Uncomfortable Transitions in Payment Models for Chronic Low Back Pain: Navigating Medicare’s Mandatory Payment Reforms in Anesthesiology and Chronic Pain Management

Anesthesia & Analgesia · 2026-04-21

Long-Term Opioid Therapy: The Burden of Adverse Effects

Pain Medicine · 2021 · 5 citations

• Medicine
• Intensive care medicine
• Anesthesia

Since introducing “pain as a fifth vital sign” campaign, the utilization of opioids to treat chronic noncancer pain has dramatically increased [1]. Chronic opioid therapy may be associated with varied deleterious effects including constipation, central sleep apnea, hypogonadism, hyperalgesia, adrenal insufficiency, osteoporosis, and tremors [2, 3]. Gomez et al. demonstrated that less than 20 morphine milligram equivalents (MME) per day did not increase morbidity and mortality, whereas threefold increase in morbidity and mortality was noted at doses over 200 MME per day [4]. Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids in chronic pain recommend using risk mitigation strategies when increasing opioid dosing to >50 MME/day and avoiding or carefully justifying increases to >90 MME/day [5].Our case highlights the possible extreme adverse effects and healthcare burden of long-term high dose opioid medication use. A 57-year-old man status...

Facet Joint Injection

StatPearls · 2021-06-28

Facet joint injections are one of the most commonly performed procedures amongst all spinal interventions. Facet joint pain can arise from osteoarthritis, segmental instability, trauma, meniscoid impingement, and inflammatory synovitis. Patients with facet joint pain may present with symptoms of neck pain, back pain, and pain worsened with hyperextension, bending laterally, and rotation.Facet mediated pain is typically axial in nature, with rare radiation into the upper extremities or lower extremities in cervical and lumbar facet disease, respectively. Therefore, a key diagnostic question to ask patients with suspected facet pain is, “Does your pain extend below the knee or beyond the elbow?” with positive responses decreasing the likelihood of facet disease as the putative source of pain. However, none of the above are specific for the diagnosis of facet disease. In addition, imaging in those with facet joint pain may be completely normal or show degenerative findings.Ultimately, facet joint pain is a diagnosis of exclusion after other etiologies have been ruled out. Thus, performing facet joint injections under image guidance has become a valuable tool in diagnosing facet joint pain and may provide therapeutic benefits.

Virtual reality for pain management: a guide to clinical implementation

ASRA news · 2020

• Computer Science
• Computer Science
• Human–computer interaction

Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California

Pain Medicine · 2020 · 13 citations

• Medicine
• Psychiatry
• Nursing

OBJECTIVE: The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD). METHODS: The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic. The workgroup had diverse specialty and disciplinary representation. This workgroup focused on developing a foundational set of educational competencies for adoption across all UC medical schools that address pain, SUD, and public health concerns related to the opioid crisis. RESULTS: The UC pain and SUD competencies were either newly created or adapted from existing competencies that addressed pain, SUD, and opioid and other prescription drug misuse. The final competencies covered three domains: pain, SUD, and public health issues related to the opioid crisis. CONCLUSIONS: The authors present a novel set of educational competencies as a response to the opioid crisis. These competencies emphasize the subject areas that are fundamental to the opioid crisis: pain management, the safe use of opioids, and understanding and treating SUD.

Evaluation of an Innovative Diagnostic Method for Detection of Antibodies and Antigens

International Journal of Clinical Medicine · 2017-01-01

Reports manifest a continuing need for the development of rapid and on-site (point of care) assays. Current diagnostic methods commonly used for detection of antibodies and antigens have significant limitations. Scientists at Micro Detect, Inc. have developed an innovative diagnostic device (method) that can be utilized broadly for antibody/antigen interactions including diagnostic assays in the medical, veterinary and food industries. The developed device can be utilized for the detection of antibodies against a single antigen or vice versa. It can also be tailored for specific panels that detect antigens or antibodies for diverse infectious agents, proteins, hormones, tumor markers, autoimmune markers, and allergens. Additionally, it can also be used for detection of toxins, antitoxins, nucleic acids, enzymes, drugs, etc. in both humans and animals. Specimens used in different formats of the device can be tears, saliva, whole blood, serum, plasma, urine, stool, and other bodily discharges. The good intra and inter precisions and acceptable linearity of the device support reliable use of the device. The CV of the device is 1.9% - 2.2%. Likewise, the performance of the device using 92 confirmed negative and positive specimens via a typical assay showed 100% sensitivity, 80% specificity, 96.8% efficacy, 80% positive predictive value, and 100% negative predictive value. The results of our feasibility study suggest reliable utility of a device for rapid, easy-to-use, inexpensive, and on-site (point of care) diagnostic assays. This presents a potential breakthrough in diagnostic methodologies that can be integrated into modern medicine and food industries.

Anesthesiology Residency Curriculum and Implementation of a Perioperative Surgical Home Curriculum: A Survey Study

Journal of Education in Perioperative Medicine · 2017-07-01 · 6 citations

Background The perioperative surgical home (PSH) is a physician-led, interdisciplinary, and patient-centered model of perioperative care that focuses on patient outcomes and comprehensive care management. Many studies to date have looked at the clinical implementation of varied PSH models with promising results discussed. There are no studies directly examining concrete plans for the various Accreditation Council for Graduate Medical Education (ACGME) anesthesiology residency programs to implement augmented PSH training into curricula. The aim of this survey study was to better assess current residency training in PSH. Methods An 18-question survey developed by a team of research personnel familiar with the PSH was sent to all ACGME accredited anesthesiology training programs in the United States. Responses were quantified, and construct and external validity of the survey tool examined. Results 41% of the programs responded. 89% (95% CI 78-96%) of programs reported moderate or better understanding of the PSH. 34% (21-47%) had incorporated additional PSH training in the previous three years, and 32% (with no significant correlation to the previous group) had plans to integrate more training in the next 3 years. Conclusions Overall, the surveyed program directors voiced understanding of the value of the PSH model in patient care but remained hesitant to incorporate training specific to PSH into the anesthesiology residency curricula. Background Perioperative medicine (POM) is faced with major challenges in the cost and quality of care as evidenced by high complication and readmission rates as well as financial incentives to perform surgeries 1 . Some approaches to address this problem have focused on further expanding the role of anesthesiologists in the perioperative period and focusing on evidence-based standardization of surgical pathways. This is exemplified by models like the perioperative surgical home (PSH) 2 and enhanced recovery after surgery (ERAS) 3 . The PSH is a physician-led, interdisciplinary, and patient-centered model of perioperative care that focuses on patient outcomes and comprehensive care management 4 and has been a focus of the American Society of Anesthesiologists (ASA) in recent years. This evolving paradigm for surgical care has been shown to reduce costs while minimizing complications associated with the perioperative timeline 5 .

Evolving healthcare delivery paradigms and the optimization of ‘value’ in anesthesiology

Current Opinion in Anaesthesiology · 2017-01-23 · 10 citations

PURPOSE OF REVIEW: Healthcare worldwide is evolving to yield enhanced care provided at a lowered cost. Patient-centric paradigms that hasten surgical recovery and strengthen collaboration amongst medical professionals are gaining impetus. This review will discuss the changing healthcare landscape and outline its implications on anesthesiology practice. RECENT FINDINGS: Anesthesiologists must be nimble and versatile as they adapt to healthcare redesign. An increased responsibility for patient outcomes should be embraced by extending the breadth and depth of clinical practice throughout the surgical care continuum. The perioperative surgical home and enhanced recovery after surgery provide paradigms to further integrate expanding clinical opportunities and improved patient outcomes. Investment is needed in perioperative medical education and research efforts to best position anesthesiologists for success both now and in the future. SUMMARY: Exemplifying opportunities to demonstrate value-added care, the scope of anesthesiology education and clinical practice should diversify to further integrate perioperative care of surgical patients.

Transforming Perioperative Care

A & A Case Reports · 2016-05-14 · 18 citations

Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents.

A case management report: a collaborative perioperative surgical home paradigm and the reduction of total joint arthroplasty readmissions

Perioperative Medicine · 2016-10-17 · 14 citations

BACKGROUND: Efforts to mitigate costs while improving surgical care quality have received much scrutiny. This includes the challenging issue of readmission subsequent to hospital discharge. Initiatives attempting to preclude readmission after surgery require planned and unified efforts extending throughout the perioperative continuum. Patient optimization prior to discharge, enhanced disease monitoring, and seamless coordination of care between hospitals and community providers is integral to this process. The perioperative surgical home (PSH) has been proposed as a model to improve the delivery of perioperative healthcare via patient-centered risk stratification strategies that emphasize value and evidence-based processes. RESULTS: This case report seeks to specifically describe implementation of readmission reduction strategies via a PSH paradigm during total joint arthroplasty (TJA) procedures at the University of California Irvine (UCI) Health. An orthopedic surgeon open to collaborate within a PSH paradigm for TJA procedures was recruited to UCI Health in October of 2012. Institution specific data was then prospectively collected for 2 years post implementation of the novel program. A total of 328 unilateral, elective primary TJA (120 hip, 208 knee) procedures were collectively performed. Demographic analysis reveals the following: mean age of 64 ± 12; BMI of 28.5 ± 6.2; ASA Score distribution of 0.3 % class 1, 23 % class 2, 72 % class 3, and 4.3 % class 4; and 62.5 % female patients. In all, a 30-day unplanned readmission rate of 2.1 % (95 % CI 0.4-3.8) was observed during the study period. As a limitation of this case report, this reported rate does not reflect readmissions that may have occurred at facilities outside UCI Health. CONCLUSIONS: As healthcare evolves to emphasize value over volume, it is integral to invest efforts in longitudinal patient outcomes including patient disposition subsequent to hospital discharge. As outlined by this case management report, the PSH provides an institution-led means to implement a series of care initiatives that optimize the important metric of readmission following TJA, potentially adding further value to patients, surgical colleagues, and health systems.