October 22 Orlando, Florida

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1 ASIPP Educational Services Excellence in the education of Interventional Pain Physicians Interventional Techniques Cadaver Workshop Up to 8 AMA PRA Category 1 Credits Basic, Intermediate, and ABIPP Exam Preparation (advanced) Plus Online Video Lectures Up to 16 AMA PRA Category 1 Credits October 22 Orlando, Florida Host Hotel: Caribe Royale, 8101 World Center Dr, Orlando FL Direct Reservation Cadaver Workshop Location: University of Central Florida, Health Sciences Campus at Lake Nona, 6850 Lake Nona Blvd., Orlando, FL Specials: $100 (per book) for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain 50% Off Meeting Fee to Fellows & Residents Special Early Bird room rates American Society of Interventional Pain Physicians The Voice of Interventional Pain Management

2 From The Chairman of the Board and CEO On behalf of the Board of the American Society of Interventional Pain Physicians (ASIPP ), it is our privilege and pleasure to invite you to attend this Hands-On Cadaver Workshop in Interventional Techniques, including online lectures. The workshop will occur October 22, 2016 in Orlando, Florida at the University of Central Florida, College of Medicine with the host hotel being Caribe Royale. Course Directors This unique course meets the continuing needs of interventionalists, based on input and needs assessment over the years and is a cutting edge educational program. It entails the equivalent of 2 days of online lectures and 1 day of hands-on cadaver workshop covering various levels of interventional techniques. Laxmaiah Manchikanti, MD Chairman of the Board and Chief Executive Officer, ASIPP The online lectures from a recent Interventional techniques course are supplied for viewing prior to the cadaver workshop and will remain available for future reference. A printable version of the lectures are included. The 1-day Cadaver Workshop involves comprehensive review of interventional techniques. This Cadaver Workshop is an essential component for interventional pain physicians and provides education opportunities to assist you in providing high-quality, competent, safe, accessible, and cost-efficient services to your patients. Aaron K. Calodney, MD President, ASIPP The Cadaver Workshop is fashioned to accommodate training levels and capacity of participants. Physicians can choose from basic, intermediate, or ABIPP examination preparation course levels to mirror your needs and skill level. The course provides necessary CME credits and/or an in-depth review of interventional techniques. Participants will experience a comprehensive and intense learning opportunity focused on meeting their needs at the highest level of medical education. Ramsin M. Benyamin, MD Past President, ASIPP Whether you have been practicing interventional pain management for many years or are new to the field with basic skills, we are confident you will find this course and cadaver workshop to be beneficial, as it is essential to learn new and relevant information to survive in the new millennium. We look forward to seeing you in Orlando. If you have questions, please feel free to contact the ASIPP office at 81 Lakeview Drive, Paducah, KY 42001, phone: , fax: , or asipp@asipp.org Thank you, Laxmaiah Manchikanti,MD 2 American Society of Interventional Pain Physicians

3 Statement of Need This Interventional Techniques Course includes: 1-day hands on cadaver workshop, video lectures, and PDF copies of the video presentations. The online lectures and cadaver workshop is planned as a CME activity to prepare for ABIPP or an in-depth review in areas of interventional techniques. This review course and cadaver workshop is based on the American Board of Interventional Pain Physicians requirements. This course will provide in-depth evaluation of the knowledge of the participants with extensive review of subject(s). As part of the comprehensive, in-depth, intense review course, ASIPP will provide participants with online lectures. Educational Objectives/Target Audience This comprehensive review course and cadaver workshop for interventional techniques is targeted to interventional pain physicians seeking CME credit hours and introduction or review of proven interventional techniques, as well as skills improvement and/ or to fulfill CME hours. Educational Objectives Review basic science and core concepts Attain understanding of interventional techniques Incorporate interventional techniques in treating your patients so that patients have better outcomes and reduced side effects Provide high-quality, competent, safe, accessible, and cost-efficient services to your patients Improve existing skills and/or develop new skills in the delivery of interventional techniques Review infection control and complications Outcome Physicians should be able to integrate multiple aspects of interventional techniques in treating their patients so that patients have better outcomes. Americans with Disabilities Act And Special Services Organizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) at least 10 days prior to the conference. Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Institute for Medical Studies and the American Society of Interventional Pain Physicians (ASIPP ). The Institute for Medical Studies is accredited by the ACCME to provide continuing medical education for physicians. ASIPP is now an ABA Registered CME Provider. Category I Credit The Institute for Medical Studies designates the online lectures for a maximum of 16 AMA PRA Category 1 Credits for the Interventional Techniques Review Course and this live activity 8 AMA PRA Category 1 Credits for Cadaver Workshop. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians of Osteopathic Medicine the American Osteopathic Association (AOA) accepts AMA PRA Category 1 Credits as AOA Category 2-B credit. Americans with Disabilities Act And Special Services Organizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact the organizers at (270) at least 10 days prior to the conference. Duplication or distribution of materials or recording of lectures without express written permission from ASIPP is prohibited. There is NO commercial support for this course. Accommodations Caribe Royale 8101 World Center Drive, Orlando FL Direct Reservation At the Caribe Royale All-Suite Hotel and Convention Center, business and pleasure go hand in hand. From the very beginning, they ve redefined and elevated the standards of the meeting, conference and family vacation experience in Florida. Inform the agent that you are booking for ASIPP. We have secured a group room rate of $159. Reserve rooms early room block cutoff date: September 30, American Society of Interventional Pain Physicians 3

4 online lectures must be reviewed PRIOR TO cadaver workshop Saturday October 22, 2016 Cadaver Workshop for Interventional Techniques 6:30am 7:15am 8:00am 8:00am 8:15am 8:15am 9:00am Shuttles depart from Hotel to the Cadaver facility Registration and Breakfast Introduction - Laxmaiah Manchikanti, MD Overview of Technical Considerations - Laxmaiah Manchikanti, MD 9:00am 12:30pm Hands-on Cadaver Workshop 12:30pm 1:30pm Lunch 1:30pm 5:00pm Hands-on Cadaver Workshop 5:00pm Shuttles depart from Cadaver facility to the Hotel & To the Airport Cadaver LAB COURSE LEVELS BASIC INTERMEDIATE ABIPP Preparation 1. Sacroiliac joint interventions 2. Lumbar interlaminar epidural injections 3. Lumbar transforaminal epidural injections 4. Lumbar facet joint nerve blocks 5. Lumbar facet radiofrequency neurotomy 6. Caudal epidural injections 1. Cervical and thoracic interlaminar epidurals 2. Cervical facet joint interventions (medial branch blocks, and radiofrequency neurotomy) 3. Thoracic facet interventions (medial branch blocks, and radiofrequency neurotomy) 4. Lumbar discography and adhesiolysis 5. Lumbar sympathetic blocks and hypogastric plexus blocks 6. Lumbar facet joint nerve blocks and radiofrequency neurotomy 1. Cervical facet joint interventions (medial branch blocks and radiofrequency neurotomy) and cervical interlaminar epidural injections 2. Thoracic facet joint interventions (medial branch blocks and radiofrequency neurotomy), intercostal nerve blocks, and thoracic interlaminar epidural injections 3. Lumbar facet joint interventions (facet joint nerve blocks, and radiofrequency neurotomy) and sacroiliac joint injections 4. Caudal epidural, interlaminar epidural, transforaminal, and percutaneous adhesiolysis 5. Spinal cord stimulation lead placement and lumbar discography 6. Sympathetic blockade (stellate ganglion, lumbar sympathetic blocks and celiac plexus blocks) 4 American Society of Interventional Pain Physicians

5 Registration Registrant INFORMATION IMPORTANT. Please answer all the questions: Medical Degree: m MD m DO m List other: Primary Specialty Certification: m Anesthesiology m Physiatry m Neurosurgery m Other: Pain Medicine Subspecialty Certification: m ABMS Pain Medicine (Anesthesiology, PMR, Neurology, Psychiatry, Emergency Medicine) m American Board of Pain Medicine m American Board of Interventional Pain Physicians m Fellow of Interventional Pain Practice (FIPP) Specialty Designation: m 09 - Interventional Pain Management m 72 - Pain Management m Other: What is your practice location: m ASC m HOPD m Office-setting Percentage of Interventional Pain Management Practice: m 0% m 1-25% m 26-50% m 51-75% m > 75% Years in Interventional Pain Management Practice: m 0 m 1-5 m 6-10 m > 10 Total number of procedures performed during past year: LOCATION ASC HOPD Office Sacroiliac Joint Injections Caudal Epidural Injections Lumbar Interlaminar Epidural Injections Lumbar/Sacral Transforaminal Epidural Injections Lumbar/Sacral Facet Joint Nerve Blocks Lumbar Facet Joint Blocks Thoracic and Cervical Interlaminar Epidural Injections Lumbar Facet Blocks and Radiofrequency Thoracic Facet Blocks and Radiofrequency Cervical Facet Joint Blocks and Radiofrequency Lumbar Discography Hydrodiscectomy Nucleoplasty Automated Percutaneous Lumbar Discectomy Register online at Please print exactly as you wish your name to appear: Name (First) (Middle Initial) (Last) Organization Address City STATE zip Phone Fax Interventional Techniques Hands-on Cadaver Workshop And Comprehensive Online Lectures Physicians only- All registrations must be approved m Hands-on Cadaver Workshop (Includes online lectures and presentation pdf s) m Cadaver Workshop Level m $2,500 Member m $2,800 Non Member m 50% Fellow Discount *** m Basic m Intermediate m Advanced (ABIPP Preparation) *** If registering as a fellow, please list below the name of fellowship program, university or hospital and fax or a letter from the program director verifying your status. Your application for registration cannot be processed and you will not receive the 50% discount until ASIPP receives this letter. Fax the letter to or to crogers@asipp.org Name of Fellowship Program Payment Method (Please check one): m Mastercard m Visa m American Express m Discover Credit Card Number Security Code (Back of Card) Exp. Date Name On Card Authorized Signature (required on all credit card orders) (Your application will not be processed if payment does not accompany registration form) Return completed form to: ASIPP, 81 Lakeview Drive, Paducah, KY or Fax to CANCELLATION POLICY: ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing by September 21, Cancellations after September 21, 2016 but prior to October 7, 2016 will forfeit 50% of their registration fee. No refunds can be made after October 7, American Society of Interventional Pain Physicians 5

6 American Society of Interventional Pain Physicians 81 Lakeview Drive, Paducah, KY Interventional Techniques Cadaver Workshop Up to 8 AMA PRA Category 1 Credits Basic, Intermediate, and ABIPP Exam Preparation (advanced) Plus Video Lectures Up to 16 AMA PRA Category 1 Credits October 22 Orlando, Florida Host Hotel: Caribe Royale, 8101 World Center Dr, Orlando FL Direct Reservation Cadaver Workshop Location: University of Central Florida, Health Sciences Campus at Lake Nona, 6850 Lake Nona Blvd., Orlando, FL Specials: $100 (per book) for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain 50% Off Meeting Fee to Fellows & Residents Special Early Bird room rates PRSRT STD U.S. Postage Paid Paducah, KY Permit #44