American Society of Interventional Pain Physicians News  | November 26, 2014


      1. Fate of Epidural Steroid Injections Hangs in the Balance: Drs. Manchikanti, Candido, and Others Testify in FDA Hearings Continue
      2. Register Now Open for ASIPP's 17th Annual Meeting
      3. Health Policy Article Addresses IT issues facing IPM Physicians
      4. Health Policy Article Addresses Electronic Medical Record Police
      5. Affordable Care Act in the News
      6. Just a Few More Participants Needed for Physician Survey on Epidural Steroid Injections 
      7. ASIPP Hosting Ultrasound for Non-spinal Techniques Review and Hands-on Workshop in Vegas 
      8. How to Arrive at the Best Health Policies 
      9. Pricey Generics Draw Senate Scrutiny 
      10. Study Shows Opioid Agonist Therapy May Prevent Spread of Hepatitis C Among Young Injection Drug Users 
      11. ASIPP Webinar: Coding Navigating 2015 Changes set for Dec. 18
      12. Doctor-Shortage Projections Challenged  
      13. Lawmakers Look for Ways to Provide Relief for Rising Cost of Generic Drugs 
      14. FDA Approves New Extended-Release, Abuse-Resistant Hydrocodone Product 
      15. Wild 'n Crazy Workflow Fixes 
      16. Submit Your Abstract Today for 17th Annual Meeting Abstract Session 

Panel Rejects Sternest FDA Warning for Steroid Shots: Drs. Manchikanti, Candido, and Others Testify in FDA Hearings Continue 

An expert advisory panel to the U.S. Food and Drug Administration decided on Tuesday not to recommend the agency issue a strong warning against the general use of steroid injections for back pain.  


As you know on April 23, 2014, the FDA issued a warning on epidural steroid injections warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death and also a lack of efficacy statement. On Nov. 24-25, the Anesthesia and Analgesic Drug Products Advisory Committee met to discuss the following regulatory perspectives for epidural steroid injections:

  •     Addition of a contraindication
  •     Addition of a boxed warning
  •     Modification of the warning statement
  •     Maintain the prescribing information as it currently reads

On Monday, Nov. 24, the open public comment portion of the meeting began with Dr. Laxmaiah Manchikanti providing testimony on behalf of Drs. David Bryce and ASIPP. Click on the following links to view Dr. Manchikanti's presentations: Manchikanti Presentation 1 & Manchikanti Presentation 2 


Directly following Dr. Manchikanti's presentation Dr. Kenneth Candido presented on behalf of Mahendra Sanapati. Click on the following link for Dr. Candido's presentation. Several ASIPP members spoke at the meeting, including, Drs. Scott Glaser, Harold Dalton, Kenneth Zahl, Roland Chalifoux.


Others testifying against the FDA regulation included: Dr. John Dombrowski on behalf of American Society of Anesthesiologists, Dr. Ray Baker on behalf of ISIS and David J. Kennedy on behalf of NASS testified against the warning, but in favor of 17 regulations proposed by Multi-Society Pain Workgroup in contrast to ASIPP speakers who testified against existing the warning as well as existing warning with its removal and against 17 recommendations by Multi-Society Pain Workgroup.


The meeting continued on Tuesday, Nov. 25 in a private session with committee members discussing their understanding of the evidence of the benefits and risks and ultimately voting on the recommendations. See Questions

In considering if the FDA should require labels for epidural injections to carry a called contraindication, the toughest federal warning, the panel agreed that the wording was too broad. With a contraindication being a situation in which the risk outweighs any possible therapeutic benefit. They then asked if there were any clinical situations in which the risks of steroid injections were greater than the benefits. The majority of the panel voted yes (15 to 7). Nearly everyone who did so explained that the choice was made based on evidence showing the risks of cervical transforaminal ESIs, a far narrower category of treatment. Additionally they voted in favor of contraindication for particulate steroids for epidural injections because they appear to carry greater risk of adverse neurological effects than nonparticulate agents.


These early reports are encouraging but we will keep our members posted as more information unfolds.


 New York Times Article 


MedPage Today 


FDA Advisory Committee Meeting Material  


Click HERE to hear and view original testimony.


annualRegister Now Open for ASIPP's 17th Annual Meeting



 April 9-11, 2015 | Loews Royal Pacific Resort at Universal Orlando® | Orlando, Florida



The American Society of Interventional Pain Physicians' (ASIPP) 17th Annual Meeting, Embrace the Future: Survival Strategies for Interventional Pain Management, in collaboration with the Florida Society of Interventional Pain Physicians will take place in Orlando, Florida on Thursday, April 9 through Saturday, April 11, 2015 at the Loews Royal Pacific Resort at Universal Orlando® Loews Royal Pacific Resort at Universal Orlando®.


This year's program should prove to be one of the most exciting, enriching, and memorable of any meeting we have ever held. This year's educational events will include evidence-based medicine , practice management, drug therapy, refinement in evidence synthesis, advocacy in IPM, abstract presentations, Resident/Fellow session for emergence into practice, and much more.


The meeting will feature: 

  • John J. Nance: New York Times Best-Seller Author, ABC Analyst, Professional Speaker, & Consultant
  • Dr. Devi Nampiaparampil: Physician, Researcher, and Assistant Professor at NYU School of Medicine 
  • P. Christopher Music:Best-Selling Author, International Speaker, and Financial Prosperity Coach
  • Laxmaiah Manchikanti, MD: Chairman of the Board and Chief Executive Officer, ASIPP and SIPMS 

Lecture Series Highlights:



Thursday: Manchikanti Distinguished Lecture Series

Surviving the Affordable Care Act Earthquake: Implications and Survival Strategies for Interventional Pain Management

Speaker: John J. Nance (





Friday: Raj-Racz Distinguished Lecture Series

IPM in the Age of Explosive Information Technology and Media:  Is it Indispensable or Irrelevant

Devi E. Nampiaparampil, MD ( )





Click HERE to Register



Health Policy Article Addresses Electronic Medical Record Polices


Metamorphosis of Medicine in the United States: A Carrot and Stick Policy of Electronic Medical Records

Pain Physician November/December 2014; 17:E671-E680


With rising tides of information technology (IT) sweeping through medical practices, electronic medical records (EMRs) or electronic health records (EHRs) are the number one and most complex issue for all medical professionals, specifically independent practitioners. In fact, Dentzer reported that many fans of the American Recovery and Reinvestment Act (ARRA) or the "stimulus" package, enacted in February 2009 might not realize how much went to health care. For each $5 in 2009 ARRA spending, $1 was allocated to the health sector, mainly health IT. The primary interest of policy makers and a key provision was the Health Information Technology for Economic and Clinical Health (HITECH) Act, aimed at bringing US health care more fully into the so-called information age. Policy makers, supporters of EMRs, and IT providers and people managing information technology in health care continue to tout the advantages of EMRs, including improved care and cost savings. However, the transition to electronic medical records has been very expensive and resulted in a variety of challenges.


This manuscript explores how electronic medical or health records are leading the metamorphosis of contemporary and independent medical practice, along with implications for the future of health care in the United States with incentive programs and financial penalties utilizing a carrot and stick policy. 


Click HERE to read entire manuscript

Health Policy Article Addresses IT issues facing IPM Physicians


Metamorphosis of Medicine in the United States: Is Information Technology a White Knight or Killer Whale?
Pain Physician November/December 2014: 17: E663-E670.


Health care reform movement aspires to provide cost effective, high-quality health care for most Americans. The Affordable Care Act was designed to be a comprehensive approach affecting the character, function and appearance of health care delivery. Sadly, the toxic environment of contemporary politics and policies continue to hinder the debate on optimized health care delivery and what that should cost. At times it appears that the health care conundrum has become a surrogate for all the problems of the country.


The debate has always focused on cost drivers, often inappropriately with the conventional wisdom citing the aging demographic trends and overuse of services in a fee-for-service environment as primary drivers. In contrast, 3 important cost drivers - information technology (IT), consolidation, and the patient consumer movement have often been ignored. The Patient Protection and Affordable Care Act (ACA), or ObamaCare, hoped to achieve the laudable triple aim of improving the individual experience of care, improving the health of the population, and reducing the per capita costs of care for various populations. The American Recovery and Reinvestment Act (ARRA) of 2009 which preceded the ACA, was heavily focused on IT for implementation and improving quality. However, multiple barriers to IT adoption in health care have been described. Many of these include issues related to technology development and costs. Technology entrepreneurs do not necessarily address the issues at hand by identifying a problem and working to solve that problem. 


Click HERE to read entire manuscript.




House G.O.P. Files Lawsuit in Battling Health Law


WASHINGTON - House Republicans filed a long-threatened lawsuit Friday against the Obama administration over unilateral actions on the health care law that they say are abuses of the president's executive authority.

The lawsuit - filed against the secretaries of Health and Human Services and the Treasury - focuses on two crucial aspects of the way the administration has put the Affordable Care Act into effect. The suit accuses the Obama administration of unlawfully postponing a requirement that larger employers offer health coverage to their full-time employees or pay penalties. (Larger companies are defined as those with 50 or more employees.)


NY Times


Fallout From Gruber's Remarks Spreads


WASHINGTON-The fallout over comments made by a Massachusetts Institute of Technology economist about the Affordable Care Act has spread to the states, where both Republicans and Democrats are pulling back from a man who sold his expertise about health systems.

Vermont said it won't continue to pay Jonathan Gruber for his work on its health-insurance plan, which aims to create universal coverage financed with public funds. Michigan lawmakers said they plan to investigate work he did for that state.

Meantime, some Republicans in Washington are calling on Mr. Gruber to return some or all of the more than $6 million he and associates received in federal and state grants and contracts since 2000, under the Obama and Bush administrations, because they say the veracity of his findings is in question.


Wall Street Journal


Access to this article may be limited. 



Just a Few More Participants Needed for Physician Survey on Epidural Steroid Injections


A survey is being conducted to support a study on the technical performance of epidural steroid injections.


The benefit of completing this survey will be a peer-reviewed publication of the group data that informs the clinical community of the current practices that relate to performance of epidural steroid injections. 


Click on the following link to take the survey:


The survey takes about 5-10 minutes to complete. 


The study has been approved by the Institutional Review Board of NYU School of Medicine. 


vegasASIPP Hosting Ultrasound for Non-spinal Techniques Review and Hands-on Workshop in Vegas

The Ultrasound for Non-spinal techniques Review and Hands-on Workshop will be Feb. 27, 2015 and the Hands-on Cadaver Workshop for IPM with be Feb. 28 - March 1, 2015


The course will have three levels: Basic, Intermediate, and ABIPP Exam Preparation (Advanced) plus online Videos and Presentations.




Room block:

The Venetian

3355 South Las Vegas Boulevard

Las Vegas, NV 89109

Phone: 702-414-1000


Click HERE to register



How to Arrive at the Best Health Policies


When the 48-year-old man from Oregon didn't have insurance, he felt he had no place to go but the emergency room. The man, who has diabetes, went to the emergency room often when he suffered from kidney stones. "Emergency rooms, from what I understand, they can never turn you away," he said. "I mean, you don't have much options when you don't have insurance."


Then, when he enrolled in the state of Oregon's Medicaid plan, that all changed. He started seeing doctors in their offices, and stayed away from the emergency room: "I have had five appointments with my primary, one with the diabetic because they had me go to a diabetic educator, and then an appointment with my pharmacist, and then he does a phone-in thing with me every two weeks."



New York Times


Pricey Generics Draw Senate Scrutiny


Robert Frankil, RPh, was dismayed when a customer accused him of price gouging. The cost of the customer's congestive heart failure medication, digoxin, had risen from $15 last year to $120 in 2014.


"I had nothing to do with the price spike, and I couldn't do anything about it," he said.


Frankil, the president of Sellersville Pharmacy, in Sellersville, Penn., said the recent price increase in many generic drugs has also hurt his business, since pharmacy benefit managers often reimburse Frankil at the lower "pre-spiked" rate. This means Frankil is forced to decide between refusing to fill a drug order or accepting the losses.



MedPage Today


Study Shows Opioid Agonist Therapy May Prevent Spread of Hepatitis C Among Young Injection Drug Users


Researchers have found that maintenance treatment with methadone or buprenorphine may help prevent hepatitis C infection among injection drug users, a population with the highest risk of infection of the virus.
Opioid agonists such as buprenorphine are medications prescribed to treat opioid addiction. At low doses buprenorphine produces sufficient agonist effect to allow opioid-addicted individuals to stop misuse of opioids without experiencing withdrawal symptoms, according to the National Alliance of Advocates for Buprenorphine Treatment.


HCP Live


webinarASIPP Webinar: Coding Navigating 2015 Changes set for Dec. 18


ASIPP is hosting a billing and coding webinar titled "Coding Navigating 2015 Changes" on Dec. 18 from 11 am to 1230 pm. Speaker will be Marvel Hammer, RN, BS, CPC, CCS-P, ACS-PM, CPCO. Cost for the webinar is $185.


This webinar will address:

  • CPT code updates including all of the new injection procedure codes that include image guidance such as joint injection and vertebroplasty / kyphoplasty procedures.
  • It will also include all the CPT code changes and new guidelines for drug screen testing both presumptive (aka qualitative) and definitive (aka confirmation or quantitative).
  • Review the OIG Workplan for 2015 and what it includes for interventional pain management providers.
  • Changes to the Medicare Physician Fee schedule, i.e. bundling of fluoroscopy with the interlaminar and caudal epidural injection procedures.
  • What interventional pain management practices should know about the changes for Medicare's PQRS reporting requirements for 2015
  • Review the Interventional Pain Management applicable CPT Assistant publications over the past year.

Click HERE to register

challengeDoctor-Shortage Projections Challenged

Is the nation really facing a serious shortage of doctors, particularly those who practice primary care?

Many medical groups, led by the Association of American Medical Colleges, say there's little doubt. "We think the shortage is going to be close to 130,000 in the next 10 to 12 years," said Atul Grover, the group's chief public policy officer.


But others, particularly healthcare economists, are less convinced. "Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common," wrote an expert panel of the Institute of Medicine (IOM) in a report on the financing of graduate medical education in July. "The committee did not find credible evidence to support such claims."


Medical Practice Insider


Lawmakers Look for Ways to Provide Relief for Rising Cost of Generic Drugs


With the prices for some common generic medicines soaring over the past 18 months, state and federal lawmakers are trying to find relief for patients struggling to pay.


On Thursday, a Senate panel convened to investigate price increases for generic drugs. Separately, Senators Amy Klobuchar and John McCain will revive stalled legislation to allow some prescription imports from Canada. And Maine is testing out a hotly contested new law that allows its residents to buy drugs from overseas, flouting United States policy.


New York Times


FDA Approves New Extended-Release, Abuse-Resistant Hydrocodone Product


On Nov. 20 the US Food and Drug Administration (FDA) Hysingla ER (hydrocodone bitartrate), an extended-release (ER) opioid analgesic to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
Manufactured by Purdue Pharma LP using the Resistec proprietary extended-release solid oral platform, Hysingla is the first and only hydrocodone product to be recognized by the FDA as having abuse-deterrent properties that are expected to deter misuse and abuse via chewing, snorting and injection. However, according to Purdue, abuse of Hysingla ER by the intravenous, intranasal, and oral routes is still possible.






Wild 'n Crazy Workflow Fixes


Workflow is something everyone wonders about; could it be better? Physician practices have typically modified existing workflow and processes as needs arise. Usually we add on a new task, or insert a new activity to fit the need.


To truly improve workflow, it is time to get wild and crazy. Think about blowing up the "way we've always done it" to create a new workflow to gain efficiency, rather than trying to create efficiency by modifying an old workflow.



Med Page Today


Join Our Mailing List!

Submit Your Abstract Today for 17th Annual Meeting Abstract Session


Make your plans now to participate in the American Society of Interventional Pain Physicians abstract and poster presentation at the 17th Annual Meeting, April 9-11 in Orlando Florida.


This year's abstract session will be bigger and better. In response to your many suggestions, the top 20 posters will be on  display through our new  electronic poster presentations with Q & A time with poster presenters. They will also be published in Pain Physician journal.


In addition the Top 8 posters will be presented for judging during Friday's session. The top three abstracts will receive cash prizes.


Posters will be on display during the meeting on both Thursday and Friday in the exhibitor hall.


The abstract submission deadline will be February 6, 2015.



For a complete set of rules and to access the online submission application, please go to:


stateState Society News



FSIPP Annual 2015 Meeting a Huge Success



In 2015 we will be having our FSIPP Annual Meeting in association with ASIPP.  The meeting will be held in Orlando at the Lowe's Royal Pacific Resort, Universal, on April 9, 10, 11, 12 of 2015.  We anticipate several hundred participants and   expect the educational agenda to blow your mind.  Link here:



Save The Date! CASIPP Meeting set for October 2015



The 2015 Annual Meeting of the California chapter of the American Society of Interventional Pain Physicians will be Oct. 16-18, 2015.  The event will take place at the Monterey Plaza Hotel in Monterey, California.  Registration will open early next year.  





* Please send your State Society meetings and news to:
 Holly Long at


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