CMS Proposed Restrictions on Peripheral Nerve Blocks and Procedures for Chronic Pain: Clinical, Ethical, and Policy Implications for Millions of Americans

Pain Med. 2026 Feb 22:pnag031. doi: 10.1093/pm/pnag031. Online ahead of print.

Chronic pain affects nearly one in four adults in the United States and imposes profound burdens on individuals, and the healthcare system. Peripheral nerve blocks (PNBs) and related interventional procedures are essential components of modern multimodal pain management. They offer targeted, reversible, and cost-effective diagnostic, prognostic and therapeutic benefits for a broad array of conditions. The recently proposed “Local Coverage Determination (LCD) for Peripheral Nerve Blocks and Procedures for Chronic Pain” threatens to severely limit access to these evidence-based interventions. As a multidisciplinary group of clinicians, researchers, and a patient advocate writing on behalf of the American Academy of Pain Medicine (AAPM), we urge the Centers for Medicare and Medicaid Services (CMS) to rescind the proposed LCD and collaborate with subject matter experts to develop clinically and scientifically sound, patientcentered coverage criteria. Federal guidelines emphasize multimodal, interdisciplinary care. The Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force Report (pmtf-finalreport-2019-05-23.pdf) and Centers for Disease Control and Prevention (CDC) 2022 Clinical Practice Guideline for Prescribing Opioids for Pain (CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 | MMWR) recommend integrating behavioral, physical, pharmacologic, and interventional approaches to reduce reliance on opioids and improve outcomes. By limiting coverage for widely used interventional procedures, the proposed LCD conflicts with federal guidance and risks reversing important progress in improving patient safety and decreasing opioid-related morbidity and mortality in the United States. 

PMID:41723816 | DOI:10.1093/pm/pnag031