A pain medicine physician has raised concerns about new Medicare policies that will limit coverage for a vast number of patients with severe pain. These policies, issued by five regional Medicare Administrative Contractors, reduce access to numerous peripheral nerve procedures employed in diagnosing and treating chronic pain.
Peripheral nerve blocks deliver numbing medication around a nerve to interrupt pain signals, providing relief that can last beyond the few hours before the numbing effect wears off. The physician has used these interventions to provide relief to patients with severe pelvic pain, allowing them to perform basic tasks like sleeping, buying groceries, or spending hours without being consumed by pain.
New Medicare Policies
The final policy is slightly less restrictive than the proposal released in 2025, thanks to feedback from patients, physicians, and advocates. However, it still excludes therapeutic procedures targeting nerves like the pudendal nerve and ganglion impar, which are used to treat severe pelvic pain. The physician worries that these restrictions will leave patients with high-impact chronic pain at risk of losing access to effective treatments.
As a pain medicine physician, the author has seen the benefits of peripheral nerve interventions, which are part of multimodal and multidisciplinary pain care. These interventions help patients participate in physical therapy, restore function, decrease medications, and avoid emergency room visits and hospitalizations. The author believes that people with chronic pain need alternatives to opioids and more individualized treatment options.
The Centers for Medicare and Medicaid Services contractors have raised concerns about the limitations of evidence supporting these procedures, including small studies and short follow-up periods. However, the physician argues that chronic pain presents a particular challenge for evidence gathering, as pain is a subjective experience and every patient experiences it differently.
A treatment that produces limited benefit on average may provide profound relief to an individual. The author notes that even a few weeks or months of decreased suffering can help patients feel like themselves again. The physician’s own mother, a cancer research scientist living with chronic migraine and abdominal pain, has inspired the author to keep looking for answers for patients who have spent years searching for relief.
The author has seen patients who have been passed from one doctor to another, desperate for help. In the author’s clinic, patients have found life-changing relief from procedures that may no longer be accessible due to the new Medicare policies. One patient, an 87-year-old with severe bladder pain, had been in despair before finding relief through a procedure that may soon be restricted.
The author acknowledges that some may question whether these procedures are used too often or whether financial incentives influence their use. However, the author believes that the answer to gaps in evidence is to seek real-world evidence while preserving access to effective non-opioid treatments. The absence of perfect evidence should not be confused with the absence of meaningful patient benefit.
Impact on Patients
One of the author’s patients developed chronic pain after gynecologic surgery and found relief through a pudendal nerve block. The patient was able to wear pants, sit in a chair, and spend the day without being distracted by pain. However, this pain relief will soon no longer be accessible to the patient due to the new Medicare policies.
Individualized pain care should not depend on luck, insurance coverage, or financial means. Effective pain care requires a broad treatment toolkit, which is meaningless if patients cannot access it. As the new policies take effect, Medicare contractors must reconsider restrictions as new evidence emerges, and researchers must build funding for larger, longer-term studies.
The author believes that coverage standards should recognize clinically meaningful benefit while continuing to demand better evidence. The tools physicians use to relieve suffering should not be put out of patients’ reach. With the new policies set to take effect in late October, the fate of millions of patients with severe pain hangs in the balance, as they may soon lose access to the very treatments that have brought them relief.
Medicare contractors will oversee the new policies, determining which procedures are covered and which are not. The Centers for Medicare and Medicaid Services will continue to write and oversee the Medicare rules.
These studies will provide the evidence needed to support coverage for peripheral nerve procedures.
