From emerging non-opioid treatments and telehealth prescribing rules to documentation and enterprise-wide compliance, five lessons from Frier Levitt’s PAINWeek 2026 presentations.
Every year, PAINWeek brings together clinicians, researchers, regulators, and other thought leaders to discuss the evolving landscape of pain management. I was honored to present at this year’s PAINWeek conference in Las Vegas on two issues increasingly shaping pain medicine: “Prescribing for Tomorrow,” addressing recent regulatory changes at the state and federal levels, and “Future-Proofing Compliance,” focused on proactive compliance measures for pain providers and clinical organizations. I also moderated a lively panel of pain providers exploring how providers can integrate the many dimensions of pain care into a more unified, patient-centered approach during “Weaving the Web of Healing: Threading All Dimensions of Pain Care into a Unified Approach.”
Across these discussions, one theme was clear: pain medicine is evolving well beyond opioid prescribing. Innovation, regulatory change, compliance expectations are reshaping how providers deliver and document care.
Here are five key takeaways for pain providers and healthcare organizations.
I. Non-Opioid Options are Reshaping the Pain Management Landscape
For years, pain management discussions have largely centered on how to prescribe opioids safely. This year was different. For years, the FDA, DEA and CDC have tried to subtly steer providers away from opioids as the first choice of pain prescribing. It does appear as though the tide is now truly turning. The focus has clearly shifted toward non-opioid therapies, multimodal treatment approaches, and new pharmaceutical innovations.
The most exciting development was the FDA approval of Journavx® (suzetrigine), the first new class of non-opioid analgesic approved for the treatment of moderate-to-severe acute pain in adults in more than two decades. The reason it matters is not simply that there is a new drug. FDA approval of a new non-opioid mechanism changes the future standard-of-care conversation. A new non-opioid class allows clinicians, payers, facilities, and policymakers to consider when non-opioid alternatives should be incorporated into treatment protocols.
From a compliance standpoint, the important question becomes documentation: when an opioid is selected, does the record show why that choice was clinically appropriate? When a non-opioid option is available, was it considered? If not used, why not?
While opioids are not obsolete, the point is that the menu of reasonable options is expanding, and documentation needs to reflect individualized decision-making.
Just as important, reimbursement policy is beginning to support this transition. The NOPAIN Act reflects growing federal interest in removing financial barriers to non-opioid pain treatment alternatives. CMS implemented temporary additional Medicare payments for qualifying non-opioid pain treatments in hospital outpatient departments and ASCs, with the policy currently applying through 2027.
II. Documentation is Equal in Importance to Proper Prescribing
The most important message I sought to get across to all participants in the clinical sphere, repeated through all of my presentations, was that regulators and payers are far more interested in a physician’s clinical reasoning rather than a single prescribing number. The mantra of state licensing boards has for years been: “If it’s not in the record, it didn’t happen.” From a compliance perspective, sound clinical decision-making can be difficult to defend after the fact if the reasoning behind it is not adequately documented.
The 2022 CDC Clinical Practice Guideline continues to emphasize individualized patient care. Dosage thresholds should not be treated as rigid mandates. Instead, providers must clearly document why treatment decisions were made, what alternatives were considered, what benefits were achieved, and how risks were assessed.
In today’s environment, good medicine increasingly requires good documentation.
III. Don’t be Lulled into Complacency by Telehealth Flexibilities
While telemedicine remains one of the most significant developments in healthcare delivery, I noted that providers should know that they conduct telemedicine under an unsettled regulatory framework. The current temporary telemedicine flexibilities are not permanent and are currently scheduled to expire at year’s end. Whether the current regulatory structure remains in place in 2027 is uncertain, and providers and their organizations should use this period to strengthen compliance protocols, patient verification procedures, prescribing workflows, and documentation practices.
IV. Compliance Risk Extends Across the Entire Pain Management Ecosystem
One of the main points in my presentations was educating the participants about what many presenters described as the “pain management ecosystem.” Both state and federal enforcement agencies increasingly evaluate the relationships surrounding a pain practice, including laboratories, pharmacies, telemedicine vendors, billing companies, referral sources, and durable medical equipment suppliers. Regulators are examining whether these relationships collectively create compliance risks.
The days when providers could focus exclusively on their own prescribing habits have largely passed. Organizations now need oversight of their entire compliance infrastructure.
V. Acute and Chronic Pain Require Different Compliance Approaches
Acute and chronic pain are often discussed together, but compliance expectations are different. Providers must know that there is far more compliance risk in chronic prescribing. While acute care focuses on short duration, immediate-release formulations, procedure-specific need, patient counseling, and safe disposal, chronic care typically requires greater emphasis on reassessment, function, risk-benefit analysis, monitoring, and alternatives. For chronic care, the chart should show why continued therapy remains justified over time. For acute care, the chart should show why the duration and dose match the expected pain trajectory. The pain category must drive the documentation category, as the same prescription quantity may look different depending on whether the clinical context is acute postoperative pain, cancer-related pain, chronic non-cancer pain, palliative care, or Opioid Use Disorder treatment.
Final Thoughts
If there was a single theme that connected all of my presentations at PAINWeek, it was this: pain management is becoming more individualized clinically and more sophisticated regulatorily. Innovation is creating new treatment options. Regulators are focusing on documentation and data. Enforcement is expanding beyond traditional prescribing metrics. And compliance now requires an organization-wide approach. For providers, these developments create challenges. But they also present an opportunity to improve patient care while building more resilient and compliant practices.
For pain providers and healthcare organizations, evolving treatment options must be accompanied by equally sophisticated documentation, oversight, and compliance systems. Organizations that begin adapting those systems now will be better prepared as clinical practice, reimbursement policy, and regulatory expectations continue to evolve.
About the author:
Alex Keoskey is a Partner in Frier Levitt’s Healthcare and Life Sciences practice groups, where he advises physicians, healthcare providers, and healthcare organizations on regulatory compliance, licensing, enforcement, and litigation matters. He is a former deputy attorney general with the N.J. Division of Law, handling licensing board actions, and also certified as a Professional Health Compliance Officer (CHC) by the American Academy of Professional Coders.
For questions about pain management compliance, prescribing regulations, or other healthcare regulatory matters, contact Alex Keoskey at akeoskey@frierlevitt.com or learn more about his practice on his Frier Levitt attorney profile.
