Tag - pain management

Surgery and Procedures During the COVID-19 Crisis

Reposted from the Texas Pain Society e-newsletter dated 3/26/2020

March 26, 2020

To assist our members in determining whether surgeries should be done during the period of the Governor’s Order and any extensions, we have put together this memo based on the CDC (Federal), Governor Abbott’s Executive Order, the Attorney General’s guidance, and guidance from the TMB (Texas).  There may also be county and city orders as well as facility requirements of which you should be aware.  These are not included in this memo, but should be researched in making your decisions.

Please keep in mind that we are doing our best to keep up with this fluid situation, and will revisit these issues as necessary.

Current CDC guidelines require rescheduling elective surgeries at inpatient facilities and rescheduling non-urgent outpatient visits to help limit the spread of COVID-19.

At the state level, on March 22 Governor Abbott issued Executive Order GA 09 ordering the following:

the surgery must be postponed unless it is immediately medically necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician.

On March 23, Texas Attorney General Ken Paxton, issued a statement that Governor Abbott’s order applies throughout the State and to all surgeries and procedures that are not immediately medically necessary.

At the licensing level, the TMB has taken the position that the performance of a non-urgent elective procedure is a continuing threat to the public welfare, and will be prosecuted by the Board.

Further, the TMB has adopted a mandatory duty to report any physician scheduling to perform, preparing to perform, performing, or who has performed a non-urgent elective surgery or procedure to the TMB.   While this order is directed to physicians and other licensed healthcare professionals, in fact any human can report the physician to the TMB.

If a report is made to the TMB, the TMB may conduct a temporary suspension or restriction hearing with or without notice. This hearing will be judged by a panel of three board members (one of which must be a physician), at which the justification for both the necessity and urgency of the surgery or procedure at issue will be determined. This would include reviewing the medical records and utilizing applicable guidelines and literature.

If a temporary suspension or restriction hearing does not occur, the normal TMB process will occur, at which a panel of at least two physicians will determine:

  1.  whether or not the surgery was medically necessary given the Orders and guidelines provided above, and
  2. whether the standard of care was met.

The TMB has stated it intends to rely on  applicable guidelines such as the CDC, CMS, or other medical or specialty guidelines and literature in making these two determinations.

If you fail to comply with this Order, the consequences to you and your career are severe, and include:

  1. $1,000 fine;
  2. 180 days in jail;
  3. Temporary suspension or restriction by the TMB;
  4. Investigation by the TMB and possible loss of license;
  5. Mandatory report to the NPDB.

Therefore, we urge our members to apply the following standard in determining whether surgery should be performed at this time:

Is the medical act a surgery or procedure?

If No, and you are performing other medical acts, such as a history, physical exam, non-invasive diagnostics, or ordering/performing lab tests, you may proceed with the medical act.

If Yes, is this immediately medically necessary to correct a serious medical condition or to preserve the life of a patient and would this patient, without immediate performance of the surgery or procedure, be at risk for serious adverse medical consequences or death?

If Yes, you may perform the surgery. 

Given the severe consequences of these decisions, we urge our members to use caution in proceeding with surgery at this time.  In fact, before even scheduling the surgery, it may be wise to obtain a second opinion from a colleague in writing or a consensus within your community, as well as the approval of all medical professionals involved.

In short, the TPS advises you to be a good doctor, care for your patients and community, consider outcomes, and document.

We understand the gravity of this situation, and the consequences to you of postponing surgeries.  However, we urge you to think long term, and recognize that this is a temporary situation.  As a physician, your skills and talents will surely be necessary as this crisis evolves.


Brian Bruel, MD
President, Texas Pain Society
On behalf of the Board of Directors

NOTICE: Texas Pain Society is providing this information as a service to its members.   Neither TPS nor its attorneys are engaged in providing legal advice to individual members with respect to their practices.  Neither TPS nor its attorneys assume legal responsibility for damages arising from the use of this information.  We encourage you to seek legal advice from your personal legal counsel.

Researchers at University of Maryland School of Medicine are testing ultrasound to treat neuropathic pain – Baltimore Sun

Steroid injections, nerve stimulators and spinal fusions were no match for the chronic pain in Tammy Durfee’s left side — never mind the “searing-hot poker” sensation that would jab her leg without warning. After a decade searching for relief, a four-hour procedure in Baltimore put her pain to rest.

Read more

American Society of Interventional Pain Physicians 21st Annual Meeting in Las Vegas on May 3-5, 2019

The American Society of Interventional Pain Physicians is excited to announce our 21st Annual Meeting in Las Vegas on May 3-5, 2019. ASIPP, “The Voice of Interventional Pain Management” with a membership of nearly 5,000 welcomes your company’s presence at the 2019 Annual Meeting. We appreciate the past attendance and support from Abbott Diagnostics and hope you will once again join us for this premier meeting in interventional pain management.

The prospectus for the 2018 ASIPP Annual Meeting is attached. You may register using the application form found in the exhibitor prospectus or online using the following link: Exhibitor Registration

View Brochure

Evidence-based pain medicine for primary care physicians

Graves Owen, MD Brian M. Bruel, MD, MS, MBA,
C. M. Schade , MD, PhD, FIPP, Maxim S. Eckmann, MD,
Erik C. Hustak, MD & Mitchell P. Engle, MD, PhD


The last several decades have seen a marked increase in both the recognition and treatment of chronic pain. Unfortunately, patients frequently misunderstand both the nature of pain and the best practices for its treatment. Because primary care physicians treat the majority of chronic pain, they are ideally situated to provide evidence-based pain care. The majority of the medical evidence supports a biopsychosocial model of pain that integrates physical, emotional, social, and cultural variables. The goal of this primer is to assist primary care physicians in their understanding of pain, evaluation of the chronic pain patient, and ability to direct evidence-based care. This article will discuss the role of physical rehabilitation, pain psychology, pharmacotherapy, and procedural interventions in the treatment of chronic pain. Given the current epidemic of drug-related deaths, particular emphasis is placed on the alternatives to opioid therapy. Unfortunately, death is not the only significant complication from opioid therapy, and this article discusses many of the most common side effects. This article provides general guidelines on the most appropriate utilization of opioids with emphasis on the recent Centers for Disease Control and Prevention guidelines, risk stratification, and patient monitoring. Finally, the article concludes with the critical role that a pain medicine specialist can play in the management of patients with chronic pain.

Read the Full Article Now

Accredited Hands-On Training Stem Cells and Biologics for the Clinical Application of Pain Management – Miami – April 2017

Accredited Hands-On Training
for the Clinical Application of
Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain ManagementMiami, Florida • April 1 & 2, 2017

2-Day ACCME Accredited Hands-on Training Course

Boston BioLife is currently executing 2-day training programs in regenerative medicine using didactic and interactive hands-on learning. These courses feature the latest scientific principles, clinical trials, research & outcomes. This course will be taught by leading scientists, research scientists, and translational medicine physicians.


  • Science behind regenerative medicine
  • Fibrin uses to mechanically repair
    intervertebral discs
  • Adipose and its uses in
    regenerative medicine
  • Platelet rich plasma (PRP), protocols
    and applications
  • Bone marrow aspirate (BMA), protocols
    and applications
  • Amniotic Fluid; landscape, research,
    clinical applications
  • Exosomes uses in regenerative medicine
  • Halting cartilage degredation using
  • Musculoskeletal (MSK) research & historical perspective in regenerative medicine
  • Stem Cell Therapies; landscape, research, clinical applications
  • Important fundamentals of injections
    using ultrasonography
  • Fundamentals of implementing regenerative medicine into your practice
  • Atraumatic adipose harvesting and processing, patient based protocols
  • BMA techniques using ultrasonography
  • Interventional biologics for
    pain management
  • Proper cell counting & processing
  • Wound healing, rejuvenation medicine
    using stem cells
  • Faculty panel discussion
Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain Management

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain Management

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain Management

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain Management

Early Registration Open! You're Invited to Boston BioLife's Hands–On Stem Cell Workshop for the Clinical Application of Pain Management in Regenerative Medicine

Boston BioLife Website

Wenchun Qu, M.D., Ph.D.
Conference Chairman

Mayo Clinic
Kevin Pauza, M.D.
Keynote Speaker

Texas Spine & Joint Hospital
Scott Brandt, M.D.
Medical Director
Diego Correa, M.D., M.Sc., Ph.D.
Scientist/Assistant Professor
University of Miami

Peter Everts, Ph.D.
General Director Hyperbaric
and Cell Therapy Specialist

Da Vinci Clinic

John Ferrell III, M.D.
Team Physician, Washington Spirit
Director of Sports Medicine
Regenerative Orthopedics
and Sports Medicine

Susanna Kauhanen, M.D.
Consultant Plastic Surgeon
Helsinki University Hospital

Todd Malan, M.D.
Medical Director, Center for Regenerative Cell Medicine

Inge Matthiesen, Ph.D.
Director Medical Affairs and
Regenerative Medicine

Human Med AG
Michael Meng, D.C.
Musculoskeletal Ultrasonographer

Carlos Mercado, M.D.
Principal, Eterna MD Medical
Rejuvenation Center

Duncan Ross, Ph.D.
Kimera Research Labs

Gaetano Scuderi, M.D.
Orthopedic Spine Surgeon and Clinical Assistant Professor of Orthopaedic Surgery, Stanford University

Dmitry Shvartsman, Ph.D.
Senior Researcher, Department of
Stem Cell & Regenerative Biology

Harvard University

Tilman Stasch, M.D.
Valentis Clinic

JW Marriott MiamiJW Marriott Miami
1109 Brickell Avenue
Miami, FL 33131T: 800.386.1592

Discounted Room Rate: Boston BioLife

You're Invited to Boston BioLife's Hands–On Stem Cell Workshop for the Clinical Application of Pain Management in Regenerative Medicine

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain ManagementDenver, Colorado, May 20-21, 2017

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain ManagementPhiladelphia, PA, July 15-16, 2017

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain ManagementMinneapolis, MN, September 16-17, 2017

Hands–On Stem Cell Therapies and Biologics for the Clinical Application of Pain ManagementSan Francisco, CA, November 18-19, 2017




Read Dr. Trescot’s New Book “Peripheral Nerve Entrapments”

Featured as a single volume, this is a comprehensive guide to possible nerve entrapment syndromes and their management. Each chapter covers a single nerve, or group of closely related nerves, and goes over the clinical presentation, anatomy, physical exam, differential diagnosis, contributing factors, injection techniques, neurolytic/surgical techniques, treatments of perpetuating factors, and complications.

  • This book features over 50 videos of examination and injection techniques, at least 2 per nerve
  • Contains “Pain Problems Index” to navigate by symptom
  • Includes anatomy, injection technique, and complications for each nerve

About the Author

Andrea M. Trescot, MD
Medical Director – Pain and Headache Center
Anchorage, AK, USA

Dr. Trescot is currently the Chair of the Education Committee of the World Institute of Pain. After 15 years of private practice, she joined academics as a professor and served as the Director of the pain fellowship programs for the University of Washington and the University of Florida/VA Pain Center, before she returned to private practice. She was President of the American Society of Interventional Pain Physicians (ASIPP) from June 2007 to June 2008.  She coauthored the book Pain-Wise: A Patient’s Guide to Pain Management (Hatherleigh Press, 2011), and co-edited the 3 volumes of Pain Medicine & Interventional Pain Management – A Comprehensive Review (American Society of Interventional Pain Physicians Publishing, 2011).

Click here for more information!


Persistent Pain After a Knee Replacement?

Do you have patients who experience persistent pain after a knee replacement?

Dr. Timothy Lubenow, Anesthesiologist & Professor of Anesthesiology at Chicago’s Rush University Medical Center, faced that familiar problem with his patient, Barbara Ford and turned to COOLIEF* Cooled RF. “It was a pain management problem at that point, which is why I recommended the COOLIEF* procedure1,” explains Dr. Lubenow. “The COOLIEF* procedure is designed to destroy the nerve fibers that innervate the inner portion of the knee joint1.”

Barbara Ford talks about how she got “99% of pain relief within fifteen minutes of coming out of anesthesia1” and how it was the best day of her life! Listen to her emotional story!

Barbara Ford video SHORT