American Society of Interventional Pain PhysiciansThe Voice of Interventional Pain Management since 1998

Visiting Denver is like visiting a new world. Everyone wants to visit Denver because of all the mountains, the waterfalls and snow cap mountains with all ski resorts. Denver, it’s really one of the countries most desirable and exciting places to visit.

Denver is home to the largest city park system in the country and has the second largest performing arts complex in the nation. The Cadaver facility, Science Care, sets the standard of excellence for the donation and responsible use of human tissue for medical research,

training and professional education. Science Care is the only organization to be accredited by both the American Association of Tissue Banks (AATB) and accredited as a provider by the Accreditation Council for Continuing Medical Education (ACCME). Science Care has fully audited

quality assurance program, and insist on the highest standards not only for us, but for the vendors and clients that we work with.

NOVEMBER 2-4, 2012 | DENVER, COLORADO HOTEL & REVIEW COURSE LOCATION:

Renaissance Denver Hotel, 3801 Quebec Street, Denver, CO 80207 | Tel. 303-399-7500

CADAVER WORKSHOP LOCATION:Science Care, 19301 East 23rd Avenue Aurora, CO 80011 | Tel. 800-417-3747

SPECIALS:• $100 for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain at Meeting for Attendees

• 10% off Foundations, Clinical Aspects, and/or Board Review Self-Assessment available in hard copy and DVD• 20% off Essentials of Practice Management: Billing, Coding, and Compliance in Interventional Pain Management

• 50% Off Meeting Fee to Fellows & Residents• Special room rates through October 11, 2012

ASIPP® Educational ServicesEXCELLENCE IN EDUCATION OF INTERVENTIONAL PAIN PHYSICIANS

NOVEMBER 2012

COMPREHENSIVE REVIEW COURSE AND

CADAVER WORKSHOP(BASIC, INTERMEDIATE, AND COMPREHENSIVE INTERVENTIONAL

PAIN MANAGEMENT EXAMINATION PREPARATION COURSE)UP TO 21.25 AMA PRA CATEGORY ™1 CREDITS™

COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP(BASIC, INTERMEDIATE, AND COMPREHENSIVE INTERVENTIONAL PAIN MANAGEMENT EXAMINATION PREPARATION COURSE)NOVEMBER 2-4, 2012 | DENVER, COLORADO

AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS2

FROM THE CHAIRMAN

On behalf of the American Society of Interventional Pain

Physicians and the ASIPP Board of Directors, I am pleased

to offer this unique educational event that can assist you in

furthering your knowledge-base and skills in the specialty

of Interventional Pain Management. This unique course is

designed for and dedicated to offering the highest level of

education, training, and measurement of skills in our goal to provide better care and

access for our patients.

The Comprehensive Review Course and Cadaver Workshop is designed to meet

the unique needs of interventional pain physicians. With our excellent participant/

instructor ratio, you will have the opportunity for personal interaction with our highly

distinguished faculty of world-renowned teachers and lecturers, creating a thorough

and compelling educational experience.

During the 2½-day Comprehensive Review Course and Cadaver Workshop, you

can improve existing skills and/or learn new techniques. 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 workshop to be beneficial

– as it is essential that we continue learning and exploring new procedures and

techniques in our specialty.

We are confident that you will benefit from this exceptional opportunity for

professional enhancement. This seminar will be conducted at The Science Care facility

in Denver, Colorado and accommodations will be at the Renaissance Denver Hotel.

Make your plans early to attend. We look forward to seeing you in Denver. If you have

any questions, please feel free to contact me at 2831 Lone Oak Road, Paducah, KY

42003, phone: 270-554-9412 fax: 270-554-5394, or e-mail: drm@asipp.org

Sincerely,

Laxmaiah Manchikanti, MD

Chairman of the Board and Chief Executive Officer, ASIPP

American Society of Interventional Pain Physicians®THE VOICE OF INTERVENTIONAL PAIN MANAGEMENT SINCE 199881 Lakeview Drive, Paducah, KY 42001Phone: 270.554.9412 Fax: 270.554-5394E-Mail: asipp@asipp.orgWeb Site: www.asipp.org

CHAIRMAN OF THE BOARD ANDCHIEF EXECUTIVE OFFICER Laxmaiah Manchikanti, MD—Paducah, KYPRESIDENT Frank J.E. Falco, MD—Newark, DE IMMEDIATE PAST PRESIDENTStandiford Helm II, MD—Laguna Hills, CA PAST PRESIDENTAllan T. Parr, MD—Covington, LA Gabor B. PRESIDENT-ELECTHans C. Hansen, MD—Conover, NC EXECUTIVE VICE PRESIDENTRamsin M. Benyamin, MD—Bloomington, ILVICE PRESIDENT STRATEGIC PLANNINGDavid L. Caraway, MD, PhD—Huntington, WVSECRETARYSukdeb Datta, MD—Summit, NJ TREASURERAaron K. Calodney, MD— Tyler, TXLIFETIME DIRECTORSCyrus E. Bakhit, MD—Roanoke, VALaxmaiah Manchikanti, MD—Paducah, KYBentley A. Ogoke, MD—Mount Vernon, NY Vijay Singh, MD—Niagara, WI

DIRECTORS AT LARGEMark V. Boswell, MD, PhD—Louisville, KY David Bryce, MD—Middleton, WIScott E. Glaser, MD—Burr Ridge, ILRodney L. Jones, MD—Wichita, KSHaroon Hameed, MD—Newark, DEDavid S. Kloth, MD—Danbury, CTGabor B. Racz, MD—Lubbock, TXFrancis Reigler, MD—Malibu, CAXiulu Ruan, MD—Mobile, ALDavid M. Schultz, MD—Minneapolis, MN Peter S. Staats, MD—Shrewsbury, NJJohn R. Swicegood, MD—Fort Smith, AR

DIRECTORS EMERITUSW. Stephen Minore, MD—Love Park, ILJoshua A Hirsch, MD—Boston, MAPAIN PHYSICIAN EDITOR-IN-CHIEFHoward S. Smith, MD—Albany, NYAMA DELEGATESLee T. Snook, MD—Sacramento, CAHaroon I. Hameed, MD—Newark, DESTAFFMelinda Martin, Director of OperationsRay Lane, Director of Public RelationsHolly Long, Coordinator of Editorial ServicesVidyasagar Pampati, Statistician and ProgrammerPaula Reynolds Spear, Meeting CoordinatorTom Prigge, Multimedia SpecialistCindy Rogers, Administrative AssistantGOVERNMENT AFFAIRS COUNSELSenator Tim Hutchinson & Randi Hutchinson, Esq., Dickstein Shapiro, LLP, 1825 Eye Street NWWashington, DC 20006 202.420.3600hutchinsont@dicksteinshapiro.comJeff Mortier, Legislative PartnerRyan, Mackinnon, Vasapoli and Berzok, LLP1634 Eye Street NW, Suite 1200Washington, DC 20006GENERAL COUNSELErin Brisbay McMahonJD, Wyatt, Tarrant & Combs, LLP, 250 West Main Street, Suite 1600Lexington, KY 40507859.288.7452 | emcmahon@wyattfirm.com

COMPREHENSIVE REVIEW COURSE AND CADAVER WORKSHOP(BASIC, INTERMEDIATE, AND COMPREHENSIVE INTERVENTIONAL PAIN MANAGEMENT EXAMINATION PREPARATION COURSE)

NOVEMBER 2-4, 2012 | DENVER, COLORADO

AMERICAN SOCIETY OF INTERVENTIONAL PAIN PHYSICIANS 3

DESCRIPTION, PURPOSE AND TARGET AUDIENCE

This 2½-day review course and workshop is designed for interventional pain physicians, for a review, skills improvement or to assist in preparation for Comprehensive Interventional Pain Management Examination qualifications. ASIPP offers the most in-depth, comprehensive, and individualized programs available in interventional pain management, featuring maximum hands-on training with cadavers in a state-of-the-art facility and maximum ability to interact with other participants. Participants will experience a comprehensive and intense learning opportunity, focusing on interventional pain management techniques.

• Each cadaver station is limited to a maximum of 8 participants.

• Participants can choose the level of participation: basic, intermediate, or Comprehensive Interventional Pain Management Examination Preparation Course.

• C-arms and state-of-the-art equipment are utilized in this course. Participants are requested to dress in casual attire or scrubs. Leaded aprons and thyroid shields will be provided. However, participants are advised to bring their own protective eyewear.

The workshop is offered to improve the delivery of multiple aspects of interventional pain management. The desired outcome is to integrate multiple aspects of interventional pain management in treating your patients so that patients have better outcomes and reduced side effects.

OUTCOME

Physicians should be able to integrate multiple aspects of interventional pain management techniques in patient treatments so that patients have better outcomes and reduced side effects.

ACCREDITATION AND CME CREDIT STATEMENTS

This CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education thru the Joing Sponsorship of the Institute for Medical

Studies (IMS) and ASIPP. IMS is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Medical Studies designates this educational activity for a maximum of 21.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMERICANS WITH DISABILITIES ACT & 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 these educational activities is in need of accommodations, please contact the organizers at (270) 554-9412 at least 10 days prior to each conference.

CADAVER WORKSHOP SITE

Science Care sets the standard of excellence for the donation and responsible use of human tissue for medical research, training and professional education. Science Care is the only organization to be accredited by both the American Association of Tissue Banks (AATB) and accredited as a provider by the Accreditation Council for Continuing Medical Education (ACCME).

There is no commercial support for this course. NO DUPLICATION OR DISTRIBUTION OF MATERIALS, OR RECORDING OF LECTURES ASSOCIATED. THERE IS NO COMMERCIAL SUPPORT FOR THIS COURSE.

ACCOMMODATIONS

RENAISSANCE DENVER HOTEL3801 Quebec Street, Denver, Co 80207 | Tel. 303-399-7500 Our award-winning Denver Colorado hotel offers 400 well-appointed hotel rooms with a choice of king or queen bedded sleeping rooms as well as many luxury in-room amenities such as high speed Internet*, and premium cable channels. We also provide onsite dining options with Vivace’ Ristorante, which offers a casual, contemporary Colorado atmosphere & traditional Italian cuisine. Inform the hotel that you are booking for ASIPP. We have secured a group room rate of $160. Reserve rooms early—all unbooked rooms will be released October 12, 2012.

4

No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved.

CADAVER LAB – SATURDAY AND SUNDAY

LAB COURSE LEVELS

BASIC

1. Caudal epidural injections

2. Lumbar interlaminar epidural injections

3. Lumbar transforaminal epidural injections

4. Sacroiliac joint interventions

5. Lumbar facet joint intraarticular injections

6. Lumbar facet joint nerve blocks

7. Lumbar facet radiofrequency neurotomy

INTERMEDIATE

1. Lumbar discography

2. Lumbar sympathetic blocks and hypogastric plexus blocks

3. Celiac plexus blocks and splanchnic nerve blocks

4. Cervical and thoracic interlaminar epidurals

5. Thoracic facet interventions (intraarticular, medial branch

blocks, and radiofrequency neurotomy)

6. Cervical facet joint interventions (intraarticular, medial

branch blocks, and radiofrequency neurotomy)

7. Percutaneous adhesiolysis

COMPREHENSIVE IPM EXAMINATION PREPARATION - ADVANCED

1. Caudal epidural, interlaminar epidural, and percutaneous adhesiolysis

2. Lumbar transforaminal and lumbar discography

3. Lumbar facet joint interventions (intraarticular, facet joint nerve

blocks, intercostal blocks, and radiofrequency neurotomy) and

sacroiliac joint injections

4. Thoracic facet joint interventions (medial branch blocks and

radiofrequency neurotomy), intercostal nerve blocks, and thoracic

interlaminar epidural injections

5. Cervical facet joint interventions (medial branch blocks

and radiofrequency neurotomy) and cervical interlaminar

epidural injections

6. Spinal cord stimulation lead placement

7. Sympathetic blockade (stellate ganglion, lumbar

sympathetic blocks and celiac plexus blocks)

7:00am–8:00am REGISTRATION AND BREAKFAST AT THE HOTEL

8:00am–8:45am Introduction to Workshop and State of Interventional Pain Management - Laxmaiah Manchikanti, MD

8:45am–9:30am Anatomy, Physiology, and Psychology of Chronic Pain: Intersection to Management - Frank Falco, MD

9:30am–10:15am An Algorithmic Approach to interventional Pain Management: Evidence Based or Comparative Effectiveness? - Laxmaiah Manchikanti, MD

10:15am–10:30am BREAK

10:30am–11:15am Imaging for Interventionalists – Fluoroscopy, Radiation Safety, and Needle Placement - Frank Falco, MD

11:15am–12:00pm Bleeding and Infection Control in Interventional Pain Management - Laxmaiah Manchikanti, MD

12:00pm-1:00pm LUNCH

COMPREHENSIVE DIDACTIC REVIEW COURSE

FRIDAY NOVEMBER 2, 2012

5

No duplication or distribution of materials, or recording of lectures associated with this conference is permitted without express written consent of the American Society of Interventional Pain Physicians. All rights reserved.

BREAKOUT SESSIONS

BASIC INTERMEDIATE IPM EXAM PREP

BASIC AND INTERMEDIATE LECTURES COVER: HISTORY, CLINICAL PRESENTATION, RELEVANT ANATOMY, TECHNICAL ASPECTS, COMPLICATIONS, EVIDENCE, AND PATIENT SELECTION OF EACH INTERVENTION

1:00pm–1:40pmCaudal Epidural Injections

Vikram Patel, MD

Lumbar Discography

Aaron Calodney, MD

Caudal Epidural, Lumbar Interlaminar Epidural, and Percutaneous Adhesiolysis

Rafael Justiz, MD

1:40am–2:20pm

Lumbar Interlaminar Epidural Injections

Harold Cordner, MD

Lumbar Sympathetic and Hypogastric Plexus Blocks

Rinoo Shah, MD

Lumbar Transforaminal Epidural and Lumbar Discography

Ramsin Benyamin, MD

2:20pm–3:00pm Sacroiliac Joint InterventionsVikram Patel, MD

Celiac Plexus and Splanchnic Nerve BlocksArthur Watanabe, MD

Lumbar Facet Joint Interventions (Intraarticular, Facet Joint Nerve Blocks, and Radiofrequency Neurotomy) and Sacroiliac

Joint InjectionsAaron Calodney, MD

3:00pm–3:40pm

Lumbar Facet Radiofrequency Neurotomy

Rinoo Shah, MD

Cervical and Thoracic Interlaminar Epidurals

Rafael Justiz, MD

Spinal Cord Stimulation Complications and Lead Placement

Ramsin Benyamin, MD

3:40pm–4:00pm BREAK

4:00pm–4:40pm

Lumbar Transforaminal Epidural Injections

Harold Cordner, MD

Thoracic Facet Joint Interventions (Intraarticular, Medial Branch Blocks, and

Radiofrequency Neurotomy)

Vikram Patel, MD

Cervical Facet Joint Interventions (Medial Branch Blocks and Radiofrequency

Neurotomy) and Cervical Interlaminar Epidural Injections

Rinoo Shah, MD

4:40pm–5:20pmLumbar Facet Joint Injections

Arthur Watanabe, MD

Cervical Facet Joint Interventions (intraarticular, medial branch blocks, and

radiofrequency neurotomy)

Aaron Calodney, MD

Sympathetic Blockade (Stellate ganglion, lumbar Sympathetic Blocks and Celiac

Plexus Blocks)

Harold Cordner, MD

5:20pm–6:00pm

Troubleshooting and Complications for Beginners

Ramsin Benyamin, MD

Percutaneous Adhesiolysis

Rafael Justiz, MD

Thoracic Facet Joint Interventions (Medial Branch Blocks , Radiofrequency Neurotomy and Intercostal Nerve Blocks) and Thoracic

Interlaminar Epidural Injections

Arthur Watanabe, MD

COMPREHENSIVE DIDACTIC REVIEW COURSE

FRIDAY NOVEMBER 2, 2012

6

6:45am–7:00am SHUTTLES DEPART FROM FROM THE HOTEL TO THE CADAVER FACILITY

7:00am–7:45am REGISTRATION AND BREAKFAST

7:45am–8:20am Introduction

8:30am–12:15pm HANDS-ON CADAVER WORKSHOPParticipants rotate through multiple stations

12:15pm MEETING ADJOURNMENT. SHUTTLES DEPART TO HOTEL AND TO THE AIRPORT

6:45am–7:00am SHUTTLES DEPART FROM FROM HOTEL TO THE CADAVER FACILITY

7:00am–7:45am REGISTRATION AND BREAKFAST

7:45am–8:20am Introduction Laxmaiah Manchikanti, MD

8:30am–1:00pm HANDS-ON CADAVER WORKSHOPParticipants rotate through multiple stations

1:00pm–2:00pm LUNCH PROVIDED

2:00pm–5:00pm HANDS-ON CADAVER WORKSHOPParticipants rotate through multiple stations

5:00pm SHUTTLES DEPART FROM CADAVER FACILITY TO THE HOTEL

HANDS-ON CADAVER WORKSHOP

SATURDAY NOVEMBER 3, 2012

HANDS-ON CADAVER WORKSHOP

SUNDAY NOVEMBER 4, 2012

7

REGISTRATION FORM

REGISTRATION INFORMATION

Please complete the enclosed registration

form and return to ASIPP with payment (your

application will not be processed if payment

does not accompany registration form).

ASIPP reserves the right to cancel this Workshop and/

or Review Preparation Course upon reasonable notice

and will assume no financial obligation to registrants

for cancellation of the course 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.

Registrants who are not accepted into this

workshop will receive notice by mail with their

returned check.

3Ways To Register

1. ON-LINE: For convenience and faster registration, register at asipp.org/meetings

2. FAX: Fax this registration form to 270.554.5394 with your Visa/MasterCard/ Discover/American Express information

3. MAIL: Mail this registration form with payment - Visa/MasterCard/Discover/ American Express information to: ASIPP, 81 Lakeview Drive, Paducah, KY 42001

PLEASE PRINT EXACTLY AS YOU WISH YOUR NAME TO APPEAR:

_____________________________________________________________________________________________________NAME (FIRST) (MIDDLE INITIAL) (LAST) (DEGREE)

_____________________________________________________________________________________________________ORGANIZATION

_____________________________________________________________________________________________________ADDRESS

_____________________________________________________________________________________________________CITY STATE ZIP

_____________________________________________________________________________________________________PHONE FAX

_____________________________________________________________________________________________________E-MAIL

Comprehensive Review Course and Cadaver Workshop

On or before October 11, 2012: m $2,200 Member m $2,500 Non-MemberAfter October 11, 2012: m $2,500 Member m $2,800 Non-MemberFellows: m 50% Discount***

***If registering as a fellow, please list below the name of fellowship program, university or hospital and fax or e-mail 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 270-554-5394 or e-mail 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 42001 or Fax to (270) 554-5394

CANCELLATION POLICY:Cancellations must be submitted in writing and received by October 3, 2012. An administrative fee of $200 will be assessed for cancellations after October 3, 2012 but prior to October 10, 2012. Cancellations after October 3, 2012 will forfeit 50% of their registration fee. No refund will be issued after October 18, 2012. Qualifying refunds will be sent after the conclusion of the meeting.

IMPORTANT. Please answer all the questions:

MEDICAL DEGREE:m MD m DO m PhD

m Other: _______________________________

PRIMARY SPECIALTY CERTIFICATION:m Anesthesiology m Physiatry

m Neurosurgery

m Other: _______________________________

PAIN MEDICINE SUBSPECIALTY CERTIFICATION:m American Board of Anesthesiology

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: ______________________________________

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

COURSE LEVEL:m Basic m Intermediate

m IPM Examination Preparation

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