Telemedicine in Pain Management: Integrating Innovation into Clinical Practice
AUSTIN, TX — Telemedicine continues to redefine the landscape of pain management, according to Amitabh Gulati, MD, board-certified anesthesiologist and pain management physician at Memorial Sloan Kettering Cancer Center in New York, NY. In his presentation at the American Academy of Pain Medicine PainConnect 2025 annual meeting in Austin, TX, Dr Gulati noted that despite reimbursement challenges, telemedicine enhances care accessibility, improves practice flexibility, reduces overhead costs, and supports continuity of care through integrated electronic health records (EHR).
The integration of telemedicine into pain management practices has grown significantly, spurred by the COVID-19 pandemic and sustained by both provider and patient demand for flexible, accessible care. The end of the public health emergency (PHE) on May 11, 2023, brought changes to telemedicine policy, but extensions granted under the Consolidated Appropriations Act have preserved some telehealth flexibilities through the fall of this year. This evolving policy environment highlights the importance of adapting clinical practices to remain compliant while leveraging telemedicine's advantages, especially as telehealth remains permanently established for mental and behavioral health care.
To implement telemedicine effectively, clinicians must adopt a structured approach that includes administrative planning, patient preparation, and tailored scheduling. Remote visits are enhanced by integrating EHR systems, enabling real-time review of imaging and consultation notes during virtual appointments. Additionally, remote patient monitoring and remote therapeutic monitoring are critical components of telemedicine in pain management. These systems enable clinicians to track physiological data such as blood pressure and heart rate, as well as non-physiological data related to therapy adherence, all of which can inform care decisions and billing practices.
The telemedicine physical examination, particularly relevant for neuromuscular assessments, has been adapted for remote settings. Dr Gulati's presentation detailed specific protocols for examining the neck, shoulder, elbow, spine, hip, and knee. For neurologic evaluations, clinicians are guided through steps to assess mental status, coordination, balance, reflexes, and sensory function. A modified mental status exam and NIH-adapted strength assessment were provided to ensure clinicians can obtain meaningful diagnostic data even in a virtual format. Visual assessments such as pupillary examinations are also feasible with proper patient positioning and camera setup.
Despite these advancements, limitations exist. Beyond technical limitations, patient preparedness, and variable reimbursement, there is also the issue that those who are in severe pain may not have the ability to work through the different positions or protocols during the telemedicine session.
“Healthy people are likely the only ones who can do these different types of positions,” Dr Gulati said. “We ask them to move their computer to their table, sit back down on their chair, move through different positions. Patients who are in a lot of pain are not going to do any of this. So I look at this as an opportunity to strengthen the muscles that might be weak.”
Still, Dr Gulati concluded his presentation by noting that the continued evolution of telemedicine will be instrumental in shaping the future of efficient, high-quality pain management care.
Reference
Gulati A. Telemedicine: transforming healthcare through technology. Presented at: American Academy of Pain Medicine PainConnect 2025. Accessed April 3, 2025. https://painconnect.org/