What Medicare Actually Pays For When the Treatment Is Pain: Physical Therapy, Chiropractic and Acupuncture

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By Lara Goulson, licensed independent insurance agent,
Goulson Insurance Services, Los Angeles

People arriving at Medicare with a chronic pain problem tend to assume the coverage question is how much. More often it is whether, and the answers are stranger and far more specific than anyone expects. Three of the most common pain treatments are handled three entirely different ways, and none of the three is intuitive. According to CMS (Centers for Medicare and Medicaid Services), coverage determinations for pain-related services depend heavily on the specific service, the setting, the diagnosis, and the documentation of medical necessity — and the rules governing each differ significantly from one another.

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Psilocybin-Assisted Therapy Shows Promise for Veterans With Treatment-Resistant PTSD in Ohio State Pilot Trial

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Mental Health Notice: If you or a veteran you know is experiencing a mental health crisis or thoughts of self-harm, please seek help immediately. Call or text 988 and press 1 for the Veterans Crisis Line (24/7), text 838255, or call 911 in an emergency.

Psychedelic Substance Notice: Psilocybin is a Schedule I controlled substance in the United States and is not FDA-approved for any medical use, including PTSD treatment. This research was conducted under strict regulatory oversight with extensive medical and psychiatric screening. This article is for informational and educational purposes only and does not constitute medical advice or a recommendation to pursue psilocybin therapy. Always consult a qualified physician before considering any treatment involving psychoactive substances.

PainRelief.com Interview with:

Stacey B. Armstrong, PhD

Senior Researcher & Associate Director

Center for Psychedelic Drug Research and Education, Columbus, OH

Stacey Armstrong, PhD
PainRelief.com: What is the background for this study? What are the main findings?

Dr. Armstrong: Post-traumatic stress disorder (PTSD) remains a significant public health concern among U.S. military veterans, who often experience more severe, chronic, and treatment-resistant symptoms than the general population. Existing treatments, including psychotherapy and antidepressant medications, do not work for everyone, and many veterans continue to struggle despite receiving the best available evidence-based care. These treatment gaps underscore the need for novel therapeutic approaches, like psilocybin-assisted therapy (PAT).

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PEPITEM — A Naturally Occurring Peptide May Offer New Hope for Early Arthritis

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PainRelief.com Interview with:

Professor Helen McGettrick PhD, MSc, BSc, FHEA
Department of Inflammation and Ageing
Professor of Inflammation and Vascular Biology
Department Head of Research
College of Medicine and Health
University of Birmingham

PainRelief.com: What is the background for this study?

Response: PEPITEM is a naturally occurring peptide that tells your immune system to stop moving from the blood into healthy tissues. Under normal conditions, your immune system does this to fight infection and heal damaged tissues. However, in arthritis the white blood cells stop responding to the hormone that releases PEPITEM causing widespread inflammation.

PainRelief.com: Where is the immunopeptide PEPITEM found and how is it regulated?

Response: What we know currently is PEPITEM is released by a type of immune cell called B-cells in response to a protein called adiponectin. PEPITEM is cut out of a much larger molecule that is expressed in a number of cell types, including the B-cells. Whether other cells can release PEPITEM and how it is cut out of its parent protein are questions we are trying to answer in ongoing studies.

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Regular Use of TENS Unit May Reduce Pain and Fatigue in Fibromyalgia Patients

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PainRelief.com Interview with:
Kathleen Sluka, PT, PhD, FAPTA
Professor of Physical Therapy and Rehabilitation Science
Carver College of Medicine
Iowa City, Iowa

PainRelief.com: What is the background for this study? Would you briefly describe the condition of fibromyalgia?

Response: My team has been studying TENS for decades. We initially started by performing studies to understand how TENS produces analgesia using animal models. We show that TENS increases our body’s inhibition and reduces excitability of pain  After determining the mechanisms, we used this information to develop and test the most effective parameters of the stimulation in randomized controlled clinical trials, including fibromyalgia.  In these studies we discovered that TENS reduced movement-evoked pain. 

Fibromyalgia is a complex condition characterized by chronic widespread pain and accompanied by fatigue, nonrefreshing sleep, and cognitive dysfunction. Fibromyalgia pain is exacerbated with movement that contributes to reduced function. Treatment guidelines recommend nonpharmacologic approaches with exercise as a first-line intervention. However, adherence to exercise is often poor due to movement-evoked pain, which presents a significant barrier to participation.

As physical therapists are primary providers of exercise to those with chronic pain, we asked if TENS would reduce movement-evoked pain in a real-world setting by implementing TENS treatment into outpatient physical therapy clinics. This allowed us to test if adding TENS to standard physical therapy in a real-world setting reduced movement-evoked pain.

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Yoga May Help Reduce Opioid Withdrawal Symptoms Through Restoring Autonomic Balance

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PainRelief.com Interview with:
Dr. Hemant Bhargav, MD, PhD
Associate Professor, Department of Integrative Medicine
National Institute of Mental Health and Neurosciences (NIMHANS)
Hosur Main Road, Bengaluru, Karnataka, India 560029

Opioid withdrawal is marked by sympathovagal imbalance, the fight or flight response system of the body remains overactive while its calming system is underactive. This dysregulation contributes to anxiety, poor sleep, pain, and heightened relapse vulnerability. While medications like buprenorphine effectively manage withdrawal symptoms, they do not fully restore this autonomic balance, representing a critical therapeutic gap.


PainRelief.com: What is the background for this study?

Response: Opioid withdrawal is marked by sympathovagal imbalance, the fight or flight response system of the body remains overactive while its calming system is underactive. This dysregulation contributes to anxiety, poor sleep, pain, and heightened relapse vulnerability. While medications like buprenorphine effectively manage withdrawal symptoms, they do not fully restore this autonomic balance, representing a critical therapeutic gap.

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AHRQ Review Evaluates Cannabis Products Containing THC and CBD for Pain Relief

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PainRelief.com Interview with:
Roger Chou, MD
Professor of Medical Informatics and Clinical Epidemiology, School of Medicine
Professor of Medicine, School of Medicine
2012-present Director, Pacific Northwest Evidence-based Practice Center
Medical Informatics and Clinical Epidemiology, School of Medicine
Oregon Health & Science University
Portland, Oregon

PainRelief.com: What is the background for this study?

Response: We started this review five years ago, it was funded by the Agency for Healthcare Research and Quality (part of the Department of Health and Human Services). Because there is a lot of interest in use of cannabis products for pain and because new research is coming out, we planned to do it as a “living” review, which means that instead of reviewing all the studies at one point of time and publishing the findings and then being done, we continually searched for new studies and updated our analyses as they became available. We conducted this review over 5 years and this article reports the final findings of the review.

An important thing to know is that cannabis products are complicated because cannabis contains different chemicals that are thought to have different properties, the most important being THC and CBD.  THC is considered the psychoactive component and CBD isn’t thought to have psychoactive properties but may have medical or therapeutic properties.  Different cannabis products (as well as the plants themselves) vary in how much THC or CBD is contained, ranging from “pure” THC or CBD to mixed products.  We separated cannabis products into different categories based on the amount of THC relative to CBD, which is important because the benefits or harms may vary according to how much THC or CBD is present.  We also looked at whether the products were taken from the plant or made in a lab (synthetic) as well as how the products were taken (e.g., a capsule or cream/oil or spray etc) which can all impact how the products work.

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University of Minnesota Study Finds Supported Self-Management May Provide Low Back Pain Relief Without Medications

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PainRelief.com Interview with:
Gert Bronfort, DC, PhD
Research Professor
Integrative Health & Wellbeing Research Program
Earl E. Bakken Center for Spirituality & Healing
University of Minnesota
Minneapolis, MN 55455

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Dr. Bronfort

PainRelief.com: What is the background for this study?

Response: It is now well recognized that low back pain (LBP) is influenced by interrelated physical, psychological, and social factors. However, most commonly used treatments (e.g. medications) focus on addressing pain symptoms while ignoring the underlying unique biopsychosocial needs of individual patients. This makes it more likely that acute, short-lasting pain, will develop into more chronic and disabling pain, placing substantial burden on patients, and society.

This study compared guideline-based medical care, spinal manipulation and supported self-management with and without spinal manipulation to see which did better at reducing pain and disability for acute and sub-acute low back pain.

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Nemours Children’s Study Evaluates Adherence to Opioid Guidelines for Pain Relief in Sickle Cell Patients

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PainRelief.com Interview with:
Ibrahim Gwarzo, DrPH, MPH, MBBS
Research Scientist at Nemours Children’s Health

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Dr. Gwarzo

PainRelief.com: What is the background for this study?

Response: Clinical guidelines for the management of sickle cell disease (SCD) pain crisis in the emergency department (ED) recommend administration of the first analgesic dose within 1 hour or arrival to the ED and subsequent doses given within 30 minutes interval according to the National Heart, Lung, and Blood Institute (NHLBI) guidelines, and within 30 to 60 minutes intervals according to American Society of Hematology (ASH) guidelines. However, reports suggest patients with SCD pain suffer extensive delays in the ED before receiving pain interventions.

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Vertex Study Finds PreOp JOURNAVX Can Deliver Effective Pain Relief and Reduce Need for Opioids

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PainRelief.com Interview with:
Vertex Spokesperson

PainRelief.com: What is the background for this study?

Response: Effective management of acute postoperative pain remains an ongoing challenge, with opioids continuing to serve as a mainstay despite their well-known risks, including nausea, constipation and the potential for misuse or addiction. Suzetrigine, brand name JOURNAVX, is a novel, selective NaV1.8 inhibitor that provides effective pain relief without engaging the brain’s reward system, meaning it has no addiction potential. JOURNAVX was approved earlier this year in the U.S. for the treatment of moderate-to-severe acute pain in adults.

Previous randomized, controlled studies demonstrated that JOURNAVX provided statistically significant postoperative pain relief compared to placebo and efficacy similar to a moderate-strength opioid. This study was designed to evaluate the real-world effectiveness and opioid-sparing potential of JOURNAVX when initiated preoperatively and used as part of multimodal therapy across a variety of aesthetic and reconstructive procedures.

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Neuropathy: New Nano-Formulated CBD May Enhance Pain Relief

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PainRelief.com Interview with:
Kuan Hong Wang, PhD
Professor of Neuroscience
 Del Monte Institute for Neuroscience at the University of Rochester
Senior author of the study

Dr. Wang

Jingyu Feng, PhD
Staff scientist
Wang Lab
First author of the study

Dr. Veng.

PainRelief.com: What is the background for this study?

Response: Neuropathic pain is one of the most difficult chronic pain conditions to treat. Current medications such as gabapentin and opioids often provide limited relief and cause unwanted side effects. Cannabidiol (CBD), a non-psychoactive compound derived from cannabis, has shown promise for pain relief, but its poor water solubility and limited ability to reach the brain have constrained its effectiveness. To overcome this challenge, our team developed a new nano-formulated version of CBD, called CBD-IN, designed to make CBD more soluble and efficient at reaching the brain.

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