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American Society of Interventional Pain Physicians News  | June 8, 2016
  1. Listen to ASIPP's Newest Podcast
  2. High Doses of Imodium Cause Serious Heart Problems, FDA Warns 
  3. FDA advisory panel recommends approval for abuse-deterrent pain medication
  4. FDA Approves Implantable Device for Steady Release of Buprenorphine 
  5. ABIPP Certification Made Simple
  6. Long-Term Use More Likely With Opioids vs NSAIDs for Low Back Pain
  7. 6 privacy landmines and how to avoid stepping on them
  8. ICD-10-CM Book Now Available: Order Your Copy Today!
  9. Doctors Test Tools to Predict Your Odds of a Disease
  10. Doctors rip VA plan to give some nurses more authority
  11. Interventional Treatments of Cancer Pain are Effective but Under-Utilized
  12. Doctors fire back at bad Yelp reviews - and reveal patients’ information online
  13. Understanding Mechanisms of Neuropathic Pain to Design Effective Treatments
  14. Medical Examiner Rules Fentanyl Killed Musician
  15. Caution Needed When Prescribing Antidepressants to Treat Chronic Pain
  16. Clinton backs Manchin plan to tax opioids
  17. State Society News
  18. Physicians Wanted
podcastListen to ASIPP's Newest Podcast
In this month's ASIPP Podcast we take a look at some of the content of ASIPP's ICD-10-CM pocket book; learn about the amazing life of Dr. John Bonica, a pioneer of pain medicine; in the news segment we have a story about a pill that could prevent tooth decay, a spider that could hold the key to a new type of pain medication, the reason NSAIDs have such a cardiac risk, and much more.
Click HERE to access Podcast
imodiumHigh Doses of Imodium Cause Serious Heart Problems, FDA Warns
Over-the-counter diarrhea drug loperamide (Imodium/Johnson & Johnson Consumer Inc.) has recently been in the news because opioid abusers have been using it to self-treat symptoms of opioid withdrawal. Others abuse it for its euphoric properties.
The alarming growth in the number of people abusing Imodium has led FDA officials to issue a warning that exceeding the recommended doses can mean serious, potentially fatal heart problems.

tevaFDA advisory panel recommends approval for abuse-deterrent pain medication

Reuters (6/7, Clarke, Grover) reports that a Food and Drug Administration advisory panel voted 14-3 to recommend approval for Teva Pharmaceutical Industries' opioid pain medication, Vantrela ER (hydrocodone bitartrate), "saying data showed it has some abuse-resistant properties." The committee found that the properties of the drug supported the claim that it could "reduce, though not necessarily prevent, abuse through swallowing, snorting or injecting."

implantFDA Approves Implantable Device for Steady Release of Buprenorphine
Buprenorphine, unlike oxycodone and heroin, is a partial opioid receptor agonist. This property confers this drug a number of advantages over other opioid analogs: it has less potential for euphoria, physical dependence and misuse, a mild withdrawal profile, and provides a ceiling on opioid effects. Buprenorphine is therefore thought of as a drug of choice to treat opioid addiction.

Thus, when adequately prescribed, buprenorphine is effective in suppressing major symptoms of opioid withdrawal, reducing cravings for opioids, and in blocking the effects of other opioids. Patients have also been found to be compliant.

Clinical Pain Advisor
abippABIPP Certification Made Simple
The American Board of Interventional Pain Physicians (ABIPP) has developed certification programs that recognize accepted levels of knowledge and expertise in the interventional pain management profession, with the goal of improved patient care. Hundreds of qualified physicians have made the commitment to become ABIPP certified. ABIPP is recognized in 11 states. Ten states have no statutes governing specialty boards. Approval is pending in remaining states.
ABIPP is a Specialty Board providing certifications in the following areas:
Board Certification in Interventional Pain Management
Either with ABMS pain medicine board certification or  ABMS primary certification only

Competency Certification in:
* Interventional Pain Management
Regenerative Medicine
Controlled Substance Management
Coding, Compliance, and Practice Management
Fluoroscopic Interpretation and Radiological Safety
Endoscopic Spinal Decompression
Click HERE to view Pathway to ABIPP Certification

More information  www.abipp.org
longLong-Term Use More Likely With Opioids vs NSAIDs for Low Back Pain
ATLANTA, Georgia - Rates of long-term opioid use for chronic noncancer pain have increased over the last 15 years, though there is scant evidence supporting this practice.1 Meanwhile, the number of overdose deaths from prescription opioids more than tripled during a similar time period: between 2001 and 2014.2 The ongoing use of nonsteroidal anti-inflammatory drugs (NSAIDs) has also been linked with risks, including gastrointestinal bleeding and kidney disease.

Despite practices to the contrary, opioids and NSAIDs are both intended for short-term use. In a study that was partially funded by a grant from the National Institutes of Health, researchers at Henry Ford Health System in Detroit recently explored whether the initial prescription choice between these two medications influenced patterns of long-term use.1
Using electronic medical records and insurance claims, the investigators compared patterns of opioid and NSAID use among patients who received new prescriptions for either medication within 2 weeks of diagnosis of new-onset, noncancer-related lower back pain between 1998 and 2012. "Exclusion criteria were any prior back pain diagnosis, procedure, or surgery; any prior diagnosis of diabetes, cancer, gastrointestinal bleeding, or renal insufficiency; or any prior recorded opioid or NSAID prescription fill," according to the paper presented at the 2016 Annual Meeting of the American Psychiatric (APA) in Atlanta, Georgia. The researchers tracked continuous medication use for 1 year after the initial prescription, and they used logistic regression to adjust for age, sex, and race/ethnicity. To account for patients whose records indicated that they had stopped and then restarted their medication during the study period, analyses were performed to adjust for the amount of time between discontinuation and restart.

Clinical Pain Advisor
landmine6 privacy landmines and how to avoid stepping on them
While the healthcare industry grapples with data breaches and privacy and security regulations, there are common pitfalls that are easy to run into without proper planning.
Erin Whaley, a partner at the law firm Troutman Sanders, outlined what those are and shared half-a-dozen tips for avoiding them.

Here is Whaley's advice:
1. As long as I have cybersecurity insurance I'll be covered in the event of a breach.It's not that simple. Whaley said that even healthcare organizations that stack policies to get to $50 million in coverage may not have enough - though she's not espousing that everyone simply plunk down for more insurance. Providers, instead, need to deploy solid security practices. "Having good security is a prerequisite to good coverage."

ICD-10 Book Now Available: Order Your Copy Today!

The initial impression of ICD-10 implementation was that it went well for both providers and CMS, however, shortly after the October 1, 2015 date when Medicare claims began processing, providers found out otherwise. In some cases, Interventional Pain Management providers continue to struggle with "finding the right code" to report for their patient's condition.

CMS released a publication "Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities" http://tinyurl.com/CMS-ICD-10-ClarifyQ-A that provided additional details as to how this ICD-10 family of codes "free pass" was going to work.
In short, CMS stated, "The recent Guidance does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10. It is important to note that these policies will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9. LCDs and NCDs that contain ICD-10 codes for right side, left side or bilateral do not allow for unspecified side."
What this means is that:
  • Interventional Pain Management providers are still being held responsible for reporting the correct ICD-10 code or risk Medicare claims denials.
  • Many Interventional Pain Management procedures are included in the various Medicare contractor's Local Coverage Policies (LCD) and include very specific lists of ICD-10 codes that meet medical necessity for the diagnostic and therapeutic procedures.
  • In some cases, Medicare contractors have separate LCD policies for each type of interventional pain procedure and often multiple pages in length.
Don't be one of the providers that have the misunderstanding if they report a valid ICD-10-CM code in the same family of codes, Medicare will accept that.
Busy Interventional Pain Management providers don't have time to check the Medicare LCD each time they perform a procedure.
Make your medical practice easier and use the ASIPP® new ICD-10-CM Pocket Guide for assistance navigating through the complexity of ICD-10 coding.

This book is 5.25 x 8.25 and can easily be placed in your jacket or any carrying case. For only $400 you will receive both the electronic and paper versions. You can recover your cost by avoiding mistakes in just one single case.
Order immediately to avoid any future losses. Get it for yourself and get copies for all your partners and staff. Multiple copies can be transferred to your EMR and save you money.
Also take a 10% discount for 5-9 copies or a 20% discount for 10 copies or more.

toolsDoctors Test Tools to Predict Your Odds of a Disease
Thomas McGinn, chairman of medicine at a major New York hospital system, is betting he can predict if a patient has strep, pneumonia or other ailments not by ordering traditional lab tests or imaging scans, but by calculating probabilities with  a software program.

Dr. McGinn believes using technology to help diagnose and treat patients can reduce the large number of unnecessary tests doctors order and antibiotics they prescribe by ruling out certain diseases. It also could expedite the appropriate care for patients by giving doctors grounds to treat them before lab tests can confirm a diagnosis.
The predictive tool, which pops up on the screen of electronic medical records, prompts the doctor to answer a short series of questions about the patient's condition. Based on that information, a calculator predicts the probability that the person has the suspected ailment. It may also recommend a course of action.

ripDoctors rip VA plan to give some nurses more authority
WASHINGTON - The Department of Veterans Affairs would dramatically expand the authority of nurses to treat patients without a doctor's supervision in a controversial proposal by the country's largest health-care system.

The plan, which would allow nurses with advanced training to broaden their responsibilities for patients, is drawing attention to a bitter debate over the relative roles of doctors and nurses. Because of VA's high visibility, it is likely to be closely watched.

cancerInterventional Treatments of Cancer Pain are Effective but Under-Utilized

A recent review by Drs. Jill Sindt and Shane Brogan of the University of Utah School of Medicine detailed the current status of a number of interventional techniques for the treatment of cancer-related pain: intrathecal drug delivery, vertebral augmentation, neurolytic plexus blocks, and image-guided percutaneous tumor ablation.1

The primary algorithm for the treatment of cancer pain in use today is a 3-step "analgesic ladder" developed by the World Health Organization (WHO). Non-opioid analgesics comprise the first step on the ladder; if pain persists, clinicians are advised to move onto the second step, which consists of non-opioids in combination with weak opioids. The third and final step consists of strong opioids plus non-opioids. Yet evidence from a 2007 systematic review of the medical literature shows that this approach to cancer pain management may be insufficient. Results showed that pain was prevalent in 64% of patients with metastatic, advanced or terminal cancer; 59% of patients undergoing cancer treatment; and 33% of patients who completed curative treatment. More than one-third of cancer patients who reported pain rated it as moderate or severe, suggesting that additional modalities may be warranted when conventional medications do not provide sufficient control.2 Due to these unmet needs, interventional techniques have been suggested as a "fourth step" in the WHO analgesic ladder.3
fireDoctors fire back at bad Yelp reviews - and reveal patients' information online
Burned by negative reviews, some health providers are casting their patients' privacy aside and sharing intimate details online as they try to rebut criticism.

In the course of these arguments -- which have spilled out publicly on ratings sites like Yelp - doctors, dentists, chiropractors and massage therapists, among others, have divulged details of patients' diagnoses, treatments and idiosyncrasies.

One Washington state dentist turned the tables on a patient who blamed him for the loss of a molar: "Due to your clenching and grinding habit, this is not the first molar tooth you have lost due to a fractured root," he wrote. "This tooth is no different."
understandingUnderstanding Mechanisms of Neuropathic Pain to Design Effective Treatments
A review article recently published in Neuron1 by the groups of Yves de Koninck, PhD and Steven Prescott, MD, PhD at the Laval University, Quebec, Canada and the Hospital for Sick Children, Toronto, Canada, respectively, highlights the need to better target treatments for chronic neuropathic pain. Individuals experiencing chronic pain with neuropathic characteristics account for 7-8% of adults2 and report higher pain levels than patients with non-neuropathic chronic pain.

Altered potassium-chloride co-transporter (KCC2) function leads to dysregulation of intracellular chloride (Cl-) levels, which severely affects inhibitory signals normally blocking pain transmission. This results in hyperexcitability of spinal neurons transmitting pain signals, causing neuropathic pain3. A recent study from the Prescott laboratory shows that alterations in KCC2 function, although impacting inhibition of both excitatory pain-producing and inhibitory pain-reducing neurons, results in low levels of excitation, which, through spatial summation results in supra-threshold excitation, thus producing allodynia4.
princeMedical Examiner Rules Fentanyl Killed Musician

Confirming off-the-record reports that drug abused figured in the April 21 death of the musician and composer Prince, the Midwest Medical Examiner's Office today released a report saying the 57-year old died of a self-administered dose of fentanyl. 

As reported in the Minneapolis Star Tribune, the investigation had long focused on Prince's abuse of painkillers. 

He reportedly had chronic pain from a hip injury due to years of jumping off speakers in high heels. 

HCP Live
cautionCaution Needed When Prescribing Antidepressants to Treat Chronic Pain
HealthDay News -- Depression accounts for only a little more than half the antidepressant prescriptions issued by Quebec physicians during the past decade, and two out of every three non-depression prescriptions are for an off-label purpose, according to a research letter published in the May 24/31 issue of the Journal of the American Medical Association.
Robyn Tamblyn, Ph.D., a professor of epidemiology and biostatistics at McGill University in Montreal, and colleagues gathered electronic medical records generated by primary care physicians in Quebec between 2006 and 2015. During that period, 101,759 antidepressant prescriptions were written by 158 physicians for 119,734 patients.

Clinical Pain Advisor
clintonClinton backs Manchin plan to tax opioids
Charleston, West Virginia (CNN)Hillary Clinton on Tuesday backed Joe Manchin's plan to tax opiods, telling the West Virginia senator that his call to levy a 1-cent tax on prescription opioid pain pills was a "great idea."

Manchin, whose state is dealing with the highest rate of drug overdose deaths in the country,  proposed earlier this year a tax of "1 cent on each milligram of active opioid ingredient in a prescription pain pill to be paid by the manufacturer or importer."

During a roundtable on opiod addiction here Tuesday morning, Clinton embraced the idea.


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State Society News

CASIPP Annual Meeting
November 11-13, 2016
Early Bird Registration is Open for the California Society of Interventional Pain Physicians annual meeting. T he meeting is set for Friday, November 11 - Sunday, November 13, 2016  at the exquisite Bacara Resort & Spa,  Santa Barbara , California. 

Please send your State Society meetings and news to: Holly Long at hlong@asipp.org


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