" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

October 11, 2012



  1. The Latest: Drug Recall Information for Meningitis Multi-State Outbreak
  2. ASIPP's Chairman of the Board Laxmaiah Manchikanti, MD, Addresses Meningitis Outbreak on National Level
  3. The CRNA Saga Continues
  4. CCI 4th Quarter Updates Now Available
  5. Time is Running Out to Register to Attend November ASIPP meetings: Deadline Tomorrow
  6. Comprehensive Board Review Videos Available
  7. Join or Renew Your AMA Membership Today!
  8. Effectiveness Research Slow to Change Practice
  9. Prescription for Addiction
  10. AHRQ: Bundled Payments May Lead to Lower Healthcare Costs
  11. Doctors cast skeptical eye on pharma-backed studies
  12. A Health Care Law Guide for Employees
  13. State Society News

  14. Physician Wanted  

latestThe Latest: Drug Recall Information for Meningitis Multi-State Outbreak


  FDA is working with several state health departments and the Massachusetts Board of Pharmacy on this outbreak. The FDA and CDC have released the following information:

Status: Ongoing Investigation

Facility Type: Outpatient Setting

Case Count: 137

States: 10

 Deaths: 12


1. CDC is aware that New England Compounding Center (NECC) has voluntarily expanded its recall to include all products currently in circulation that were compounded at and distributed from its facility in Framingham, Massachusetts.

2. The New England Compounding Center (NECC) conducted a voluntary recall of 3 lots of Methylprednisolone (PF) 80mg/ml Injection produced at NECC. The lot numbers of this product are:

  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, Beyond Use Date (BUD) 11/17/2012
  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013

3. Clinicians should continue to contact patients who have received medicines associated with three lots of preservative-free methylprednisolone acetate (80mg/ml) recalled on September 26. The potentially contaminated injections were given starting May 21, 2012. See: Clinician Guidance

 4.  CDC's guidance to patients has not changed as a result of this voluntary recall. Patients who feel ill and are concerned about whether they received a medication from NECC at one of the affected facilities should contact their physicians.

  •  Patients have had symptoms generally starting from 1 to 4 weeks after their injection. Not all patients who received the medicine will become sick. Symptoms that should prompt patients to seek medical care include: fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, increasing pain, redness or swelling of the injection site.  


CDC: http://www.cdc.gov/HAI/outbreaks/meningitis.html



We at ASIPP express our deep sorrow at this tragedy. Even though this is due to a mistake by a compounding company, the situation has people coming out of the woodwork with negative comments and complaints. The main focus should be on the effectiveness of epidural steroids. The highly flawed Cochrane Review was performed several years ago. Since then there have been many new studies and several systematic reviews published. All of which have shown significant positive effects with epidural injections with or without steroids, which is the most important factor. When evaluated for effectiveness, in contemporary pain management settings, epidural injections were effective for disc herniation, spinal stenosis, discogenic pain, and post surgery syndrome, however, complications could occur if performed inappropriately.


Physicians who are unable to identify subarachnoid punctures and inject steroids, whether compounded or commercial, will face problems. It is extremely important to note that the role of methylprednisolone is very small. There is no proof that any of the steroids work differently or they work better than local anesthetic alone. The only indication for steroid in epidural injections is a strong inflammatory component.

laxASIPP's Chairman of the Board Laxmaiah Manchikanti, MD, Addresses Meningitis Outbreak on National Level

Epidural steroid shots debated amid meningitis scare


As authorities continue to focus on a potentially contaminated steroid as the source of a widening outbreak of fungal meningitis, some patient-safety advocates are calling for greater restrictions on the type of injection involved.

They say epidural steroid injections, like the ones given to the meningitis victims, are far too dangerous and should be limited or even banned. But those who give the injections say they are safe when done properly and note the current outbreak appears to have originated from the medicine, not the procedure itself.


USA Today



Meningitis outbreak puts attention on pharmacy rules


Although six people have died from a fungal meningitis outbreak in Tennessee, the state has not yet revoked the license of the Massachusetts pharmacy believed to be responsible, and Tennessee Gov. Bill Haslam says the state will not rush to implement new rules.


Nashville Tennessean



Doctors Rethink Use of Custom Pharmacies


The outbreak of a rare form of meningitis is prompting some doctors to rethink their use of a specialized type of pharmacy that created steroid injections tied to 119 illnesses and 12 deaths.

MedStar Health, a health-care provider that includes Georgetown University and Washington Hospital Center in Washington, D.C., said it is reconsidering its currently limited use of compounding pharmacies, which create alternative versions of medicines, such as liquid forms of pills. "I think the whole [health-care] industry is going to undergo some serious internal rethinking," said Bonnie Levin, assistant vice president for pharmacy services at MedStar.


Wall Street Journal



Marion surgery center director addresses meningitis concerns


The director of a Marion surgery center is addressing concerns about the recent meningitis outbreak.

Dr. Laxmaiah Manchikanti, Medical Director of the Ambulatory Surgery Center (ASC) in Lone Oak says that the recent announcement by the CDC, related to a meningitis outbreak is not a cause for concern for patients of the ASC or the Pain Care Surgery in Marion.







Pain Control Expert: How to Avoid Another Fungal Meningitis Outbreak



Confused about the fungal meningitis outbreak that resulted from contaminated steroid injections? Want to know if you're at risk? Here, an interventional pain doctor tells you what you need to know.



Everyday Health




Meningitis Outbreak Spreading



Federal health officials say the death toll in an outbreak of meningitis has risen to seven, with more than 60 people sickened in nine states. The outbreak has been been linked to a steroid used in epidural injections to control back pain.



American News Report

NursesThe CRNA Saga Continues


Here is addtional informaton on the CRNA saga. Based on ASIPP's request for a GAO study, Congressman Ed Whitfield sent a formal request to the GAO asking them to provide answers to a number of questions:


Do CRNAs have the appropriate education and training to perform chronic pain management services?


What impact would this proposed rule have on access to care for patients seeking chronic pain management?


Whitfield Letter to GAO 


Additionally, 13 doctors from the House of Representatives have signed and sent a letter to the Acting Administrator of CMS, Marilyn Tavenner, on this issue: Congressional Letter to CMS.


While this is encouraging news, we have discovered some very disturbing news regarding this scope of practice issue. ASIPP has learned that the American Association of Nurse Anesthetists (AANA) has taken on a very aggressive and misleading advertising campaign at a national level. On September 21, 2012, they placed a two-page spread feature story advertisement in the national insert USA Today featuring. Distribution markets for the print version of the insert include the New York, Chicago, Los Angeles, and Philadelphia editions of USA Today. According to the AANA Web site, this ad reached a print circulation exceeding 460,000. To view the advertisement, click here: http://doc.mediaplanet.com/all_projects/11025.pdf  


We have done very well so far and ASIPP continues to work on gathering more letters of  support.. Based on our own numbers from ASIPP Web site we have sent nearly 2,000 letters to CMS and over 10,000 letters to members of the congress, this in addition to the numerous phone calls, personal meetings, and the many other letters sent from other organizations, including the American Society of Anesthesiologists, who are collaborating with us on this issue. ISIS also sent a letter to CMS. 


In the coming weeks we have crucial work on this issue to survive into the future. For more information on the CRNA issue please look at the following manuscript:


Proposed physician payment schedule for 2013: guarded prognosis for interventional pain management



NCCICCI 4th Quarter Updates Now Available


The National Correct Coding Initiative (NCCI, or more commonly, CCI) is an automated edit system to control specific Current Procedural Terminology (CPT) code pairs that can be reported on the same day. It was developed by the Centers for Medicare and Medicaid Services (CMS) for use in all Medicare Part B and, more recently, Medicaid claims. The goal of CCI is to eliminate "mutually exclusive" code pairings and codes considered to be components of more comprehensive services or otherwise inappropriate to be delivered to the same patient on the same day. The CCI is updated quarterly.


As a member benefit, we are providing you with the 4th quarter updates for IPM codes.


CCI  Updates for IPM Procedures




videosComprehensive Board Review Videos Available

 This Review Course in IPM is designed to prepare physicians seeking board certification, re-certification, or an in-depth review of the specialty of interventional pain medicine.

This review course will be based on the specifications of subspecialty in pain medicine examination of The American Board of Anesthesiology, Physical Medicine and Rehabilitation, and Neurology and Psychiatry. This review course will also meet 90% curriculum of ABIPP Part 1.

This comprehensive Review Course is intended as an overview of the anatomy, physiology, diagnosis, and treatment of a wide range of painful disorders, in order for participants to pass certification or re-certification and obtain in-depth review; and therefore be able to provide improved interventional management, controlled substance management, and practice management.

Order the online videos and receive 5 days of course video via the Internet. You can watch them on your computer or any computer with Internet access. You will be given a password to access the high quality streaming video of each day.
JoinJoin the AMA or Renew Your Membership Today!

The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years which is 2013 for ASIPP.  In order for ASIPP to retain our seat, the AMA requires that 35% of  our physician members also be members of the AMA . 


We encourage you to join or renew their 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, 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.


effectEffectiveness Research Slow to Change Practice



Comparative effectiveness research is slow to change clinical practice, and separate papers published in the October issue of Health Affairs seek to explain why.


Financial barriers such as fee-for-service models, biases, and limited use of tools to aid in treatments better aligned with evidence all prevent more cost-effective, results-driven treatments from taking root, wrote Justin Timbie, PhD, a health policy researcher at the RAND Corporation in Arlington, Va., and colleagues.


"In the face of such deeply rooted and intertwined barriers, policymakers hoping to speed the translation of comparative effectiveness results face a daunting challenge," Timbie and colleagues wrote in the paper, published Tuesday.


MedPage Today


prescriptionPrescription for Addiction


Jaclyn Kinkade, a 23-year-old doctor's-office receptionist and occasional model, was a casualty of America's No. 1 drug menace when she overdosed and died, alone, in a tumbledown clapboard house in Dunnellon, Fla.


The drugs that killed her didn't come from the Colombian jungles or an Afghan poppy field. Two of the three drugs found in her system were sold to Ms. Kinkade, legally, at Walgreen Co and CVS Caremark shops, the two biggest U.S. pharmacies. Both prescription drugs found in her body were made in the U.S.-the oxycodone in Elizabeth, N.J., by a company being acquired by generic-drug giant Watson Pharmaceuticals Inc and the methadone in Hobart, N.Y., by Covidien Ltd another major manufacturer. Every stage of their distribution was government-regulated. In addition, Ms. Kinkade had small amounts of methamphetamine in her system when she died.



Wall Street Journal

ahrqAHRQ: Bundled Payments May Lead to Lower Healthcare Costs


Bundled payments may lead to reductions in healthcare spending without affecting quality, according to a recent report by the Agency for Healthcare Research and Quality.

The report concluded that bundled payments are associated with reductions in healthcare spending and inconsistent, small effects on quality measures. Switching from fee-for-service to bundled payments generally led to a decrease in spending of about 10 percent, according to the report.


Becker's ASC Review

eyeDoctors cast skeptical eye on pharma-backed studies


Physicians are deeply suspicious of industry-funded randomized clinical trials, even when they are of high methodological rigor, according to recently published findings.


The study, which appeared in the Sept. 20 issue of The New England Journal of Medicine, comes amid efforts by leading pharmaceutical companies to close what they see as a "credibility gap" faced by industry-sponsored research. The study's authors and other experts argue that high-profile controversies such as misleading and selectively reported trial data related to Merck's Vioxx (rofecoxib) and GlaxoSmithKline's Avandia (rosiglitazone) have made physicians more doubtful of pharma-sponsored studies.



AMA news

guideA Health Care Law Guide for Employees


The Patient Protection and Affordable Care Act (PPACA) creates many new requirements that can be overwhelming to employees as they try to understand how the law will affect them. Some provisions help employees and others will impose more taxes and make obtaining insurance a headache, says the National Federation of Independent Business.

Despite all the seemingly employee-friendly provisions in the law, there are many provisions that hurt employees.


Americans must have insurance or face a tax.

  • If an employee gets insurance through his or her small business or on their own, they'll have to pay a Health Insurance Tax of around $500 in increased premiums annually.
  • Drug companies will be forced pay new taxes on brand-name drugs and medical device companies will pay a 2.3 percent tax on their products, which will be reflected in higher premiums.
  •  An employee with a Flexible Spending Account or a Health Savings Account can no longer use pretax dollars to buy over-the-counter medications and other health care items.
  •  Furthermore, the PPACA places a $2,500 cap on the amount of pretax dollars you can spend on health expenditures.







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American Society of Interventional Pain Physicians ®
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Phone 270.554.9412, Fax 270.554.5394
E-mail asipp@asipp.org