people notice early changes between visits.
Visits 4 to 8
Lower the baseline
Day-to-day symptoms ease, flares become shorter and less frequent, and normal routines start to feel more manageable.
Visits 9 to 12 and beyond
Build resilience
Visits are spaced out as improvement holds. You leave with a maintenance and early-flare plan.
Complex pain usually takes longer to settle than a recent injury. Most patients are seen weekly during active care, with gentler dosing early on. Individual results vary, and progress is reassessed at every visit.
Not sure how to describe it? Put your pain or discomfort into words before your visit
"Dr. Gordon is an excellent doctor who has had a multi faceted approach to my treatments. ... To begin with, he sat with me for nearly an hour and discussed the details of my lifestyle (workouts, sleep, nutrition, etc) to help paint the picture he needed to best plan my treatments, which informed me that his approach is truly holistic as well as individual. I've experienced immense relief with Dr. Gordon where many others have failed, and I would recommend his services to anyone and everyone."
Joe Friedman, Google Review
Individual results vary.
Chronic and Refractory Pain Questions
Answers About Chronic and Refractory Pain
Still unsure whether this is the right fit? Reach out before you book and Dr. Gordon will talk through your history with you.
It means pain that has not improved enough with standard treatments. It does not mean the pain cannot improve.
Many patients with refractory pain have never had their muscles and nerves examined in detail. Finding a missed driver often changes the plan.
No. A sensitized nervous system is a real, physical change in how pain signals are processed, and it can be treated.
Yes. Dr. Gordon does not change medications. Any changes are made with your prescribing physician.
Dr. Gordon starts gently and adjusts treatment to what your body tolerates, so flares are kept to a minimum.
Complex pain often needs eight to twelve sessions or more. Dr. Gordon reassesses at every visit and tells you how you are responding.
Before You Book
General Questions
The clinic is an out-of-network practice. The initial evaluation is $300 and follow-up visits are $250. After each visit you receive a detailed superbill to submit to your PPO plan for possible reimbursement. FSA and HSA cards are accepted, and the clinic can run a complimentary benefits check before your first appointment. The check is a courtesy, so please confirm your coverage with your plan. See Insurance & Fees for details.
The first evaluation is 60 to 75 minutes and usually includes treatment. Follow-up visits run 45 to 60 minutes.
Yes. Call (516) 597-5400 or send a message through the contact page. This is especially helpful if your case is complex and you want to understand the approach before committing to a full evaluation.
1508 Union Turnpike, Suite 133, North New Hyde Park, NY 11040, with free parking on site. The clinic is an easy drive from Manhasset, Great Neck, Garden City, Lake Success, Floral Park and Mineola. Early morning, evening and weekend hours are available.
Most people feel a quick muscle twitch or a deep ache that lasts a few seconds. That twitch is a normal sign the trigger point is releasing. Mild soreness for 24 to 48 hours afterward, similar to a hard workout, is common. Depth, angle and stimulation are adjusted to your comfort.
Both use the same fine, sterile, single-use needles. Dry needling targets specific trigger points and tight bands in muscle based on your exam. Neuro-functional acupuncture targets nerve pathways, often with gentle electrical stimulation, to calm nerve sensitivity. For chronic and refractory pain, Dr. Gordon commonly uses both.
When performed by a trained, licensed provider with detailed knowledge of anatomy, it has a strong safety record. Tell Dr. Gordon if you take blood thinners, have a bleeding disorder, are pregnant or have a weakened immune system so he can plan accordingly.
About Dr. Anthony J. Gordon
Dr. Anthony J. Gordon is a Doctor of Acupuncture licensed in New York and board certified. He holds ASE certification in intrapelvic and extrapelvic dry needling, along with advanced certifications in Functional Dry Needling and Neuro-Functional Acupuncture. With more than 18 years of clinical experience and over 3,000 complex cases treated, he focuses on pelvic, spinal and orthopedic conditions that have not responded to standard care, and works closely with each patient's physicians and physical therapists.
Read Dr. Gordon's full bioBook an Evaluation for Chronic and Refractory Pain
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Early morning, evening and weekend appointments available. Free on-site parking.