Gabriella Kovi, MD, is a fellowship-trained, board-certified pain specialist. She is also board certified in anesthesiology. She completed her training in pain management at Albany Medical Center and received additional training in acute pain management at Yale University in New Haven and cancer pain management at Memorial Sloan Kettering Cancer Center in New York City. Dr. Kovi had been in private practice in Lenox, MA and New York City before joining Meeting House Lane Medical Practice.
Dr. Kovi has office hours in Amagansett and Sag Harbor. To make an appointment, please call (631) 725-2112.
What is chronic pain? How does it differ from acute pain?
By definition, chronic pain is any pain that lasts longer than 3 months. Acute pain is shorter. It helps avoid trauma and prompts us to see a doctor. Chronic pain doesn’t have these benefits and can be very difficult to treat.
When should a person see a pain specialist, and what can a pain specialist do to help them?
The onset of acute pain is often sudden and therefore patients start by seeing their primary care physician or an emergency room physician. However, patients should consult a pain specialist if traditional treatments do not result in pain relief.
What are some common ways to manage and treat pain?
Beside medication, pain specialists address pain with less well-known tools such as nerve blocks, joint and soft tissue injections, and certain types of physical therapy for long-term management. For severe, intractable pain, there are advanced treatments such as a spinal cord stimulators or intrathecal pump implants.
Because of the opioid epidemic, are pain specialists approaching treatment differently? If so, how?
The entire country is paying close attention to this issue due to the four-fold increase in death rates from prescribed opioid medications in the last decade. This increase is why the mainstream news media describe this as an “opioid crisis.”
The word “epidemic” describes the situation well: it conveys the need to approach patients differently. Just like in an infectious disease outbreak, the patients who already have been exposed to high doses of opioids need to be re-evaluated. Their treatment should be reconsidered and safer choices of medication and better psychological support are required. New patients with chronic pain problems should be carefully evaluated and treated with other methods of pain management to avoid unnecessary problems with opioids. Patients and their families should carefully consider treatment options and tradeoffs; they should not demand more and more medication without regard to the risks. One of the most serious risks is respiratory depression. Now that the risks are so well understood and publicized, I am confident that people will take them seriously.
New medical insurance guidelines are also needed. Currently, our insurance system is based on the outdated thinking that the body will heal in 2-12 weeks and, therefore, physical therapy is only covered for that period. Obtaining coverage for long term care is nearly impossible. Yet patients need physical therapy for as long as they have chronic pain.
The other issue is the need for long-term psychological counseling. It can ease the burden of anxiety and depression, which are so frequently coupled with chronic pain. I do not think we have enough resources to help patients with their conditions. We need more physical therapists, massage therapists, and psychological counselors for chronic pain patients.
Can lifestyle factors such as nutrition, exercise, and stress management help with managing pain symptoms?
Most musculoskeletal pain can be managed with yoga, exercise, massage, and cold-heat therapy. Fortunately, the younger generation is growing up more aware of the problems with opioid pain medications and they are intentionally looking for pain treatment methods that avoid them.
In New York City, where I practiced before coming to Long Island, my patient population was very young. They almost never asked for prescription medication, not wanting more than short-term nonsteroidal anti-inflammatory drugs (NSAiDs) that are available over the counter. Instead, they sought alternative treatments, understanding that they take time. For instance, they came for physical therapy twice a week and massages. They considered injections and were open to recommendations of regenerative medicinal approaches (i.e., non-conventional methods such as platelet-rich plasma).
As of now, we do not have pain medication that offers complete pain relief without side effects. Therefore, what’s most important for treating physicians is to manage chronic pain to help patients achieve an acceptable level of pain with the fewest adverse effects.