There is a prison with no walls, no guards, no sentence—and yet it holds millions of people captive every single day. It does not show up on a background check. It does not appear in a courtroom. But it destroys sleep, devours relationships, and slowly convinces its inmates that there is no way out.
It is the shadow prison of chronic pain.
"Am I going to be like this forever?" That question—repeating on a loop at 3 a.m. when the pain won't let you find a position that works—is the sound of the lock turning. Chronic back pain and chronic neck pain don't just attack the body. They wage a full-spectrum assault on the mind, trapping sufferers in a cycle of anxiety, despair, and medical dead-ends that can feel more hopeless than any diagnosis.
On this episode of The World's Mayor Experience, host Joshua T. Berglan sat down with Dr. Georgiy Brusovanik —a Duke-trained orthopedic spine surgeon, a pioneer of minimally invasive spine surgery, and a man who has been on both sides of the operating table—for a no-spin, no-jargon conversation about how chronic pain patients can finally break free.
What followed was one of the most candid medical interviews you'll hear this year.
The Surgeon Who Became the Patient: How Personal Pain Rewired Dr. Brusovanik's Empathy
Before Dr. Brusovanik became known for freeing chronic pain patients, he became one himself. Severe back pain put him on the other side of his own specialty—and what he found there fundamentally changed his approach to medicine.
Early in his career, he followed the conventional script: be conservative, delay surgery, send patients through rounds of injections, and wait. Then came his own agonizing experience with a disc injury that left him unable to function. The recovery playbook he had prescribed for others suddenly felt like a cruel joke.
"When a patient sits across from me and says they are dying in pain, I no longer try to slow them down. I fix it. My own pain made me more righteous in that decision." — Dr. Georgiy Brusovanik
That shift wasn't just philosophical—it was operational. Dr. Brusovanik stopped forcing patients to repeat injections they'd already tried. He stopped putting the cautious institutional timeline ahead of the human being in front of him. He became, in his own words, a better listener. After receiving an artificial disc replacement himself, he was back to full activity—including hauling stone crab traps—within a couple of weeks.
His origin story also explains the gratitude that runs beneath his work. Born in Russia, brought to the United States by parents who gave him access to education he might never have had, Dr. Brusovanik views his career not as a ladder climbed but as a debt being repaid—one spine at a time.
The Two Shadow Prisons: Why Chronic Pain Is a Mental Health Crisis
Dr. Brusovanik doesn't just see chronic pain as a physical problem—he sees it as a psychological emergency. He identifies two distinct shadow prisons that patients fall into.
The first prison is the unknown. You wake up one day with back pain that doesn't go away. You see a doctor. You get an MRI. Nobody can tell you what's wrong—or worse, they tell you it's "in your head." The anxiety of not knowing the cause of your pain—the sleepless nights, the fear that this is permanent—creates a mental prison that is just as debilitating as the physical sensation.
The second prison is post-surgical abandonment. A patient goes through surgery, finds themselves in a new kind of pain, and suddenly the system that operated on them goes quiet. Follow-up care stalls. Imaging gets delayed. They feel discarded.
"If a physician cannot identify the source of the pain, it should be considered an absence of knowledge—not a logical conclusion that 'it must be in your head.'" — Dr. Georgiy Brusovanik
This philosophy drives everything in his practice. He points to conditions like fibromyalgia, which lack definitive diagnostic criteria or imaging support, and suggests that many of those diagnoses are actually the result of clinicians not listening carefully enough—he has personally resolved patients' fibromyalgia symptoms by treating an underlying C5-6 disc problem that was missed.
Is Back Pain a Design Flaw?
One of the most common questions chronic pain sufferers ask is whether their pain is simply the price of being human. Dr. Brusovanik's answer is direct: humans are destined for back pain because we walk upright. Being bipedal loads the spine in ways that quadrupeds never experience, which is why back and neck pain are so extraordinarily common. But he draws a hard line at normalizing it. There is no such thing as "normal pain." If you are living in pain, something is wrong—and it can be found.
The Keyhole Revolution: Minimally Invasive Spine Surgery vs. Traditional Methods
Traditional spine surgery is, to put it plainly, brutal. Surgeons operate from the back, stripping muscles away from bone to access the spine. The collateral damage is significant. Recovery is long. And the numbers tell the story:
Dr. Brusovanik's keyhole approach changes the equation entirely. Using a tube inserted from the side or front, he bypasses fat and soft tissue to reach the spine without stripping a single muscle fiber. The technique works even on obese patients, where traditional surgery becomes particularly difficult.
But the real breakthrough isn't just about the incision size—it's about sagittal balance. The American Academy of Orthopedic Surgeons has concluded that restoring sagittal balance—essentially making the patient taller and realigning their head over their pelvis—is the factor most associated with long-term back pain relief. Minimally invasive surgery from the side or front is the approach that makes this restoration possible.
Motion Preservation: The "Tiger Woods" Standard
Here is where the conversation gets revolutionary. Traditional spinal fusion permanently locks vertebrae together. It stops motion at the surgical site—but biomechanical studies show that fusing one segment cascades stress into adjacent segments, accelerating their deterioration. For a patient under 50 who gets a neck fusion, the chance of needing another surgery in their lifetime approaches 100%.
Motion preservation through artificial disc replacement takes the opposite approach: it restores the spine's ability to move naturally. Dr. Brusovanik—who received a disc replacement himself—describes it as a miracle. His recovery was measured in weeks, not months, and he returned to full physical activity without restriction.
"The human spine is meant to move. Fusing it is taking away its sovereignty. Motion preservation is the way to go." — Dr. Georgiy Brusovanik
How to Select a Spine Surgeon
Joshua T. Berglan raised a critical point that many accident victims encounter: attorneys steering patients toward specific doctors for financial rather than medical reasons. Dr. Brusovanik offered a three-part vetting process that anyone considering spine surgery should follow.
First, read the bad reviews. Every surgeon has complications—what matters is how they respond. Defensiveness or silence is a red flag. Accountability and empathy are green lights.
Second, watch how the doctor interacts with their staff. A toxic relationship between a surgeon and their team tells you everything about the culture of care you'll receive.
Third—and most importantly—ask if you can speak with a patient who experienced a complication. A surgeon who is confident in their outcomes and their ability to manage problems will say yes. A surgeon who refuses has something to hide.
Your MRI Might Be Lying to You: The Diagnostic Injection Mandate
This is one of the most important points in the entire interview, and it's one that most chronic pain patients have never heard: an MRI alone cannot tell a surgeon which disc is causing your pain.
Roughly 80% of people who have zero back pain will still show surgical pathology on an MRI—bulging discs, herniations, degeneration. The scan reveals structure, not source. Dr. Brusovanik has seen cases where surgeons operated on the worst-looking disc on the MRI, only to find that the pain was actually originating from the second or third worst disc.
The solution is diagnostic injections —specifically, transforaminal epidurals that place medicine directly behind a specific disc. If the patient's pain disappears by 70 to 80% immediately after the injection, the surgeon can guarantee they've found the problem and can fix it. Without this step, surgery is a gamble.
"An MRI is insufficient. Eighty percent of people without back pain have surgical pathology on their MRI. A diagnostic injection proves the source. Without it, you're guessing." — Dr. Georgiy Brusovanik
The Pillow for Pain: A Simple Invention Solving a Massive Misdiagnosis
Not every innovation in spine medicine involves a robot or an operating room. Sometimes it involves Velcro and a thin pillow.
Dr. Brusovanik grew tired of explaining to patients that they should wrap a towel around their elbow at night to prevent elbow hyperflexion —a condition where the arm bends too tightly during sleep, compressing the ulnar nerve and causing symptoms that range from carpal tunnel syndrome to elbow pain to hand numbness. The problem? These symptoms are frequently misdiagnosed as a neck problem, sending patients down an expensive, invasive, and wrong treatment path.
So he built the Pillow for Pain —a simple, thin pillow with Velcro that wraps around the elbow and stops hyperflexion during sleep. Patients have reported pain disappearing after the first night of use. The condition affects as many as 50,000 Americans every month, and the existing surgical option— ulnar nerve transposition —is notoriously unreliable because the nerve can be easily irritated during the procedure.
The Pillow for Pain is currently available at Pillow4Pain.com and on Amazon, and Dr. Brusovanik is approximately one month from securing Medicare and insurance coding approval, which would make the device available to patients at no out-of-pocket cost.
Dr. Brusovanik also had an important message for anyone who blames themselves for making their pain worse during sleep: stop. You cannot control how you toss and turn. Most pain problems are minor and can be addressed with small interventions—not necessarily surgery.
Busting the Biggest Myths in Spine and Pain Medicine
The Stem Cell "Fairy Tale"
Dr. Brusovanik did not mince words about the multibillion-dollar stem cell industry: he called it a fairy tale. His reasoning is grounded in basic biology. Stem cells are undifferentiated—they're like babies that need to be told what to become. Simply injecting them into a joint and expecting them to transform into cartilage is fantasy; the body's immune system will likely destroy them before they do anything useful.
The deeper problem is retrospective bias. Because roughly 75% of musculoskeletal issues resolve on their own over time, patients who pay thousands for stem cell injections and then feel better naturally attribute the improvement to the treatment. Dr. Brusovanik's advice: always get a second opinion before spending money on unproven therapies.
The Testosterone Replacement Trap
In a surprising detour, Dr. Brusovanik issued a warning about Testosterone Replacement Therapy (TRT). When the body receives exogenous testosterone, it triggers a negative feedback loop—the pituitary gland tells the body to produce less of its own. Over time, the patient becomes dependent on supplemental hormones, and the downstream effects can include dangerously high hemoglobin requiring regular blood draws and increased risk of blood clots.
He also raised concerns about the reliability of testosterone testing itself, noting that factors as simple as hunger or stress at the time of the blood draw can significantly skew results, leading to prescriptions that may not be necessary.
His unconventional recommendation for men concerned about low testosterone: consult your spouse and prioritize a regular, healthy intimate life—which he says has far-reaching benefits for bone density, skin quality, and cognitive function that extend well into old age.
The Opioid Question
On the opioid crisis, Dr. Brusovanik was equally direct. He considers it criminal to prescribe narcotics for chronic pain without first establishing a diagnosis. Handing a patient painkillers without understanding the source of their suffering is not treatment—it's a setup for withdrawal, tolerance, and dependence. Minimally invasive surgery, by reducing surgical trauma, also reduces the amount of post-operative pain medicine patients require—a critical advantage in the current era of opioid awareness.
The Future of Spine Surgery: Robots, Conservative Innovation, and Curing Back Pain Today
Dr. Brusovanik is optimistic but deliberate about technology. He believes the tools to cure back and neck pain already exist— motion preservation, disc replacement, minimally invasive robotic surgery. Within three to five years, he expects surgeons will be operating "behind corners" without direct visualization. Fully autonomous surgery, however, is still a distant prospect.
His caution is intentional. He has seen colleagues adopt new technologies too quickly, becoming dependent on gadgets—3D helmets, navigation systems—that introduce a "fiddle factor" of unreliability. When the technology fails mid-surgery, the surgeon's fundamental skills are what save the patient. Dr. Brusovanik insists on maintaining strong surgical principles first and using technology as an enhancement, not a crutch.
The Vision of Freedom: Life After Minimally Invasive Spine Surgery
So what does freedom actually look like on the other side?
Dr. Brusovanik describes patients who are in the gym working out one week after surgery. He describes recoveries where no physical therapy is needed—because when you don't strip muscles from bone, there's nothing that needs to be rehabilitated. He compares his role to that of an electrician: find the electrical problem, fix it, and sneak out.
"You should be back to your normal life. Minimal injury. Most patients don't need therapy after my surgery. I fix the problem and sneak out." — Dr. Georgiy Brusovanik
For anyone reading this at 3 a.m. because the pain won't let you sleep—for anyone who has been told it's in your head, that you just have to live with it, that the MRI doesn't show anything—this conversation is your evidence that another path exists. The shadow prison has a door. And surgeons like Dr. Brusovanik are standing on the other side of it, ready to open it.
People Also Ask
Dr. Georgiy Brusovanik
Dr. Georgiy Brusovanik is a Duke-trained orthopedic spine surgeon specializing in minimally invasive spine surgery, artificial disc replacement, and motion preservation. He has treated elite athletes and everyday patients with equal commitment at his clinics in Miami and New York City. A pioneer of the keyhole surgical approach and creator of the Pillow for Pain, Dr. Brusovanik combines cutting-edge technique with a patient-first philosophy rooted in his own experience as a chronic pain sufferer. He welcomes patients from all over the world regardless of insurance status.
