Managing Chronic Pain Without Opioids
For the last seven years, Dr. Mila Mogilevsky has dedicated her practice to treating acute chronic pain without opioid medications.
“In the long run, they [opioids] usually do not prove to work well when it comes to managing chronic, non-malignant pain,” she explained. “People develop opioid tolerance and dependence.”
Her approach is two-pronged: First, she uses non-surgical treatments that target painful areas, then she works with patients to make sure they have a comprehensive and customized rehabilitation plan.
These methods significantly resolve pain for months or years.
“The idea is that the nerves will not bother the patient for hopefully at least nine months to a year and a half. [But] they [the nerves] do grow back … which is why I tell my patients nothing we do is permanent and that’s probably a good thing, as opposed to, say, drastic surgery where changes are irreversible,” she said.
That is not to say that surgery does not have its place, she adds. “We work with a wonderful group of surgeons, who treat patients conservatively and provide excellent care when needed.”
Dr. Mogilevsky, who is board certified in pain medicine as well as physical medicine and rehabilitation, has firsthand knowledge of the rehabilitation process. Before becoming a physician, she worked for several years as a trained physical therapist.
“I know exactly who to send my patients to and how to follow up on their progress,” she said.
She also helps patients taper off opioids.
One patient, Celeste Willford, 42, suffered for three years with severe pain shooting down her arm caused by a herniated disc in her neck. Before meeting Dr. Mogilevsky, she had been taking opioid medications as prescribed, but the pain persisted.
“I had that electrical pain going down my arm all the time,” Willford said, “I couldn’t look up or turn my head to the right without pain.”
About seven months ago, Dr. Mogilevsky gave Willford a steroid injection in her neck (called an epidural steroid injection), followed by a local anesthetic in the side of her neck (a cervical facet injection), which immediately alleviated the pain.
“I had been in pain for three years, so I started to cry,” Willford said, “This has changed my life.”
Willford said she has only had some minor pain now since receiving the injection, and she wants to undergo another procedure—ablation therapy—for maximum relief.
Ablation therapy involves heating a small area of nerve tissue to decrease pain signals.
No Conventional Surgery
Dr. Mogilevsky and her team have a variety of non-surgical treatments to stop pain.
These treatments can address sports injuries, headaches, and chronic pain in the joints, back, and neck. Since there is no major cutting involved (only small incisions or injections), patients experience minimal downtime and do not need to stay overnight in the hospital.
Some of the treatments require only one to two injections to relieve the pain.
Dr. Mogilevsky said these are good alternatives to conventional surgery, which involves cutting the nerves to permanently disable them. With the temporary procedures, patients can get relief and, in best-case scenarios, fully heal with physical therapy or other rehabilitation.
Opiod Free Treatment Options
Lumbar and Cervical Facet Injections and Ablation
For chronic back pain or neck pain, patients can get one or two injections of local anesthetic with or without steroid medication into the facet joints in the spine and neck. These injections numb pain and help diagnose if the facet joint is indeed the cause of discomfort.
If the patient shows an at least 60 percent improvement, the injection can be followed by ablation therapy, in which the nerves are subjected to radio frequencies that heat and destroy nerve tissue so the nerve cannot transmit pain signals.
Spinal Cord Stimulator
For people who have pain in their back or limbs that does not respond well to other treatments, a spinal cord stimulator can help. Wire leads are inserted next to the spine and electrodes on them stimulate the spinal nerves with electrical pulses. A small, battery-operated pulse generator is implanted under the skin (often in the buttocks or abdomen) and connected to the leads. The patient can set the level of stimulation with an external programmer. The electrical impulses stop pain signals from reaching the brain and create a pleasant sensation.
For younger people with mild-to-moderate osteoarthritis or people who have injured muscles, tendons, or other soft tissues, platelet-rich plasma (PRP) treatments can help them heal. Treatments involve concentrating platelets from the patient’s own blood and injecting them into damaged tissue. The big benefit of PRP is that it helps restore full health to the injury.
Epidural Steroid Injections
For those with sciatica or acute low back or neck pain, or who wake up with pain shooting down their arm or leg, epidural steroid injections can help. These injections are given directly at the site of pain to immediately neutralize it. They can help relieve pain for months, allowing patients to make progress with a rehabilitation program.
Kyphoplasty is a minimally invasive surgical procedure for patients with severe back pain due to a compression fracture (collapsed vertebrae) in their spine, which is often caused by osteoporosis. The doctor inflates the collapsed vertebrae, then fills it with a cement compound to keep it stable.
Unique Pain Medicine
369 Lexington Ave.
New York, NY 10017