On December 29, 2022, the Consolidated Appropriations Act of 2023 enacted a new one-time, eight-hour training requirement for all Drug Enforcement Administration (DEA)-registered practitioners on the treatment and management of patients with opioid or other substance use disorders (Medication Access and Training Expansion (MATE) Act).
Beginning on June 27, 2023, practitioners will be required to check a box on their online DEA registration form—regardless of whether a registrant is completing their initial registration application or renewing their registration—affirming that they have completed the new training requirement.
The deadline for satisfying this new training requirement is the date of a practitioner’s next scheduled DEA registration submission—regardless of whether it is an initial registration or a renewal registration—on or after June 27, 2023.
This one-time training requirement affirmation will not be a part of future registration renewals.
In response to this need, ASIPP has developed the virtual review course Controlled Substance Management Virtual Review Course: Medication Access and Training Expansion (MATE) Act. This virtual review course will be held on May 20 & 21, 2023.
In addition to covering the required Curriculum to Meet MATE Act Requirements for DEA Licensing, it will also provide 20 AMA PRA Category 1 Credits™.
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*Please note: Discounted room rate ends May 17, 2023* |
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Recently, Dhruva, et al published an article on Long-Term Outcomes in Use of Opioids, Nonpharmacologic Pain Interventions, and Total Costs of Spinal Cord Stimulators Compared with Conventional Medical Therapy for Chronic Pain, showing no difference (click here to read the full article).
In response Drs. Manchikanti, Sanapati, and Hirsch sent a Letter to the Editor pointing out various issues related to this study and potential reasons (click here to read the letter).
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The Office of Inspector General for the United States Department of Health and Human Services has conducted yet another audit on facet joint interventions, this is the third audit. There have been extensive audits from UPICs, SMRC, Nordian, and RAC, and MAC contractors.
In this study (click here to read), OIG looked at 120 sample sessions, with only 54 complying with Medicare requirements.
The overall estimated overpayments appear to be $29.6 million for facet joint interventions for an audit period of August 1 through October 31, 2021, with new LCDs in effect.
Obviously, there will be even more audits and there will be recoupment from multiple providers on these claims.
It is crucial that we follow appropriate algorithmic approach and utilize checklists to avoid such issues.
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The severity of neurologic and non-neurologic symptoms associated with long COVID appear to be linked to the severity of the initial infection, new research suggests.
Investigators at Chicago's Northwestern Hospital compared neurologic post-acute sequelae of COVID infection in hospitalized and nonhospitalized patients about 7 months after onset of the virus and found only 60% reported they had "recovered" from the virus.
Both study groups of had an average of seven neurological symptoms, with 91% experiencing more than four symptoms. Brain fog, headache, and dizziness were the most common neurologic symptoms and fatigue was the most common non-neurologic symptom in all patients. Both groups reported impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression.
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The brain in your head and the one in your gut are always exchanging info. But how do they do it? Neuroscientist Diego Bohórquez is trying to find out the answers.
If you were asked where the human body’s nervous system is located, you’d probably answer “the brain” or “the spinal cord.” But besides the central nervous system, which consists of those two organs, our bodies also contain the enteric nervous system, a two-layer lining with more than 100 million nerve cells that spans our guts from the esophagus to the rectum. The enteric nervous system has been called “the second brain,” and it’s in constant contact with the one in our skull. That’s why just thinking about food can lead your stomach to start secreting enzymes, or why giving a speech can lead to your feeling queasy.
Until recently, scientists thought the two systems communicated solely via hormones produced by enteroendocrine cells scattered throughout the gut’s lining. After sensing food or bacteria, the cells release molecular messengers that prompt the nervous system to modulate behavior. But it turns out the process may be much more direct. Intriguingly, Duke University gut-brain neuroscientist Diego Bohórquez, a TED Fellow, has found that some enteroendocrine cells also make physical contact with the enteric nervous system, forming synapses with nerves. This revelation opens the door to rethinking how we might affect these signals — and might someday change how we treat conditions as varied as obesity, anorexia, irritable bowel syndrome, autism and PTSD.
What fueled Bohórquez’s interest in the gut-brain connection? Chickens.
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Virtual
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine
Memphis, TN
ABIPP Part II - Practical Portion; ABIPP Competency Exam - Practical Portion; ABIPP Regenerative Medicine Competency Exam - Practical Portion
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The FDA has authorized a second updated COVID booster for older people and immunocompromised individuals. Most healthy adults still have to wait
Many people in the U.S. who are fully vaccinated and boosted for COVID have been waiting—eagerly in some cases—to receive another layer of protection as they pass the six-month mark after their last booster in fall 2022. But most will have to continue to wait. Late last month the Centers for Disease Control and Prevention upheld its existing COVID vaccination recommendations: the agency says that just one dose of the latest updated booster, often called the bivalent booster, is necessary for now. The Food and Drug Administration has also only authorized the same one-dose booster.
This contrasts with official guidance in other countries. In early March Canada and the U.K., for example, began offering an additional booster dose to certain populations at high risk of severe COVID, including elderly people, residents of long-term care facilities and immunocompromised individuals. The World Health Organization (WHO) recommends countries consider an additional booster six or 12 months after the last for older adults, those who have comorbidities or who are immunocompromised or pregnant, and frontline health care workers. The WHO also says healthy children from six months to 17 years old may not need any additional boosters.
“The messaging could get very confusing,” says William Schaffner, a preventive medicine and health policy professor at Vanderbilt University Medical Center, who is a consultant to the CDC’s Advisory Committee on Immunization Practices (ACIP). “One of the most difficult things I’ve learned during this pandemic is how hard it is for the general public to live with changing recommendations over time. They would like a definitive answer now.”
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Furthermore, just one in five patients remained on therapy for at least 180 days
Monthly initiation rates for buprenorphine increased and then flattened from 2016 to 2022, suggesting that recent efforts to increase use of the treatment for opioid use disorder have been insufficient, an analysis of prescription data showed.
Using data from the IQVIA Longitudinal Prescription Database, an all-payer database that includes 92% of prescriptions dispensed in U.S. retail pharmacies, the monthly buprenorphine initiation rate increased from 12.5 to 15.9 per 100,000 from January 2016 through September 2018 (monthly percentage change 0.62%, 95% CI 0.40-0.84, P<0.001), reported Kao-Ping Chua, MD, PhD, of the University of Michigan Medical School in Ann Arbor, and co-authors.
The initiation rate then became flat from October 2018 through October 2022 (monthly percentage change -0.03%, 95% CI -0.16% to 0.09%, P=0.62), they noted in a JAMA research letter.
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The suffering caused by exorbitant drug prices is all too clear for doctors to see
The phone rings at 2 a.m. The resident doctor on call that night is contacted to discuss a Latinx patient who presented with seizures. He had missed his medication for about a week. He had recently been laid off and lost insurance coverage. He couldn't afford to refill his eslicarbazepine acetate (Aptiom) prescription. This was a recurrent scenario in my training years.
Other similar stories involved Black and Latinx patients with multiple sclerosis on Medicaid, who came in with severe exacerbations and end-stage courses of their disease. The lapses in their vital therapy were related to the impact of social and economic determinants of health, including lack of transportation, underinsurance, and inadequate social support. Unfortunately, their medication co-pays were unaffordable. Their disease courses progressed rapidly to disability and total functional dependence; they were destined to become patients in a skilled nursing facility.
Such unjust outcomes are all-too common. They result from the rampant health inequities associated with exorbitant drug prices, lack of access, and a fragmented healthcare system that puts profits over patients. Vulnerable populations, including ethnic and racial minorities, bear the burden of these sky-high drug prices. Meanwhile, pharmaceutical companies are filling their coffers with trillions of dollars as millions of chronically ill people get even sicker.
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ASIPP has been actively addressing recent coverage issues through letter correspondence to various agencies. The issues and letters include the following:
AIM published new guidelines effective 04/09/2023. Owned by Anthem, Inc (ANTM), the AIM guidelines are utilized by multiple insurers. ASIPP has addressed the guidelines with a comment letter on the guidelines for Appropriate Use Criteria: Interventional Pain Management. Our comments were related to paravertebral facet joint injection/medial branch nerve block/neurolysis/therapeutic facet joint interventions.
We are requesting LCD reconsideration requests to all of the Medicare Contractors for the LCD covering Facet Joint Interventions for Pain Management.
ASIPP immediate past president, Amol Soin, sent a letter to Cigna on February 7 addressing their Medical Policy Update on Peripheral Nerve Block Procedures (for trigeminal and occipital neuralgia) which considering them experimental, investigational, or unproven, with an efficacy date of April 18th, 2023. In the letter, we ask that the policy update restricting the use of peripheral nerve blocks be re-evaluated and modified. We recommended that these procedures continue to be covered and we find the characterization of these procedures to be experimental or investigational to be inaccurate.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Phase II study misses primary endpoint, but likely to move forward anyway
An investigational medication that, if approved, would be a first-in-class treatment for post-herpetic neuralgia (PHN) still has a future despite missing the primary efficacy endpoint in a phase II study, a researcher said here.
Called LX9211, the non-opioid drug inhibits adapter protein 2-associated kinase-1 (AAK1), which earlier studies had established as a mediator of neuropathic pain, explained Anand Patel, MD, of Conquest Research in Winter Park, Florida.
Patients receiving it in the 79-patient phase II study -- the second completed thus far -- showed a mean decrease of 2.42 points in average daily pain scores at week 6, which have a range of 0-11 and served as the primary efficacy endpoint, Patel reported at the American Academy of Neurology annual meeting. Scores in a placebo group declined 1.62 points on average.
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Decision avoids restrictions on widely used abortion pill while appeals process plays out
The Supreme Court on Friday preserved access to mifepristone (Mifeprex), a drug used in medication abortions by millions of women since its approval more than two decades ago, rejecting restrictions set to be imposed by lower courts while the case can be fully heard.
"Although the Supreme Court has kept mifepristone available to patients for the duration of this legal battle, much of the damage of this process remains in place," said Iffath Abbasi Hoskins, MD, and Maureen G. Phipps, MD, MPH, the president and CEO, respectively, of the American College of Obstetricians and Gynecologists (ACOG).
"We know that the attacks on abortion care will not stop, no matter how many times medical professionals declare that abortion is essential, evidence-based healthcare and that interference in the patient-physician relationship must stop," they continued. "We will continue to lead the medical community in providing the clear, strong evidence about mifepristone so that the Supreme Court can make the right decision in the end. ACOG remains steadfastly in opposition to interference in the patient-physician relationship."
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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 |
Christian Vangeison, DO, Dominic Salvatore, III, OMS, and Dominick Utrie, DO
Abstract
BACKGROUND: The treatment of complex regional pain syndrome (CRPS) is a difficult endeavor. The advent of neuromodulation interventions has led to new therapeutic options for chronic pain syndromes. Coinciding neuromodulation devices, such as spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRGS), may have a part in refractory CRPS.
CASE REPORT: The authors present a case of a 50-year-old man status post a traumatic skiing accident 3 years prior to presentation with residual CRPS symptoms after an SCS implant. Additional multilevel coverage for refractory chronic neuropathic pain was achieved with the implantation of multiple DRGS devices.
DISCUSSION: This case provides support for the use of DRGS in patients needing supplementary neuropathic pain coverage. Outcomes were reflected in diminished pain scores, an enriched quality of life, and enhanced functional capacity measures.
KEY WORDS: Complex regional pain syndrome, dorsal root ganglion stimulator, dorsal root ganglion stimulation, neuromodulation, spinal cord stimulator, spinal cord stimulation, chronic pain, case report
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| PROSPECTIVE STUDY |
Xin Chai, MD, Jiawen Xu, MD, Ying Yao, MD, Jun-Song Yang, MD, Hui Xu, MD, Peng Zou, MD, Tuan-jiang Liu, MD, Lei Chu, MD, Ding-Jun Hao, MD, and Yuan-Ting Zhao, MD
Abstract
BACKGROUND: Studies have found that the rate of improvement in pain after percutaneous kyphoplasty (PKP) is 49% to 90%, and there are still some patients who may continue to sustain intractable back pain after surgery.
OBJECTIVES: To compare the clinical efficacy and imaging results between unilateral PKP performed from the symptom-dominating side and the non-dominating side in OVCF treatment.
STUDY DESIGN: Prospective study.
SETTING: All data were from Honghui Hospital in Xi’an.
METHODS: One hundred forty-two patients of osteoporotic vertebral compression fracture (OVCF) treated with unilateral PKP were eventually recruited and randomly assigned to either the A or B group. Patients in group A received PKP from the symptom-dominating side; patients in group B received PKP from the symptom non-dominating side. The demographic characteristics, related surgical information, and complications observed within both groups were recorded. The clinical outcomes evaluation included the visual analog scale (VAS) score for low back pain and the Oswestry Disability Index (ODI). Evaluation of imaging results included anterior height (AH), kyphosis angulation (KA), and contralateral distribution rate of bone cement.
RESULTS: One hundred eighteen patients (48 men and 70 women; age range: 60-83 years), including 59 patients in the A group and 59 patients in the B group, were available for the complete assessment. There were 5 cases and 7 cases of bone cement leakage in groups A and B, respectively, which were asymptomatic para-vertebral or inter-vertebral leakage without intra-spinal leakage. Compared with the preoperative data, significant improvements in the VAS scores and ODI were observed at each follow-up interval. The VAS score and ODI in the A group were significantly lower than in the B group only within 2 months (P < 0.05). Compared with the preoperative data, the AH and KA in the 2 groups were improved (P < 0.05). There was no significant difference in AH and KA between the 2 groups at each follow-up interval (P > 0.05).
LIMITATIONS: A single-center study.
CONCLUSIONS: The unilateral PKP performed via the symptom-dominating side can effectively relieve back pain and improve the patient’s quality of life at the early stage.
KEY WORDS: Kyphoplasty, unilateral approach, postoperative pain, operative side, osteoporotic thoracolumbar fracture
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| ANIMAL TRIAL |
Chao Lyu, BA, Jiahao Zhou, MD, Qiaolin Wu, MD, and Xiangyu Fang, MD
Abstract
BACKGROUND: Pain-depression comorbidity has become a great burden to individuals and society. Nevertheless, the mechanisms underlying comorbid diseases have still not been fully revealed. Ultrasound-guided pulsed radiofrequency (PRF) on peripheral nerves, which produces remarkable analgesia via high-frequency electromagnetic energy, has become a main, minimally invasive treatment for chronic neuropathic pain.
OBJECTIVES: The aim of this study was to explore the effect of ultrasound-guided PRF on the sciatic nerve of spared nerve injury (SNI) rats to relieve pain-induced depression.
STUDY DESIGN: Experimental trial in rats.
SETTING: The research took place in the Laboratory of The First Affiliated Hospital of Wenzhou Medical University.
METHODS: Sixty male Wistar rats were randomly divided into a sham group, an SNI group, an SNI + free-PRF group, and an SNI + PRF group. Ultrasound-guided PRF was applied to the sciatic nerve on day 7 after SNI. The basal paw mechanical withdrawal threshold (PMWT) was evaluated as a measure for pain-related behavior, and a sucrose preference test was performed as a measure for depression-related behavior. The expression levels of spinal interferon regulatory factor 8 (IRF8) and of brain-derived neurotrophic factor (BDNF) in the prefrontal cortex (PFC) were also studied on days 21 and 42.
RESULTS: The results showed that the PMWT was significantly decreased in rats following SNI operation; the decreased levels of PMWT were reversed in the SNI + PRF group after the application of PRF on the sciatic nerve on day 7. There were no statistically significant differences among the groups in the sucrose preference rate on day 21 after SNI operation. The sucrose preference rate on day 42 was higher in the SNI + PRF group than in the SNI + free-PRF group. Western blot and reverse transcription polymerase chain reaction also demonstrated that ultrasound-guided PRF on the sciatic nerve downregulated overexpression of spinal IRF8 and increased the levels of BDNF in the PFC.
LIMITATIONS: This study was performed using only an SNI rat model which cannot represent all rodent neuropathic pain models. Only the short-term effectiveness of ultrasound-guided PRF on the sciatic nerve of SNI rats was investigated. The BDNF changes of other important brain areas were not taken into consideration in this study.
CONCLUSIONS: These findings suggest that ultrasound-guided PRF on sciatic nerve could alleviate pain-induced depression. The mechanisms of this treatment may be involved in the downregulated spinal IRF8 and the increased BDNF in PFC.
KEY WORDS: Neuropathic pain, depression, ultrasound, pulsed radiofrequency, interferon regulatory factor 8, brain-derived neurotrophic factor, spinal cord, prefrontal cortex
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ASIPP is now in collaboration with Curi Medical Liability Program
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.
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, visit our website.
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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 independent physicians. 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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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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up-to-date news related to you, your practice, and your patients!
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