Unclear what, if anything, new NCHS report means
"Prescription Opioid Use Among Adults With Chronic Pain: United States, 2019," the government report's title reads. Inside, based on responses from the National Health Interview Survey (NHIS) that year, it says, "22.1% of U.S. adults with chronic pain used a prescription opioid in the past 3 months."
Given that there might be no hotter topic around treatment for chronic pain than the utility of opioids, that sounded like important news.
But a closer look is likely to leave the field scratching its collective head as to whether these data mean anything at all -- and raises questions about the extent to which broad, poly-topic surveys like the NHIS can inform practice and policy.
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On-Site Registration ACCEPTED |
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Meeting Safely and
Responsibly in Cincinnati!
Designated for 15 AMA PRA Category 1 Credits™
Meeting rooms will allow attendees
to spread out and remain at least 6-feet apart.
We have also reserved the largest outdoor suite
for the Cincinnati Reds game on Saturday
so attendees will have a lot of elbow room!
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If you have any questions, contact
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Reports of physicians misbehaving in their practice, in their personal life, or on social media seem more frequent lately. Some say physicians’ job pressure, long hours, and payment frustrations spur the bad behavior. Others blame each physician’s own personality and judgement. Most agree that the medical profession needs to police itself to prevent improper behavior. Medscape surveyed more than 2000 physicians to uncover the extent and nature of bad behavior among physicians within the past 5 years.
More than half (56%) of physicians say they have witnessed or experienced other physicians behaving inappropriately, more often in the workplace. We defined “inappropriate behavior” as being disrespectful to patients, medical professionals, or others; being visibly inebriated or scantily dressed; harassing others; using offensive sexual or racist language in front of others; making fun of patients or disregarding patient privacy on social media; or other clear examples of poor behavior choices.
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Data are in short supply, but hard-hit children's hospitals are sounding alarms
With recent increases in COVID-19 cases and hospitalizations in children, some experts are concerned that the Delta variant may cause more severe illness in kids than previous variants.
Though the data remain in short supply, some have suggested it would be reasonable to extrapolate mounting evidence of increased severity with Delta in adults to children.
The CDC stated that some data suggest Delta may cause more severe illness in the unvaccinated. The agency called attention to two studies -- one from Scotland, one from Canada -- that showed patients infected with Delta were more likely to be hospitalized than those infected with other variants.
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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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The main index used to measure obesity—called BMI—is far from perfect. Here’s why doctors continue to use it.
When it comes to BMI—the most common measure of obesity—the price is right.
BMI, or body-mass index, is calculated by dividing weight in kilograms by height in meters squared. A result less than 18.5 is considered underweight, according to the Centers for Disease Control and Prevention; 18.5 to 24.9 is healthy; 25 to 29.9 is overweight, and 30 or higher is obese.
Medical experts rely on BMI to assess the prevalence of obesity because it’s simple, cheap and generally accurate.
But the index doesn’t distinguish fat from muscle or other tissue, and that causes some people to be placed in the wrong category.
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In December 2020, the Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUAs) for Pfizer-BioNTech and Moderna COVID-19 vaccines, and in February 2021, FDA issued an EUA for the Janssen (Johnson & Johnson) COVID-19 vaccine.
After each EUA, the Advisory Committee on Immunization Practices (ACIP) issued interim recommendations for vaccine use; currently Pfizer-BioNTech is authorized and recommended for persons aged ≥12 years and Moderna and Janssen for persons aged ≥18 years (1–3). Both Pfizer-BioNTech and Moderna vaccines, administered as 2-dose series, are mRNA-based COVID-19 vaccines, whereas the Janssen COVID-19 vaccine, administered as a single dose, is a recombinant replication-incompetent adenovirus-vector vaccine. As of July 22, 2021, 187 million persons in the United States had received at least 1 dose of COVID-19 vaccine (4); close monitoring of safety surveillance has demonstrated that serious adverse events after COVID-19 vaccination are rare (5,6).
Three medical conditions have been reported in temporal association with receipt of COVID-19 vaccines. Two of these (thrombosis with thrombocytopenia syndrome [TTS], a rare syndrome characterized by venous or arterial thrombosis and thrombocytopenia, and Guillain-Barré syndrome [GBS], a rare autoimmune neurologic disorder characterized by ascending weakness and paralysis) have been reported after Janssen COVID-19 vaccination. One (myocarditis, cardiac inflammation) has been reported after Pfizer-BioNTech COVID-19 vaccination or Moderna COVID-19 vaccination, particularly after the second dose; these were reviewed together and will hereafter be referred to as mRNA COVID-19 vaccination.
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Variant knocked down effectiveness of one vaccine more than another, preprint finds
Moderna's COVID-19 vaccine appeared to have a higher effectiveness rate compared with the Pfizer vaccine during the period of time when the Delta variant first became predominant, researchers reported.
While both vaccines were highly protective against infection from January to July in Minnesota (Moderna 86%, Pfizer 76%), their effectiveness estimates declined during the month of July, with an estimate of 76% for Moderna (95% CI 69-81) and 42% for Pfizer (95% CI 13-62), reported Venky Soundararajan, PhD, of nference, a healthcare research company in Cambridge, Massachusetts, and colleagues.
Moreover, in a matched cohort from multiple states, a two-fold risk reduction against breakthrough infection was seen with Moderna's vaccine versus Pfizer's (incidence rate ratio [IRR] 0.50, 95% CI 0.39-0.64), the authors wrote in a study published on the preprint server medRxiv.
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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. The following are examples of the ASIPP comment letters:
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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 |
Ian Dworkin, MD, Roya Moheimani, MD, Edward Pang, DO,
Milena Zirovich, MD, and Sanjog Pangarkar, MD
Abstract
BACKGROUND: Complex regional pain syndrome (CRPS) is a term describing signs and symptoms of a poorly understood neuropathic pain condition. Despite a number of treatment options, patients with CRPS often suffer from significant impairment and unsatisfactory pain relief. An option rarely considered in managing this condition is amputation due to concerns of pain recurrence or disease progression.
CASE REPORT: A 50-year-old man with a history of refractory CRPS on high-dose opioids (over 400 morphine daily equivalents) presented with a request to consider amputation. After extensive interdisciplinary discussion, it was decided to proceed with amputation resulting in successful resolution of his CRPS symptoms with aggressive peri- and postoperative ketamine infusions and a comprehensive therapy program. The patient is now 6 years post amputation and denies phantom limb pain or the spread of CRPS to other limbs. He was subsequently tapered off all opioid medication and has only needed the occasional acetaminophen for pain.
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| THEMATIC ANALYSIS |
Benjamin Goodwin, MS, Hwa-Pyung (David) Lim, MS, Judy Butler, MS,
Daniel Paglia, MS, Matthew T. Dempsey, MS, Bonnie O'Connor, PhD,
and Adriane Fugh-Berman, MD
Abstract
BACKGROUND: Overprescription of opioids has fueled an epidemic of addiction and overdose deaths. The FDA required manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing medical education (CME) on opioids as part of a Risk Evaluation and Mitigation Strategy (REMS).
OBJECTIVES: We sought to determine whether industry-funded REMS on long-acting opioids were consistent with the FDA's goal to reduce serious, adverse outcomes resulting from inappropriate prescribing, misuse, and abuse.
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| SYSTEMATIC REVIEW |
Sevilay Tumkaya Yilmaz, MSc, Ömer Elma, MSc, Tom Deliens, PhD, Iris Coppieters, PhD, Peter Clarys, PhD, Jo Nijs, PhD, and Anneleen Malfliet, PhD
Abstract
BACKGROUND: Chronic pain is one of the most often seen, but often undertreated, sequelae in survivors of cancer. Also, this population often shows significant nutritional deficiencies, which can affect quality of life, general health status, and even risk of relapse. Given the influence of nutrition on brain plasticity and function, which in turn is associated with chronic pain in the population with cancer, it becomes relevant to focus on the association between pain and nutritional aspects in this population.
OBJECTIVE: To identify relevant evidence regarding nutrition and chronic pain in patients with cancer/survivors of cancer.
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September 18, 2021
Kansas Society of Interventional Pain Physicians ANNUAL MEETING
Location: Intercontinental Kansas City at The Plaza
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Registration & Agendas Coming Soon! |
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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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