Pain physician
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The forced implementation of ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes that are specific to the United States, scheduled for implementation October 1, 2015, which is vastly different from ICD-10 (International Classification of Diseases, Tenth Revision), implemented worldwide, which has 14,400 codes, compared to ICD-10-CM with 144,000 codes to be implemented in the United States is a major concern to practicing U. S. physicians and a bonanza for health IT and hospital industry. This implementation is based on a liberal interpretation of the Health Insurance Portability and Accountability Act (HIPAA), which requires an update to ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and says nothing about ICD-10 or beyond. ⋯ Physician groups are not a party to these cooperating parties or coalitions, having only a peripheral involvement. ICD-10-CM creates numerous deficiencies with 500 codes that are more specific in ICD-9-CM than ICD-10-CM. The costs of an implementation are enormous, along with maintenance costs, productivity, and cash disruptions.
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Intrathecal baclofen (ITB) delivered by programmable pump devices represents an important modality for long-term treatment of severe spinal spasticity. ⋯ ITB withdrawal syndrome is a rare but life-threatening event and prompt diagnosis before treatment initiation is critical. The reported events were mostly mild due to the acute treatment regime and probably due to a lower dose of ITB. A prerequisite for successful ITB treatment is a deep knowledge of complications and their prompt management in the hands of a multidisciplinary team in specialized centers.
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The prevalence of HIV-related neuropathy may rise nationwide as Highly Active Antiretroviral Therapy (HAART) usage and HIV-survival rates increase, resulting in higher referral rates to pain practitioners for analgesic strategies. However, if patients' symptoms are refractory to conservative measures, an advanced interventional approach may be indicated. ⋯ These 2 cases demonstrate that SCS neuromodulation is a safe, viable, and efficacious option for patients whose HIV-related neuropathic type pain is refractory to conventional treatment modalities. Our patients appear to be the first case reports that show a remarkable efficacy of SCS in the management of HIV-related polyneuropathy.