October 2, 2019
October 15 Fundraiser for ASIPP and ASIPP-PAC

The American Society of Interventional Pain Physicians is holding an ASIPP-PAC and ASIPP fundraiser on October 15, 2019 at the Melrose Georgetown in Washington, DC in conjunction with the 2019 Legislative Meeting and Capitol Hill visits. Whether or not you plan to attend the event, we ask that you contribute to this fundraising campaign to enable ASIPP to continue the fight for the survival and practice of interventional pain physicians.
Current Advocacy Issues include:
  • Medicare Advantage plans to cover and provide a level playing field with Medicare coverage regulations.
  • Providing uniform and appropriate LCDs for all interventional techniques.
  • Reduce the impact of numerous expensive and excessive regulations ($16 billion just to implement meaningless quality assessment regulations).
  • National Interventional Pain Management - Qualified Clinical Data Registry (NIPM-QCDR)

Successful Actions in the Reimbursement arena include: 
  • 15% increase in office based payment for stimulator trials 
  • 12.5% increase from 2018 for percutaneous adhesiolysis procedure, transforaminal epidural injections, facet joint injections, sympathetic blocks, celiac plexus, intercostal nerve and pudendal nerve neurolysis from $350.20 to $393.80.
  • 8.9% increase from 2018 for Cervical and lumbar interlaminar epidural injections and Sacroiliac joint injections from $283.10 to $308.32. 
To continue our forward momentum in this fight, the ASIPP-PAC and ASIPP General Funds must have a full tank . Unfortunately, today we are far below full and in fact the refuel light is on. Now is the time to show your support to an organization that does so much for you. 
Let today be the day you choose to act on your future and the future of interventional pain management.  CLICK HERE TO MAKE AN ASIPP PAC CONTRIBUTION    
OR C l i c k on t his li n k for your PAC form and return it along with your PAC and/or ASIPP lobbying contribution.
To contribute to ASIPP with either personal or business funds, please use the following link to the form:  ASIPP Physician Sponsorship
PAC contributions must be from personal credit cards or personal checks only. However, you may use either a corporate OR a personal check/credit card for contributions to the ASIPP Lobbying Fund or ASIPP.

Calling for an Overhaul of Buprenorphine Policy for More Comprehensive Addiction Treatment

The Drug Addiction Treatment Act of 2000 (DATA) should be updated to keep pace with the current state of the opioid crisis, according to a commentary published in National Academy of Medicine Perspectives. The authors suggest that removing X-waiver requirements would allow healthcare providers to better assist patients with opioid use disorder.

DATA successfully expanded access to opioid use disorder medications outside of treatment programs in support of a wider range of effective treatment options and allowed for the creation of innovative care models. However, DATA ultimately limited treatment expansion and placed regulatory burdens on medical providers who may have otherwise been able to help individuals recover from opioid use disorder because of the “X-waiver,” which refers to the permit physicians obtain through formal training, approval, and certification to prescribe Schedule 3 to 5 medications to treat patients with opioid use disorder in an outpatient setting. Buprenorphine is currently the only medication prescribed via this certification mechanism.

Burnout and Work-Life Integration: Physicians vs Other US Workers 2011-2017

Although rates of burnout and satisfaction with work-life integration improved among US physicians between 2014 and 2017, they still face an increased risk for burnout compared with workers in other fields, according to a study published in Mayo Clinic Proceedings.

Starting in 2011, investigators surveyed physicians and workers in the United States every 3 years to chronicle burnout rates and work-life integration satisfaction. In the initial 2011 survey, 45% of physicians had at least 1 manifestation of professional burnout . The burnout-associated problems were more common in physicians than other types of workers even after adjusting for confounders such as hours worked per week, and these gaps only widened by 2014. Recognizing that physician distress caused by burnout could adversely affect quality of care, the American Medical Association took steps toward ameliorating this in 2012, and after commissioning a RAND report in 2013, convened numerous meetings with experts. This led to the creation of various online resources and modules aimed at addressing physician burnout.

Pain Physician
September/October 2019 Issue Features
The September/October issue of Pain Physician features a cost utility analysis of cervical interlaminar epidural injections as well as several systematic reviews, randomized trials and original research.
Cost Utility Analysis
Laxmaiah Manchikanti, MD, Vidyasagar Pampati, MSc, Allan Parr, III, MS, Maanasa V. Manchikanti, ., Mahendra R. Sanapati, MD, Alan D. Kaye, MD, PhD, and Joshua A. Hirsch, MD.

Narrative Review
Inna Blyakhman, MSc, and Krishnan Chakravarthy, MD, PhD.

Comprehensive Review
Ajay B. Antony, MD, Anthony J. Mazzola, MD, Gurpreet S. Dhaliwal, MD, and Corey W. Hunter, MD.

Narrative Review
Gabriel Fregoso, MD, Annie Wang, MD, Kelly Tseng, MD, and Jingping Wang, MD, PhD.

Retrospective Review
Leonardo Kapural, MD, PhD, Nicholas Lee, ., Kevin Neal, MD, and Michael Burchell, MD.

Problematic Alcohol, Cannabis Consumption and Opioid Misuse in Chronic Pain

Problems with alcohol or cannabis use may be uniquely associated with opioid misuse in adults with chronic pain, according to study results published in the International Journal of Behavioral Medicine.

A total of 440 adults (mean age, 38.44 years) who reported current moderate to severe chronic pain and opioid use were assessed for substance abuse problems with the Alcohol, Smoking, and Substance Involvement Screening Test; the Current Opioid Misuse Measure; the Severity of Dependence Scale; and the Graded Chronic Pain Scale. In the cohort, 55.8% and 39.1% of individuals were currently consuming alcohol and cannabis, respectively.

Age, sex, education, smoking status, other drug use, and pain intensity were all found to be significant predictors of current opioid misuse (P <.001), and there were significant main effects for alcohol problems (P <.001) and cannabis problems (P <.001) on current opioid misuse, resulting in a further 15% of variance.

June 27 - June 28, 2020 | Memphis, TN
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 now offers the only competency certification program for regenerative medicine.
For complete information about the examination requirements and to obtain an application packet, visit www.abipp.org or call 270-554-9412 x4217 or by email at summer@asipp.org.
June 27
ABIPP Part I  
Combined CSM/CCPM Exam for ABIPP Path
Competency Exam in Controlled Substance Management
Competency Exam in Coding, Compliance, and
Practice Management

June 27-28
ABIPP Competency Exam
Regenerative Medicine Competency Exam
Endoscopic Lumbar Decompression Competency Exam

939 Ridge Lake Blvd. | Memphis, TN 38120  
Will 'Produce Prescriptions' Show Healthy Returns?

When low-income patients with high blood pressure fill their prescriptions at certain New York City pharmacies, they walk away with $30 in vouchers to spend on fresh fruits and vegetables at the city's farmer's markets.

The city's "Pharmacy to Farm Prescriptions Program" has reached more than 1,000 hypertensive SNAP recipients since it launched in 2017, and has grown from 3 to 16 participating pharmacies. It is set to report outcomes data next year.

The program is supported in part by a grant from the U.S. Department of Agriculture (USDA), which is poised to make an even bigger impact on the food-as-pharmacy programs that have been growing in popularity. The 2018 Farm Bill established a national Produce Prescription Program that sets aside millions in grants each year.

Most Who Die by Suicide Leave No Notes
Iowa study shows guns are preferred by men, poison by women

KISSIMMEE, Fla. – A review of 15 years of suicides that were autopsied indicated that, most frequently, the person involved was a man, using a gun, in his home – and most of the time the individual left no explanation, researchers reported here.

In reviewing records of 657 suicide deaths autopsied at the University of Iowa Hospital and Clinics in Iowa City, Jane Persons, PhD, a postgraduate medical student at the university, reported that men were far more likely to die by suicide than women were -- 509 men died at their own hands compared with 146 women (gender data was missing in two autopsy reports).

Variation in Prescription Drug Prices by Retail Pharmacy Type: A National Cross-sectional Study

Cash prices for prescription drugs vary widely in the United States.

To describe cash price variation by retail pharmacy type for 10 generic and 6 brand-name drugs throughout the United States and stratified by ZIP code.

Cross-sectional study.

Drug pricing data from GoodRx, an online tool for comparing drug prices, representing more than 60 000 U.S. pharmacies (fall 2015).

Cash prices for a 1-month supply of generic and brand-name drugs were ascertained. Stratified by ZIP code, relative cash prices for groups of generic and brand-name drugs were estimated for big box, grocery-based, small chain, and independent pharmacies compared with a reference group of large chain pharmacies.

Across 16 325 ZIP codes, 68 353 unique pharmacy stores contributed cash prices. When stratified by 5-digit ZIP code, the relative cash prices for generic drugs at big box, grocery-based, small chain, and independent pharmacies compared with those at large chain pharmacies were 0.52 (95% CI, 0.51 to 0.53), 0.82 (CI, 0.81 to 0.83), 1.51 (CI, 1.45 to 1.56), and 1.61 (CI, 1.58 to 1.64), respectively. The relative cash prices for brand-name drugs were 0.97 (CI, 0.96 to 0.97), 1.00 (CI, 0.99 to 1.00), 1.06 (CI, 1.05 to 1.08), and 1.03 (CI, 1.02 to 1.04), respectively.

Results may not reflect current drug prices and do not account for point-of-sale discounts or price matching that may be offered by smaller pharmacies.

Compared with large chains, independent pharmacies and small chains had the highest cash prices for generic drugs and big box pharmacies the lowest. Relative differences in cash prices for brand-name drugs were modest across types of retail pharmacies.

Is Everything We Know About Meat Consumption Wrong?
A new dietary guideline appearing in Annals of Internal Medicine declared eating red meat and processed meats won't adversely affect health.

However, many experts in the field are hitting back stating there is simply no scientific evidence to support this claim made by Bradley Johnston, PhD, of Dalhousie University in Canada, and colleagues of NutriRECS.
Based upon five reviews, the 14-member voting panel concluded adults can continue to consume unprocessed red meat and processed meats, based on "low-certainty evidence" and yielding "weak recommendations."
Click below to read guidelines.

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

Spending Variation 'Substantial' Between Providers in Same Specialty
A report indicates that variation among providers affects spending on "medications, labs and radiology."
Behavioral factors by doctors contribute to significant cost variations, even among the same type of patients, according to an Illumicare report released Tuesday morning.

The analysis of 15 sub-specialty groups with the largest cost variations found that the most significant factor was "what type of spender a patient's provider is," with cardiology and OB/GYN specialists leading the way.

Between the 25th and 75th percentiles, there was a $5,438 variation among pediatric hematology-oncologists, a difference of $3,885 among OB/GYN orders of cesarean sections without complications or comorbidities, and almost a $3,000 difference among OB/GYN orders on vaginal delivery without complicating diagnosis. 

Baby Teeth May Identify ADHD
— How a child metabolizes nutrients and toxins may play a role in ADHD and autism

Baby teeth revealed how a child metabolized essential and toxic elements and differed among children with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder versus those without such symptoms, a small twin study suggested.
Prenatal and newborn children form a new tooth layer daily which captures an imprint of chemicals circulating in the body and produces a chronological exposure record, like rings on a tree. This record, which shows cyclical processes involved in metabolizing nutrients and metals during fetal and early postnatal development, differed significantly in children who had ADHD, autism, or both disorders, reported Christine Austin, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in Translational Psychiatry .
These findings suggest metabolic regulation of nutrients and toxins may play a role in ADHD and autism, the authors noted.

2019 MIPS Reporting? Start Now.
MIPS-eligible clinicians must report a full year of data. Don’t fall behind – keep up with NIPM-QCDR.
MIPS 2019 has brought larger payment adjustments and greater reporting requirements, including a 365-day performance period for the Quality and Cost categories. The sooner you start your MIPS reporting for 2019, the better.
Sign up today to use ASIPP’s NIPM-QCDR for MIPS.
This powerful tool makes MIPS reporting easy through the use of our new patient-reported outcomes measures for 2019, which ease the burden on providers and reduces costly EMR integration.

Get started today at ASIPP.ArborMetrix.net

Fibromyalgia Assessment Screening Tool May Facilitate Diagnosis in Routine Care

The American College of Rheumatology developed classification criteria for fibromyalgia, but these are not typically used in routine clinical care.

Simple Fibromyalgia Assessment Screening Tool (FAST) indices may facilitate the diagnosis of fibromyalgia (FM) in the routine care of patients with other rheumatic diseases, according to study results published in The Journal of Rheumatology .

Although FM is common in patients with rheumatic diseases, there is no diagnostic marker for the disease. The American College of Rheumatology developed classification criteria for FM, but these are not typically used in routine clinical care other than by subspecialists, which may result in FM being misdiagnosed or not diagnosed.  

Common Antidepressant May Have Better Effect on Anxiety Symptoms
-Sertraline works for a broader range of patients than previously thought, large-scale study suggests
The goals of this study were to examine the clinical effectiveness of sertraline, an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class, in primary care patients with depressive symptoms ranging from mild to severe and to assess the role of severity and duration in treatment response.
Question Addressed:
  • What were the clinical outcomes from the randomized, double-blind, placebo-controlled PANDA trial, in which participants presenting with depression of any severity in primary care settings were individually randomized to sertraline or placebo?

Action Points
  • Among patients with depression of any severity, there was strong evidence that sertraline reduced generalized anxiety symptoms, with continued improvement from 6 weeks to 12 weeks, and this, in turn, led to better mental health-related quality of life.
  • Note that sertraline is unlikely to reduce depressive symptoms within 6 weeks, but it can lead to clinical benefits for patients with depressive symptoms in a real-world primary care setting, due to improvements in anxiety symptoms and quality of life.

In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain

Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.

She's had endless disappointing visits with doctors. Some said they couldn't help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome .

Pinkley has taken opioids a few times after surgeries but says they never helped her underlying pain.
"I hate opioids with a passion," Pinkley says. "An absolute passion."

Recently, she joined a growing group of patients using an outside-the-box remedy: naltrexone. It is usually used to treat addiction, in a pill form for alcohol and as a pill or a monthly shot for opioids.


State Society News 
October 25-27, 2019

California Society of Interventional Pain Physicians 10 th annual meeting
The Resort at Squaw Creek, Lake Tahoe.

Send in your state society meeting news to Holly Long, hlong@asipp.org
ASIPP | Pain Physician Journal | Phone | Fax | Email