"Missing the Mark: Why Medicare's New Pain Policy Could Push Patients Back to Opioids – and How We Change course"

By: Stephanie G. Vanterpool, MD, MBA, FASA November 7, 2025

In the midst of a decades-long opioid crisis that is only just showing the first signs of decline, Medicare is considering a policy that could send patients back to the very drugs that fueled the opioid epidemic in the first place. Under the proposed policy, Medicare would stop covering targeted nerve procedures that often help patients relieve pain, restore mobility, and improve quality of life. As an academic pain physician and researcher, I have spent the last decade advocating for targeted pain treatments that effectively treat pain, reduce opioid use and improve function. If this proposed Medicare policy takes effect, millions of seniors with chronic pain who have exhausted all other conservative treatment options will face a devastating choice: suffer needlessly or take opioids.

The Problem - Eliminating Access to Peripheral Nerve Procedures

On September 25, 2025, Medicare released a proposed rule that would eliminate coverage for peripheral nerve procedures used to treat chronic pain. The proposal appeared across multiple Medicare regions covering 25 states, signaling a coordinated effort to restrict access to these treatments. The move runs counter to the federal government’s own 2019 Pain Management Best Practices Report, which states that peripheral nerve injections can play a role in preventing and reducing chronic pain. These procedures involve injecting local anesthetic, sometimes with anti-inflammatory medication, around specific nerves to stop abnormal pain signaling. When done accurately, they can relieve localized nerve pain for weeks to months and help restore normal movement and function. For many older adults, these targeted treatments can mean the difference between living in pain and returning to the activities they love.

Consider one of my patients, a 72-year-old lady who came to me after two knee replacement surgeries but still lived in constant pain. She struggled to walk into my office, leaning on her cane. Her orthopedic surgeon told her there was nothing more he could do. She had tried multiple medications and therapy, and was adamant about not taking opioids because of her fear of becoming addicted. Instead, she suffered and did less each day, no longer going on daily walks, or working in her garden. I performed a targeted nerve block around her knee, and her pain disappeared almost immediately. After completing her treatment, she was back to walking with friends, gardening, and enjoying life again.

Her story is not unique. Across the country, millions of patients with similar, treatable nerve pain rely on these same procedures to regain mobility and function. Yet, Medicare is now proposing to remove coverage, and therefore access, to the very procedures that make these recoveries possible.

The proposed policy specifically names 13 peripheral nerve procedures -- from the base of the skull to the sole of the foot -- as “not reasonable and necessary,” essentially eliminating access to precision pain treatment across the body. By removing coverage for these procedures, Medicare would dismantle a vital component of chronic pain treatment—one that has proven effective when performed correctly in appropriately selected patients. Importantly, the policy offers no effective alternative to the procedures it would eliminate. And because private insurers frequently follow Medicare’s lead, this policy could eventually strip access to these life-changing procedures from millions of privately insured Americans as well. Without access to targeted nerve-specific treatment options, patients and clinicians are left with less precise, less effective treatments - often opioids.

Medicare is Missing the Point of Chronic Pain Care

Medicare is missing the central point of chronic pain care. The goal of treatment is to reduce pain sufficiently so that the patient can then participate in activity and rehabilitation to ultimately function without being limited by their pain. Unlike opioids, peripheral nerve procedures target the precise source of pain rather than the entire nervous system. It’s like putting out a candle with a snuffer versus blasting it with a fire extinguisher: one solves the problem cleanly, leaving the candle intact and usable, the latter creates a big mess that takes forever to clean up. By denying coverage for these procedures, Medicare isn’t saving money; it’s shifting the burden to patients who will suffer longer, take more drugs, and require more costly, risker care down the line.

It doesn’t have to be this way. Too often, pain care has focused on suppressing symptoms rather than addressing their source. After years of treating patients and studying outcomes, I’ve learned that effective pain care isn’t about driving pain scores to zero; it’s about restoring lives. Instead of eliminating procedures that allow patients to regain function, Medicare should instead focus on creating pathways that ensure appropriate utilization, while preserving access to care.

A Principled Solution - Targeted Pain Treatment

Rather than blanket elimination of peripheral nerve procedures, the answer lies in appropriate patient selection and function-focused care. That’s the core philosophy behind Targeted Pain Treatment: a paradigm shift in pain management philosophy that accurately identifies the precise causes of pain and uses targeted treatments to reduce pain and restore function. All of this while reducing opioid use and educating and empowering the patient to participate in their care. The Targeted Pain Treatment (TPT) process centers on four core principles.

TPT Principle 1: Ensure accurate diagnosis - For example - the LCDs list that Occipital nerve blocks are not effective for chronic migraine. That’s because Occipital nerve blocks are used to treat occipital neuralgia, a very specific type of headache that starts in the back of the head. Using an occipital nerve block to treat a migraine not caused by occipital nerve irritation will be ineffective. Accurate diagnosis of the underlying cause of pain is critical to ensure effective treatment.

TPT Principle 2: Confirm targeted treatment - ensure that the peripheral nerve blocks are being performed with appropriate image guidance when needed. Ultrasound and fluoroscopically (x-ray) guided techniques.

TPT Principle 3: Focus on function - The peripheral nerve procedure should be a means to an end; the end being improved function through concerted function restoration efforts such as physical therapy and increased activity.

TPT Principle 4: Empathetic Education and Empowerment - Educating the patient and the clinician on the appropriate patient and procedure selection is key to ensuring efficacy of peripheral nerve procedures. Additionally, the patient should be empathetically educated on how the peripheral nerve procedure is an integral part of a comprehensive function restoration plan.

These principles make pain care more precise, more humane, and ultimately more effective - and that’s exactly what Medicare should be encouraging, not eliminating.

In the midst of an opioid crisis and with chronic pain affecting one in four adults, we should be looking for solutions, not closing doors. Medicare’s proposed policy would block access to an essential component of comprehensive, function-focused treatment for chronic pain. For patients and clinicians alike, Medicare must pivot from restriction to restoration and support targeted, evidence-based treatments that meaningfully reduce suffering and facilitate improved function, without reviving the opioid epidemic. We need to preserve access to precision over prescriptions, and effective targeted treatment of pain is the way to do it.