Dear Texas Pain Society (TPS) Members,

Happy 2024!  I hope your year is off to a good start so far. It is my pleasure as President to introduce a valuable addition to the TPS communication channels - the Texas Pain Pulse, our exclusive members-only newsletter produced in partnership with ARP. Ensure [email protected] is a trusted email address so you receive it.

Texas Pain Pulse is a curated source of insights, updates, and news designed specifically for TPS members. This monthly newsletter aims to keep you informed about the latest developments in the field of pain management, share best practices, keep you posted on upcoming events and foster a sense of community among our esteemed members.

This year, the Texas Pain Society was honored to present the Schade-Hill Public Policy Award to Stefanie Turner, founder of the nonprofit Texas Against Fentanyl. 

Each year at its annual conference, the Texas Pain Society (TPS) gives out awards to distinguished individuals in the pain industry. One such honor is the Schade-Hill Public Policy Award, which was inspired by the countless hours that Drs. C.M. Schade and Stratton Hill dedicated to TPS, in order to help craft the pain medicine laws that govern Texas today. In its eleventh year, the award recognizes outstanding work that has made a positive change in the world of pain medicine, and this year – during the TPS 15th Annual Scientific Conference – it went to Stefanie Turner.

Turner lost her 19-year-old son, Tucker Roe, after he purchased one illicit fentanyl pill from a peer on social media. After he passed, she began sharing his story and educating others on the deadly effects of this dangerous drug. Texas Against Fentanyl (TXAF), a 501c3 nonprofit, was born.

Her work didn’t stop there, though.

Federal Register Notice

DEA is pleased to announce the July 27, 2023 final rule, Transfer of Electronic Prescriptions for Schedules II-V Controlled Substances between Pharmacies for Initial Filling, which was developed to provide clarity on existing Federal regulatory requirements, as well as to facilitate the proper dispensing of electronic prescriptions for controlled substances. This final rule, effective on August 28, 2023, amends DEA regulations to allow the transfer of electronic prescriptions for schedules II-V controlled substances between registered retail pharmacies for initial filling, upon request from the patient, on a one-time basis. The final rule requires that the transfer must be communicated directly between two licensed pharmacists, the prescription must remain in its electronic form, and the prescription information required by 21 CFR part 1306 must not be altered during the transmission. The final rule also stipulates that the transfer of electronic prescriptions for controlled substances (EPCS) for initial filling is permissible only if allowable under existing State or other applicable law.

In addition, the final rule describes the recordkeeping requirements for pharmacies transferring EPCS for initial filling, as well as pharmacies receiving and filling such prescriptions. The final rule only addresses the transfer of EPCS for initial filling and does not address the transfer of EPCS for refill dispensing, which is outlined in 21 CFR 1306.25.

Further, the final rule does not change the existing requirements for all prescriptions, as outlined in 21 CFR part 1306, nor the requirements for electronic prescription and pharmacy applications, as outlined in 21 CFR part 1311.
We hope this information is helpful.

If you have any questions pertaining to this rule, please contact: 

Scott A Brinks, Regulatory Drafting and Policy Support Section, Diversion Control Division, Drug Enforcement Administration; Telephone: (571) 776-3882; Email: [email protected].

Pain physicians from across the state met at the Capitol in Austin, in order to spread awareness of pain medicine topics to policymakers in Texas.

On March 23, Texas Pain Society members traveled from all over the state to meet with legislators and discuss issues relevant to pain medicine. 

The participants were:

• C.M. Schade, M.D. of Advanced Pain Solutions

• Heidi Seifert, M.D.

It is now easier to prescribe buprenorphine to patients with opioid use disorders.

During the recent State of the Union address, President Joe Biden mentioned a law that simplifies prescribing opioid addiction treatments. He was referring to the X-Waiver, which had been around for over 20 years before it was done away with on December 29, 2022.

“With the signing of the Consolidated Appropriations Act of 2023, Congress eliminated the DATA-Waiver Program,” states the Drug Enforcement Administration (DEA)’s website. “The elimination of the X-Waiver will increase access to buprenorphine for those in need.” 

With the waiver, doctors had to jump through multiple hoops (training, audits, a patient limit) if/when they prescribed the drug. Therefore, as the vice president for research at UT Health San Antonio, Jennifer Potter, told NBC News, health professionals had been waiting for its removal for “years if not a decade or more.”

Dr. Menard of Hill Country Memorial will step into the role of president as the Texas Pain Society (TPS) on October 29, 2022. Recently, he discussed how he started working in the pain medicine industry, as well as his goals for the organization. 

I have always been interested in pain, even during medical school and residency and before pain fellowships were a thing. I did a rotation at Fort Gordon, the US Army hospital in Georgia, with an anesthesiologist who treated pain, which helped me pursue that path. After my residency, I went back on active duty in the US Navy, as they paid for my medical school. I was primarily stationed in Orlando and opened a small pain clinic in the hospital with the help of a couple other physicians, including one of our own Texas Pain Society physicians, Dr. Ashley Classen. 

I moved to Lubbock, Texas, after leaving the Navy, specifically because they had an opportunity open for a combined anesthesia and pain doctor. For most of my time in Lubbock, I was a solo practitioner and was affiliated with Texas Tech University Health Sciences Center (TTUHSC). Fortunately, my association with TTUHSC was during a time when Dr. Prithvi Raj was still there. Both he and Dr. Gabor Racz provided indispensable professional and personal guidance. In fact, I was there when they brought up the idea of the Texas Pain Society and was one of the founding members, donating $1,000 to help get it started. There were probably only 20-30 or so of us attending those early pain conferences at TTU back then, and many of them were residents and fellows.

As to my goals as the new president of TPS, I would like to expand on what my predecessor, Dr. Maxim Eckmann, started by expanding our use of social media (Be sure to follow TPS on Twitter and LinkedIn!). I would like to see an expanded use of the TPS forum to include articles of best practices for members. I would also like to see more use of the TPS educational offerings, such as IPOC and the online modules that offer CME courses. Another thing I want to emphasize to members is how important it is to attend First Tuesdays, in order to get to know your legislators and talk to them on a personal basis. Pain medicine has some big problems looming this next year during the legislative session, and we need to start working on them now. As Dr. CM Schade, our leading expert on legislative affairs, says, "If you aren’t at the table, then you are on the menu.”

New guideline provides evidence-based recommendations to help patients and clinicians make informed, patient-centered decisions about effective pain care.

 Where are they now? Read what previous Case Study and Scholarship winners have been up to...

Previous Winner of the 2020 Hassenbusch Continued Learning Case Study Presentation and 2021 Hassenbusch Continued Learning Scholarship

George Polson MD
Case Study (2020) – PM&R Residency at Baylor College of Medicine
Scholarship (2021) – PM&R Residency at Baylor College of Medicine (Accepted to MD Anderson Pain Medicine Fellowship)

In what ways have you used what you presented in your recent practice?
While the case study I presented involved the use of Peripheral Nerve Stimulation for Hemiplegic Shoulder Pain, during my fellowship training we have found a multitude of other clinical uses for this new technology, all of which ultimately has led to better patient outcomes. It is exciting to be a part of all the innovation and treatment options that neuromodulation has to offer!

What professional development have you gone through since your award? 
              As of July 2022, I have begun my Pain Fellowship training at MD Anderson Cancer Center

Where are you working now? 
              The Texas Medical Center in Houston, TX

What's one piece of advice you'd give to a Fellow going into PM? 
Take advantage of opportunities such as Texas Pain Society’s Annual Conference! The ability to meet various individuals within the practice of pain management, all gathered in a familiar setting here in the great state of Texas (Hook em Horns!), has definitely served as the foundation of many relationships that I will continue to hold on to as I begin my own career within this field.
 

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Previous Winner of the 2021 Hassenbusch Continued Learning Case Study Presentation

Grayson Koval, MD

Pain fellow at Texas Tech when award was received. 

In what ways have you used what you presented in your recent practice?
I have used my case study to remind myself of the importance of being a clinician who thoroughly evaluates his patients. 

What professional development have you gone through since your award? 
Since last year, I have finished my fellowship, been board certified in anesthesia, and started a private practice job in Midland, TX. 

Where are you working now? Midland Spine Institute in Midland, TX.

What's one piece of advice you'd give to a Fellow going into PM? Take advantage of every learning opportunity in fellowship
 

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Previous Winner of the 2021 Hassenbusch Continued Learning Case Study Presentation

Adedeji Olusanya DO, MPH

• At University of Texas Health Science Center at San Antonio when award was received. 
  
  
• In what ways have you used what you presented in your recent practice? 
  I was able to talk about spinal stenosis and different treatment approaches on rotations 
  
  
• What professional development have you gone through since your award?  Since the last conference, I have been able to attend more national pain conferences where I was able to net work with other fellows, and pain physicians. I also have and the opportunity to join numerous of webinars where I was able to expand my knowledge in pain medicine, patient management, and new innovative procedure to help shape the future of pain medicine.
  
  Where are you working now? Right now I am PGY-3  at university of Texas Health science Center at San Antonio. This year, I will be applying for the next pain fellowship cycle.
  
  What's one piece of advice you'd give to a Fellow going into PM? I wouldn’t imagine that I could give a Fellow much advice. But what I would say to a resident or medical student that is interested in pain, is to get into research early! Also networking while attending pain conferences is vital. Interventional pain is a small field, it is important to know your colleagues!

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 Previous Winner of the  2021 Hassenbusch Continued Learning Scholarship

Vishal Bansal, MD 

When award was received, Dr. Bansal was Physical Medicine and Rehabilitation at University of Texas Health Science Center at Houston 

What professional development have you gone through since your award? 
I've been fortunate to attend the TPS for the past 3 years due to the assistance of the scholarship award. It has been a rewarding experience for me as a resident due to its educational sessions and the ability to network with pain physicians specific to Texas where I plan on practicing in the future. I am applying for pain fellowships this year, and plan to attend this year's TPS again to further network and keep myself up to date. I've been able to follow up with some of the attendees to get mentorship and additional clinical experience and prepare me for my future transition into pain medicine. It has also given me exposure to the broad scope of pain medicine that I have not seen in my residency training and sparking my interest into neuromodulation. 

Where are you working now? 
Resident Physician (PGY-3) and will be applying for Pain Medicine fellowship

What's one piece of advice you'd give to a Fellow going into PM?
One piece of advice I would have for residents considering pain medicine fellowship would be to get involved with research and attend regional and national conferences in Pain Medicine. Research or publications is often a great way for yourself to get familiar with a particular topic and to also form connections with other pain physicians. Conferences are a great way to meet future colleagues and learn about the current practices and latest advances in pain medicine, making you well equipped to start your journey into pain medicine fellowship. 

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 Previous Winner of the 2019, 2020 & 2021 Hassenbusch Continued Learning Case Study Presentation

Joseph Liao, M.D.

When award was received, Dr. Liao was at the University of Texas - Houston, Department of Anesthesiology

In what ways have you used what you presented in your recent practice? The majority of my studies involved interventional procedures in the treatment of refractory pain conditions. Presenting complex scenarios and receiving feedback from the physician leaders in Texas have shaped how I approach patient care, especially when it comes to patient selection and determining what next steps may possibly be offered to patients. The moderators and seasoned pain physicians at Texas Pain Society have a wealth of knowledge and invaluable experience.

What professional development have you gone through since your award? 
I am an anesthesiologist and pain management fellow at Stanford University. My goal is to offer my patients quality, best-in-class treatments. I am also working towards being more involved in industry and physician leadership. 

This awareness day, focused on opioids, exists to encourage patients to only use opioids as prescribed.

Recently, there has been an influx of news on the topic of opioids, the opioid epidemic, illicit fentanyl overdoses, and National Opioid Awareness Day, which falls on September 21. This awareness date urges people to learn more about these drugs, including the dangers of abusing legitimately prescribed opioids, the potentially fatal results of using or trying illicit opioids, and the proper way to handle opioid prescriptions. 

What are opioids?

Opioids are a class of drugs that are chemicals (either natural or synthetic), which interact with nerve cells and, in turn, treat pain. Also known as narcotics, they include illegal drugs like heroin, synthetics like fentanyl, and prescriptions (both natural and semi-synthetic) like oxycodone, hydrocodone, codeine, and morphine. They can come as oral pills, lozenges, oral solutions, injections, IVs, patches, or suppositories. 

From what drew her to the pain management industry to her favorite part of being a pain doctor, Dhanalakshmi Koyyalagunta opens up in our latest profile feature!

Dhanalakshmi Koyyalagunta, MD is a Texas Pain Society Board Member and professor for the Department of Pain Medicine, Division of Anesthesiology and Critical Care, The University of Texas M.D. Anderson Cancer Center.

Area of Specialty & Special Interest: Cancer pain, opioid addiction

What got you into pain medicine? The blend of pharmacology and interventions! 

Texas Pain Society Board Member Carlos Omar Viesca, MD shares how he got involved in Pain Management. 

Carlos Omar Viesca, MD is a Texas Pain Society Board Member and physician for Interventional Pain Medicine Institute.

   1250 E. Cliff Dr., Suite 3D
    El Paso, TX 79912-6431

You have until May 15 to review and dispute the program year 2021 Open Payments data before CMS publishes it in June. Reviewing your data is voluntary but strongly encouraged. Log into the Open Payments system to review your data. If you have a dispute, work directly with the reporting entity to resolve it; we don’t mediate or facilitate disputes.

Accessing Your Account:

• If you don’t have an account, register in the Open Payments system
• If you haven’t accessed your account in 60 days or more, unlock your account in the CMS Portal
• If you haven’t accessed your account in 180 days or more, call the Open Payments Help Desk

More Information:

• Review and Dispute Timing and Data Publication Quick Reference Guide (PDF)
• Open Payments website
• Contact the help desk at [email protected] or 855-326-8366 (TTY: 844-649-2766)

 

Deadlines this Week

If you’re interested in issues involving the disclosure of risks and hazards related to medical care and surgical procedures, you may want to apply to be a member of the Texas Medical Disclosure Panel. The Texas Health and Human Services Commission executive commissioner will appoint a physician and an attorney licensed to practice in Texas to the panel to serve a term expiring Aug. 31, 2028.

Applications are due by 11:59 p.m., May 27.

HHSC will consider applicants' qualifications, background and interest in serving on the panel and will try to choose panel members who represent the diversity of all Texans. For this reason, HHSC considers applicants' ethnicity, gender and geographic location.

• Review the Texas Medical Disclosure Panel Membership application letter to find out who the panel is seeking as representatives and if you qualify.
• After reviewing the application letter and verifying you meet the qualifications for at least one category, click on the application to apply to be on the panel.

A Texas Medical Disclosure Panel member must regularly participate in panel meetings. They may also have to take part in subpanel meetings, projects and presentations. Panel meetings are held about once every three months in Austin or at the call of the presiding officer. To the extent permitted by the current state budget, a panel member may be repaid for their travel expenses to and from meetings if money is available and in accordance with the HHSC Travel Policy.

The first-ever National Fentanyl Awareness Day launches Tuesday, May 10, 2022. Download Social Media Assets   #NationalFentanylAwarenessDay #FentanylAwareness Download Flyers for your Office  Visit the National Fentanyl Awareness Day website for more information.You can find additional social media, draft emails to share with partners, key messages, and more using the official toolkit. Founded by parents who have lost loved ones to the drug overdose epidemic, National Fentanyl Awareness Day is supported by a group of subject matter experts, corporations, nonprofits, schools, families, and elected officials who are coming together to amplify the issue via social media.

The DEA’s Take Back Day events provide an opportunity for Americans to prevent drug addiction and overdose deaths. Encourage the gathering of unused, unwanted, or expired prescription drugs to dispose of safely during the upcoming event. When: Saturday,  April 30th 2022 – 10 AM to 2 PM

DWC Asks for Input for Return-to-Work Plan-Based Audit DWC seeks input for the Return-to-Work (RTW) Plan-Based Audit, which evaluates the reasonableness of a doctor’s decision and recordkeeping for RTW. The plan-based audit sets the scope, methodology, selection standards, and program area duties as laid out in the Medical Quality Review Process. Comments are due by April 27, 2022. Learn more.

Federal Register Notice

Requiring Online Submission of Applications for and Renewals of DEA Registration (PDF)

ACTION: Final rule.

SUMMARY: This rulemaking amends the Drug Enforcement Administration's (DEA) regulations to now require all applications for DEA registrations, and renewal of those registrations, to be submitted online.

DATES: This final rule is effective May 11, 2022.

FOR FURTHER INFORMATION CONTACT:
Scott A. Brinks, Regulatory Drafting and Policy Support Section, Diversion Control Division, Drug Enforcement Administration; Mailing Address: 8701 Morrissette Drive, Springfield, Virginia 22152; Telephone: (571) 776–2265.

Physicians Call for Better Access to Naloxone, Treatment Programs for Opioids

Read the TMA article