Ehsan
Abdeshahian, MD

For years, the spine world operated in silos. Surgeons handled the operating room; interventional pain physicians handled the fluoroscopy suite. Referral patterns were linear, turf battles were real, and the patient often got caught in between. That era is ending.

At the 2026 Becker's Spine Conference, a striking consensus emerged among industry leaders: the word defining this year is "integration." The most forward-thinking practices are breaking down walls between surgical and interventional disciplines, creating unified care pathways that start with the least invasive option and escalate only when clinically justified.

Why this matters for pain physicians

This convergence isn't a threat to interventional pain — it's a massive opportunity. As evidence mounts that conservative and minimally invasive approaches produce comparable outcomes for many spine conditions, the interventional pain physician becomes the quarterback of the care team, not the backup.

We're also seeing this play out in ASC development. Pain management procedures are increasingly moving to outpatient settings where we control the environment, the patient experience, and the economics. With real-time imaging advances and augmented reality tools now available for percutaneous pedicle screw placement, the technical capabilities in interventional suites are approaching what was once exclusively surgical territory.

What I'm watching

The practices that will thrive are the ones building multidisciplinary teams now — PM&R physicians, interventional pain specialists, orthopedic spine surgeons, physical therapists, and behavioral health providers all under one coordinated umbrella. At Clearway, we've seen firsthand how this model improves outcomes, reduces costs, and drives patient satisfaction.

The question for every pain physician in 2026 is simple: are you building bridges, or are you still guarding your silo?

Patients are already running their doctor's notes through ChatGPT. Hospitals are deploying AI documentation tools that cut charting time in half. Robotic-guided needle placement is achieving sub-millimeter accuracy in spine procedures. The AI revolution in healthcare isn't coming — it's here, and interventional pain is no exception.

The question I hear most from colleagues is: "Will AI replace us?" The answer is unequivocally no. But AI will separate the physicians who leverage it from those who don't.

Where AI is already making an impact

In the procedure suite, AI-powered imaging is allowing us to visualize anatomy in real time with greater precision than traditional fluoroscopy. Robotic arms don't replace the physician's hands — they stabilize and guide them, reducing tissue trauma and radiation exposure for both doctor and patient.

On the administrative side, AI-generated progress notes are on track to be accepted by CMS and major insurers for billing purposes by mid-2026. For a specialty where documentation burden is crushing — physicians spend up to 70% of their time on administrative tasks — this could be transformative. We're talking about reclaiming 15 to 20 hours per week.

The human element remains irreplaceable

What AI cannot do is understand the patient sitting across from you. It can't read the frustration of a construction worker who's been in pain for three years, or calibrate the emotional weight of telling someone their options are narrowing. Pain is inherently subjective, and the physician's ability to interpret that subjectivity alongside objective data is what makes our field both science and art.

My advice to every pain practice: start integrating AI tools into your workflow now. Not because the technology is perfect, but because the learning curve is real, and the practices that build competency today will be the ones leading tomorrow.

Pain management has become one of the fastest-growing targets for private equity investment in healthcare. A JAMA Network Open study revealed that PE-backed groups grew from employing just 0.4% of U.S. pain physicians in 2013 to over 8.2% by 2023. And that number is accelerating.

In January 2026 alone, Resolve Pain Solutions acquired Spine Diagnostic & Pain Treatment Center in Louisiana. KPMG's recent analysis identified Clearway Pain Solutions, National Spine & Pain Centers, and Capitol Pain Institute among the platforms actively expanding through add-on acquisitions. The U.S. pain management market is projected to reach $53.6 billion by 2030.

Why PE loves pain management

The fundamentals are compelling: chronic pain prevalence has risen from 20.4% to 24.3% of the population. The specialty is highly fragmented, with nearly 70% of practices having fewer than 10 providers. And the shift from inpatient to outpatient settings creates margin expansion opportunities that PE firms understand well.

What physicians should consider

If you're a practice owner being approached by PE, understand that you have one shot to choose the right partner. Running a competitive process matters enormously — both for deal economics and for protecting your clinical autonomy post-transaction.

For those already inside a PE-backed platform, the opportunity lies in driving growth through ancillary services, ASC development, and geographic expansion. The physicians who create enterprise value beyond their own production are the ones who benefit most from recapitalization events.

Having navigated this landscape firsthand at Clearway, I can tell you that the key is alignment: finding a partner whose values around physician leadership and patient care match your own. Everything else is negotiable.

Serving as Education Chairman for Maryland's Medical Cannabis Commission for over three years gave me a front-row seat to one of healthcare's most complex regulatory evolutions. We built frameworks from scratch — education standards, provider guidelines, patient safety protocols — in a space where the clinical evidence was still catching up to patient demand.

Now, several years later, the landscape has matured significantly, but the fundamental challenge remains: medical cannabis still lacks the clinical standardization that every other therapeutic modality in medicine takes for granted.

The standardization gap

We can prescribe opioids with precise dosing protocols and well-understood pharmacokinetics. We can titrate anticonvulsants for neuropathic pain with established guidelines. But when it comes to cannabis-based therapies for chronic pain, we're still operating with too much variability — in formulation, dosing, delivery mechanisms, and outcome measurement.

This isn't an argument against medical cannabis. It's an argument for elevating it to the same evidentiary standard we apply to everything else in our toolkit. Patients deserve that rigor.

Where I see opportunity

The states that invested early in robust education and regulatory infrastructure are now best positioned for the next wave: clinical research partnerships, pharmaceutical-grade product development, and integration into multimodal pain management protocols. For physician-entrepreneurs with regulatory experience, the advisory and consulting opportunities in this space are substantial and growing.

The medical aesthetics industry is experiencing explosive growth, and with it, an equally explosive proliferation of unregulated operators. Walk through any major metro area and you'll find storefronts offering injectable treatments, laser procedures, and IV therapies with varying degrees of medical supervision — or none at all.

When my sister Anita and I co-founded Javan Wellness, we built it on a simple premise: advanced aesthetics is medicine, and it should be practiced as such. Licensed professionals, physician oversight, evidence-based protocols, and medical-grade technology aren't differentiators — they're the minimum standard.

The market is self-correcting

As patient education improves and complications from unqualified providers make headlines, the market is beginning to sort itself. Patients are asking better questions: Who is supervising this treatment? What are your credentials? What happens if something goes wrong? The practices that can answer those questions with confidence are winning.

The business case

Physician-led medspas also have a structural advantage in the private equity market. Investors value clinical governance, regulatory compliance, and defensible market positions. A practice with physician leadership, standardized treatment protocols, and a track record of safety commands significantly higher valuations than one built purely on marketing volume.

At Javan, adding advanced technology like the Candela Matrix laser system isn't just a clinical decision — it's a strategic one. Each capability we add deepens our moat and strengthens the case for the physician-led model.

Medication-assisted treatment works. The data is overwhelming: buprenorphine and methadone reduce opioid overdose deaths, improve treatment retention, and support long-term recovery more effectively than abstinence-only approaches. This isn't debatable — it's established science.

And yet, the majority of people with opioid use disorder in the United States still don't have access to MAT. The gap between what the evidence says and what patients can actually receive remains one of the most consequential failures in American healthcare.

Why the gap persists

The barriers are both structural and cultural. On the structural side, there aren't enough providers. Despite regulatory changes making it easier to prescribe buprenorphine, the number of physicians actually doing so remains far below what's needed, particularly in rural areas and underserved communities.

On the cultural side, stigma — both within the medical profession and in society broadly — continues to suppress adoption. Too many treatment programs still operate from ideological frameworks rather than evidence-based ones.

What entrepreneurs can do

This is why I founded Outreach Recovery. The vision wasn't just to provide treatment — it was to build a model that could scale. Evidence-based protocols, compassionate care teams, and operational infrastructure that can be replicated across locations.

Addiction medicine needs more physician-entrepreneurs who are willing to build, not just treat. The clinical evidence is there. The patient need is there. What's been missing is the operational and business sophistication to deliver MAT at the scale the crisis demands.