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American Society of Interventional Pain Physicians News  | August 26, 2015

  1. AHRQ Technology Assessment Moves to Publication in Annals of Internal Medicine: Lack of Scientific Integrity
  2. Register today for the Ultrasound for Regenerative Medicine Workshop and the Hands-On Cadaver Workshop for IPM Techniques in Memphis 
  3. ASIPP to hold ICD-9-CM to ICD-10-CM Webinar 
  4. Registration for ASIPP's 2016 Annual Meeting is Now Open 
  5. Robust Medicare Advantage Competition Almost Nonexistent 
  6. Few Medicare ACOs Earned Bonuses in 2014 
  7. Death of Pill Mill Patient Focus of Doctor's Murder Trial 
  8. Jeremy Hunt: NHS Bosses Face Jail Over Links to Drug Firms
  9. Three NY hospitals Included in $8M Fraud, Kickback Settlement
  10. Spinal Injections of Steroids Temporarily Ease Low Back Pain
  11. New Insight Into How Antidepressants Target Brain in Neuropathic Pain
  12. How Stanford Plans to Save Physicians from Burnout
  13. Inhaled Cannabis for Neuropathic Pain: Results From First-of-Kind Study
  14. Opioids in Pregnancy: What Raises the Risk for Neonatal Abstinence?
  15. State Society News 
  16. Physician Wanted 
ahrqAHRQ Technology Assessment Moves to Publication in Annals of Internal Medicine: Lack of Scientific Integrity
Thousands of physicians and millions of patients are disappointed with the publication of the Technology Assessment for Pain Management Injection Therapy for Low Back Pain  and now, it is followed by a so-called systematic review in Annals of Internal Medicine.
Both projects are headed by Chou et al who also spearheaded the American Pain Society guidelines as part of the $1.4 million payment he received for, participating in the Spectrum guideline preparation for injection therapies for Washington State Health Technology Assessment, Washington State Health Care Authority. Spinal Injections,Updated Final Evidence Report. Spectrum Research, Inc., March 10, 2011 and now once again the same issue is being rehashed with the same lack of scientific integrity. This is also very similar to the manuscript which was inadequately published by Pinto et al (Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, McLachlan AJ, Koes B, Ferreira PH. Epidural corticosteroid injections in the management of sciatica: A systematic review and meta-analysis. Ann Intern Med 2012; 157:865-877.).
The AHRQ's mission statement is "to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work." AHRQ and the Annals of Internal Medicine seem to ignore this mission since none of these other than individual glory and disruption of the scientific process, are achievable.
Science is one of the most obvious missing elements in these manuscripts and also numerous other publications of Chou and the others. There is also a lack of necessity. There is no proven necessity for reviews reaching the same conclusions, intellectual bias and conflicts of interest, and lack of clinical experience.
There are numerous conflicts for the authors in addition to the funding from the American Pain Society. They also sell their advice through multiple organizations
These are some inconsistencies which do not follow the Institute of Medicine (IOM) standards for a systematic review. (Eden J, Levit L, Berg A, Morton S (eds); Committee on Standards for Systematic Reviews of Comparative Effectiveness Research; Institute of Medicine. Finding What Works in Health Care. Standards for Systematic Reviews. The National Academies Press, Washington, DC, 2011
Ironically, this manuscript deviates from any professional standards converting local anesthetic into placebo. Obviously, billions of people have received placebos to numb them, provide analgesia, and prove short-term and long-term analgesia. They do not take into consideration placebos and nocebo, both of which have been widely researched by the National Institutes of Health (NIH) with numerous publications.
Chou continues to unilaterally convert all active control trials into placebo control and when questioned, he calls it unprofessional. As we all know, a true placebo is when you inject an inert substance into an inert structure. Even injecting an inert substance such as sodium chloride solution into an active structure results in multiple physiologic effects. Calling local anesthetic a placebo is like, calling skim milk in comparison to whole milk a placebo, instead of comparison of water and whole milk.
Scientists who understand study design know that absolute effect size can only be measured in a true placebo control trial, not a fake placebo or one converted from active control to placebo control for convenience.
 Just remember issues we are facing with opioids with 16,917 deaths a year, NSAIDs with 17,000 deaths a year, lumbar surgery with 1,286 deaths a year, and over 100,000 hospitalizations and most recent warnings compared to only 131 deaths from interventional techniques over 10-20 years.
If you would like to write a letter to the editor on this issue, you can write to the Annals of Internal Medicine; however, the chances of getting these published are miniscule. As an alternative you may write a letter to other journals including Pain Physician which may publish your responses.
Below are links to letters we sent to Annals of Internal Medicine and AHRQ asking them to withdraw the manuscript and technology assessment.

If you desire more literature on this issue, there are multiple publications showing the effectiveness of epidural injections with local anesthetic alone or with local anesthetic and steroids in properly performed systematic reviews.
Manchikanti L, Benyamin RM, Falco FJ, Kaye AD, Hirsch JA. Do epidural injections provide short- and long-term relief for lumbar disc herniation? A systematic review. Clin Orthop Relat Res 2015; 473:1940-1956.
Kaye AD et al.  Efficacy of epidural injections in managing chronic spinal pain: A best evidence synthesis. Pain Physician 2015; in press.
Manchikanti L, Kaye AD, Manchikanti KN, Boswell MV, Pampati V, Hirsch JA. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: A systematic review. Anesth Pain Med 2015; 5:e23139.
Bicket M, Gupta A, Brown CH, Cohen SP. Epidural injections for spinal pain: A systematic review and meta-analysis evaluating the control injections in randomized controlled trials. Anesthesiology 2013; 119:907-931.
Liu K, Liu P, Liu R, Wu X, Cai M. Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis. Drug Des Devel Ther 2015; 9:707-716.

Below please find the stories developing in the media:


CadaverRegister Today for Ultrasound for Regenerative Medicine Workshop and Hands-On Cadaver Workshop for IPM Techniques Held in Memphis 

Hurry! Room Block Discount Rates End September 3rd


ASIPP's Ultrasound for Regenerative Medicine Workshop is scheduled for September 18, 2015 and the Hands-on Cadaver Workshop for IPM Techniques, September 19 - 20, 2015 at the Medical Education and Research Institute in Memphis, Tennessee.


Objectives for the Intensive Ultrasound for Regenerative Medicine Workshop:

  • Attain the ability to understand ultrasound interpretation and regenerative medicine.
  • To incorporate ultrasound and regenerative medicine in treating your patients so that patients have better outcomes and reduced side effects.
  • Improve existing skills and/or develop new skills in the delivery of interventional techniques involving ultrasound and regenerative medicine.
  • Ability to demonstrate skills.

Objectives for the Hands-On Cadaver Workshop for IPM Techniques:

  • To integrate multiple aspects of interventional pain management in treating your patients so that patients have better outcomes and reduced side effects.
  • Provide high-quality, competent, safe, accessible, and cost-efficient services to your patients.
  • Improve existing skills and/or develop new skills in the delivery of interventional techniques.
  • Review multiple areas of interventional pain management including fluoroscopic interpretation and radiation safety.
  • Demonstrate skills through interactive review of images.


The Westin Memphis Beale Street Hotel

170 Lt. George W. Lee Avenue ยท Memphis, TN, 38103 | 901-334-5900

We have secured a group room rate of $129.

Reserve rooms early-all unbooked rooms will be released after Sept 3.

Brochure  |  Register Online  

WebinarASIPP ICD-9-CM to ICD-10-CM Webinar
The focus of this two-part webinar will be on ICD-9-CM to ICD-10-CM coding crosswalks and necessary documentation.
The webinar will be in two parts: Part 1 will cover chapters 1-10 and Part 2 will cover chapters 11-21.
Part 1: Thursday, September 3, 11am -12:30pm CDT 
Part 2: Thursday, September 3, 11am-12:30pm CDT
Marvel Hammer, RN, CPC,
MJH Consulting, Denver, Colorado
There will be time for Q&A with the presenter.    
* This program has the approval of the American Academy of Professional Coders (AAPC) for 3 continuing education hours. Granting of prior approval in no way constitutes endorsement by the AAPC of the program content or the program sponsor.
AM Registration Now Open for ASIPP's 2016 Annual Meeting. Click Here!
MedicareRobust Medicare Advantage Competition Almost Nonexistent
    Competition among Medicare Advantage plans more closely resembles local oligopolies instead of a buzzing market overflowing with options for seniors, a new study from the Commonwealth Fund shows.
   The lack of competition is especially relevant as the U.S. health insurance market teeters on the precipice of further consolidation. Aetna and Anthem are undergoing federal scrutiny over their deals that would drastically enlarge their Medicare Advantage memberships.
   "People are focusing on the potential for competition to be the answer to many of Medicare's challenges," said Stuart Guterman, co-author of the report and a former vice president at the Commonwealth Fund who studied Medicare. "But I'd be careful about using the concept of competition as some kind of magic bullet to address Medicare's problems. There isn't really competition."

ACOFew Medicare ACOs Earned Bonuses in 2014
  Three out of four Medicare accountable care organizations did not slow health spending enough to earn bonuses last year, a continuation of mixed results for an initiative that federal officials have targeted for rapid expansion.
   Medicare released 2014 results for 353 accountable care organizations, which include hospitals and physician groups that agreed to meet targets for quality and slow spending. Those that succeed can keep a share of money they save. In January the Obama administration announced plans to aggressively increase the share of Medicare spending under accountable care and other alternative payment models through 2018.
   Last year, 97 ACOs earned bonuses totaling $422 million out of $833 million in savings they produced. Savings are awarded under formulas that account for performance on quality targets after the first year in the program. (For ACOs in their first year, organizations must report quality scores but do not have to meet performance targets.)

PillMillDeath of Pill Mill Patient Focus of Doctor's Murder Trial

   When testimony in the murder trial of Gerald Klein started Monday, jurors heard contrasting portrayals of the former doctor-turned-defendant and the patient he's accused of killing during pain treatments in early 2009.
   But the jurors never heard the actual words at the heart of the prosecution: "pill mill." That term, with all of its negative connotations, is off-limits for the expected two-week trial by order of Circuit Judge Karen Miller.
   So prosecutors instead described Klein, 81, as a money-hungry practitioner who responded to a Craigslist ad and partnered with crooks in a mostly cash-based "cookie-cutter" clinic operation, making him responsible for the death of a 24-year-old customer with a "pill problem" from West Palm Beach.

HuntJeremy Hunt: NHS Bosses Face Jail Over Links to Drug Firms
Hospitals and GP groups will be required to keep a register of hospitality and gifts from pharmaceutical firms to health service staff in a major crackdown on corruption in the NHS 
   Senior medical staff will be forced to declare all gifts and hospitality they receive from drug companies or face the sack and the threat of jail.
   In a major crackdown on corruption in the NHS, all hospitals and GP groups will be required to keep a register of hospitality and gifts from pharmaceutical firms to health service staff.
   Jeremy Hunt, the Health Secretary, says he was forced to act after the Telegraph uncovered "disturbing" evidence of senior NHS managers being paid thousands of pounds and taken on expensive trips by firms lobbying to get their drugs used.
   The transparency, or "Sunshine rule", will be mandatory from next year and any member of staff who fails to declare full details of perks they receive will face disciplinary action.
   If they are found guilty of wrongdoing - such as for accepting gifts or luxury foreign trips in exchange for influencing the NHS to buy particular products - they could be prosecuted under the Bribery Act, which can result in unlimited fines and up to 10 years in jail.

ThreeThree NY hospitals Included in $8M Fraud, Kickback Settlement
  Kingston, N.Y.-based Benedictine Hospital, Columbia Memorial Hospital in Hudson, N.Y., and Yonkers, N.Y.-based St. Joseph's Medical Center as well as St. Louis-based Special Care Hospital Management Corporation and its CEO have agreed to pay more than $8 million to resolve claims that they defrauded the Medicare and Medicaid programs, according to the Department of Justice.

NewNew Insight Into How Antidepressants Target
Brain in Neuropathic Pain

    Commonly used antidepressants appear to target specific neurotransmitters in the brain that regulate chronic pain and depression-like symptoms, a newly understood mechanism that could shape future treatments for nerve pain and depression.
   Published in the Proceedings of the National Academy of Sciences (PNAS), this study from researchers at the Icahn School of Medicine at Mount Sinai Medical Center used mice with chronic neuropathic pain to gain greater understanding of molecular pathways and antidepressant treatment for pain and depression. The molecular adaptations required for "recovery" from pain and depression are controlled by the gene RGS9 and RGS9-2, the protein it codes. Mice that lacked RGS9 responded significantly earlier to very low doses of antidepressants, had significant improvement of sensory deficits, and had no signs of depression-related behaviors. By inhibiting RGS9-2, the function of hundreds of other molecules vital for pain-relief and mood-elevation were also improved.

StanfordHow Stanford Plans to Save Physicians from Burnout
   Stanford (Calif.) Hospital's two-year "time-banking" pilot program, now implemented in its department of emergency medicine, has proved to increase physician job satisfaction, work-life balance, collegiality and retention rate, according to The Washington Post.
   The program, which is designed to ease stress and burnout, allows physicians to earn credits for participating in work-related "extra-curriculars," such as mentoring, serving on committees or covering shifts on short notice, and these credits can be applied to at-home perks, according to the report.
   These perks include services like housecleaning, babysitting, elder care, movie tickets, premade meal delivery services, grant writing help, dry cleaning pickup and more, according to the report.

CannabisInhaled Cannabis for Neuropathic Pain: Results From Study
   Inhaled cannabis had a significant effect on neuropathic pain that appears to be dose-dependent, in the first published research on cannabinoids for painful diabetic neuropathy in humans.
   In a study appearing in The Journal of Pain, researchers from the University of California, San Diego conducted a randomized, double-blind, placebo-controlled crossover study of 16 patients with painful diabetic neuropathy to evaluate the short-term efficacy and tolerability of inhaled cannabis. Each participant was exposed to four single dosing sessions of low (1% tetrahydrocannabinol [THC]), medium (4% THC), or high (7% THC) doses of cannabis, or placebo. Baseline spontaneous and evoked pain were measured, and cognitive testing was performed; the participants then received aerosolized cannabis or placebo and the pain intensity and subjective "highness" score was measured at 5, 15, 30, 45, and 60 minutes and then every 30 minutes for an additional three hours. Cognitive testing was performed at 5 and 30 minutes and then every 30 minutes for an additional three hours.

NASOpioids in Pregnancy: What Raises the Risk for Neonatal Abstinence?
Opioid Exposure and Neonatal Abstinence

    Coincident increases have been observed in prescriptions for oral opioids in pregnancy and in neonatal abstinence syndrome (NAS), characterized by a range of symptoms, from poor feeding, irritability, and hypertonicity, to other neurologic symptoms, such as seizures. This study used Tennessee Medicaid data and other vital records to assess maternal use of opioids and other drugs during the 30 days prior to delivery to determine whether opioid use patterns were associated with risk for NAS. Specifically, the researchers evaluated whether maternal cumulative opioid exposure, the type of opioid, tobacco smoke exposure, and use of selective serotonin reuptake inhibitors (SSRIs) were associated with NAS in the women's offspring.
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Save The Date! CASIPP Meeting set for October 2015
The California Chapter of the American Society of Interventional Pain Physicians   will hold its 6th Annual Meeting in Monterey, CA at the Monterey Plaza Hotel Resort over the weekend of October 16-18. Agenda and registration can be found online at www.casipp.com or by calling 661-435-3473. 
NY and NJ Societies hold Pain Symposium Nov. 5-8
The New York and New Jersey Societies of Interventional Pain Physicians will host a Pain Symposium titled Evolving Pain Therapies on November 5-8, 2015 at the Hyatt Regency, Jersey City, NJ. 
Click HERE for Schedule and more information.  
SAVE the DATE: FSIPP Meeting May 20-22, 2016
The Florida Society of Interventional Pain Physicians will hold its annual meeting in 2016 on May 20-22. The meeting will be held at the Orlando World Center Marriott in Orlando.
Watch FSIPP.org for more details.
FSIPP Releases Summer Newsletter
FSIPP has just published its Summer 2015 newsletter. The newsletter features highlights of the joint ASIPP/FSIPP meeting and articles such as: Collections, Connections and Corrections, Medical Marijuana, and Superficial Radial Nerve Entrapment.
Click HERE to read.
Please send your State Society meetings and news to: Holly Long at hlong@asipp.org