ASPN Newsletter Issue 6

Proactive. That is the word on my mind for this newsletter. We as members of ASPN, ISPN, and the overall healthcare community with concerns of patient access and safety need a new motto and that, in my opinion, is “Proactive.” It is time to consider the unfortunate and coordinated misinformation coming from those with misguided goals to undermine new, less invasive, safer, less expensive, and more effective means of treating those with spine, nerve, and joint disorders.

We have spent the past several years responding to poorly designed studies on radiofrequency ablation from Europe, very unfortunate and poor science from Norway, and—even worse—biased and potentially harmful Cochrane analysis and JAMA Neurology articles with heavy bias in authorship for those working for a profit-driven insurance conglomeration. These responses, of which I have been a part of, have done a service to correct misperceptions, point out design flaws, and open the discussion on reverse bias of insurance. On separate fronts, we have had “turf battles,” oftentimes driven by those in different specialties that involve maintaining a more invasive yet higher risk procedure, “because that is how we do it.” This has led to patient harm and limited access. It is now time to be proactive on all of these fronts.

This is a call for all who care about patient efficacy, safety, and access, to become more proactive and less reactive. We need more evidence creation on all fronts from registries to big data to prospective multicenter randomized trials to office-based practice outcome data. This data should drive us in the best direction for care and lead to modifications in the treatment of those who are in need. This information can also drive product development, coding, reimbursement, and the overall patient care pathway.

In addition, we need to drive collaboration for all specialties who are stakeholders in this process. From Interventional Pain to Ortho Spine to Neurosurgery to Interventional Radiology and others who want to make an impact. ASPN is committed to this goal and the desire to take a path where all have a voice, and we work together to offer the appropriate procedures, based on a patient-focused goal. This can only happen when all of these groups analyze data together and make the correct decisions in a consensus fashion. This is part of the NEURON process to create living guidelines to improve care and make us all better healthcare professionals.

See y’all in Miami.

It’s hard to believe, but we are quickly approaching our fifth Annual American Society of Pain and Neuroscience Annual Meeting.

This year’s meeting is titled “Raising the Bar: Innovation and Collaboration to Improve Patient Care.” As the title implies, ASPN 2023 will be focused on cross specialty collaboration to enhance patient outcomes in multiple emerging therapeutic frontiers. Although remaining in our “home base” of Miami Beach, we shifted our location to the beautiful and historic Fontainebleu Miami Beach Hotel. As the largest hotel in Miami Beach, this location allows ample space for our continued growth.

Meeting highlights include the most advanced hands-on lab, our scientific panel agendas, breakout sessions, and podium presentations of the top research in the fields of pain and neuroscience. This year I look forward to moderating the ASPN Town Hall with my colleagues Tim Deer and Kas Amerdelfan.

With industry representation across the entire spectrum of pain and neuroscience, the networking opportunities at our annual meeting are unmatched in the field.

If you have never attended our meeting in the past, the energy and enthusiasm is unparalleled. I look forward to seeing you all on South Beach this July 13-16, 2023.

On February 25, 2023, ASPN submitted comments in response to the HCSC (Blue Cross Blue Shield of TX, IL, NM, OK, MT) draft policy that categorized closed-loop SCS therapy as investigational. HCSC has recently published their SCS policy update and removed the investigational label for Evoke®. As a result, HCSC continues to recognize the Evoke® Closed-Loop SCS System as a covered, medically necessary therapy. This is a significant milestone in improving patient access to this innovative therapy. The revised policy will enable more patients to benefit from the Evoke® Closed-Loop SCS System, which has demonstrated its efficacy in multiple studies.

Recently, “Oklahoma interventional pain management and treatment act” (Oklahoma House Bill 2168) was introduced which was intended to authorize Certified Registered Nurse Anesthetists (CRNAs) to perform interventional pain procedures—putting patients at risk of avoidable complications and poor outcomes. ASPN vehemently opposed this bill and urged Oklahoma constituents to voice their concerns to their elected state representatives.

We also provided strong responses to recent LCDs from Medicare Administrative Contractors—CGS, Palmetto, WPS, NGS, and Noridian—in relation to misclassifying sacroiliac joint radiofrequency neurotomy (SIJ RFN) as not reasonable or necessary. Unfortunately, despite our collaborative efforts, all of these MACs, except for Novitas and FirstCoast, have a non-coverage policy for SIJ RFN which went into effect 03/19/23.

We continue to work tirelessly for our members. Please feel free to reach out if you have any policy-related specific issues in your region.

As of the new year, the American Society of Pain and Neuroscience (ASPN) has published three peer-reviewed best practice guidelines in the Journal of Pain Research (JPR).

The largest of those manuscripts was a comprehensive guideline on interventional treatments for low back pain (Sayed et al.), both rating literature and providing evidence-based grading of each therapy.

The second paper (Petersen et al.) was on “Clinical Research During a Pandemic or Emergency.” This manuscript fills a void for protocols to improve patient safety and efficacy and anticipating any future disasters and spreading global infectious diseases. And the most recent ASPN publication was a narrative review on the use of dorsal root ganglion stimulation (drg-s)(Chapman et al.).

The manuscript is the most comprehensive manuscript to date on drg-s, covering safety management, implantation techniques, and mitigation of the potential complications reported in the literature.

Moving forward, ASPN will be publishing a set of consensus statements titled NEURON, which are purposed to document the standard of care for the field of interventional and surgical spine. Presently, topics include Spinal Cord Stimulation, Dorsal Root Ganglion Stimulation, Peripheral Nerve Stimulation, Pain Educational and Knowledge Guidelines for Neuromodulation, Discogenic Pain, Radiofrequency Ablation for Spine and Peripheral Joints, and Sacroiliac Joint Treatments.

These consensus statements will be regularly updated as new evidence is made available.

We are excited to announce that we will be having our first International Society of Pain and Neuroscience (ISPN) inaugural meeting at the Intercontinental Hotel in Dubai, UAE, on December 8-10, 2023.

ISPN society will serve the core mission of the parent society ASPN: to improve education, highlight scientific curiosity, establish best practice, and to elevate each other in a quest to improve the field.

The meeting will bring well-renowned US and international key opinion leaders in the field of pain and neuroscience.

The first two days will include cutting-edge updates and discussion on topics in pain and neuroscience. The last day will host cadaveric lab stations that will include a variety of interventions ranging from basic fluoroscopic and US-guided procedures to Neuromodulation and Minimally Invasive Spine procedures with extended rotation time.

We are excited to finally be expanding our reach to the international community, and we are looking forward to seeing you all in Dubai!

WELCOME
Timothy R. Deer, MD, Dawood Sayed, MD, Jason E. Pope, MD, and Erika A. Petersen, MD

LIFETIME ACHIEVEMENT AWARD
Recipients: Timothy R. Lubenow, MD, and Douglas P. Beall, MD
Presented by Timothy R. Deer, MD

FUNCTIONAL NEUROSURGEON OF THE YEAR AWARD
Presented by Konstantin V. Slavin, MD, FAANS
Recipient: Ahmed Raslan, MD

3RD ANNUAL LISA STEARNS LEGACY DIVERSITY AWARD
Presented by Michael F. Esposito, MD
Recipient: Stephanie Vanterpool, MD, MBA

CLINICAL EXCELLENCE AWARDS
Presented by Jackie Weisbein, DO and Sean Li, MD
Recipients: Denis G. Patterson, DO, Jennifer Marie Lee, MD

EDUCATOR OF THE YEAR AWARDS
Presented by Scott G. Pritzlaff, MD, CIPS, FIPP, and Shravani Durbhakula, MD, MPH, MBA
Recipients: Alaa Abd-Elsayed, MD, MPH, Sayed Emal Wahezi, MD

INNOVATION AND PATIENT SAFETY AWARD
Presented by Christopher J. Gilligan, MD
Recipient: Ajay Antony, MD, Brian Durkin, DO

CHAIRMAN’S ARMED FORCES SERVICE AWARD
Presented by David Reece, DO
Recipients: Michael Verdolin, MD, and Alane Costanzo, MD

YOUNG INNOVATORS AWARDS
Presented by Nasir Khatri, MD, and Ryan Budwany, MD
Recipients: Ashley Bailey-Classen, DO, and Chau Vu, MD

At the American Society of Pain and Neuroscience (ASPN) we embrace the foundational importance of our membership. As we continue to push our space forward, the growth and strength of our membership are imperative for the society as a whole in order to achieve our goals.

We will continue to strive to include a mix of physicians at all levels (residents/fellows/practicing), multiple collaborative specialties (interventional pain, IR, spine surgery, etc.), and APPs. Further, we will always be an all-inclusive organization with an emphasis on diversity both in the US and abroad.

We look forward to utilizing the ASPN newsletter as one of the many tools to maintain a robust engagement with our members.

We hope this message finds you well. Our social media committee has been working diligently to create engaging and informative content for our followers across various platforms. As a team, we strive to provide value to our community and foster a sense of belonging. With that in mind, we have some exciting plans in the works that we cannot wait to share with you all.

Firstly, we will be sharing educational experiences throughout the year to provide our followers with valuable insights and advice. We believe this will be a great opportunity for our community to learn from the best and gain valuable knowledge that can be applied to the practice of pain medicine.

Additionally, we will be sharing information on how to register for the annual ASPN meeting in Miami this July. We believe this is a great way to engage with our pain medicine community and build a sense of camaraderie. We have some unique and exciting events planned, so make sure to keep an eye out for those!

We also will share upcoming award recipients, abstract winners, and other exciting news!

As always, we welcome your engagement and encourage you to connect with us via the links provided below. We value your input and are always looking for ways to better serve our community. If you have any ideas or suggestions, please do not hesitate to reach out to us.

Thank you for being a part of our community. We appreciate your continued support and look forward to providing you with valuable content and experiences. Stay tuned for more updates from our social media committee.

As we move toward our Annual Meeting in July 2023, I often reflect on where we’ve been and the path we’ve taken, pivotal decisions made along it, on our collective journey toward our mission “to improve education, highlight scientific curiosity, establish ‘best practice,’ and to elevate each other in a quest to improve the field.” We have survived pandemics with shelters in place that forever changed the landscape of medicine. Fires. Tornadoes. Our survival was contingent on grit, courage, fluidity, and friendship. Success foundationally requires a vision of what our field could be, of the partners we might have, and of the patients’ lives we may change. We volunteer because we are compelled to do so.

Our field has been scrutinized in all aspects of the care continuum: medication management, regional interventions (including radiofrequency ablation), medical device (Spinal Cord Stimulation), and minimally invasive decompressive or fusion surgery (fusion or fixation or decompression). We face these concerns not myopically but broadly and collaboratively, focused on safety, efficacy, and ultimately, patient access if warranted. We face these challenges focused on patients, acknowledging that turf wars or the industry marketing machines may not have our patients’ best interest at heart. We require education, peer review, accountability, and data.

I was humbled and honored to serve as your president for the last 2 years. We are in good hands with Erika Petersen taking over the reins. But as we prepare for 2024 and beyond, think of accountability with the choices you make. Think of our space. Think of our credibility. Think of our patients. Think of ASPN helping forge the way, and think of ways you can actively contribute.