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American Society of Interventional Pain Physicians News  | October 8, 2014


  1. FDA Schedules Public Hearing on Epidural Steroids on Nov. 24: ASIPP Files Citizen Petition with FDA Regarding Safety Warning
  2. Conflicting Opioid Guidelines Released by Government and Non-Government Organizations 
  3. Intermediate Level Cadaver Workshops Spaces Still Available for the October Orlando Meeting
  4. ASIPP Launches Career Center to Connect Job Seekers and Employers in Interventional Pain Management
  5. ICD-10 Preparation Webinar Set for Nov. 4
  6. One Year Later: The Affordable Care Act's Launch on October 1, 2013--So How Did it Go?  
  7. Congressman Michael C. Burgess, M.D. announced the launch of STAT Initiative
  8. Heroin Deaths Still Rising, CDC Says 
  9. Loud, Startling Noises May Lead to Knee Injuries 
  10. Wal-Mart to End Health Insurance for Some Part-Time Employees  
  11. Sunshine Act Database Debuts to Skepticism 

Congressional Support Flooding in for ASIPP's Stance Against Epidural Cuts


Since our last update regarding the reversal of fluoroscopy bundling with epidural codes in the 2015 fee schedule, which will create major cuts to epidural reimbursements, we have received two additional Congressional letters of support, one from Minority Leader,  Sen. Mitch McConnell (R-KY) on Oct. 2 and another from  Rep. Gene Green (D-TX) on Oct. 3.


These two letters were preceded by a bipartisan Senate letter  from the Appropriations Committee signed by Senator Mark Pryor (D-AR), Senator John Boozman (R-AR), and Senator Roy Blunt (R-MO). In addition, a strong bipartisan letter with request for reversal of cuts signed by 13 members of the House Energy Commerce Committee. The letter was led by Vice Chair of the Health Subcommittee, Congressman Michael Burgess, MD (R-TX).


We continue to work for additional letters from both the Senate and House are expected within the next week. To learn more about the issue, read the Pain Physician Journal article, Reversal of Epidural Cuts in 2015 Physician Payment Schedule: Two Steps Forward One Step Back: http://www.ncbi.nlm.nih.gov/pubmed/25247906

FDA Schedules Public Hearing on Epidural Steroids on Nov. 24

ASIPP Files Citizen Petition with FDA Regarding Safety Warning


As you know, ASIPP has filed an FDA Citizen Petition requesting the Commissioner withdraw the present Safety Warning for steroid epidural injections. 


As we work to resolve this issue, it is important to discuss the advantages and disadvantages with our patients, explaining to them this is a common off-label use, which we have been doing for some time in our practices. You can also submit comments to FDA on the Regulations.gov Web site: http://www.regulations.gov/#!documentDetail;D=FDA-2013-S-0610-0001


ASIPP will attend and has requested the opportunity to provide a presentation during the public comment section of the FDA Advisory Committee meeting on epidural steroid injections, on November 24, 2014.


For more information on this the following references will be helpful:


Health Policy Opinion: Epidural Steroid Injections Safety Recommendations by the Multi-Society Pain Workgroup (MPW): More Regulations Without Evidence or Clarification Click HERE TO READ


Health Policy Review: Epidural Steroid Warning Controversy Still Dogging FDA Click HERE TO READ


Letter to the Editor: The Food and Drug Administration's Recent Action on April 23, 2014 Failed to Appropriately Address Safety Concerns about Epidural Steroid Use Click HERE TO READ


We have also created a fact sheet or your reference.


Conflicting Opioid Guidelines Released by Government and Non-Government Organizations


Below you will find links to three conflicting guidelines on opioids released by the Agency for Healthcare Research and Quality (AHRQ) the National Institutes for Health (NIH) and  the American Academy of Neurology:




The National Institutes of Health has released a panel draft report  titled Pathways to Prevention: The Role of Opioids in the Treatment of  Chronic Pain.


The draft report from the NIH Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain is now available online. Comments will be accepted through October 17, 2014.




Chronic pain is a major public health problem, which is estimated to affect more than 100 million people in the United States and about 20-30% of the population worldwide. The prevalence of persistent pain is expected to rise in the near future as the incidence of associated diseases (including diabetes, obesity, cardiovascular disorders, arthritis, and cancer) increases in the aging U.S. population.

Opioids are powerful analgesics which are commonly used and found to be effective for many types of pain. However, opioids can produce significant side effects, including constipation, nausea, mental clouding, and respiratory depression, which can sometimes lead to death.

In addition, long-term opioid use can also result in physical dependence, making it difficult to discontinue use even when the original cause of pain is no longer present. Furthermore, there is mounting evidence that long-term opioid use for pain can actually produce a chronic pain state, whereby patients find themselves in a vicious cycle, where opioids are used to treat pain caused by previous opioid use.





AHRQ releases Evidence Report/ Technology Assessement on The Effectiveness and Risks of Long-Term Opioid Treament of Chronic Pain


Structured Abstract

Objectives. Chronic pain is common and use of long-term opioid therapy for chronic pain has increased dramatically. This report reviews the current evidence on effectiveness and harms of opioid therapy for chronic pain, focusing on long-term (>1 year) outcomes.

Data sources. A prior systematic review (searches through October 2008), electronic databases (Ovid MEDLINE, Scopus, and the Cochrane Libraries January 2008 to August 2014), reference lists, and clinical trials registries.

Review methods. Using predefined criteria, we selected randomized trials and comparative observational studies of patients with cancer or noncancer chronic pain being considered for or prescribed long-term opioid therapy that addressed effectiveness or harms versus placebo, no opioid use, or nonopioid therapies; different opioid dosing methods; or risk mitigation strategies. We also included uncontrolled studies >1 year that reported rates of abuse, addiction, or misuse, and studies on the accuracy of risk prediction instruments for predicting subsequent opioid abuse or misuse. The quality of included studies was assessed, data were extracted, and results were summarized qualitatively.

Results. Of the 4,209 citations identified at the title and abstract level, a total of 39 studies were included. For a number of Key Questions, we identified no studies meeting inclusion criteria.

Where studies were available, the strength of evidence was rated no higher than low, due to imprecision and methodological shortcomings, with the exception of buccal or intranasal fentanyl for pain relief outcomes within 2 hours after dosing (strength of evidence: moderate). No study evaluated effects of long-term opioid therapy versus no opioid therapy. In 10 uncontrolled studies, rates of opioid abuse were 0.6 percent to 8 percent and rates of dependence were 3.1 percent to 26 percent in primary care settings, but studies varied in methods used to define and ascertain outcomes. Rates of aberrant drug-related behaviors ranged from 5.7 percent to 37.1 percent. Compared with nonuse, long-term opioid therapy was associated with increased risk of abuse (one cohort study), overdose (one cohort study), fracture (two observational studies), myocardial infarction (two observational studies), and markers of sexual dysfunction (one cross-sectional study), with several studies showing a dose-dependent association. One randomized trial found no difference between a more liberal opioid dose escalation strategy and maintenance of current dose in pain or function, but differences between groups in daily opioid doses at the end of the trial were small. One cohort study found methadone associated with lower risk of mortality than long-acting morphine in a Veterans Affairs population in a propensity adjusted analysis (adjusted HR 0.56, 95 percent CI 0.51 to 0.62). Estimates of diagnostic accuracy for the Opioid Risk Tool were extremely inconsistent and other risk assessment instruments were evaluated in only one or two studies. No study evaluated the effectiveness of risk mitigation strategies on outcomes related to overdose, addiction, abuse, or misuse. Evidence was insufficient to evaluate benefits and harms of long-term opioid therapy in high-risk patients or in other subgroups.


CLICK HERE to read guidelines.



American Academy of Neurology 


Opioids for chronic noncancer pain

A position paper of the American Academy of Neurology



The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.


CLICK HERE for full report





Intermediate Level Cadaver Workshops Spaces Still Available for the October Orlando Meeting



This 1-day workshop is designed for interventional pain physicians, for a review, skills improvement, or to assist in preparation for Comprehensive Interventional Pain Management Examination qualifications. ASIPP offers the most in-depth, comprehensive, and individualized programs available in interventional pain management, featuring maximum hands-on training with cadavers in a state-of-the-art facility and maximum ability to interact with other participants. 



Participants will experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques.

  • Each cadaver station is limited to a maximum of 7 participants.
  • Participants can choose the level of participation: basic, intermediate, or ABIPP Preparation
  • C-arms and state-of-the-art equipment are utilized in this course. Participants are requested to dress in casual attire or scrubs. Leaded aprons and thyroid shields will be provided. However, participants are advised to bring their own protective eyewear.
  • Participants will be provided with 7 video lectures relevant to the course material


Click HERE to register




 ABIPP Part I Examination- Application 





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careerASIPP Launches Career Center to Connect Job Seekers and Employers in Interventional Pain Management


The American Society of Interventional Pain Physicians (ASIPP) today announced the launch of the ASIPP Job Board, a new online career center designed specifically to connect employers and talent in the field of Interventional Pain Management.   


The ASIPP Job Board is powered by JobTarget, the leading provider of job websites and career centers for organizations that serve niche audiences.  It can be found at http://jobs.asipp.org/home/  and can be accessed by ASIPP members and non-members alike.  


Members use coupon code "20Member" to receive 20% off the listed prices for job postings.


icd10ICD-10 Preparation Webinar Set for Nov. 4



  • Background on ICD-10
  • Technology readiness to make sure the products are ready
  • The new 'Road to 10' tool to create a custojmized action plan for ICD-10
  • Key steps to ensure a successful transition
  • Resources to help with a smooth implementation
  • Discover the top ICD-10 areas likely requiring documentation updates for pain management providers
  • Technology readiness to make sure the products are ready
  • What are the testing procedures needed with payers
  • Practice determining the correct ICD-10 diagnosis codes in common pain management conditions


WEBINAR FEE:   $175     

WEBINAR DATE: November 4, 2014  

TIME:   11:00am-12:30am CST


LENGTH: 90 Minutes


Marvel J Hammer, RN, BS, CPC, CCS-P,  ACS-PM, CPCO   


Click HERE to register:



One Year Later: The Affordable Care Act's Launch on October 1, 2013--So How Did it Go?

Here unedited is what I posted on September 29, 2013: 

The Affordable Health Care Act's Launch On October 1st--So How Did it Go?

Unavoidably, that will be the big question come Tuesday.

But there will be much more to it than that.



Health Care Policy and Market Place



burgessCongressman Michael C. Burgess, M.D. announced the launch of STAT Initiative



The critical goal of the STAT initiative is to get more healthcare professionals involved in the political process.  Dr. Burgess ran for office because he hoped to be a voice for health care.  What he's quickly realized is that in order to affect change, there needs to be a greater presence of experts. STAT's mission is not only to educate on the importance of getting involved, but also to encourage those that are active to become more involved.  They hold the key to making the necessary changesthe future of health care in our country.


Dr. Burgess' op-ed in the  Washington Times gives you a sense of his passion for the STAT InitiativeTo read more about the effort, Roll Call has the story here


Heroin Deaths Still Rising, CDC Says


More data from the CDC are pointing to an increase in heroin overdose deaths.


A new report from the agency's National Center for Injury Prevention and Control (NCIPC) showed that heroin death rates doubled from 2010 to 2012 -- from 1.0 to 2.1 per 100,000 people, Len Paulozzi, MD, MPH, of the CDC, and colleagues reported in Morbidity & Mortality Weekly Report.


The report is based on data from only 28 states, representing 56% of the population. But it's consistent with nationwide data from the National Center for Health Statistics that heroin overdose deaths have been increasing.



MedPage Today


Loud, Startling Noises May Lead to Knee Injuries


Loud, startling noises may increase the risk of knee injury, says a study published online in the Scandinavian Journal of Medicine & Science in Sports.


Honking horns, sirens and other sudden noises can disrupt circuits in the brain controlling muscles and ligaments that stabilize the knee, causing people to trip and fall, researchers suggest. Buzzers and shouting during sports competitions could affect athletes who normally have good balance and muscular control, they said.


An estimated 250,000 sprains and tears to the anterior cruciate ligament, which is essential for normal knee function, are reported every year in the U.S., according to the Centers for Disease Control and Prevention. Researchers suggest some ACL injuries are likely due to a noise-induced startle response in the central nervous system that results in coordination errors.



Wall Street Journal


Access to this article may be limited.
Wal-Mart to End Health Insurance for Some Part-Time Employees

Wal-Mart is cutting health insurance for some of part-time workers in an attempt to curtail rising costs, Shelly Banjo reports on the News Hub with Sara Murray. Photo: Getty.


Wal-Mart Stores Inc. WMT -0.06% is cutting health insurance for another 30,000 part-time workers and raising premiums for its other employees, as U.S. corporations push to contain costs in the wake of the federal health-care law.


Autumn is typically when U.S. companies unveil changes to employee insurance plans. This is the first such enrollment period since employers could assess the full financial impact of the federal health-care overhaul, and it is a key moment as companies work to lower their spending ahead of looming taxes on the most generous plans.



Wall Street Journal


Access to this article may be limited.
sunshineSunshine Act Database Debuts to Skepticism


WASHINGTON -- Medical groups and health policy experts were cool to the debut of the Open Payments database showing payments made by drug and device companies to physicians and other healthcare professionals.


The database, which the Centers for Medicare and Medicaid Services (CMS) opened to the public on Tuesday, provides some details on $3.5 billion in drug- and device-related payments to doctors. The payments, which span only the last 5 months of 2013, are for consulting, research, travel expenses, and other purposes and were made to 546,000 physicians and nearly 1,360 teaching hospitals.



MedPage Today

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Save the Date: NY/NJ Chapters Schedule Pain Medicine Symposium


The New York and New Jersey Societies of Interventional Pain Physicians' 2014 Pain Medicine Symposium will be held on November 6 - 9, 2014 at the Hyatt Regency Jersey City in New Jersey.


More information will be available soon.



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


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