Raising the Bar: Innovation and Collaboration to Treat Chronic Pain

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.

ASPN Advocacy & Policy Committee Continues to Advocate for Access to Evidenced-Based Therapy for Its Members.

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.

First International Society of Pain and Neuroscience ISPN Inaugural Meeting

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!

We embrace the foundational importance of our membership.

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.

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.