Pain Pumps, Nerve Blocks, and Other Interventional Options: Who They Help

When medications, physical therapy, and mind-body methods have been tried and chronic pain is still in the 5 to 8 range, interventional pain procedures may be the next step. These are office-based or outpatient procedures performed by a board-certified pain specialist (an anesthesiologist or physical medicine and rehabilitation physician with extra training in interventional pain medicine). The four most common procedures for older adults are epidural steroid injections, radiofrequency ablation (also called RFA or nerve burning), peripheral nerve blocks, and intrathecal pain pumps. Each has a clear set of conditions it treats, an evidence base, and Medicare coverage. The 2019 American Geriatrics Society guideline supports interventional procedures as part of a multimodal pain plan when conservative care has not been enough.

Epidural steroid injections (ESIs) deliver an anti-inflammatory steroid into the epidural space around irritated nerve roots in the spine. The procedure takes 15 to 30 minutes, is done under fluoroscopy (live X-ray) for accuracy, and most patients walk out within an hour. ESIs work best for pain that radiates from the spine down an arm or leg (radicular pain, often called sciatica when in the leg). About 60 percent of patients see meaningful pain relief that lasts 3 to 6 months. Medicare Part B covers up to 3 ESIs per spinal region per year. Out-of-pocket cost after Medicare runs $50 to $200 per injection depending on your supplement.

Radiofrequency ablation (RFA) treats facet joint pain in the spine, which causes most chronic low back pain that does not radiate down the leg. The pain specialist places a thin needle next to the small nerves that feed the facet joints and uses heat to disable those nerves for 6 to 12 months. The procedure takes 30 to 60 minutes. Before RFA, the patient must have two successful diagnostic nerve blocks confirming the facets are the source. Medicare covers RFA when the diagnostic block protocol is followed. Out-of-pocket cost after Medicare usually runs $100 to $400 depending on supplement coverage.

Peripheral nerve blocks target one specific nerve outside the spine. Common targets are the genicular nerves around the knee (for severe knee arthritis pain in patients who cannot have knee replacement surgery), the suprascapular nerve in the shoulder, and the occipital nerve for chronic headache pain. The procedure is 20 to 40 minutes in the doctor's office under ultrasound guidance. Effects last weeks to months. Medicare covers peripheral nerve blocks when medical necessity is documented. They are particularly useful for older adults whose other health conditions rule out joint replacement surgery.

Intrathecal pain pumps are the most involved option and are reserved for patients with severe persistent pain that has not responded to anything else. A small pump (about the size of a hockey puck) is surgically placed under the skin of the abdomen, and a thin catheter delivers tiny doses of medication directly into the spinal fluid. Because the medication does not have to travel through the bloodstream, doses are 100 to 300 times smaller than oral doses, with far fewer side effects. Pumps are refilled at the doctor's office every 1 to 6 months. Medicare Part B covers the device and the refills when criteria are met. Total Medicare-covered cost over a 5-year period runs $40,000 to $60,000, of which the patient usually owes the 20 percent Part B coinsurance unless covered by a Medigap plan.

Finding the right interventional pain specialist matters. Look for board certification in pain medicine through the American Board of Anesthesiology, American Board of Physical Medicine and Rehabilitation, or American Board of Psychiatry and Neurology. The American Society of Regional Anesthesia and Pain Medicine (asra.com) maintains a free directory. A good first appointment will not promise a procedure on the first visit — instead, the doctor will review your records, examine you, and discuss conservative options before recommending a procedure.

This is not medical advice. Interventional procedures carry real risks (bleeding, infection, nerve damage, pneumothorax in some procedures) and should only be considered after discussion with a board-certified specialist.

(Sources: American Geriatrics Society 2019 chronic pain guideline; American Society of Interventional Pain Physicians clinical guidelines 2024; CMS Local Coverage Determinations for spinal injections and radiofrequency ablation; Medicare.gov coverage tool, accessed May 2026)