American Society of Interventional Pain Physicians | October 3, 2018



AND CADAVER WORKSHOP ( 11 AMA PRA Category 1 Credits™)

AND CADAVER WORKSHOP ( 11 AMA PRA Category 1 Credits™)
An outbreak of synthetic cannabinoid–associated coagulopathy in Illinois

New England Journal of Medicine  — Kelkar AH, et al. | September 28, 2018
Researchers focused on the outbreak of synthetic cannabinoid–associated coagulopathy that occurred March-April 2018 in Illinois. During this outbreak, > 150 patients presented to hospitals with coagulopathy and bleeding diathesis. A link between coagulopathy and synthetic cannabinoid use was identified by area physicians and public health organizations. Serum samples and drug samples of patients were tested, and initial reports revealed that brodifacoum, an anticoagulant, was the likely adulterant. According to findings of this study, the occurrence of clinically significant coagulopathy could be attributed to superwarfarin adulterants of synthetic cannabinoids. Vitamin K1 replacement therapy was found to result in symptom control in most of the cases of the series in which the patient presented with bleeding diathesis. The specific synthetic cannabinoid compounds were not known.

  •  Investigators reviewed the physician-reported data from patients admitted to Saint Francis Medical Center in Peoria, IL, between March 28 and April 21, 2018, and analyzed the case series of adult patients who met the criteria used to diagnose synthetic cannabinoid–associated coagulopathy.
  • At the discretion of the treating physician, a confirmatory anticoagulant poisoning panel was ordered.
  • Results
  •  During 45 hospitalizations, synthetic cannabinoid–associated coagulopathy was detected in a total of 34 patients.
  •  Of these patients, 15 underwent confirmatory anticoagulant testing, and superwarfarin poisoning was confirmed in all.
  •  Anticoagulant tests were positive for brodifacoum in 100% of patients, difenacoum in 33%, bromadiolone in 13%, and warfarin in 7%.
  • ·   Gross hematuria in 19 patients (56%) and abdominal pain in 16 (47%) comprised symptoms that were commonly documented at presentation.
  • ·  Abdominal pain was assessed using computed tomography and revealed renal abnormalities in 12 patients.
  • · Oral administration of vitamin K1 (phytonadione) in all 34 patients and its intravenous administration in 23 (68%) was reported.
  •  Five patients (15%) had red-cell transfusion and 19 (56%) received fresh-frozen plasma infusion.
  •  Use of four-factor prothrombin complex concentrate in one patient was reported.
  • Complications of spontaneous intracranial hemorrhage led to death of one patient.
Read the full article on  New England Journal of Medicine

Business Degree Increasingly Useful for Physicians

HealthDay News — Having a Master of Business Administration degree (M.B.A.) can help doctors with important, practice-related decisions, according to a report published recently in  Physician Practice .
With the move to value-based care and increased scrutiny of health care costs, experts say a business approach to medicine is increasingly required. More medical schools are responding to this need by offering dual-degree M.D./M.B.A. programs. The number of such programs has grown from six in 1993 to more than 65 now.

3 surgeons charged in $580M spine surgery kickback scheme: 5 things to know
Three more surgeons in Corona Del Mar, Irvine and Dana Point, Calif., have been charged with involvement in an alleged $580 million kickback scheme, according to Patch .
Here are five things to know:
1. Investigators allege multiple surgeons took kickbacks and bribes to direct or perform spine surgeons at Pacific Hospital of Long Beach (Calif.).
2. David Hobart Payne, MD, an orthopedic surgeon is accused of taking $450,000 in kickbacks to funnel $10 million in spine surgeries to the hospital.
3. Neurosurgeon Jeffrey Lokesh Tantuwaya, MD, is accused of receiving $3.2 million in bribes to direct or perform $38 million in surgeries at Pacific Hospital of Long Beach.
4. Orthopedic surgeon Jeffrey David Gross, MD, is the third surgeon accused of taking $622,000 for referring $19 million in surgeries at the hospital.
5. In total, nine people have been convicted in part of the scheme that dates back 15 years. Former Pacific Hospital of Long Beach owner Michael Drobot was sentenced to more than five years in federal prison back in January for his role in the scheme.

Strategies and Considerations for Improving Global Healthcare

Although recent times have brought about significant technological and social advancements, the quality of healthcare worldwide continues to be inadequate.
Estimates suggest that between 5.7 and 8.4 million people die yearly because of the poor quality of care in low- and middle-income countries; up to 15% of hospital costs in these countries are a result of patient harm caused by adverse events. A viewpoint article published in  JAMA 1  lays out some of the obstacles to improving healthcare across the globe, and the authors attempt to provide some possible solutions.

Make the Most of Employment: Guidelines for Evaluating Physician Employment Contracts
Physician recruiting has become highly competitive because of the increasing shortage of physicians. In fields such as primary care, more than 50% of physicians receive 100 or more job solicitations throughout their training; the need for physicians working in family medicine is also on the rise. Because of this large volume of job offers, it is important for physicians to be able to evaluate contracts from potential employers.
The primary part of a physician's employment contract is the base salary. This is sometimes coupled with a production bonus formula based on relative value units or other metrics, such as adherence to treatment protocols or patient satisfaction scores. With the outline of a base salary and production bonus, physicians can determine the minimum and maximum amounts they might earn during a contract period.

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

CDC Guideline for Opioid Prescribing May Have Effectively Reduced Opioid Prescribing Practices

The Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for Chronic Pain released in March 2016 may have contributed to a further reduction in several  opioid prescribing practices , according to a study published in the  Annals of Internal Medicine .
An interrupted time series analysis of monthly opioid prescribing practices in the United States between 2012 and 2017 was conducted using the IQVIA transactional data warehouse and the Real-World Data Longitudinal Prescriptions population-level estimates, which are based on retail pharmacy data. Study outcomes based on 6 of the 12 CDC guideline recommendations for opioid prescribing were rate of high-dosage opioid prescriptions (≥90  morphine  equivalent milligrams [MME] per day), average MME per capita, average daily MME per prescription, percentage of ≤3 prescriptions with ≤7 days supplied, overall prescription rate, and overall opioid prescribing rates.

Justice Department is Awarding Almost $320 Million to Combat Opioid Crisis
On the first day of National Substance Abuse Prevention Month, the Department of Justice announced it is awarding almost $320 million to combat the opioid crisis in America. The unprecedented funding will directly help those most impacted by the deadliest drug crisis in American history, including crime victims, children, families, and first responders.
"President Trump has made ending the opioid crisis a priority for this administration, and under his leadership, the Department of Justice has taken historic action," said Attorney General Jeff Sessions. "Today we are announcing our next steps: investing $320 million into all three parts of the President’s comprehensive plan to end the epidemic: prevention, treatment, and enforcement. We are attacking this crisis from every angle—and we will not let up until we bring it to an end."
In 2017, more than 72,000 Americans lost their lives to drug overdoses, an increase from the 64,000 overdose deaths in 2016, according to the Centers for Disease Control and Prevention. The majority of these deaths can be attributed to opioids, including illicit fentanyl and its analogues. October marks two important anti-drug events: Red Ribbon Week and National Prescription Drug Takeback Day. Red Ribbon Week takes place every year between October 23-31 and encourages students, parents, schools, and communities to promote drug-free lifestyles. The Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day on October 27 aims to provide an opportunity for Americans to prevent overdose deaths and drug addictions before they start. DOJ expanded on DEA's Drug Takeback Days and collected more than 2.7 million pounds of expired or unused prescription drugs since April 2017. 

Pain Physician
September/October 2018 Issue Features

Health Policy Review
  • Reframing Medicare Physician Payment Policy for 2019: A Look at Proposed Policy     
Systematic Reviews
  • Efficacy Assessment of Radiofrequency Ablation as a Palliative Pain Treatment in Patients with Painful Metastatic Spinal Lesions: A Systematic Review
  • Comparison of Clinical Efficacy Between Transforaminal and Interlaminar Epidural Injections in Lumbosacral Disc Herniation: A Systematic Review and Meta-Analysis
  • Comparison of Clinical Efficacy of Epidural Injection With or Without Steroid in Lumbosacral Disc Herniation: A Systematic Review and Meta-analysis
Randomized Trials
  • Effectiveness and Safety of High-Voltage Pulsed Radiofrequency to Treat Patients with Primary Trigeminal Neuralgia: A Multicenter, Randomized, Double-Blind, Controlled Study Protocol
  • Preemptive Analgesia with Parecoxib in Total Hip Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial
  • Comparison of Efficacy of Lateral Branch Pulsed Radiofrequency Denervation and Intraarticular Depot Methylprednisolone Injection for Sacroiliac Joint Pain

Missouri neurosurgeon, fiancee fined $5.49M in kickback case involving spinal implant distributor: 5 things to know
Cape Girardeau, Mo.-based neurosurgeon Sonjay Fonn, MD, and his fiancee Deborah Seeger were convicted of submitting false claims to CMS and incurred fines of $5.49 million, according to the Southeast Missourian.
Here are five things to know:
1. Prosecutors said Ms. Seeger founded DS Medical, a spinal implant distributorship, in November 2008 and Dr. Fonn used the company's implants in most of his surgeries from 2009 to 2012. CMS reportedly paid for 228 of Dr. Fonn's spine surgeries using those devices.
2. When Dr. Fonn used DS Medical implants, Ms. Seeger reportedly received 50 percent commission. According to the report, she used some of that income to "benefit" Dr. Fonn with purchases including home improvements and a yacht.
3. Prosecutors accused Dr. Fonn and Ms. Seeger of violating anti-kickback statute. Initially, a group of Cape Girardeau-based physicians brought a civil case against the couple before the federal government stepped in, and those individuals will receive a percentage of the final award.
4. In 2014, a federal grand jury indicted the couple on one count of conspiracy to solicit and receive illegal kickbacks and three additional counts of violating the anti-kickback statute.
5. The original case alleged Dr. Fonn's practice in Cape Girardeau, Midwest Neurosurgeons, had an "exclusive arrangement" with Ms. Seeger, generating significant profits.

State Society News 
November 8-11, 2018
NY/NJSIPP Pain Medicine Symposium 2018 
Hyatt Regency Jersey City.
CLICK HERE for more details

November 12 and 14, 2018
FSIPP Regional Meetings: 
November 12, 2 018 @6:30pm
Carrabba's Italian Grill
2370 SW College Road, Ocala, FL 34471
November 14, 2018 @6:30pm
Carrabba's Italian Grill
5820 Red Bug Lake Road, Winter Springs, FL 32708
CLICK HERE to register for either meeting

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.

July 26-28, 2019
PAIN 2019
West Virginia Society of Pain Physicians
Loews Miami Beach, FL

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