The American Boards of Internal Medicine, Family Medicine, and Pediatrics back FSMB's warning
Medical boards in the U.S. continue to voice their support for sanctioning physicians who spread falsehoods about the COVID-19 vaccines.
The American Board of Internal Medicine (ABIM), American Board of Family Medicine (ABFM) and American Board of Pediatrics (ABP) issued a joint statement Thursday supporting the Federation of State Medical Boards, which warned physicians in early August that their licenses could be taken away or otherwise sanctioned by state boards if they disseminated misinformation about the COVID vaccines.
Their statement follows a similar one from the American Board of Emergency Medicine issued in late August.
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A proposed LCD on Epidural Procedures for Pain Management services was announced on June 10, 2021. This nationwide policy contains many onerous changes that will detrimentally affect patient access to care. ASIPP has written comment letters with detailed explanations of the issues and needed changes to each Medicare Contractor.
To date, with the help of ASIPP members, we have received interest and support from 70 Congress. Let us keep the momentum going! If you have not yet sent your letter and patients' letters, please do as soon as possible. If you have, please continue to collect and submit patient letters as we need each physician to send at least 100 letters from patients, colleagues, and staff. This is not that hard to do - it only takes a bit of time each day.
Instruction for patient letters:
- Print it off daily changing the date and ask your patients to sign as the check-in.
- Remember, your office should enter the letters otherwise the odds are they won't be submitted!
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Congress can reverse a troubling trend that creates patient care disruptions
When millions of Americans had to delay or cancel their routine or non-emergent care due to the COVID-19 pandemic last year, it was frustrating, but it also made sense. The health and protection of patients had to come first.
Now, although safety protocols and vaccines are helping physicians resume appointments as usual, thousands of patients remain stuck in a backlog of needed care because their physicians are facing down a different crisis, a crisis that is man-made: an insurance company-imposed pre-approval process for all routine cataract surgeries.
Aetna -- the nation's third-largest insurer -- instituted a new preauthorization requirement for all cataract surgeries, effective July 1. It's a decision that was made with little notice to physicians and without data to support it. For patients who need cataract surgery to restore their vision, the new policy has created delays and disruptions in care. People who need surgery shouldn't have to fight through a tangle of red tape to receive the care their physicians have prescribed.
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There's no shame in reaching out for help
As if working in the healthcare field wasn't already stressful, overwhelming, and sometimes downright depressing, the COVID-19 pandemic has added tremendous pressure to already overworked medical staff. They've witnessed unspeakable tragedy and loss of life on a scale they couldn't possibly be prepared for. Many are facing mounting mental health challenges as a result.
Unfortunately, this perfect storm puts these essential workers at tremendous risk of developing a substance use disorder (SUD). In addition to stress and burnout, healthcare professionals also have a unique "advantage": easy access to drugs. Whether it's through self-prescribing, prescription fraud, or simply diverting medications from the hospital or office, opioids, anti-anxiety medications, anti-depressants, and many other drugs are readily accessible.
I know because I've been there. Thanks to an old injury that caused nagging pain, coupled with the stress of running a busy surgery practice while also serving as head of the surgery department at a major metro hospital, I turned to opioids to self-medicate.
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Must-reads about the latest news and trends in healthcare careers
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Kansas Society of Interventional Pain Physicians ANNUAL MEETING
Location: Intercontinental
Kansas City at The Plaza
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Room Block Update
We have added additional rooms for Thursday, October 14 & Friday, October 15.
If you plan to attend the Thursday afternoon workshop, Regenerative Medicine Techniques with Ultrasound Guidance, we recommend you book your hotel reservations today!
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CMS plans to require ASCs, along with all other healthcare providers, to mandate COVID-19 vaccines for staff as a condition of participating in Medicare.
The agency issued emergency regulations mandating vaccination for nursing home workers Aug. 18 and expanded the regulations to include hospitals, ASCs, dialysis facilities and home health agencies Sept. 9. CMS is expected to issue an interim final with additional details on the vaccination mandate in October, followed by a comment period.
"We know that those working in healthcare want to do what is best for their patients in order to keep them safe," Chiquita Brooks-LaSure, CMS administrator, said in a statement. "As the delta variant continues to spread, we know the best defense against it lies with the COVID-19 vaccine. Data shows that the higher the level of vaccination rates among providers and staff, the lower the infection rate is among patients who are dependent upon them for care. Now is the time to act."
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ASIPP® is pleased to offer a new feature for
its members to help provide value to you and your practice.
Click here to visit ASIPP®'s newly created site where you can
make purchases on our Amazon Store, learn more about and
join the ASIPP® GPO and ASIPP®’s partnership with
Fedora Billing & Revenue Cycle Management Company.
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Soin Therapeutics, a pharmaceutical company based in Dayton, OH, was granted orphan drug status from the FDA for low-dose naltrexone (LDN) to treat complex regional pain syndrome (CRPS).
Complex Regional Pain Syndrome is a rare, orphan disease that is characterized by severe pain, usually starting in an extremity, and associated with extreme swelling, limited range of motion, changes to the skin or bone structure, and debilitating pain.
Naltrexone is a medication that is primarily used to manage alcohol or opioid use disorder by reducing cravings or feelings of euphoria associated with substance use disorder. It has also been shown in anecdotal reports to alleviate symptoms stemming from CRPS at very low doses (approximately 1/10th the dose) of currently approved indications. When the dose of the drug is substantially lowered, the pharmacological effects change favorably to treat CRPS.
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SIRVA is mainly in the medicolegal realm, but physicians acknowledge its rare possibility
Within a few hours of getting her first COVID-19 shot, Leah Jackson had severe pain in her left shoulder.
The New York City-based veterinarian said the nurse lodged the shot "extraordinarily high" into her left shoulder, hitting the bursa rather than the deltoid muscle. When the nurse got resistance, she redirected the vaccination into the joint space, Jackson said.
As a veterinarian, Jackson is well versed in giving injections: "This was just poor administration technique," she told MedPage Today.
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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 |
Jordan Orr, MD, and Mahmood Gharib, MD
Abstract
BACKGROUND: This case report describes the use of ultrasound-guided doxycycline injection as sclerotherapy for the treatment of aseptic olecranon bursitis.
CASE REPORT: Our patient presented with a several-week history of posterior elbow swelling and tenderness. The clinical picture was consistent with aseptic olecranon bursitis. Ultrasonography was used to visualize posterior elbow structures and provide needle guidance to aspirate the fluid within the olecranon bursa and inject a sclerosant, doxycycline. The patient’s recovery was uneventful, and the bursitis did not recur.
CONCLUSION: There are no other case reports describing ultrasound-guided injection of a sclerosant for treatment of aseptic olecranon bursitis. Doxycycline is an effective and safe sclerosant that can be considered for the treatment of aseptic olecranon bursitis.
KEY WORDS: Olecranon bursitis, doxycycline, sclerotherapy, ultrasonography, injections, elbow
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| SYSTEMATIC REVIEW |
Rajesh N Janapala, MD, Laxmaiah Manchikanti, MD
Mahendra R Sanapati, MD, Srinivasa Thota, MD,
Alaa Abd-Elsayed, MD, Alan D Kaye, MD, PhD,
and Joshua A Hirsch, MD
Abstract
PURPOSE: The objective of the systematic review and meta-analysis is to evaluate the efficacy of radiofrequency neurotomy as a therapeutic lumbar facet joint intervention.
PATIENTS and METHODS: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a systematic review and meta-analysis was performed. A comprehensive literature search of multiple data sources from 1966 to September 2020 including manual searches of bibliography of known review articles was performed. The inclusion criteria were based on the selection of patients with chronic low back pain with diagnosis confirmed based on controlled diagnostic blocks and with the publication of at least 6 months of results of appropriate outcome parameters. Quality assessment of the trials was performed with Cochrane review criteria and interventional pain management techniques-quality appraisal of reliability and risk of bias assessment (IPM-QRB). The level of evidence of effectiveness is classified at five levels ranging from Level I to Level V. The primary outcome measure was a significant reduction in pain, eg, short term (up to 6 months) and long term (more than 6 months). The secondary outcome measure was an improvement in functional status.
RESULTS: A total of 12 randomized controlled trials (RCTs) met the inclusion criteria for evaluating the efficacy of lumbar radiofrequency neurotomy. Radiofrequency neurotomy showed Level II evidence for efficacy for both the short term and long term.
CONCLUSION: This systematic review of the assessment of the efficacy of radiofrequency neurotomy in managing chronic low back pain was based on the inclusion of 12 RCTs with a diagnostic block and at least 6 months of follow-up results that showed Level II evidence for both short-term and long-term improvement.
KEY WORDS: Diagnostic facet joint nerve blocks, facet joint pain, facet joint nerve blocks, randomized trials, radiofrequency neurotomy, systematic review, meta-analysis
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| SYSTEMATIC REVIEW |
Laxmaiah Manchikanti, MD, Emilija Knezevic,
Nebojsa Nick Knezevic, MD, PhD, Mahendra R. Sanapati, MD,
Alan D. Kaye, MD, PhD, Srinivasa Thota, MD,
and Joshua A. Hirsch, MD
Abstract
BACKGROUND: Recalcitrant disc herniation may result in chronic lumbar radiculopathy or sciatica. Fluoroscopically directed epidural injections and other conservative modalities may provide inadequate improvement in some patients. In these cases, percutaneous neurolysis with targeted delivery of medications is often the next step in pain management.
METHODS: An evidence-based system of methodologic assessment, namely, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used. Multiple databases were searched from 1966 to January 2021. Principles of the best evidence synthesis were incorporated into qualitative evidence synthesis. The primary outcome measure was the proportion of patients with significant pain relief and functional improvement (≥ 50%). Duration of relief was categorized as short-term (< 6 months) and long-term (≥ 6 months).
RESULTS: This assessment identified one high-quality randomized controlled trial (RCT) and 5 moderate-quality non-randomized studies with an application of percutaneous neurolysis in disc herniation. Overall, the results were positive, with level II evidence.
CONCLUSIONS: Based on the present systematic review, with one RCT and 5 nonrandomized studies, the evidence level is II for percutaneous neurolysis in managing lumbar disc herniation.
KEY WORDS: Catheterization, Epidural Space, Evidence-Based Medicine, Intervertebral Disc Displacement, Low Back Pain, Meta-Analysis, Observational Study, Pain Management, Radiculopathy, Randomized Controlled Trial, Saline Solution, Hypertonic, Systematic Review.
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| COCHRANE REVIEW |
Joshua A. Hirsch, MD, Alaa Abd-Elsayed, MD,
Mahendra R. Sanapati, MD, Srinivasa Thota, MD,
Emilija Knezevic, Nebojsa Nick Knezevic, MD, PhD,
and Laxmaiah Manchikanti, MD
Abstract
BACKGROUND: Epidural injections are one of the commonly performed procedures in managing low back and lower extremity pain. In the past, Pinto et al and Chou et al performed systematic reviews and meta-analyses with a recent update from Oliveira et al showing lack of effectiveness of epidural steroid injections in managing lumbar radiculopathy. In contrast, multiple other systematic reviews and meta-analyses have supported the efficacy and use of epidural injections utilizing fluoroscopic guidance.
STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs) of epidural injections in managing chronic low back and lower extremity pain with sciatica or lumbar radiculopathy.
OBJECTIVES: To assess the efficacy of 3 categories of epidural injections for lumbar radiculopathy or sciatica performed utilizing saline with steroids, local anesthetic alone, or steroids with local anesthetic.
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| SYSTEMATIC REVIEW |
Alan D. Kaye, MD, PhD, Mark V. Boswell, MD, PhD,
Nebojsa Nick Knezevic, MD, PhD, Laxmaiah Manchikanti, MD,
and Joshua A. Hirsch, MD
Abstract
BACKGROUND: The prevalence of chronic low back pain and related disability is rapidly increasing as are the myriad treatments, including epidural injections. Even though epidural injections are one of the most commonly performed procedures in managing low back and lower extremity pain, starting in 1901 with local anesthetic alone, conflicting recommendations have been provided, despite the extensive literature. Recently Chou et al performed a technology assessment review for Agency for Healthcare Research and Quality (AHRQ) part of which was published in Annals of Internal Medicine showing lack of effectiveness of epidural steroid injections in managing lumbar radiculopathy and spinal stenosis. In contrast, multiple other publications have supported the efficacy and use of epidural injections.
PURPOSE: To assess the efficacy of 3 categories of epidural injections for lumbar and spinal stenosis: performed with saline with steroids, local anesthetic alone, or steroids with local anesthetic and separate facts from opinions.
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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 license 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® 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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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 the independent physician. 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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up-to-date news related to you, your practice, and your patients!
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