Paincast discussion on the following topics
- FDA's Position on Stem Cell Therapy.
- Clinical Trials for Stem Cells to Treat Spine and Joint Pains.
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Community clinics say the easing of restrictions on telehealth during the pandemic has made it possible for health workers to connect with hard-to-reach patients via a phone call — people who are poor, elderly or live in remote areas, and don't have access to a computer or cellphone with video capability. Read More
This NPR article spotlights the need for action to keep voice-only telehealth which ASIPP has been working to maintain.
The public health emergency (PHE) was set to expire on October 18, 2021. Secretary Becerra has once again renewed this PHE for a period of 90 days, which will extend the coverage for telephone-only services until at least January 17, 2022. Currently, it is expected that HHS will continue to renew its declaration of the PHE every 90 days through the end of 2021 and will provide 60 days’ notice prior to ending it.
CMS has said no to extending it so now only Congress can save it. Our letter campaign to Congress is trying to prevent cuts of 9.75% for physician payment and 6% for facility payment. To participate in the letter campaign and to read more about this issue by visiting the ASIPP Advocacy site at. https://asipp.org/advocacy/
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Questions about efficacy, safety were chief among concerns, regardless of how members voted
A divided FDA advisory panel voted 13-10 to recommend the oral antiviral molnupiravir for emergency use authorization (EUA) for adults at high risk of progressing to severe COVID-19 on Tuesday.
While votes at the Antimicrobial Drugs Advisory Committee (AMDAC) were largely split, similar questions were raised on both sides of the vote about modest efficacy, especially in light of other available treatments. Very few committee members offered strong "yes" or "no" votes, as most were in the middle. Ultimately, the positive votes felt that despite a number of questions, the benefits of the drug outweighed the risk.
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Some scientists say the virus will likely remain vulnerable to immune cells; ‘Don’t freak out,’ says BioNTech co-founder
At least 50 percent of people who survive COVID-19 experience a variety of physical and psychological health issues for six months or more after their initial recovery, according to research on the long-term effects of the disease, published in the journal JAMA Network Open.
Often referred to as “long COVID,” the adverse health effects vary from person to person. But the research, based on data from 250,351 adults and children, found that more than half experience a decline in general well-being, resulting in weight loss, fatigue, fever or pain.
About 20 percent have decreased mobility, 25 percent have trouble thinking or concentrating (called “brain fog”), 30 percent develop an anxiety disorder, 25 percent have breathing problems, and 20 percent have hair loss or skin rashes. Cardiovascular issues — chest pain and palpitations — are common, as are stomach and gastrointestinal problems.
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A debate is emerging around what it means to be fully vaccinated against COVID-19, as some state and local officials push to change the definition to include an additional dose of a coronavirus vaccine.
Governors in two states in the past week indicated they think three shots are necessary for full vaccination, but public health experts warn such a move would result in massive confusion, and a return to the piecemeal, scattered response that marked the early days of the pandemic.
"We've just moved from lots of confusion where most people were not aware, could not figure out, if they were eligible for a booster," said Jennifer Kates, a senior vice president at the Kaiser Family Foundation.
"If states move out ahead and kind of change their definition of who they're qualifying as fully vaccinated ... that could create a lot more confusion again, because you'd have these different standards all over the country," she said.
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Currently on the list of states:
- Arizona
- Arkansas
- Georgia
- Florida
- Indiana
- Montana
- New Hampshire
- North Dakota
- Oklahoma
- Tennessee
- Texas
- Utah
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The NYU Grossman School of Medicine is surveying pain medicine fellowship graduates' perception of their training and level of preparedness for entering the practice of pain medicine. The survey committee is comprised of Christopher Gharibo, MD; Krupali Chokshi, MD; Gopal Desai, MD; and Lisa Doan, MD. Their goal is to publish information on which areas fellowship graduates feel most prepared and where needs are unmet that can provide constructive feedback to fellowship programs and ACGME. IRB approval has been obtained for the survey and all responses will be completely anonymous.
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No, but the Hulu series holds lessons for physicians about trusting pharma messaging
Does the TV series "Dopesick" make some doctors look gullible or greedy, easily swayed to prescribe opioids by the lure of pharma swag and all-paid trips to posh golf resorts?
Does it portray federal medical officers in charge of ensuring the safety of the nation's prescription medicines as willing to approve Purdue Pharma's favored label language -- that OxyContin's delayed absorption reduces the risk of abuse despite no evidence -- because it would lead to a six-figure job with the industry?
Are many physicians depicted as making millions running pill-mill clinics, where drug seekers line up for blocks to obtain hundreds of prescriptions at higher and higher doses, with many receiving no physical exam?
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False billing wasted "millions and millions" in federal money, investigator says
Providers across the country have been billing more frequently for neurostimulator implantation, a surgical procedure for patients with chronic pain. The problem is, they may not actually be doing it.
Within the last 2 years, the Department of Justice has prosecuted more than a dozen cases involving fraudulent billing of P-Stim, a type of auricular electroacupuncture device used to treat chronic and acute pain.
P-Stim devices -- which are vastly different from implantable neurostimulators -- are small, battery-operated instruments that providers attach behind a patient's ear. Small needles are inserted inside the ear, and the device transmits recurrent electric pulses to the patient for approximately 4 days until it's removed.
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Strategies for Successful Practice Management in IPM
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Responsible, Safe, and Evidence-Based Controlled Substance Management in IPM
Agenda and Registration coming soon!
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Registration coming soon! |
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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 |
Mateusz J. Graca, MD, Bryce T. Austell, MD, Amanda C. Sremac, BS, and Timothy R. Lubenow, MD
Abstract
BACKGROUND: Dorsal root ganglion (DRG) stimulation therapy has been shown to provide effective relief in controlling chronic regional pain syndrome (CRPS)-related pain; however, there is little information on its efficacy and safety in pediatric patients.
CASE REPORT: Following Institutional Review Board approval, a review of pediatric patients who underwent DRG therapy at a single university pain center was conducted.
Five patients under 18 years old with CRPS or intercostal neuralgia who failed prior therapies received DRG stimulation therapy. Three of 5 patients (60%) reported 50% or more relief with DRG therapy. Secondary outcomes including resolution of allodynia, sudomotor and vasomotor dysfunction, and tropic changes as well as school/work attendance and reduced physical restrictions at the longest follow-up were improved in responders.
CONCLUSION: In our limited series we found substantially improved analgesia, reduction in symptoms of CRPS, and improved functional outcomes in pediatric patients treated with DRG neuromodulation for unresponsive chronic pain.
KEY WORDS: Chronic regional pain syndrome, intercostal neuralgia, neuromodulation, pediatric
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| SYSTEMATIC REVIEW |
Yan Dai, MD, Jiachen Huang, MD, Qinghui Hu, MD, Lili Huang, MD,
Jie Wu, PhD, and Jun Hu, MD, PhD
Abstract
BACKGROUND: Increased pericranial tenderness is considered to be a typical characteristic of tension-type headache (TTH). Assessment of pericranial tenderness in TTH using the total tenderness score is recommended by the International Classification of Headache Disorders-3 (ICHD-3). However, to what extent pericranial tenderness differs between patients with TTH or migraine and healthy patients is unknown.
OBJECTIVE: To assess the presence and differences in total tenderness score between patients with TTH or migraine, and healthy patients.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: A literature search was performed in Pubmed/MEDLINE, EMBASE, CINAHL, and Google Scholar databases from inception to August 14, 2020 and identified 4,197 hits. Two independent reviewers selected the studies, extracted data, and performed a risk of bias assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall evidence was assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From the 185 papers identified, 15 case-control and 2 cross-sectional studies were included.
RESULTS: In total 1,200 (327 men, 873 women) patients with TTH or migraine were included in the systematic review. In the meta-analysis, 15 studies were analyzed and showed that the total tenderness score is higher in people with episodic TTH (standardized mean difference [SMD] 0.91; 95% confidence interval [CI]: 0.63 to 1.19), chronic TTH (SMD 1.57; 95% CI 1.24 to 1.91) and migraine (SMD 1.27; 95% CI: 0.91to 1.63) compared to healthy patients.
LIMITATIONS: The description and performance of the total tenderness score differed across the studies. In 7 studies, patients were included with coexisting types of headache.
CONCLUSION: We found moderate quality evidence for higher tenderness in chronic TTH and migraine, and low quality evidence for higher tenderness in episodic TTH compared to healthy patients. Pericranial tenderness is a common finding in patients with headache and healthy patients. These findings apply for a critical evaluation of the total tenderness score in the current ICHD-3 classification of TTH.
KEY WORDS: Tension-type headache, migraine, pericranial muscles, mechanical sensitivity, tenderness, meta-analysis, diagnostic criteria, ICHD-3
The study protocol is preregistered in the Prospective Register of Systematic Reviews under number CRD42019103583.
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| RANDOMIZED CONTROLLED STUDY |
Ki Seok Kim, MD, PhD, Jnug Hwan Ahn, MD, Ju Hyun Yoon, MD,
Ho Tae Ji, MD, and Il Seok Kim, MD, PhD.
Abstract
BACKGROUND: An interscalene brachial plexus block is a commonly conducted nerve block for anesthesia and analgesia in shoulder surgery. Due to its proximity to the targeted nerve, the phrenic nerve, which innervates the diaphragm, is typically inadvertently blocked by ventral spread of the local anesthetic. Although hemidiaphragmatic paresis is tolerable in healthy patients, it would be an irreversible risk to patients with compromised lung reserve.
OBJECTIVES: To investigate the effect of interscalene brachial plexus block on hemidiaphragmatic paresis by comparing the conventional local anesthetic volume with a reduced experimental volume at a more specific position using an ultrasound-guided 2-point injection technique.
STUDY DESIGN: Prospective, randomized controlled study registered with the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp. KCT0005575. 04/11/2020).
SETTING: This study was conducted at a single hospital affiliated with an academic institution between April and December 2020.
METHODS: Patients undergoing brisement manipulation and arthroscopic shoulder surgery were randomized to the experimental (10 mL of ropivacaine 0.5%) and control groups (15 mL of ropivacaine 0.5%). Fifty-two patients who received an interscalene brachial plexus block for anesthesia and analgesia in the shoulder region. The interscalene block was performed using a 2-point injection and observing the spread pattern of the local anesthetic. The primary outcome was the incidence of hemidiaphragmatic paresis, estimated by the thickening fraction of the diaphragm. The secondary outcomes included oxygen saturation, presence of dyspnea, resting pain score, and handgrip strength score.
RESULTS: Thickening fraction was significantly decreased in the control group compared with the experimental group (median [interquartile range], 13.9 [10.0–18.5] versus 28.5 [14.5–38.8], P < 0.001). The incidence of hemidiaphragmatic paresis was significantly higher in the control group than in the experimental group (92.3% versus 53.8%, P = 0.004). Handgrip strength was significantly reduced in the control group compared with the experimental group (P = 0.029).
LIMITATIONS: We did not perform a phrenic nerve conduction study, as it is rarely performed in routine clinical operations. We did not formally assess the distance and spatial relationship of the phrenic nerve to the targeted nerve. Outcome variables including pain assessment were limited to the immediate postoperative period.
CONCLUSIONS: Reducing the local anesthetic volume by selective injection and observing the spread pattern resulted in a decreased incidence of hemidiaphragmatic paresis and preserved handgrip strength after interscalene block.
KEY WORDS: Arthroscopic shoulder surgery, brisement manipulation, diaphragm, hemidiaphragmatic paresis, interscalene brachial plexus block, local anesthetic, phrenic nerve, ultrasonography
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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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