APRIL 9, 2025
In addition to feeding into the opioid crisis, the COVID-19 pandemic exposed deficiencies in the comprehensive treatment of pain. During the pandemic, regulators reined in local, regional and federal rigamarole that previously governed innovation in the field of telehealth. Waived temporarily were the local, regional and national health policies that made the reality of virtual care ponderous.
At the time, leading experts openly questioned whether the explosion in virtual visits for pain
In addition to feeding into the opioid crisis, the COVID-19 pandemic exposed deficiencies in the comprehensive treatment of pain. During the pandemic, regulators reined in local, regional and federal rigamarole that previously governed innovation in the field of telehealth. Waived temporarily were the local, regional and national health policies that made the reality of virtual care ponderous.
At the time, leading experts openly questioned whether the explosion in virtual visits for pain represented a “new normal,” an ushering in of a transformative low-resource, barrier-free means to parlay multidisciplinary pain management delivered in an interdisciplinary fashion.
Medicare’s broad telehealth coverage was set to expire on March 31, 2025. Because private insurers usually follow Medicare’s lead, such expiry spelled bad news for pain medicine and all other types of virtual visits. As part of a continuing resolution aimed to fund the government through Sept. 30, 2025, however, the House of Representatives voted to extend Medicare telehealth flexibilities, and the Senate followed suit. But continued provision for telehealth is by no means guaranteed, pain physicians worry.
Tomorrow’s Problem
In an interview with Pain Medicine News, Michael E. Schatman, PhD, a clinical instructor in the Department of Anesthesiology, Perioperative Care and Pain Medicine and faculty member in the Division of Medical Ethics at NYU Grossman School of Medicine, in New York City, as well as a Pain Medicine News editorial advisory board member, discussed the calculus.
“Telehealth has been demonstrated empirically as being cost-effective, but the insurers don’t really care about cost-effective,” Schatman said. “And that may sound like a contradiction, but what they do is they say it could be cost-effective this week, but what happens in the future?”
Schatman is quick to point out the lack of compunction, which troubles him as a medical ethicist and healthcare provider. Government officials are “very comfortable with just cutting off services and making them inaccessible.”
Benefits of Telehealth
Currently, 21% of Americans struggle with chronic pain, with 8% experiencing high-impact chronic pain, according to data cited by the National Institutes of Health (JAMA Netw Open 2023;6[5]: e2313563). Approximately 25% of pain medicine visits worldwide are conducted virtually, Schatman noted.
The benefits of pain medicine telehealth are overwhelming, according to Schatman and colleagues in a February 2025 editorial published in the Journal of Pain Research (2025;18:1057-1059).
“Chronic pain patients benefit significantly from telehealth,” the authors wrote. “Virtual visits improve access, reduce the need for travel, improve treatment adherence, provide greater support for multidisciplinary consultation, and lower healthcare costs by preventing emergency visits and hospitalizations.”
Schatman conceded that telehealth isn’t appropriate in every clinical context, including appointments requiring physical exams, procedures or certain postoperative follow-ups. Nevertheless, telehealth is expedient with regard to a vast number of clinical presentations.
“Many of these appointments are management appointments, and that can be done without any problem. If the doctor wants to do a drug test if a patient is on opioids, then probably every other town, even in rural areas, there’s a lab they can go to. The results can be the prescribing position. So, there’s just no reason not to save money again without any real concern whatsoever for these patients,” he said.
According to Schatman and co-authors, patients report satisfaction with telehealth, including travel cost savings, reduced caregiver burden and decreased disruption to daily life.
“Patients, especially those with mobility issues who live far from their doctors and need frequent follow-ups, benefit from virtual visits in reducing social isolation and improving compliance with care plans,” the authors wrote.
Who Will Hurt Most?
As with many other disparities, rural populations may bear the brunt of a dearth of telehealth visits for pain management.
Interventional pain specialist Timothy Deer, MD, the president of The Spine and Nerve Centers of the Virginias, in Charleston, W.Va., and a clinical professor of anesthesiology at West Virginia School of Medicine, in Morgantown, practices in rural areas of the state and sees patients from surrounding states. He stresses the importance of virtual care to his patients.
“You may end up needing five to six visits for one invasive surgery. For an elderly person to drive two hours each direction, they have to pay someone a lot of times to drive them. Then, they show up and they just tell their doctor how the block went after the diagnostic procedure. It really becomes a six- or seven-hour expensive journey for a very direct meeting,” said Deer, a Pain Medicine News editorial advisory board member.
In a separate interview, interventional pain specialist Hemant Kalia, MD, MPH, of the Center for Research and Innovation in Spine and Pain and the vice president of Reimbursement and Regulatory Affairs at the American Society of Pain & Neuroscience, offered his perspective on rural telehealth.
“The telehealth flexibilities have been particularly transformative for chronic pain management in rural settings. Specialized interventions like cognitive behavioral therapy for pain and remote neuromodulation therapies with multidisciplinary approaches can now reach patients previously unable to access such evidence-based treatments. For physical therapists working with rural chronic pain patients, telerehabilitation represents an opportunity to increase treatment adherence and reduce reliance on opioid medications,” he said.
Results from a retrospective cohort study published by Veterans Affairs researchers suggested that although rural patients with pain did not achieve the same degree of access and utilization as urban dwellers, uptake by rural patients increased substantially and may have substituted for in-person visits (Pain Med 2022;23[3]:466-474).
The authors advised, “Targeted implementation efforts may be needed to further increase the reach of services to patients living in areas with limited specialty pain care options.”
Despite the recommendation of its own researchers, however, the VA will likely also end telehealth appointments for pain management if there is no permanent solution, Schatman predicted. He pointed to deserts replete of healthcare such as those in Northern California.
He observed, “Once you get past Sacramento, which is where University California at Davis is, then you don’t have any serious medical centers to the north until you get to Portland.”
He added that these rural areas “have a lot of older people who don’t drive and/or are on Medicare. Dependent people tend not to be all that well off. They’ve been relying on telehealth largely since COVID.”
Stopgap Measure
Schatman is worried about the immediate future of telehealth for the treatment of pain. He views Medicare’s potential abandonment of broad telehealth coverage as an existential threat to its effective practice.
“My concern is that legislators are treating access to much-needed telehealth as nothing more than a trading chip—failing to consider that this is truly a life-or-death matter, particularly for the tens of millions of chronic pain sufferers in underserved areas,” he continued.
Kalia also hopes for a permanent solution in lieu of stopgap measures.
“Telehealth plays such a significant role in delivering quality healthcare to our Medicare/Medicaid beneficiaries and patients residing in rural America,” he noted. “Congress needs to act swiftly and consider fixing this issue permanently as opposed to these time-bound extensions.
”The temporary nature of these extensions creates hesitation among some healthcare providers to fully invest in telehealth infrastructure,” he continued. “The uncertainty surrounding reimbursement makes long-term planning extremely difficult, especially for rural practices operating on thinner margins.”
Finally, although Deer acknowledges the importance of telehealth options—particularly among rural populations—he also recognizes the need for balance and Congress to further consider the issue.
“I think there’s a balance between excessive spending on people who really don’t need telehealth versus for those who it’s really essential for their care. I understand the need for that balance, so I think that the best thing that Congress could do would be to implement some very direct guidelines that are very absolute, and patients should meet those guidelines.”
—Naveed Saleh, MD, MS
