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We can prepare for this drug class in the supply without reinventing the wheel
Move over fentanyl! There's a new boogeyman in town. At least that's what you might be hearing from the news. And if you haven't already heard the word "nitazenes" then you can expect to soon.
Nitazenes are a class of synthetic opioids, also known as the benzimidazole opioids, which have received more and more attention as they are being detected with increasing frequency in street drugs and overdoses. Media coverage has primarily focused on nitazenes being "more potent than fentanyl," and a cause for concern in our ongoing overdose crisis.
Make no mistake, fentanyl continues to drive the overwhelming majority of overdose deaths in the U.S. and the rest of North America, and so far, nitazenes have primarily been detected in drug samples with fentanyl. While detection seems to be increasing, it remains unclear what their true prevalence is in the drug supply because testing for nitazenes is limited and they are still not routinely tested for in overdose deaths. As detection capabilities are expanded, we can expect to see an increase in overdoses involving nitazenes, and we can prepare for this drug class in the supply without reinventing the wheel.
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Congratulations to the
2024 ASIPP Award Recipients!
We are honored to present the following recipients:
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Giants of Pain Management
Richard Derby, MD and
David Schultz, MD
Lifetime Achievement Award
Ramsin Benyamin, MD, Aaron Calodney, MD, and Allan Parr, MD
Raj/Racz Excellence Award
Laxmaiah Manchikanti, MD
Manchikanti Excellence Award
Sheri Albers, DO
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Falco Excellence Award
Obi Onyewu, MD
Distinguished Research Award
Ramsin Benyamin, MD, Leo Kapural, MD, PhD, Konstantin Slavin, MD, Amol Soin, MD, and Ricardo Vallejo, MD, PhD
Distinguished Young Physician
Allan Parr, III, MD
League of Presidents
Sal Abdi, MD, PhD
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The National Board of Physicians and Surgeons, a nonprofit that provides accessible, ongoing certification in medical specialties, has released a plan aimed at reducing clinician burnout and burdens in rural care.
The relatively new nonprofit organization, founded in 2015 and based in El Cajon, Calif., offers a continuous way for physicians to achieve continuing medical education credits via a less burdensome pathway for certifications. The NBPAS' goal is to "modernize the onerous, unproven continuous board certification market that is driving physicians out of medicine, reducing patient access to care and elevating costs," according to a Feb. 13 news release.
Using this model, the continuing medical education is tailored to a physician's practice, they do not need to answer any clinical questions outside their selected specialty, which frees their time while also getting them the relevant information and training they need.
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Virtual
February 17, March 16, & April 30
Click here for the complete list of upcoming exams.
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam;
ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine;
CSM Competency Exam; DCCPM Competency Exam
In Person
October 18, 2024
ABIPP Part II - Practical Examination
Lab Venue: MERI, 44 S. Cleveland Street, Memphis, TN 38104
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Sen. Bernie Sanders blamed "corrupt" system, well-paid lobbyists
Senators pummeled the CEOs of three of the largest pharmaceutical companies with demands that they explain why one in four Americans can't afford their prescription drugs, prices of which are higher in the U.S. compared with other wealthy nations.
"How many die as a result of that? How many suffer unnecessarily? Nobody knows. But my guess, it is in the millions," said Sen. Bernie Sanders (I-Vt.), chair of the Senate Health, Education, Labor, and Pensions Committee, which on Thursday held its second hearing on the topic of high drug costs.
Facing the lawmakers were Johnson & Johnson CEO Joaquin Duato, MBA, and Merck CEO Robert Davis, JD -- who had refused to appear before the committee until Sanders threatened in January to subpoena them -- and recently named Bristol Myers Squibb CEO Christopher Boerner, PhD, who had volunteered to appear.
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Medicare made $83.4 billion very real dollars in 2022. The 17% discounts below the average cost of fee-for-service Medicare, that happen in every county for Medicare Advantage, have been very real and extremely successful in paying for Medicare coverage — in a way that now makes the program a profit center for the US Government.
You can see the actual financial report page from the 2023 Medicare trustee report above. It shows that the Medicare trust fund grew in 2022 for the first time in decades. More than half of the Medicare members are now enrolled in Medicare Advantage plans. Those members cost significantly less than their equivalent fee-for-service Medicare patients.
These are the actual numbers from the trustee report.
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Excellent opportunities for Residents & Fellows
at ASIPP's 2024 Annual Meeting:
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Resident & Fellow Scholarship — Limited to 100 - only 5 left!
- Abstract Session (April 4, 3:30–5:30pm) and Podium Presentation for Best Abstracts during General Session (April 5, 3:30–4:15pm)
- Half-Day Session dedicated to Young Physicians in Interventional Pain Management
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This glossary can help those interested in healthcare AI find their footing in the field
The language of artificial intelligence (AI) can seem inaccessible to those not working in the field, so MedPage Today created this glossary of some of the most common AI-related terms.
Definitions have been adapted from multiple sources, including Stanford Medicine, JAMA, and the World Health Organization.
Artificial Intelligence: A branch of computer science that focuses on creating machines, computer programs, or software systems that can perform tasks, solve problems, and learn from those experiences in ways that usually require human intelligence.
Algorithm: A step-by-step set of instructions that a computer follows to solve a problem or perform a task.
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ASIPP State Society Meetings | |
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Headlines present conflicting narratives about the healthcare workforce, with CEOs highlighting it as a top concern while researchers emphasize a rapidly growing healthcare labor supply above pre-pandemic levels.
To reconcile these disparities, several crucial considerations come to light:
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Demand matters. Merely citing an increase in the labor supply overlooks the crucial factor of demand. Despite a reported surge in the workforce from 2008 to 2023, various market forces contribute to heightened demand: The Affordable Care Act, Medicaid expansion, rising early cancer rates, the opioid crisis, extended pandemic effects, mental health decline, increased gun violence, and an aging population. Despite supply growth, the increases in demand may still lead to workforce shortages.
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Save $250 on Your TOBI Conference Registration
by Completing Our Quick Survey
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TOBI is dedicated to providing the best possible experience for our conference attendees—we ask that you complete this 60-second survey for us to better understand your preferences.
Those who complete the survey will receive a $250 discount on their TOBI Conference registration as our thanks!
*Discount unavailable for fellows, residents, and medical students
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Researchers uncovered a new mechanism by which fasting reduces inflammation, a key factor in chronic diseases.
Their study reveals that fasting increases blood levels of arachidonic acid, which inhibits the NLRP3 inflammasome, thereby reducing inflammation. This discovery sheds light on the anti-inflammatory effects of fasting and offers insights into the benefits of calorie restriction for conditions like obesity, diabetes, heart disease, and neurodegenerative disorders.
The research also provides clues to how drugs like aspirin might function, further highlighting the intricate relationship between diet, inflammation, and disease prevention.
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COVID seems to have peaked at around the same time
Influenza is hanging around in the U.S., intensifying in some areas of the country after weeks of an apparent national decline.
CDC data released Friday showed a continued national drop in flu hospitalizations, but other indicators were up -- including the number of states with high or very high levels for respiratory illnesses.
"Nationally, we can say we've peaked, but on a regional level it varies," said the CDC's Alicia Budd, MPH. "A couple of regions haven't peaked yet."
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Maria Maio wasn't the only person in her workplace battling COVID-19 in early December 2023. But while everyone else she knows got better, she got long COVID.
A celebrity makeup artist, the 55-year-old New Yorker had been boosted and vaccinated at every opportunity since vaccines were approved at the end of 2020, until the fall of 2023, when she skipped the shot.
"I really started subscribing to the mindset that you have an immune system and your immune system is supposed to work for you," she said. "That was the stupidest thing I've ever done."
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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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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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Aidan S. Weitzner, BSE, Rafael Felix P. Tiongco, BA, Lindsay B. Giocochea, MD, and Eric H. Williams, MD
Abstract
BACKGROUND: Glomus tumors are a rare, yet painful, neoplasm commonly occurring in the subungual area of the digits. While uncommon, a glomus tumor can present in extradigital locations, leading to delays in diagnosis.
CASE REPORT: We present a case of a 53-year-old man with a 20-year history of right thigh pain. Previous diagnostic workup and treatment with spinal cord stimulation and peripheral nerve stimulation did not yield resolution. Exam with ultrasound revealed a hypoechoic lesion. Upon targeted surgical exploration, a mass near the right anterior femoral cutaneous nerve was identified and resected. Pathology was consistent with a glomus tumor. Since the operation, the patient has experienced complete relief after a 1.2-year follow-up.
CONCLUSION: Glomus tumors are treated surgically. Ultrasound may be useful in well-localized, neuropathic pain of the extremity, highlighting the importance of clinicians becoming familiar with employing this modality. While rare, a glomus tumor should be included in the differential diagnosis.
KEY WORDS: Glomus tumor, chronic neuropathic pain, case report
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Laxmaiah Manchikanti, MD, Emilija Knezevic, Nebojsa Nick Knezevic, MD, PhD, Mahendra R. Sanapati, MD, Alan D. Kaye, MD, PhD, Salahadin Abdi, MD, PhD, Amol Soin, MD, and Joshua A. Hirsch, MD
Abstract
BACKGROUND: Chronic axial spinal pain is one of the major causes of disability. Literature shows that spending on low back and neck pain and musculoskeletal disorders continues to escalate, not only with disability, but also with increasing costs, accounting for the highest amount of various disease categories. Based on the current literature utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been shown as potential sources of spinal pain. Therapeutic facet joint interventional modalities of axial spinal pain include radiofrequency neurotomy, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections.
OBJECTIVE: The objective of this systematic review and meta-analysis is to evaluate the effectiveness of facet joint nerve blocks as a therapeutic modality in managing chronic axial spinal pain of facet joint origin.
STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
METHODS: The available literature on facet joint nerve blocks in axial spinal pain was reviewed. The quality assessment criteria utilized were the Cochrane review criteria to assess risk of bias, the Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for randomized therapeutic trials, and the Interventional Pain Management Techniques – Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for nonrandomized studies. The evidence was graded according to Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessment criteria. The level of evidence was based on best evidence synthesis with modified grading of qualitative evidence from Level I to Level V.
A comprehensive literature search of multiple databases from 1966 to July 2023, including manual searches of the bibliography of known review articles was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into qualitative and quantitative evidence synthesis.
OUTCOME MEASURES: The primary outcome measure was the proportion of patients with significant relief and functional improvement of greater than 50% of at least 3 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months).
RESULTS: This assessment identified 8 high-quality and one moderate quality RCTs and 8 high quality and 4 moderate quality non-randomized studies with application of spinal facet joint nerve blocks as therapeutic modalities. However, based on the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high levels of evidence and clinical applicability, with 11 studies showing moderate levels of GRADE evidence and clinical applicability.
LIMITATIONS: Despite the paucity of literature is considered as the major drawback. Based on Grading of Recommendations, Assessment Development, and Evaluations (GRADE) assessment, only 3 of the 21 studies showed high levels of evidence and clinical applicability.
CONCLUSION: Based on the present systematic review and meta-analysis with 9 RCTs and 12 non-randomized studies, the evidence is Level II with moderate to strong recommendation for therapeutic facet joint nerve blocks in managing spinal facet joint pain.
KEY WORDS: Facet joint pain, facet joint nerve blocks, radiofrequency neurotomy, diagnostic facet joint nerve blocks, therapeutic facet joint nerve blocks, randomized controlled trials, meta-analysis, observational studies
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Amber De Groote, Thijs Vande Vyvere, PhD, Wiebren Tjalma, MD, PhD, Wim Vanden Berghe, PhD, Samir Kumar-Singh, PhD, An De Groef, PhD, and Mira Meeus, PhD
Abstract
BACKGROUND: Chronic cancer-related pain remains underdiagnosed and undertreated, although it affects 40% of cancer survivors. Recent insights suggest that cytokine signaling between immune, neuro, and glial cells contributes to chronic pain.
OBJECTIVES: This study systematically reviewed cytokine levels and their relation to chronic cancer-related pain and, additionally, investigated differences in cytokine levels between cancer survivors with and without chronic pain.
STUDY DESIGN: Systematic review.
METHODS: This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). The study conducted a systematic literature search in the databases PubMed, Web of Science, and Embase for articles examining cytokine levels and pain experience at a time point of a minimum of 3 months post-cancer diagnosis. Pain experience was categorized into a total pain score, pain intensity, and pain interference. The risk of bias was assessed using the Newcastle Ottawa Scale.
RESULTS: Eight articles were included, investigating 6 cancer types and 30 cytokines. Moderate evidence was found for pro-inflammatory cytokine IL-6 to be correlated with pain intensity, of which higher levels are observed in cancer survivors experiencing chronic pain compared to pain-free survivors. Moderate evidence was found for TNF-alpha to be not correlated with any pain experience, which is similar for anti-inflammatory cytokines IL-8 and IL-10 with pain intensity. For the remaining 26 cytokines and pain outcomes, only limited evidence was found for an association or alteration.
LIMITATIONS: The number of included studies was small. Overall, studies showed a moderate risk of bias, except one indicated a high risk of bias.
CONCLUSION: More standardized post-cancer treatment studies are warranted to confirm these results and explore associations and alterations of other cytokines. Nonetheless, moderate evidence suggests that elevated levels of IL-6, in contrast with TNF-alpha levels, are correlated with pain intensity in cancer survivors experiencing chronic pain compared to pain-free survivors.
KEY WORDS: Cytokines, interleukin, chronic cancer-related pain, chronic pain, persistent pain, cancer pain, IL-6, TNF-alpha
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ASIPP is now in collaboration with Curi Medical Liability Program
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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.
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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Group Purchasing Organization Offer Better Pricing and Creates Added Value
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, Fedora Billing,
and Revenue Cycle Management Partnership
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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