Our Team

The spine specialists at SPINE OPTIONS will coordinate all of your spine care needs. Team members collaborate regularly to offer you the best treatment options. Spine Options brings together a team of medical and holistic professionals who specialize only in disorders of the back and neck. The group offers an impressive array of services and treatments that optimize pain management and the healing process. The expertise of the Spine Options Team, is an excellent resource for both primary care physicians and specialists. The group of professionals offers a unique combination of neck and back pain specialists.

Bradley S. Cash, MD, FAAPMR

Medical Director, Founder


Dr. Cash is a Board-certified physiatrist, or an MD trained in physical medicine and rehabilitation. He does see a variety of patients of any age for any musculoskeletal or neurological condition, but he specializes in back and neck pain. At your first visit SPINE OPTIONS, he performs an extensive evaluation to uncover the cause of your pain. Diagnostic testing is ordered if needed and a treatment planned tailored to the patient’s condition is developed. Then, throughout the course of your treatment plan, he leads the multidisciplinary team that cares for you. He has devoted his career to evaluating and designing treatment programs for individuals suffering from neck and back pain. That is why at SPINE OPTIONS, we routinely treat patients successfully where otherwise conventional treatment has failed. SPINE OPTIONS not only helps patients hoping to avoid surgery, but also focuses on recovery and rehabilitation for those that have completed surgery. As a Pain Management specialist, he is an expert in diagnosing spinal conditions, as well as experienced in managing pain to give your body an opportunity to heal and function at its best level. In addition, Dr. Cash has had extensive training in treating spinal dysfunction, neuromusculoskeletal disorders, and the use of therapeutic BOTOX and other injections. He has served on several national Chronic Pain and Botulinum Toxin Advisory Boards.

Dr. Cash completed his residency in Physical Medicine and Rehabilitation at Mount Sinai Hospital in Manhattan, and served as medical director of Rehab Institute of New York, a large, sub-acute rehabilitation program. He received his medical degree from New York Medical College in 1995 and a BA in Psychology with a Spanish minor from Emory University in 1990. He has maintained several hospital affiliations and an active member of local and national societies. He is a founding Board Member of the New York State Pain Society which is involved both in academic and political issues surrounding his Specialty.

Dr. Cash has years of experience and has expertise in Electrodiagnostic testing as well as various local myofascial and joint injections. He also has advanced skills in BOTOX injections for therapeutic techniques; Cervical Dystonia, Migraine Headaches and Spasticity. He also has specialized training in cosmetic BOTOX as well has Juvederm injections. SPINE OPTIONS does offer various interventional pain management injections to the lumbar and cervical spines under Flouroscopic Guidance by Dr. Lyle Posecion.


Lyle W.F. Posecion, MD, FAAPMR, DABPM

Interventional Spine Specialist


Dr. Posecion is a board-certified in physical medicine and rehabilitation and board certified in pain medicine. He is a physician trained in the diagnosis and management of spine-oriented pain whether the cause is disease of the nerves, discs, muscles, joints and/or bones. The goal is to promote optimal patient health and function by combining exercise with evidence-based medical treatment.

Originally from Queens, NY, he received his undergraduate degree from New York University. He completed his medical education by interning at Long Island College Hospital, in Brooklyn, NY. He went on to finish a three-year residency in Physical Medicine and Rehabilitation at Kingsbrook Jewish Medical Center in Brooklyn, NY. He continued his training as a fellow in Interventional Spine and Pain Management with the Alabama Orthopedic, Spine, & Sports Medicine Associates in Birmingham, AL.

Dr. Posecion has a special interest in non-operative treatment of neck and back disorders, orthopedic rehabilitation, and sports injuries. He has extensive training and experience in minimally invasive pain management techniques, including epidural steroid injections, facet joint injections, and intradiscal procedures. He also performs electro-diagnostic studies to assist in diagnosing complex cases.

His objective is to work with his patients to design an individualized treatment program tailored to restore function and promote an active lifestyle. Different aspects of a treatment plan may include physical therapy, medications, or x-ray guided steroid injections. He provides non-operative care to patients that suffer with neck/back pain, arthritis, and work/sports related injuries with the intent of adding quality to life.

He is an active member of the New York State Pain Society, the American Academy of Physical Medicine and Rehabilitation, and the International Spine Intervention Society.


Neil Patel, MD

Interventional Pain Specialist


Dr. Neil Patel is a double boarded-certified Interventional Pain Management physician.  He provides comprehensive care for a wide variety of painful conditions of the spine, nerves, joints, and muscles by integrating interventional procedures, physical therapy, and medications.

The various minimally invasive treatments Dr. Patel offers include fluoroscopic guided spine injections, peripheral nerve blocks, regenerative medicine, and spinal cord stimulation.  In addition, Dr. Patel has a particular interest in cancer pain as well as the merging fields of neuromodulation and regenerative medicine.

After earning his medical degree, Dr. Patel performed his residency in Physical Medicine and Rehabilitation at Mount Sinai Hospital in New York City.  Dr. Patel then completed an interventional pain management fellowship at Memorial Sloan-Kettering Cancer Center and then served as a pain management physician in the Department of Anesthesia and Critical Care Medicine at Memorial Sloan-Kettering Cancer Center.

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Dr. Patel is currently the Medical Director of Pain Management and Palliative Care Medicine at Montefiore Nyack Hospital. His goal is to provide targeted individualized treatment plans for his patients, with a focus on functional outcomes and quality of life.


headshot of dr. elvis remains

Elvis Rema, MD

Interventional Pain Specialist & Anesthesiologist

Dr. Elvis Rema is double board-certified in Interventional Pain Management and Anesthesiology. He completed his Interventional Pain Medicine fellowship at the prestigious Columbia University-New York Presbyterian Hospital in New York City and Anesthesiology residency at the George Washington University Hospital in Washington DC.

Dr. Rema specializes in the treatment of back and neck pain caused by arthritis, degenerative disc disease, herniated discs, sciatica, spinal stenosis, and pain following spine surgery. He also has expertise in treating neuropathic pain, cancer-related pain, complex regional pain syndrome (CRPS), facial pain syndromes, pelvic pain, headache syndromes, and peripheral neuralgias.

Dr. Rema offers a variety of treatment options to help ease pain intractable to previous therapy.  These include epidurals, nerve blocks, radiofrequency ablation, spinal cord stimulation, dorsal root ganglion stimulation, kyphoplasty, etc.  He also has extensive experience in the use of intravenous ketamine therapy for certain chronic pain syndromes as well as the use of ketamine for the moderation of treatment resistant depression.

Through evidence-based medicine and compassion, Dr. Rema strives to help patients improve functionality and resume an active lifestyle. He strongly believes that the management of pain is not just addressing a physical issue but also tackling the emotional toll that one experiences with pain. 

To learn more about Dr. Rema, visit his personal website at epain.net.


Vincent Carlesi, MD
Board-Certified Anesthesiologist


Dr. Vincent Carlesi is a board-certified anesthesiologist with sub-specialty board certification in pain management. He is currently on the staff of Stamford Hospital in Stamford, CT. He specializes in the interventional treatment for chronic pain. As a leader in this field, Dr. Carlesi has had extensive training in pain management techniques including epidural steroid injections, facet injections, and joint injections. In addition, Dr. Carlesi specializes in innovative procedures such as vertebroplasty, discography, intradiscal decompression, IDET, platelet-rich plasma (PRP) treatments, and amniotic stem cell treatments, as well as implantable devices such as spinal cord stimulators and intrathecal pumps. Dr. Carlesi is also a certified prescriber for medical marijuana in both Connecticut and New York.


Dr. Carlesi graduated from Ross University School of Medicine and completed a residency in internal medicine at Stamford Hospital. To further his training, Dr. Carlesi completed a residency in anesthesia at Albany Medical Center and New York Medical College where he was Chief Resident.

After his training, Dr. Carlesi directed a primary care facility at St. Luke’s Hospital, as a primary care physician for the indigent. His positive experience treating pain patients inspired him to do a fellowship in pain management. He then completed fellowship training in pain management at Albany Medical Center and at St. Vincent’s Medical Center in New York.

Dr. Carlesi opened his pain management practice in Stamford, CT and quickly expanded to Danbury, CT. As Medical Director of the Pain Management Associates of Connecticut, Dr. Carlesi oversees a team of specialists with advanced training that work together across multiple healthcare disciplines to treat patients with chronic pain.

The American Pain Foundation estimates that 100 million Americans have chronic pain. According to Dr. Carlesi, only a quarter of those are properly treated.


“Only in the last decade has the medical community begun to embrace pain as a disease that needs to be treated in its own,” he said. “My practice is committed to helping our patients – with the right approach – manage their pain so that they may continue to function at the highest level possible.” 

Dr. Carlesi is a member of the Medical Board of Physicians for the State of Connecticut Medical Marijuana Program. He certifies patients with medical conditions that have been approved and allow the use of medical marijuana for pain and symptom relief.


For more information about Dr. Carlesi, click here to visit his personal website.



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Michael Kullman, MD
Board-Certified Anesthesiologist


Dr. Michael Kullman is a board-certified anesthesiologist who specializes in managing patient pain levels before, during, and after surgical procedures. 

Dr. Kullman has been practicing for more than three decades. After graduating with his medical degree from New York Medical College, Dr. Kullman worked as an intern at Westchester County Medical Center, where he also performed his residency in Cardiothoracic and Neuro Anesthesia. 

Dr. Kullman is a member of the American Society of Anesthesiologists and the New York State Society of Anesthesiologists. In addition, he is a former Commander in the United States Navy Reserve, serving as Battalion Surgeon for 2/25 Marines for eight years.




Caren Goldstein, NP-BC

Adult-Gerontology Nurse Practitioner


Caren Goldstein is a Board-Certified Adult-Gerontology Nurse Practitioner specializing in the care of pain management. Working closely with Dr. Elvis Rema, she is skilled in performing physical assessment, diagnosing, coordinating plan of care and performing in-office therapeutic procedures. She began her career in health care as a paramedic and then a registered nurse, working in acute care settings. She advanced her skills while working as a registered nurse in emergency medicine which then led to her role as an educator for the staff of the emergency department. 

After 10 years of working in emergency medicine, she transitioned into orthopedics; coordinating care and providing patient education for joint replacement and spine surgery patients. Caren then pursued her interest in advancing her nursing education and earned her Master’s in Nursing as a Nurse Practitioner from Western Connecticut State University in Danbury, CT. 

Caren is a member of the American Association of Nurse Practitioners as well as the Sigma Theta Tau International Honor Society of Nursing in 2014. 

Outside the office, Caren enjoys anything that involves spending time with her family, especially hiking, biking and traveling with her husband and three sons.