American Society of Interventional Pain Physicians | August 22, 2018
6.75 A MA PRA Category 1 Credits™
11 AMA PRA Category 1 Credits

Neuromodulation Cadaver Workshop will be
limited to 4 physicians per station.
Minimum attendance of 4 physicians required thirty days prior to meeting or
course and workshop is subject to cancellation. Register early!

1 Day Review Course and 1.5 Day Cadaver Workshop.
1. Trial lead placement for low back pain
2. Trial lead placement for neck pain
3. Spinal cord stimulator permanent implant placement (conventional)
4. Wireless trial and permanent placement
5. Transforaminal trial and permanent placement
6. Placement of intrathecal infusion system
7. Intercostal nerve stimulation
8. Sacroiliac stimulation
9. Suprascapular nerve stimulation
10. Free forum

Procedures are subject to change.

18 A MA PRA Category 1 Credits™

6.75 A MA PRA Category 1 Credits™

11 AMA PRA Category 1 Credits

7 AMA PRA Category 1 Credits™
(Plus Free Online Lectures)
11 AMA PRA Category 1 Credits™
OHSIPP/KYSIPP Meeting a Big Success

The OHSIPP/KYSIPP 2018 meeting was held in  Cincinnati Aug 17-19. This was the second meeting held jointly by these societies. The meeting had 305 total and t exhibitors area sold out much in advance of the meeting. The exhibitor's area was well attended by the registrants and the  lunch/brunch sessions were all packed.

Click Here for a  link to photo gallery of OHKYSIPP meeting.

Why a patient paid a $285 copay for a $40 drug

Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help manage her blood pressure.
Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.
The copay for a 90-day supply was $285, which seemed high to Ma.


The doctor is out? Why physicians are leaving their practices to pursue other careers

The news that  New York University will offer free tuition to all its medical school students , in the hope of encouraging more doctors to choose lower-paying specialties, offered hope to those wishing to pursue a career in the field.
However, becoming a doctor remains one of the most challenging career paths you can embark upon. It requires extensive (and expensive) schooling followed by intensive residencies before you’re fully on your feet. The idea, generally, is that all the hard work will pay off not only financially, but also in terms of job satisfaction and work-life balance; then there’s the immeasurable personal benefits of helping people, and possibly even saving lives. In terms of both nobility and prestige, few occupations rank as high.
So why is there waning interest in being a physician? A  recent report from the Association of American Medical Colleges projected a shortage of 42,600 to 121,300 physicians by 2030, up from its  2017 projected shortage  of 40,800 to 104,900 doctors.

New York University Makes Tuition Free for All Medical Students

New York University said Thursday that it will cover tuition for all its medical students regardless of their financial situation, a first among the nation’s major medical schools and an attempt to expand career options for graduates who won’t be saddled with six figure debt.
School officials worry that rising tuition and soaring loan balances are pushing new doctors into high-paying fields and contributing to a shortage of researchers and primary care physicians. Medical schools nationwide have been conducting aggressive fundraising campaigns to compete for top prospects, alleviate the debt burden and give graduates more career choices.

Access to this article may be limited

Interventional Pain Management Reports is an Open Access online journal, a peer-reviews journal dedicated to the publication of case reports, brief commentaries and reviews and letters to the editor. It is a peer-reviewed journal written by and directed to an audience of interventional pain physicians, clinicians and basic scientists with an interest in interventional pain management and pain medicine. 

Interventional Pain Management Reports is an official publication of the American Society of Interventional Pain Physicians (ASIPP) and is a sister publication of Pain Physician . Interventional Pain Management Reports Interventional Pain Management Reports is an open access journal, available online with free full manuscripts.  

The benefits of publishing in an open access journal that has a corresponding
print edition journal are:  
  • Your article will have the potential to obtain more citations.
  • Your article will be peer-reviewed and published faster than other journals.
  • Your article can be read by a potentially much larger audience compared with traditional subscription-only journals.  
  • Open Access journals are FREE to view, download and to print.

So submit today your:
  • Case Reports
  • Technical Reports
  • Editorials
  • Short Perspectives

Reimbursement for and Documentation of Evaluation and Management Services: CMS Proposes Important Modifications

On July 12, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule (“Proposed Rule”) that would, among other changes: (1) reduce the documentation requirements with which physicians and other practitioners must comply in providing and billing for Evaluation and Management (E/M) services under the Medicare Physician Fee Schedule (“PFS”) on or after January 1, 2019; and (2) revise the current reimbursement methodology for E/M services under the PFS. CMS is seeking comment on the Proposed Rule through September 10, 2018.
The prevailing documentation requirements for E/M services were published in 1995 and 1997. For over 20 years, physicians have complained that these requirements were overly complex and burdensome. More recently, commenters have noted that the 1995 and 1997 guidelines are inadequate to address the evolving demands for chronic care management and the growing need for enhanced primary care services provided during in-office visits. In short, there has been a growing concern that the existing guidelines are not aligned with the current practice of medicine. The Proposed Rule attempts to address these concerns, ease the burden on physicians and other practitioners, and modernize outdated practices by making important and substantive changes to the reimbursement methodology and documentation requirements for E/M services.

I Didn't Study Medicine to Prescribe Weed

Pennsylvania fully implemented its medical marijuana law in 2018 and joined 38 states and the District of Columbia that have authorized medical or recreational marijuana at a state level. In an attempt to regulate  medical marijuana  as a pharmaceutical medication to the extent possible, Pennsylvania instituted a process for certification of patients by qualified physicians, and those certifications can only be honored by licensed dispensaries supplying cannabis products from approved growers within the state. Similar to other states, the requests are overwhelmingly by patients to treat chronic pain.
At the University of Pittsburgh Medical Center (UPMC) where I practice, we have been inundated with such requests and physicians are scrambling to follow the  guidelines in the literature  and meet the patient demand for medical marijuana certification. I led the effort to author UPMC specific guidelines for medical marijuana certification and the emailed responses I received from physicians after the rollout ranged from congratulations to "horror" that we would institutionalize a process for such an evil substance outside the scope of medical practice. Every time I consider certifying a patient my brain is flooded by more questions than answers: By giving patients our "approval" to use marijuana for chro nic pain are we just catering to consumer demand or are we  offering them a reasonable nonopioid option ?

Lowering Default Pill Counts in EMRs May Effectively Reduce Postoperative Opioid Prescription Numbers

According to a recent study published in  JAMA Surgery , lowering the default number of opioid pills prescribed in an electronic medical record (EMR) system can decrease  the amount of opioid medication prescribed after procedures  significantly.
For this preintervention/postintervention study, researchers assessed the effects of a reduction in default pill count from 30 to 12 in an EMR system. The investigators examined postprocedural prescribing patterns at a multihospital healthcare system using Epic EMR 3 months before and 3 months after implementing the default change.
Prior to the default change, 1447 participants (average age, 54.4) who underwent one of the hospital system's 10 most frequent outpatient procedures were prescribed a median of 30 opioid pills per prescription. After the change, 1463 participants (average age, 54.5) were prescribed a median of 20 pills per prescription ( P  <.001).

Pain Physician
July/August 2018 Issue Features

Health Policy Review
  • Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic
Systematic Reviews
  • Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures? Evidence from a Systematic Review of Discordant Meta-Analyses
  • Prevalence of Recurrent Herniation Following Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysi
Randomized Trials
  • Thermal Versus Super Voltage Pulsed Radiofrequency of Stellate Ganglion in Post-Mastectomy Neuropathic Pain Syndrome: A Prospective Randomized Trial
  • Evaluation of an Experimental Pain Model by Noncompartmental Analysis of Results from a Randomized Placebo Controlled Trial
  • Transforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial

Work Improves in Spine Patients on Biologics
Productivity and activity benefits seen with biologic therapy in axial spondyloarthritis

Patients with axial spondyloarthritis (axSpA) who received biologic therapy experienced less work and activity impairment than those not treated with biologics, a British study found.
Among 577 biologics-naive patients enrolled in the British Society for Rheumatology (BSR) Biologics Register in Axial Spondyloarthritis, those who commenced biologic treatment had significantly decreased overall work impairment at 12 months (-13.9%, 95% CI -21.1 to -6.7) compared with those not receiving biologic therapy, according to Gary J. Macfarlane, MD, PhD, of the University of Aberdeen in Scotland, and colleagues.

Set of Personality Traits May Predict Prescription Drug Use, Misuse in Young Adults

Personality traits such as anxiety sensitivity, hopelessness, sensation seeking, and impulsivity may be predictors of use and  misuse of prescription drugs  in young adults, particularly undergraduate students, according to a recent study published in  Addictive Behaviors .
Investigators evaluated the drug use habits of 1755 freshmen at a Canadian university (average age, 18.6 years; 68.9% women). Using surveys, students reported their use and frequency of use of prescription drugs during the current semester. Study participants were also asked to indicate whether they received prescription drugs from a clinician and the reason for using them (ie, to treat a medical condition, in combination with alcohol, to get high, or as a study aid). The relationships between 3 types of prescription drugs  (sedatives/tranquilizers, opioids, and stimulants)  and the above-mentioned personality traits were examined.

DOJ News
Justice Department, DEA Propose Significant Opioid Manufacturing Reduction in 2019
The Department of Justice and U.S. Drug Enforcement Administration (DEA) have proposed a reduction for controlled substances that may be manufactured in the U.S. next year. Consistent with President Trump’s  “Safe Prescribing Plan”  that seeks to “cut nationwide opioid prescription fills by one-third within three years,” the proposal decreases manufacturing quotas for the most six frequently misused opioids for 2019 by an average ten percent as compared to the 2018 amount. The Notice of Proposed Rulemaking (NPRM) marks the third straight year of proposed reductions, which help reduce the amount of drugs potentially diverted for trafficking and used to facilitate addiction.
On July 11, 2018, the Justice Department  announced  that DEA was issuing a final rule amending its regulations to improve the agency’s ability consider the likelihood of whether a drug can be diverted for abuse when it sets annual opioid production limits. The final rule also promotes greater involvement from state attorneys general, and today’s proposed reduction will be sent to those offices.
In setting the aggregate production quote (APQ), DEA considers data from many sources, including estimates of the legitimate medical need from the Food and Drug Administration; estimates of retail consumption based on prescriptions dispensed; manufacturers’ disposition history and forecasts; data from DEA’s own internal system for tracking controlled substance transactions; and past quota histories.


State Society News 

July 12-14, 2019
GSIPP 2019 - 15th Annual Meeting & Pain Summit
The Cloister Hotel at Sea Island
Sea Island, GA
For more information, contact Karrie Kirwan at or Tara Morrison at or 770-613-0932.

Send in your state society meeting news to Holly Long,
ASIPP | Pain Physician Journal | Phone | Fax | Email