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It's time for CDC to update its guidance
by Amesh Adalja, MD
Adalja is a practicing infectious disease, critical care, and emergency physician.
News surfaced last week suggesting a potential shift in COVID-19 isolation guidance from the CDC. The planned guidance, which is expected to be released this spring for public comment, indicates a significant switch in how COVID-19 is conceptualized. The guidance would bring COVID-19 into line with how other common respiratory viruses are managed: with isolation recommended until the individual has mild and improving symptoms, and is fever-free (without pharmaceutical aid) for 24 hours.
With the news of the proposed guidance, many voices rose up to immediately attack the proposed guidance as a capitulation and not evidence-based. This was similar to the refrain from opponents when the federal or state governments dropped or loosened mask requirements or guidance.
I was not one of them.
Indeed, I welcome the proposed guidance change because it reflects the progress that has been made in the management of COVID-19. When evaluating this guidance, it is critical to understand that SARS-CoV-2, the cause of COVID-19, is situated among the myriad respiratory viruses that infect humans.
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Join the AMA or Renew your Membership Today!
As of now, ASIPP has two positions available in the House of Delegates and all of the other memberships where they are available, even for the other societies within AMA. The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years. To keep and hopefully increase ASIPP's membership in these committees, we have to keep at a minimum 20% AMA membership, otherwise, ASIPP will lose the AMA membership with all the available advantages.
We encourage you to join or renew your membership in the AMA. Joining the AMA will further strengthen our specialty’s representation at the national level through the AMA House of Delegates, the AMA’s policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses.
As a member of the AMA, you become part of the organization that unites physicians nationwide to tackle the major issues we all face: 47 million uninsured Americans, looming Medicare payment cuts, and the need for medical liability reform. Membership also gives you access to a broad range of practice management resources and award-winning publications such as the Journal of the American Medical Association, AMNews, AMA Morning Rounds, and the Archives journals.
Please take this opportunity to support the critical activities of ASIPP by joining the AMA today. To join or renew the AMA, we encourage you to visit www.ama-assn.org or call (800) 262-3211.
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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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In most fatal cases, other substances are also implicated
Keifer Geers was born with a hole in his diaphragm that led to painful surgeries in adulthood. Despite physical challenges that included deafness, Geers graduated from Texas A&M University with a degree in biomedical engineering. He hoped to one day create medical devices for disabled children and wounded veterans.
On a spring day as Geers walked with his mother through an airport in Midland, Tex., he stumbled, then collapsed into a seizure, his face contorted in shock. Geers, 33, was pronounced dead at a hospital. His mother later found inside his suitcase several packages of powder kratom, an herbal product he consumed to manage pain from surgeries. Patricia Geers said she was stunned when an autopsy concluded that her son died from the toxic effects of kratom — levels in his blood were more than nine times what some experts believe can prove lethal.
The death of Keifer Geers was hardly an isolated episode. A Washington Post review of federal and state statistics shows that medical examiners and coroners are increasingly blaming deaths on kratom — it was listed as contributing to or causing at least 4,100 deaths in 44 states and D.C. between 2020 and 2022. The vast majority of those cases involved other drugs in addition to kratom, which is made from the leaves of tropical trees. Still, the kratom-involved deaths account for a small fraction of the more than 300,000 U.S. overdose deaths recorded in those three years.
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Virtual
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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Vaccines that protect against severe illness, death and lingering long Covid symptoms from a coronavirus infection were linked to small increases in neurological, blood, and heart-related conditions in the largest global vaccine safety study to date.
The rare events — identified early in the pandemic — included a higher risk of heart-related inflammation from mRNA shots made by Pfizer Inc., BioNTech SE, and Moderna Inc., and an increased risk of a type of blood clot in the brain after immunization with viral-vector vaccines such as the one developed by the University of Oxford and made by AstraZeneca Plc.
The viral-vector jabs were also tied to an increased risk of Guillain-Barre Syndrome, a neurological disorder in which the immune system mistakenly attacks the peripheral nervous system.
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Number of vaso-occlusive crises tied to days' supply
No patterns of long-term or increasing use of opioids were identified within 3 years among opioid-naive children with sickle cell disease (SCD) who were prescribed the drugs for an acute pain episode, according to a retrospective cohort study.
In the cohort of 725 children, mean days' supply of opioids over 3 years was 30, despite 45.5% of patients having a least one vaso-occlusive crisis, reported Angela Snyder, PhD, MPH, of the Georgia Health Policy Center at Georgia State University in Atlanta, and colleagues in a research letter in JAMA Pediatrics. The correlation between number of vaso-occlusive crises and days' supply was r=0.58 (P<0.001).
Among patients with one to three vaso-occlusive crises during follow-up, 45.6% filled less than a 10-day supply of opioids, 54.1% filled a supply for 10-36 days, and 29.8% filled a supply for >36 days. For those patients with more than three vaso-occlusive crises, these rates were 9.3%, 25.6%, and 62.8%.
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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!
- 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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Two breakdown products from excess niacin, called 2PY and 4PY, were strongly associated with myocardial infarction, stroke, and other adverse cardiac events, suggesting that niacin supplementation may require a more "nuanced, titrated approach," researchers said.
METHODOLOGY:
- Investigators performed an untargeted metabolomics analysis of fasting plasma from stable cardiac patients in a prospective discovery cohort of 1162 individuals (36% women).
- Additional analyses were performed in a US validation cohort, including measurement of soluble vascular adhesion molecule-1 (sVCAM-1), and on archival fasting samples from patients in a European validation cohort undergoing diagnostic coronary angiography.
- Genetic analyses of samples from the UK Biobank were used to test the association with sVCAM-1 levels of a genetic variant, rs10496731, which was significantly associated with both N1-methyl-2-pyridone-5-carboxamide (2 PY) and N1-methyl-4-pyridone-3-carboxamide (4PY) levels.
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ASIPP State Society Meetings | |
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SUMMARY
GLP-1 receptor agonists are an increasingly popular class of medications for weight loss and diabetes management. An important mechanism for these medications is direct gastric stimulation of GLP-1 receptors leading to delayed gastric emptying and potential for retained gastric contents in patients presenting for anesthesia. This article explores the challenges these medications may pose for the anesthesia professional.
INTRODUCTION
Glucagon-like peptide (GLP-1) receptor agonists are an emerging and increasingly popular class of medications used for the treatment of type 2 diabetes mellitus and, more recently, obesity. Since the expansion of approved uses to include weight loss, these medications have become increasingly popular. One mechanism of action of GLP-1 agonists is delayed gastric emptying.1 We describe two cases of patients taking GLP-1 receptor agonists that were found to have high volumes of complex gastric contents despite appropriate fasting per American Society of Anesthesiologists (ASA) practice guidelines for preoperative fasting.2 With the use of GLP-1 receptor agonists becoming increasingly more common, anesthesia professionals need to be aware of these medications and the potential risks they pose to patients receiving anesthesia.
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Loneliness is no longer just a personal struggle; it's a silent epidemic. The US surgeon general has compared it with smoking, claiming it's as harmful as up to 15 cigarettes a day. The toll on health is staggering, from cardiovascular risks to mental health struggles. It's time to face the brutal truth: Loneliness isn't just hurting hearts, it's a threat to our very well-being.
In older adults, loneliness is linked to a 50% higher risk of developing dementia, a 30% increased risk for incident coronary artery disease or stroke, and a 26% increased risk for all-cause mortality. It is also associated with a higher risk for heart disease in people with diabetes. In fact, loneliness is a stronger predictor of cardiovascular disease in people with diabetes than diet, exercise, smoking, or depression.
Recognizing loneliness as a global public health priority, the World Health Organization (WHO) has launched a Commission on Social Connection, which aims to provide clear evidence to policymakers and practitioners about the best ways to improve social interaction.
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Alternatives prove mettle in studies
Adolescents undergoing surgery for idiopathic scoliosis appeared to fare just fine with opioid-sparing analgesic regimens in the days following their procedures, researchers said here.
In one study focusing on a multimodal protocol that combined up to five non-opioid medications along with non-pharmacologic therapies, half of patients needed no add-on opioids during inpatient recovery to maintain tolerable pain levels, and fewer than one-third were prescribed opioids at discharge.
Another study found that a regimen based on liposomal bupivacaine (Exparel) appeared to speed patients' recovery relative to a conventional as-needed analgesic regimen, with fewer opioids required.
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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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Uzondu C. Osuagwu, MD, Carlos J. Roldan, MD, and Billy K. Huh, MD, PhD
Abstract
BACKGROUND: Pelvic insufficiency fractures can be a delayed effect from radiation therapy. As a result, significant pain, debility, and reduction in quality of life can occur. We describes the utility of ganglion impar blockade in the treatment of coccydynia and pelvic pain related to insufficiency fracture.
CASE REPORT: The patient is a 71-year-old woman with stage 2 grade II endometrial cancer that presented with pelvic and tailbone pain approximately 4 years after completing radiation therapy and was found to have a sacral insufficiency fracture. She underwent ganglion impar blockade on 2 occasions with marked improvement in her pain and functionality after each injection.
CONCLUSIONS: Fluoroscopic-guided ganglion impar block may be a safe and useful intervention to reduce pain in cancer patients with pelvic and/or tailbone pain related to insufficiency fracture
KEY WORDS: Cancer pain, pelvic pain, tailbone pain, insufficiency fracture, ganglion impar block
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Gokhan Yildiz, MD, Gevher Rabia Genc Perdecioglu, MD, Omer Taylan Akkaya, MD, Ezgi Can, MD, and Damla Yuruk, MD
Abstract
BACKGROUND: Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods.
OBJECTIVES: This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events.
STUDY DESIGN: A prospective, randomized controlled trial
SETTING: Outpatient department of a single-center pain clinic.
METHODS: Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment’s effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events.
RESULTS: The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups.
LIMITATIONS: There was no sham or control group, and the follow-up period was limited to 6 months.
CONCLUSIONS: Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.
KEY WORDS: Pulsed radiofrequency treatment, epidural injections, steroids, radiculopathy, neck pain, fluoroscopy, ligamentum flavum, ultrasonography
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Taher Saed Thabet, MD, and Suzan Adlan Khedr, MD
Abstract
BACKGROUND: Post-mastectomy pain syndrome (PMPS) is a persistent post-surgical neuropathic pain. Stellate ganglion (SG) block is used for diagnosis, prognosis, and treatment of pain syndrome.
OBJECTIVES: We aimed to evaluate the efficacy of SG destruction with alcohol versus thermal ablation for PMPS management.
STUDY DESIGN: Randomized, double-blind clinical trial.
SETTING: National Cancer Institute, Cairo University, Egypt.
METHODS: Female patients aged 20-65 years who underwent breast cancer surgery and suffered moderate to severe pain for more than 6 months were categorized equally into 2 groups. SG destruction was with ultrasound (US) guidance and C7 level confirmation by fluoroscopy either by alcohol injection in Group A or thermal ablation with a time of 60 seconds at 80ºC repeated twice in Group B. Follow-up was at 1, 4, 8, and 12 weeks.
RESULTS: Visual analog scale (VAS) measurements after 1, 4, 8, and 12 weeks were significantly lower than pre-procedure measurements in both groups (P value < 0.001). There was a significant reduction in VAS score after 4 and 8 weeks in Group A than in Group B (P value = 0.003 and 0.018). Oxycodone and pregabalin consumption after 4 and 8 weeks were significantly lower in Group A than in Group B. Physical health, mental health, and satisfaction scores were comparable. There were no significant complications in both groups.
LIMITATIONS: The relatively small sample size and short follow-up period are limitations to our study.
CONCLUSION: US-guided SG destruction with alcohol was more effective than thermal radiofrequency for managing acute postoperative pain by decreasing pain score, oxycodone, and pregabalin consumption, which were consumed before the block.
KEY WORDS: Alcohol, mastectomy, neuropathic pain, stellate ganglion, thermal, pain, radiofrequency, PMP
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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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Like and follow ASIPP® on Facebook, X, and LinkedIn for the most
up-to-date news related to you, your practice, and your patients!
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