2026 Pain Management M&A Market Update: Private Equity Interest Remains Strong for High-Quality Assets

The pain management sector is undergoing a period of meaningful change. A large, fragmented market, along with continued investment from private equity-backed platforms, is prompting independent practices to consider a range of strategic options, including liquidity opportunities and longer-term partnerships.

This immense buyer appetite is largely driven by the prevalence of chronic pain in the United States, a structural shortage of fellowship-trained pain specialists, highly profitable ancillary service lines, and an accelerating shift away from opioid-dependent care models toward interventional approaches. PE-backed platforms such as American Pain Consortium, DxTx Pain & Spine, Integrated Pain Associates, and Capitol Pain Institute, among others, are actively competing to acquire and partner with high-quality independent interventional pain management groups. This report draws on the latest market data, recent transactions, and Physician Growth Partners’ experience and perspective on the pain management M&A landscape to help you better understand current market dynamics and determine whether now is the right time to evaluate a transaction.

The U.S. pain management market was valued at approximately $31.2 billion in 2025 and is projected to grow to nearly $43 billion by 2034, a compound annual growth rate of approximately 3.6%.¹ When broader chronic pain treatment modalities – including device-based neuromodulation – are incorporated, the addressable market expands considerably. The sector remains highly fragmented: as of 2023, only 8.2% of U.S. pain physicians worked within PE-backed groups, up from just 0.4% in 2013, indicating substantial runway for further consolidation.³

Demand fundamentals are formidable. The CDC estimates that 24.3% of U.S. adults—more than 80 million people—currently suffer from chronic pain.⁵ The societal cost of chronic pain in the United States exceeds $635 billion annually. Demand is compounded by an aging population increasingly burdened by degenerative musculoskeletal conditions, neuropathic disorders, and post-surgical pain syndromes.

In contrast, provider supply is structurally constrained. Overall fellowship applications to pain medicine have declined 14.2% in recent years.⁵ The Health Resources and Services Administration designates 89% of rural U.S. counties as Health Professional Shortage Areas for pain management, with average wait times for interventional procedures exceeding 14 weeks in underserved regions.¹ The specialty faces headwinds attracting new trainees, as the widespread shortage of anesthesiologists – pain medicine’s primary feeder specialty – continues to compress fellowship pipelines.

These factors are key drivers behind the attractiveness of the pain management sector for private equity investors and strategic consolidators, given the substantial advantages created through economies of scale and the expansion of high-margin ancillary service lines such as ambulatory surgery centers and advanced interventional procedure suites. Seeking efficiencies to fill the supply/demand imbalance is a key benefit of consolidation.

Valuations in the pain management sector are influenced by several factors, including operational scale, ancillary service mix, ASC ownership, provider demographics, and geographic density. Based on PGP’s firsthand experience advising pain management platforms, scaled and sophisticated groups with meaningful ASC ownership, strong procedural volumes, and a diversified ancillary service offering tend to command the strongest valuations, with EBITDA multiples reaching the high single digits to low double digits (8.0x-10.0x). Importantly, ancillary services must be supported by appropriate operational infrastructure and a robust compliance function to ensure they are managed effectively and in accordance with applicable requirements. At the same time, the smaller add-on practices generally trade in mid-single digits EBITDA multiples.

The pain management sector has entered a more mature phase of private equity investment, with secondary and tertiary private equity recapitalizations emerging more frequently. In March 2025, Summit Spine & Joint Centers completed its third private equity recapitalization in seven years, with Wellspring Capital Management partnering with the platform’s management team and existing sponsor MSouth Equity Partners. Several additional platforms are expected to complete a liquidity event this year. These transactions demonstrate the continued development of the MSO model in pain management and provide independent practices with additional reference points as they evaluate potential strategic and liquidity alternatives.

These recapitalization events are also bringing additional capital into the pain management sector, increasing competition among investors and strategic buyers. As a result, groups are continuing to be aggressive in seeking scaled platforms that can serve as attractive additions to their broader pain management portfolio.

The pain management buyer universe consists of several distinct acquirers:

• PE-Backed Interventional Pain Platforms: The most active buyer segment. National and regional platforms such as American Pain Consortium (American Discovery Capital, Cedar Pine, Peakline Partners), DxTx Pain & Spine (Family Office), Capitol Pain Institute (Iron Path), Integrated Pain Associates (Triton Pacific), and Resolve Pain Solutions (Compass) , among others, are aggressively pursuing add-on acquisitions to densify existing geographies and expand into new markets.
• PE-Backed MSK & Orthopedic Platforms: Scaled PE-backed orthopedic & MSK platforms are investing in pain management as a complementary area for investment, reflecting the strategic overlap between the two specialties and the opportunity to expand the continuum of musculoskeletal care.
• Traditional Private Equity Investors: Private equity investors continue to pursue initial platform investments in interventional pain management, with growth strategies centered on expanding ancillary services and increasing geographic reach. These initiatives typically include a combination of organic growth through de novo clinic openings and inorganic expansion through M&A, creating greater scale while broadening in-house ancillary service capabilities. For private equity investors to pursue a dedicated pain management strategy, the initial platform investment typically needs to demonstrate meaningful scale, a developed ancillary services offering, and a capable management and shareholder team that can support continued growth while maintaining a strong focus on clinical excellence.
• Surgical Center Operators: Surgery center operators, including Surgery Partners, are actively evaluating opportunities in the pain management sector and may pursue acquisitions of both the physician practice and ASC components to capture a broader share of the patient care continuum and associated ancillary services.
• Regional Health Systems: Local health systems continue to express interest in independent pain management practices, as decreasing access to pain specialists disrupts rural communities and threatens referral relationships that health systems depend on for high-acuity surgical cases.

PGP is one of the most active advisors in the pain management sector, having represented numerous independent pain management groups in transactions with leading private equity firms and strategic buyers. PGP is also currently advising several large independent pain management platforms, providing the firm with a unique and highly informed perspective on the evolving market landscape.

A few notable PGP pain management transactions are as follows:

1. PGP advised Integrated Pain Associates in its partnership with Triton Pacific, establishing a new platform in the interventional pain management sector. Based in Central Texas, IPA is a leading minimally invasive spine and pain management provider. The company operated seven clinics and three ambulatory surgery centers, supported by a team of nine physicians and eleven advanced practitioners. Integrated Pain Associates sought a private equity partner to provide additional capital and strategic resources to accelerate the platform’s growth, including through the acquisition of like-minded pain management groups.
2. PGP advised Mays & Schnapp Neurospine and Pain of Memphis, Tennessee, in its private equity partnership with Compass Group Equity Partners. The transaction established a new private equity-backed platform in the interventional pain management sector and positioned Mays & Schnapp Neurospine and Pain for accelerated growth. The partnership provides the organization with additional capital, strategic support, and operational resources to pursue expansion opportunities and strengthen its market presence.
3. PGP advised Wellspring Pain Solutions, a Bloomington, Indiana-based pain management practice, in its transaction with Capitol Pain Institute and Iron Path Capital. Led by Dr. Jeffrey Beck, Wellspring’s team of ten providers serves patients across South Central Indiana, including Bloomington, Batesville, Columbus, Greenwood, and Terre Haute. Through the partnership, CPI, led by Dr. Matt Shocket, will provide the operational resources and clinical expertise needed to accelerate Wellspring’s growth and expand its regional footprint.

PGP’s firsthand experience suggests it is a great time to evaluate a potential transaction given the following factors:

• Premium Valuation Environment: PGP is currently seeing valuations reach premium levels for scaled well-positioned interventional pain management practices. EBITDA multiples are approaching double-digits to groups with meaningful ASC ownership and procedural volume. Improved stability in the credit markets and a highly competitive buyer landscape supported by an influx of new capital over the past few years have pushed valuations for high quality assets of all sizes.
• Structural Fragmentation Creates Urgency for Buyers: With only approximately 8% of pain physicians currently affiliated with PE-backed groups, platforms are continuing to consolidate market share. Independent practices that transact in the current window benefit from maximum buyer competition.^[3].
• Increased State Restrictions: State legislature has continued to impose stricter rules on investors and strategic buyers seeking to invest in the provider sector. Recent policy changes in Oregon and California have added new limitations and increased reporting requirements, prompting many investors to avoid or reduce exposure to these states. Physician Growth Partners (PGP) believes that additional states are likely to adopt similar restrictions and reporting obligations in the future.
• Continued Pressure from Health Systems: There is ongoing pressure from health systems leveraging their market dominance to bring pain management services in-house and limit opportunities for independent groups in surrounding areas. As the supply of pain specialists continues to shrink, health systems have stepped up recruitment efforts by offering competitive salaries, signing bonuses, and institutional stability that independent practices often struggle to match.
• A Tightening Reimbursement Environment: Proposed CMS physician payment rules for 2026 include efficiency-based reductions of 2.5% in physician payments, compounded by practice expense reductions of 4% to 6% that will affect independent pain management practices operating in ASCs. Supply costs have increased 56% to 80% over the past several years, and approximately 30% of interventional pain physicians are under payer audit at any given time.⁶
• Substantial Institutional Dry Powder: Private equity investors and strategic consolidators entered 2026 with significant reserves of uncommitted capital to deploy. Global healthcare private equity delivered a record-breaking performance in 2025, with disclosed deal value exceeding an estimated $191 billion and surpassing the previous high watermark set in 2021. This liquidity ensures a deep bench of extremely motivated buyers, protecting the sector from broader macroeconomic credit tightening and sustaining transaction volumes.
• Succession and Workforce Planning: The pain management workforce faces a structural recruitment challenge. Fellowship applications have declined 14.2% in recent years, making provider recruitment increasingly difficult for independent groups.⁵ Partnering with a scaled platform provides access to centralized recruitment infrastructure, advanced practice provider pipelines, and compensation benchmarking that independent practices cannot easily replicate.

As early private equity investments in pain management reach the end of their typical hold periods, the market is beginning to see meaningful recapitalization activity and continued strategic acquisition interest. Summit Spine & Joint Centers’ third private equity recapitalization, combined with sustained appetite for add-on acquisitions across the sector, provides tangible evidence that the MSO model can create durable value.

These outcomes should help address some of the historical skepticism among physicians regarding the long-term viability of the MSO framework and its ability to support income growth. That skepticism was not entirely unfounded, as several of the industry’s earlier private equity-backed pain management consolidators struggled to develop effective models for partnerships with pain management groups.

Over time, however, the relationship between independent physician groups and private equity sponsors has evolved. Models that adopted this evolution which increasingly centered on true partnership, physician empowerment, and alignment of incentives have demonstrated greater success. That said, successful outcomes are far from universal. The market still includes a wide range of platforms and sponsors of varying quality. As a result, physician groups considering a transaction must carefully evaluate the prospective partner, including its governance structure, available resources, and track record.

On the other hand, pain management buyers are becoming increasingly selective, prioritizing groups that demonstrate clinical excellence, maintain robust compliance infrastructure, have meaningful scale, and operate as established interventional pain management platforms.