Chronic pain can lead to significant emotional comorbidities, including but not limited to depression, anxiety, and suicide. Improving coverage for interventional pain procedures is crucial to providing pain relief for patients who fail conservative management.

We read with sadness the news about the killing of the CEO of UnitedHealthcare Insurance Company. Mortified by the senseless murder, but very aware of two issues: the helplessness that accompanies being in pain or having a loved one who suffers, and the frustration of insurance denial of therapies that are FDA-approved and CMS-listed.

As pain physicians, we see the suffering of our patients every day, and we experience an increasing number of denials from insurance companies every year, which limits our ability to perform interventional, evidence-based, and patient-focused therapies.

Chronic pain can lead to anxiety, depression, and a low quality of life. Suffering from chronic pain daily can lead to changes in levels of stress hormones and neurochemicals within the nervous system, which can affect mood and behavior. It is estimated that 35-40% of patients with chronic pain suffer from depression.1,2 Neuroimaging studies showed an intimate relationship between brain areas associated with emotional and sensory features of pain and regions affected by depression, which further indicates the close relationship between both.3

Patients with severe chronic pain cannot socialize or perform activities they like. When incapacitated, they cannot even perform essential daily activities such as self-care, grocery shopping, and simple activities. When patients are not active, they can gain weight and develop cardiovascular comorbidities, among the many other comorbidities obesity can cause, leading to more depression, anxiety, and low self-esteem. The lack of ability to have an everyday life leads to anxiety and depression.

Chronic pain is a risk factor for suicide, and it is estimated that 18-50% of patients with chronic pain have suicidal ideation.4 There are no precise statistics on the relationship between chronic pain and homicide, but it has been reported.

Patient violence against healthcare workers is increasing. In the United States, workplace violence against health care and social service industries is higher than in other sectors, based on the Bureau of Labor Statistics.5

In the period from 1980 to 1990, 26 physicians became victims of homicide at the workplace.6 A national survey by Kim et al. reported that 52% of surveyed chronic pain providers experienced threats of bodily harm from patients.7,8

The use of chronic pain medications can lead to addiction, misuse, and tolerance, among many other adverse effects. While the use of non-pharmacological and pharmacological methods always comes first when we treat chronic pain, many chronic pain patients will fail those modalities. They will require interventional pain procedures, which insurance companies increasingly deny. Furthermore, advanced interventional pain procedures, which are used as a last resort for severe chronic incapacitating pain, experience more denials, and a minimal number of insurance companies cover several of those interventions.

Insurance companies must approve interventional pain procedures without creating the obstacles patients encounter, such as long prior authorization processes and denials, and forcing physicians to consume a large portion of their time in appeals and peer-to-peer calls/processes.

While there is no good news in the senseless murder of Brian Thompson, the CEO of United Healthcare, we want to use this moment to give a critical opinion: Insurance companies should be held to the standard that once a therapy for chronic pain has been FDA-approved or cleared and approved by the Center for Medicare Services, an insurance company should be required to approve the treatment when patients meet the selection criteria. There must be an immediate stop to Medicare Managed Care plans and other payors calling approved procedures “experimental” when this is misleading.

Our opinion piece is not meant by any means to justify harm to self or others due to suffering from chronic pain. Instead, it sheds light on a significant healthcare crisis that chronic pain patients encounter due to the lack of insurance coverage for many essential procedures, with the unfortunate outcome of patient depression, anxiety, declining quality of life, and possibly suicide and homicide.

We hope that insurance companies will support patient-centered care by providing more coverage for interventional pain procedures and minimally invasive surgeries needed for treating patients with chronic pain to avoid the unfortunate mental and physical health consequences that chronic pain patients, their families, and the community suffer because of the lack of reimbursed treatment modalities.