Pain Societies Unite in Effort to Combat Therapy Obstacles

by Jeremy Koff, senior consulting editor

In the evolving field of neuromodulation and spine care, three major societies—the North American Neuromodulation Society, the American Society of Pain and Neuroscience, and the North American Spine Society—have forged an unprecedented collaboration. This alliance aims to unify the voice of interventional pain physicians and spine doctors, ensuring a stronger position in health policy, reimbursement negotiations, and advocacy for improved patient care. Neurotech Reports had the opportunity to talk to each of the leaders of these societies, all who participated the recent NANS annual meeting, to discuss this collaboration and to better understand the impact on the field of neuromodulation.

The Need for Collaboration

The increasing complexity of healthcare policies and reimbursement structures has posed significant challenges for specialists in neuromodulation and spine care. Scott Kreiner, the current president of NASS and one of only eight physical medicine and rehabilitation physicians appointed to this role in its 40 year history, emphasized the importance of a collective approach, stating, “If we don’t all try to get on the same page for a lot of these things, there’s going to be a lot of struggles with getting reimbursed.” By working together, this “helps move the needle for health policy more than anything else, which I think is hugely important.”

NASS membership, which numbers 8,000, is predominantly made up of surgeons—comprising roughly 70% of its membership. Of those, orthopedic spine surgeons make up two-thirds and neurosurgeons one-third. Of the non-surgical groups, PM&R is the largest group, with the remainder being anesthesia, radiology, chiropractors.

NANS, with its 3,000 members, is made up of around two-thirds interventional anesthesiologists, and the remaining third split between neurosurgeons and PM&R.

ASPN, although a relatively young organization, has managed to grow quickly to roughly 4,000 members. According to Tim Deer, founder and president, ASPN has managed to attract a great number of young physicians who come to the group’s annual meeting to learn about not just neuromodulation, but all the minimally-invasive spine methods.

By combining the societies, the future of neuromodulation looks promising. “The future of pain management is going to be a combination of neuromodulation with invasive spine,” said Deer. “If we can do something minimally invasive and help the patient and then add neuromodulation when needed, we can probably solve about 80% of the problems out there.”

Strength in Numbers: A Unified Front for Policy Influence

Corey Hunter, the president of NANS during the conference, led the effort in bringing the organizations together, and highlighted a historical precedent for such unity. Drawing inspiration from the radiology field, which successfully consolidated multiple societies under the American College of Radiology to form a powerful advocacy group, Hunter envisioned a similar model for neuromodulation. “What I want my legacy to be, is being the person that was able to do that,” he said. To achieve this objective, he tried to do everything to unite the society under the common goals of access, advocacy, and coverage. “I started working toward different goals and speaking to different societies about creating a common entity where we can move together. We need to have the ability to respond with one voice when stuff happens, whether there’s issues with coverage or insurance companies.”

Addressing Challenges in Neuromodulation Adoption

Despite the advances in neuromodulation, its adoption within surgical communities, particularly orthopedic spine, has been uneven. Kreiner noted a decline in ortho/spine surgeons’ willingness to implant neuromodulation devices, attributing this to reimbursement issues and a shifting focus toward delegating procedures to nonsurgical specialists. “Surgeons are now more inclined to have non-surgeons handle neuromodulation procedures,” he observed.

The collaboration also seeks to bridge historical gaps in perception. While neuromodulation practitioners and spine surgeons have sometimes viewed each other with skepticism, the increasing necessity for cross-disciplinary expertise is fostering greater mutual respect. Kreiner remarked that skepticism is often rooted in cases where spinal cord stimulators failed post-surgery, leading surgeons to question their efficacy. However, he pointed out that these same surgeons are also referring patients for neuromodulation trials, demonstrating a growing openness to the therapy’s potential.

Driving Reimbursement Policy

As the largest and oldest of the three organizations, NASS has a strong track record in developing and implementing coverage policy recommendations. According to Kleiner, there’s not a lot of other organizations that can do that and then have them adopted by payers. This specific strength of NASS could be instrumental in shaping the future guidelines for neuromodulation.

Shaping the Future of Neuromodulation and Spine Care

One of the key initiatives of this collaboration is the development of comprehensive coverage policies that integrate the perspectives of all three societies. NASS, with its ability to influence payer policies, has committed to ensuring that new guidelines on spinal cord stimulation and other neuromodulation therapies reflect the input of NANS and ASPN. This collaborative effort could lead to policy endorsements that benefit all stakeholders involved.

Additionally, the societies are working to refine terminology to better reflect patient conditions. The term “Failed Back Surgery Syndrome” has been replaced by “Persistent Spinal Pain Syndrome” to avoid the implication that the surgical procedure itself was a failure. This shift underscores the evolving understanding of chronic pain management and the role of neuromodulation in addressing complex post-surgical pain cases.

A New Era of Professional Collaboration

Hunter pointed out the enhanced impact that the collaboration will bring. “Instead of saying ‘on behalf of NANS and its 3,000 members,’ I can now say, ‘On behalf of six societies and 150,000 members,’” he said. “This strengthened alliance ensures that the field of neuromodulation and spine care will not only keep pace with policy changes but will actively shape the future of patient-centered treatments.”

Everyone Wins

By bringing the societies together, Deer noted, pain patients will benefit through improved patient access for therapies and improved outcomes. “Rather than having competing guidelines, the organizations can endorse each others’ work. That’s going to be very helpful because insurance companies don’t want competing guidelines.”

By working together, NANS, ASPN, and NASS are setting a precedent for interdisciplinary collaboration. Their collective efforts promise to improve access to neuromodulation therapies, influence health policy more effectively, and ultimately enhance patient outcomes. In a healthcare landscape that increasingly demands unity, these societies have chosen to lead together, ensuring that their voices are heard loud and clear.