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American Society of Interventional Pain Physicians News  | June 4, 2014




  1. Are Epidural Injections Efficacious and Safe? An Important Message from the ASIPP Board of Directors 
  2. Still Time to Register for the Spinal and Non-Spinal Interventional Techniques Review Course and Cadaver Workshop   
  3. We Successfully Challenged the Constitutionality of Washington's Health Technology Clinical Committee
  4. Healthcare and pharma cyber security rated worst in S&P 500
  5. Data discrepancies in health sign-ups
  6. Healthcare data breaches decline, but ACA could be increasing risks
  7. 'Vaporizers' Are the New Draw in E-Cigarettes
  8. FDA E-Cig Complaints Pile Up
  9. Medicare Frequently Overpays Doctors For Patients' Visits
  10. ASIPP Now Offers Animations to Enhance Your Communication and Marketing Needs
  11. Study Finds Nearly 29% of World Population Is Overweight or Obese
  12. Efforts to Curb College Costs Face Resistance
  13. State Society News 
  14. Physician Wanted 

epiduralsAre Epidural Injections Efficacious and Safe?

An Important Message from the ASIPP Board of Directors


The recent warning from the FDA that all epidural steroid injections pose a serious risk for neurological injury, paralysis and death is concerning. The FDA document also says that safety has not been demonstrated.


A systematic review published in Clinical Orthopeadics and Related Research by Manchikanti et al entitled "Do Epidural Injections Provide Short- and Long-term Relief for Lumbar Disc Herniation?" (Clin Orthop Relat Res 2014 Feb 11 published online first) concluded that the available evidence suggests that epidural injections performed under fluoroscopy by trained physicians offer improvement in pain and function in well-selected patients with lumbar disc herniation. The results showed strong evidence for short-term efficacy in multiple high-quality trials and moderate evidence for long-term efficacy in at least one high-quality trial. The authors also found that fluoroscopic caudal, lumbar interlaminar, and transforaminal epidural injections were efficacious at managing lumbar disc herniation in terms of pain relief and functional improvement.


A systematic review published in Pain Medicine by MacVicar et al (The effectiveness of lumbar transforaminal injection of steroids: a comprehensive review with systematic analysis of the published data. Pain Med 2013; 14:14-28) also reached similar conclusions.


In fact, even the most negatively viewed and referred systematic review by Pinto et al (Epidural corticosteroid injections in the management of sciatica: A systematic review and meta-analysis. Ann Intern Med 2012; 157:865-877) also showed short-term efficacy even though it did not find long-term efficacy. Pinto's highly flawed manuscript has been heavily criticized by multiple authors for its methodology and the inaccurate and inappropriate analysis which does not follow the design of a randomized trial. (Criticism - Nampiaparampil DE, Engel AJ. A response to two recent reviews of epidural steroid injections. Pain Med 2013;14:954-955; Manchikanti L, Falco FJE, Hirsch JA. Epidural corticosteroid injections in the management of sciatica. Ann Intern Med 2012;157:865-877;online comment posted March 29, 2013; Rothenberg HI. To the Editor re Pinto et al - Epidural corticosteroid injections in the management of sciatica: A systematic review and meta-analysis. Ann Intern Med 2012;157:865-877;online comment posted December 20, 2012). 


Essentially there is significant evidence that epidural injections provide short and long-term relief for lumbar disc herniation. There is also evidence that they provide short and long-term relief for cervical and thoracic disc herniation; lumbar, cervical and thoracic discogenic pain without facet joint pain or disc herniation; cervical and lumbar central spinal stenosis; and post surgery syndrome in the lumbar and cervical spine (http://www.painphysicianjournal.com/2013/april/2013;16;S49-S283.pdf).


It is essential for all interventional pain physicians to appraise and synthesize the evidence, and then get involved. Please read the manuscripts, conduct randomized controlled trials, and participate in evidence development.


If you need any of the full manuscripts please contact drlm@thepainmd.com




MeetingStill Time to Register for the Spinal and Non-Spinal Interventional Techniques Review Course and Cadaver Workshop 



This 2-day comprehensive review course and cadaver workshop on spinal interventional techniques (basic and intermediate levels) and non-spinal interventional techniques. Participants experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques.



This intensive review course in spinal and non-spinal interventional techniques is planned as a CME activity for interventional pain physicians-for review, skills improvement or to fullfil state board requirements for CME hours.



After this course, participants should be able to:

- Describe the delivery of multiple aspects of interventional pain management.

- Review multiple areas of interventional pain management including spinal and non-spinal techniques.

- Demonstrate skills through interactive hands-on cadaver workshop.



Physicians should be able to integrate multiple aspects of spinal and non-spinal techniques in interventional pain management in treating their patients so that patients have better outcomes and reduced side effects.






212 N. Kingshighway, St. Louis, MO 63108 - (877) 587-2427

 Be sure to ask for the ASIPP room block when booking your room.


CLICK HERE for Brochure


CLICK HERE to Register

WeWe Successfully Challenged the Constitutionality of Washington's Health Technology Clinical Committee



Few people have ever heard of Washington's Health Technology Clinical Committee, or HTCC. Here's a quick overview: It's a committee of unelected individuals given the power to evaluate health technologies and determine whether participating Washington state agencies may lawfully cover them. HTCC decisions carry the force of law. The decisions affect the health care of hundreds of thousands, if not more than a million, Washingtonians.


Despite having this breathtaking power over matters of health-matters of life and death-the law establishing the HTCC rendered the committee totally unaccountable. Avenues for reviewing HTCC decisions were explicitly foreclosed. When the HTCC disfavored a technology, regardless of whether its decision was right or wrong, it meant that courts and participating agencies were prohibited from considering whether the technology was "medically necessary, or proper and necessary treatment" in the case of the individual patient. RCW 70.14.120(3)





HealthcareHealthcare and pharma cyber security rated worst in S&P 500



Healthcare and pharmaceutical companies have the worst cyber security among Standard & Poor's (S&P) 500, and could suffer from wide-scale security breaches in 2014 similar to those experienced by retail companies such as Target and Neiman Marcus, according to a recent report.


BitSight Technologies, a securities ratings company, examined the cyber health of companies on the S&P 500, and found that 82% had been victims of some sort of security breach. Healthcare and pharmaceutical companies ranked the lowest among the four industry categories studied, because of its high volume of incidents and slow response times.


The finance industry ranked best in cyber security, followed closely by the utilities industry. The retail industry, which was rated with a poor performance, came in third. The finance industry has made cyber security a priority and a part of business operations, which led to it outperforming other sectors, according to the study.


Medical Economics 

discrepenciesData discrepancies in health sign-ups


 More than 2 million people who got health insurance under President Barack Obama's law have data discrepancies that could jeopardize coverage for some, a government document shows.


About 1 in 4 people who signed up have discrepancies, creating a huge paperwork jam for the feds and exposing some consumers to repayment demands, or possibly even loss of coverage, if they got too generous a subsidy.


The 7-page slide presentation from the Health and Human Services department was provided to The Associated Press as several congressional committees are actively investigating the discrepancies, most of which involve important details on income, citizenship and immigration status.



Yahoo News 

dataHealthcare data breaches decline, but ACA could be increasing risks


Changes to the Health Insurance Portability and Accountability Act (HIPAA) in 2012 made business associates of HIPAA-covered businesses also responsible for safeguarding protected health information. But nearly three-quarters of survey respondents said they were "not confident" or only "somewhat confident" that their business associates could detect a data breach incident, perform an incident risk assessment, and notify them as required under a HIPAA business associate agreement. While most of the causes of breaches have stayed fairly consistent over the four years in which the survey has been conducted, only 20% of respondents reported a criminal attack in 2010, compared with 40% in 2013.


Medical Economics  


vapors 'Vaporizers' Are the New Draw in E-Cigarettes



The fastest growth in e-cigarettes comes from devices called 'vaporizers' sold in specialty shops like Popie's Vapor Lounge, in Marlton, N.J. Will Figg for The Wall Street Journal


ATLANTA-VapeRite, a specialty store in a strip mall here, represents the latest rage in electronic cigarettes and the newest headache for Big Tobacco: Do-It-Yourself.


Shelves are crammed with more than 100 flavored liquids with names like Purple Haze, Red Riding Hood and Cherry Cola, alongside gadgets like refillable cartridges, heating coils and liquid drippers that customers can use to build their own e-cigarettes.


Wall Street Journal 


Access to this article may be limited



DeviFDA E-Cig Complaints Pile Up


NYU School of Medicine associate professor Dr. Devi Nampiaparampil (Dr. Devi) discusses the possible side effects of e-cigs and casual marijuana use. on the Fox Business Network's "Money with Melissa Francis" 

  Click here to watch Dr. Devi's Video Clip  

MedicareMedicare Frequently Overpays Doctors For Patients' Visits


Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a report from the inspector general of the Department of Health and Human Services.


But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most expensive visits because it isn't cost-effective to do so.


The inspector general's report, released today, estimates that overpayments account for 21 percent of the $32.3 billion spent on evaluation and management services in 2010. The evaluation and management category includes office visits, emergency room assessments and inpatient hospital evaluations.



NPR News  

ASIPPASIPP Now Offers Animations to Enhance Your Communication and Marketing Needs


ASIPP Marketing Services (AMS) is now a reseller of View Medica Pain Management procedure animations. Procedure animations can be used on ASIPP-TV24 in your waiting room, your web site, and/or hand held devices in consultations with your patients. These high-quality, low-cost animations can be purchased through ASIPP by contacting Ray Lane at rlane@asipp.org or 270-554-9412. ext. 220. 


study Study Finds Nearly 29% of World Population Is Overweight or Obese


The obesity epidemic is global: 2.1 billion people, or about 29% of the world's population, were either overweight or obese in 2013, and nearly two out of three of the obese live in developing countries, according to a study released Thursday.


The prevalence of overweight and obese people rose by 27.5% for adults and 47.1% for children between 1980 and 2013, according to the study, led by researchers at the Institute for Health Metrics and Evaluation at the University of Washington and published Thursday in the journal the Lancet. In 1980, 857 million people were overweight or obese.



The Wall Street Journal 

Effort Efforts to Curb College Costs Face Resistance



WASHINGTON-Obama administration initiatives intended to help restrain soaring college costs are facing resistance from schools and from a bipartisan bloc of lawmakers looking to protect institutions in their districts.


Groups representing colleges and universities this week formally opposed the administration's plan to more tightly oversee programs that officials say leave students in steep debt but with weak job prospects. The new rules cover for-profit schools along with career-training programs-those that lead to certificates, but not degrees, in a given field, such as mechanics or cosmetology-at public schools and nonprofits. A bipartisan group in Congress is seeking ways to kill the plan, which the administration wants to have in place by November.




The Wall Street Journal 


Access to this article may be limited.

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stateState Society News


CASIPP to Hold Annual Meeting on September 12-14 


The California Society of Interventional Pain Physicians will hold its 2014 Annual Meeting September 12-14 at the Terranea Resort (www.terranea.com) in Rancho Palos Verdes, CA.


For more information, go to www.casipp.com


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


adsPhysicians Wanted


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Fax: (270) 554-5394



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