Please only complete if you are an MD or DO
As you know, your feedback is essential to ASIPP’s advocacy efforts for interventional pain management. We are conducting a survey on “Practice Patterns of Facet Joint Interventions.” The survey is simple and easy and will take less than five minutes to complete.
Your responses will be analyzed, posted on the ASIPP website, and published in a peer-reviewed journal.
Thank you for taking the time to complete the survey.
If you already have completed it – Once again, Thank you very much!
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Patients need a path for reducing and eliminating use before taking the first pill
In Homer's epic poem The Odyssey, sirens lured sailors to shipwreck off the coast of their island with the temptation of music and song. Recognizing the danger, Ulysses devised a plan to tie himself to the mast to guarantee restraint as he sailed by. While it proved more challenging for him and his crew than they imagined, they made it home. The wisdom of this ancient story relates to today's battle with opioids: to get past the allure of continued and often troublesome opioid use patterns, patients and doctors need a plan in hand before the first opioid is ever used.
The proposed new federal guidelines for prescribing opioids seek to fill that gap, but they are a mixed blessing for physicians who are trying to help patients deal with pain. It is a massive document from the CDC, alternately praising the medicinal value of the drugs while warning of severe dangers.
No More Dosage Ceiling
The headline takeaway is that doctors are free to ignore a previously recommended ceiling on dosage. The new guidance says doctors should use their best judgment while turning first to non-opioid therapies in as many cases as possible. This change comes after the outcry of many pain patients who have been dependent on opioids for years and have trouble getting continued prescription orders.
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ASIPP 24th Annual Meeting
May 5-7, 2022 | Las Vegas, Nevada
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24 YEARS & COUNTING!
Focusing on Fundamentals to Build the Future of IPM
Discussion on health policy with three prominent members of congress:
- The Honorable Ed Whitfield
- The Honorable Larry Buschon
- The Honorable James Comer
Raj/Racz Distinguished Lectures:
- Neuromodulation
- Documentation of medical necessity to perform epidural and facet joint intervention LCDs and evaluation and management services
Multiple General Session Topics:
- Various types of solutions in epidural injections
Keynote speech by Harsha Shanthanna, MD
- Facet joint interventions
- The opioid/illicit drug epidemic
- Compassionate prescribing
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The CDC’s opioid guidelines are being revised, and the proposed 2022 CDC guidelines have been issued. If these guidelines are adopted as proposed, we would have missed an opportunity-to incorporate Interventional Pain Management-yet again. The CDC guidelines is seeking stakeholder comments before April 11, 2022. Your voice and the voice of your patients are critical because the proposed guidelines are suggesting that there is minimal evidence for IPM, and that IPM is not effective, undermining the true role of IPM in both diagnosing and treating the patient holistically.
Ask the CDC for the following in your own words. To submit your comments, identify Docket No. CDC-2022-0024. Federal Rulemaking Portal: http://www.regulations.gov.
The CDC must advocate for multidisciplinary care, personalized for each individual patient. This includes behavioral therapy, restorative therapy, complementary medicine pharmacologic therapies, and Interventional Pain Management (IPM) strategies. This is consistent with the AMA and the 2019 HHS Best Practices report that embrace a multidisciplinary model that includes IPM.
IPM procedures, including epidural and facet joint interventions, spinal cord stimulation, infusion systems, minimally invasive endoscopic surgery, interspinous prosthesis, and other nerve block, in conjunction with opioids, are both safe and effective. The proposed 2022 CDC guidelines are suggesting that IPM procedures have limited evidence and are unsafe. the language that suggests that IPM has limited evidence and is not safe should be removed.
Please contact Congress requesting that they ask the CDC to adopt the 2019 HHS Best Practices report, specifically Section 2.4 dealing with IPM.
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Evidence-based medicine has been corrupted by corporate interests, failed regulation, and commercialization of academia, argue these authors
The advent of evidence-based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends on reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry-sponsored clinical trials are misrepresented1,2,3,4. Until this problem is corrected, evidence-based medicine will remain an illusion.
The philosophy of critical rationalism, advanced by the philosopher Karl Popper, famously advocated for the integrity of science and its role in an open, democratic society. A science of real integrity would be one in which practitioners are careful not to cling to cherished hypotheses and take seriously the outcome of the most stringent experiments.5 This ideal is, however, threatened by corporations, in which financial interests trump the common good. Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to expanding that market. The short-term stimulus to biomedical research because of privatisation has been celebrated by free-market champions, but the unintended, long-term consequences for medicine have been severe. Scientific progress is thwarted by the ownership of data and knowledge because industry suppresses negative trial results, fails to report adverse events, and does not share raw data with the academic research community. Patients die because of the adverse impact of commercial interests on the research agenda, universities, and regulators.
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NEXT EXAM DATES:
Part I
May 28, June 18, July 30, August 27, September 17, October 22, November 19 & December 17
Part II
July 15 & September 23
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State budget removes need for formal, documented relationships between NPs and MDs, facilities
Nurse practitioners (NPs) licensed in New York are now fully able to practice independently, joining those in 24 other states who have already been granted this authority.
As part of the state budget signed by Gov. Kathy Hochul (D) on April 9, NPs with more than 3,600 hours of experience no longer need a formal relationship with a medical doctor to practice, and can "evaluate patients; diagnose, order and interpret diagnostic tests; initiate and manage treatments; and prescribe medications," according to the American Association of Nurse Practitioners (AANP).
Before this change, New York was one of 15 states with "reduced" practice authority for NPs (rather than "restricted" or "full"), meaning that they were required to have a "written practice agreement" with a physician in their specialty area, with provisions for the physician to review patient records periodically, make referrals, be available for consultation, and have the final word in disagreements over patient care, among others.
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Federal officials will allow some clinicians the chance to catch up on a missed reporting deadline for aid payments provided during the pandemic, following requests for such clemency from physician groups.
The Health Resources and Services Administration (HRSA) on Wednesday said certain clinicians will be able to submit requests between April 11 and April 22 to make up for missed filings. At issue are missing filings for what's called Reporting Period 1 that could trigger demands for repayment of funds.
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COVID's "new normal" response must target those repeatedly left behind
Weeks after political leaders and media elites put the U.S. on a course to "return to normalcy," the country finds itself again contending with an uptick in cases fueled by the highly transmissible BA.2 Omicron subvariant and the ending of public health measures. Some regions and cities, like Washington, D.C. and New York, are seeing particularly sharp rises in new daily cases. Many lawmakers and Biden administration officials have tested positive in recent weeks, including from a super-spreader event at the Gridiron Club.
The U.S. is clearly in a very different place today than we were when we faced the first surge. We now have safe, highly effective vaccines that dramatically reduce the risk of hospitalization and death from COVID-19. We have rapid tests and powerful new antiviral drugs like nirmatrelvir/ritonavir (Paxlovid) that can keep vulnerable people out of the hospital. However, we have not done nearly enough to ensure these life-saving tools reach those who need them the most.
As a result, there's a risk that if BA.2 does lead to a wave, it could wreak unequal havoc. We worry that the "new normal" will be plentiful boosters and rapid, easy access to antivirals for the well-off, while the least-off are left behind.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Bartolomaus Muskala, MD, and Niek Vanquathem, BA
Abstract
BACKGROUND: Recently, externally powered spinal cord stimulation has been introduced for clinical use and has been shown to have good long-term outcomes in treating chronic back and leg pain (CBLP).
CASE REPORT: Twelve patients with CBLP of different etiologies were included in this case series. All patients underwent percutaneous implantation of a permanent spinal cord stimulator (SCS) device. All patients were programmed with a pulse rate of 1,499 Hz with a 32 μs wavelength and followed for up to 12 months.
CONCLUSION: Externally powered spinal cord simulation is a good option for debilitating back and/or leg pain.
KEY WORDS: Chronic back and leg pain, failed back surgery syndrome, high frequency, phantom limb pain, spinal cord stimulation, spinal deformity, wireless
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New edition now available! |
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| HEALTH SERVICES RESEARCH |
Laxmaiah Manchikanti, MD, Vanila Mathur Singh, MD, Peter S. Staats, MD, Andrea M. Trescot, MD, John Prunskis, MD, Nebojsa Nick Knezevic, MD, PhD, Amol Soin, MD, Alan D. Kaye, MD, PhD, Sairam Atluri, MD, Mark V. Boswell, MD, PhD, Alaa Abd-Elsayed, MD, and Joshua A. Hirsch, MD
Abstract
BACKGROUND: In the midst of the COVID-19 pandemic, data has shown that age-adjusted overdose death rates involving synthetic opioids, psychostimulants, cocaine, and heroin have been increasing, including prescription opioid deaths, which were declining, but, recently, reversing the trends. Contrary to widely held perceptions, the problem of misuse, abuse, and diversion of prescription opioids has been the least of all the factors in recent years. Consequently, it is important to properly distinguish between the role of illicit and prescription opioids in the current opioid crisis. Multiple efforts have been based on consensus on administrative policies for certain harm reduction strategies for individuals actively using illicit drugs and reducing opioid prescriptions leading to curbing of medically needed opioids, which have been ineffective. While there is no denial that prescription opioids can be misused, abused, and diverted, the policies have oversimplified the issue by curbing prescription opioids and the pendulum has swung too far in the direction of severely limiting prescription opioids, without acknowledgement that opioids have legitimate uses for persons suffering from chronic pain.
Similar to the opioid crisis, interventional pain management procedures have been affected by various policies being applied to reduce overuse, abuse, and finally utilization. Medical policies have been becoming more restrictive with reduction of access to certain procedures, with the pendulum swinging too far in the direction of limiting interventional techniques. Recent utilization assessments have shown a consistent decline for most interventional techniques, with a 18.7% decrease from 2019 to 2020.
The causes for these dynamic changes are multifactorial likely including the misapplication of the 2016 Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain, the relative ease of access to illicit synthetic opioids and more recently issues related to the COVID-19 pandemic. In addition, recent publications have shown association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids. These findings are leading to the hypothesis that federal guidelines may inadvertently be contributing to an increase in overall opioid deaths and diminished access to interventional techniques. Together, these have resulted in a fourth wave of the opioid epidemic.
METHODS: A narrative review.
RESULTS: The fourth wave results from a confluence of multiple factors, including misapplication of CDC guidelines, the increased availability of illicit drugs, the COVID-19 pandemic, and policies reducing access to interventional procedures. The CDC guidelines and subsequent regulatory atmosphere have led to aggressive tapering up to and including, at times, the overall reduction or stoppage of opioid prescriptions. Forced tapering has been linked to an increase of 69% for overdoses and 130% for mental health crisis. The data thus suggests that the diminution in access to opioid prescriptions may be occurring simultaneously with an increase in illicit narcotic use.
Combined with CDC guidelines, the curbing of opioid prescriptions to medically needed individuals, among non-opioid treatments, interventional techniques have been affected with declining utilization rates and medical policies reducing access to such modalities.
CONCLUSION: The opioid overdose waves over the past three decades have resulted from different etiologies. Wave one was associated with prescription opioid overdose deaths and wave two with the rise in heroin and overdose deaths from 1999 to 2013. Wave three was associated with a rise in synthetic opioid overdose deaths.
Sadly, wave four continues to escalate with increasing number of deaths as a confluence of factors including the CDC guidelines, the COVID pandemic, increased availability of illicit synthetic opioids and the reduction of access to interventional techniques, which leads patients to seek remedies on their own.
KEY WORDS: Opioid overdose deaths, rapid tapering, access to interventional techniques, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, Drug Enforcement Agency, Food and Drug Administration, conflicts of interest
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| SURVEY |
Rebecca Dale, DO, Logan Kinch, MD, Lynn Kohan, MD, Timothy Furnish, MD, Rene Przkora, MD, PhD, Shalini Shah, MD, Boris Spektor, MD, Shravani Durbhakula, MD, Manuel Lombardero, MS, and Scott Brancolini, MD
Abstract
BACKGROUND: The COVID-19 pandemic ushered in a shift to a video format for pain medicine fellowship interviews for the 2021-2022 academic year, which represented a major change in the fellowship interview paradigm.
OBJECTIVES: Our aim was to assess the experience of a video-only format in place of in-person interviews for Pain Medicine fellowship program directors and applicants after the 2020 fellowship interview season to determine the feasibility for continuation beyond COVID-19 travel restrictions.
STUDY DESIGN: Survey via Qualtrics.
SETTING: Academic pain medicine programs.
METHODS: A consortium of program directors converged to discuss methods for determining the effectiveness and future direction of the video format for pain medicine fellowship interviews. Two surveys were formulated, one targeting pain medicine fellowship program directors and the other for candidates interviewing for the year 2021-2022.
RESULTS: For applicants, 55 out of 170 responded for a response rate of 32.3%, and for program directors, 38 out of 95 responded for a response rate of 40%. Of the applicants, 45.7% stated that they would prefer video interviews, whereas 27.3% of program directors preferred video interviews. Savings of time and money were the most common reason for preferring video interviews.
LIMITATIONS: The number of pain fellowship applicants invited was limited to those who interviewed at a subset of pain fellowships, which may not have been representative of all pain fellow applicants.
CONCLUSIONS: The video format for pain medicine fellowship interviews was viewed positively by both candidates and program directors. We suspect that the video format alone or as a part of a hybrid model will become a routine method for the interview process in the future, given its time and cost benefits.
KEY WORDS: Video format interview, tele-interview, virtual interview, pain medicine fellowship
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Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Norcal Mutual is A-Rated by AM best and is licensed in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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up-to-date news related to you, your practice, and your patients!
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