Insurance Noncoverage of Interventional Pain Procedures: Paving the Road Toward the Second Prescription Opioid Crisis.

BACKGROUND: Related to a lack of a perceived fiduciary obligation, the health insurance industry has not historically been supportive of the efforts of providers who treat pain. In the United States and several other nations, the early years of this millennium were marked by a prescription opioid crisis, resulting in abuse, addiction and hundreds of thousands of deaths. OBJECTIVE: The temporal contiguity between payors' withdrawal of support for interdisciplinary pain management and the onset of the prescription opioid crisis has been noted in the literature, as were payors' global instruction to physicians to just prescribe medications. STUDY DESIGN: This is a perspective on health policy. RESULTS: With the explosion of interventional technology and techniques over the past decades, physicians have been able to provide more effective and certainly safer pain management to sufferers of chronic pain. However, over the past several years, payors' willingness to reimburse for previously covered interventional treatments has waned, causing considerable suffering for patients and frustration for clinicians. These payors include the Centers for Medicare and Medicaid Services as well as private insurers. LIMITATIONS: This is a perspective article with limited literature on the topic. CONCLUSION: At present, clinicians are being told to resort to medications, despite a dearth of novel, safe pharmacological agents appropriate for chronic pain management. The availability of restorative, behavioral and alternative medicine approaches is limited in terms of insurance reimbursement. Accordingly, noncoverage of interventional approaches to chronic pain management has the potential to indirectly result in another prescription opioid crisis, which neither our patients nor providers deserve.