1. 2025;28;S121-S136Updated Analysis of Decline of 16.8% in Utilization of Interventional Pain Management Techniques Among Traditional (Fee-for-Service) Medicare Beneficiaries from 2019 to 2024
   Health Policy Research
   Laxmaiah Manchikanti, MD, Vidyasagar Pampati, MSc, Mahendra Sanapati, MD, Nebojsa Nick Knezevic, MD, PhD, Alan D. Kaye, MD, PhD, Amol Soin, MD, Alaa Abd-Elsayed, MD, and Joshua A. Hirsch, MD.

BACKGROUND: In recent years, rising costs associated with managing spinal pain and other musculoskeletal disorders have been well documented. Prior to the COVID-19 pandemic, the use of interventional techniques to manage spinal pain and other musculoskeletal disorders had steadily increased. However, the pandemic disrupted chronic pain management, including interventional procedures and opioid use, reflecting a broader reduction in healthcare services.

OBJECTIVES: To provide an updated assessment of interventional technique utilization for chronic pain management in the U.S. Medicare population from 2000 to 2024.

STUDY DESIGN: Retrospective cohort study examining trends and factors influencing interventional technique use for chronic pain management within the traditional fee-for-service (FFS) Medicare population in the United States between 2000 and 2024.

METHODS: Data were obtained from the Centers for Medicare & Medicaid Services (CMS) master database, specifically the physician/supplier procedure summary, covering the years 2000 through 2024.

RESULTS: Service rates for interventional pain management per 100,000 Medicare beneficiaries significantly declined by 16.8% cumulatively from 2019 to 2024, corresponding to an average annual decrease of 3.6%. This contrasts with the 2010-2019 period, during which a cumulative increase of 14.5% was observed, along with an average annual growth rate of 1.5%. The steepest decline occurred between 2019 and 2020, with a 15.4% reduction coinciding with the onset of the COVID-19 pandemic.

LIMITATIONS: The analysis is limited to traditional (FFS) Medicare beneficiaries, excluding Medicare Advantage Plans, which represented nearly 54% of Medicare enrollment in 2024. Additionally, as with all retrospective claims-based studies, inherent limitations of coding accuracy and incomplete clinical detail apply.

CONCLUSION: From 2019 to 2024, the use of interventional pain management techniques declined significantly. Contributing factors likely include the lingering effects of COVID-19, economic pressures, the Affordable Care Act, and evolving local coverage determination (LCD) policies.

KEY WORDS: Interventional pain management, chronic spinal pain, interventional techniques, epidural injections, adhesiolysis, facet joint interventions, sacroiliac joint injections, disc procedures, other types of nerve blocks, economic decline, Affordable Care Act (ACA)