Interventional Pain Management According to Evidence-Based Medicine

Evidence-based medicine (EBM) endeavors to apply the best available evidence gained from scientific methods to clinical decision making (1). It aims to assess the strength of the evidence based on both the risks and benefits of treatments and diagnostic tests. The quality of the evidence can be evaluated from the source type (mostly from meta-analyses and systematic reviews of doubleblind, placebo-controlled clinical trials), as well as other factors which include statistical validity, efficacy, clinical relevance, currency, and peer-review acceptance (2). A systematic review is, however, the best method in order to identify, and critically evaluate all relevant research on the effectiveness of a particular treatment. Initially, EBM was called, “a critical appraisal,” as it described the application of basic rules of evidence. This evidence was first presented by a group of clinical epidemiologists at McMaster University in 1990, usage of this technique later expanded to all medical fields, and it has now found global acceptance. In our practice, it is generally accepted that interventional pain management techniques have gained a definite place in the management of chronic pain syndromes. Actually, the most important goal of pain medicine is to use a specific treatment; conservative and/or interventional, for the right patient at the right time. Therefore, treatment selection should be made according to the clinical diagnoses. In reality, patients receive treatments that vary both due to their geographical location, as well as the specialty of the treating physicians. According to the literature, the treatment of pain syndromes should involve a multidisciplinary approach and should ideally entail the evaluation and treatment of the patient by; physicians, physical therapists, and psychologists well-versed in the complex biopsychosocial and pathophysiological causes in the development and maintenance of pain syndromes. For the correct application of interventional pain management techniques, both a good theoretical knowledge, as well as practical experience is mandatory. In evaluating the literature and developing recommendations, the Cochrane Database and other recent systematic reviews are emphasized the most. Efficacy of a procedure or drug is considered to have been demonstrated if the results of a randomized clinical trial (RCT) are found to give statistically significant greater pain reduction, versus a placebo for the primary outcome measure, and the results are then assessed by the centers responsible for levels of EBM. All medications or procedures with efficacy supported by at least one systematic review or positive placebo-controlled or procedure or dose-response RCT, in which the reduction of chronic pain is a primary * Corresponding author: Poupak Rahimzadeh, Department of Anesthesiology and Pain Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Tel/Fax: +98-2166509059, E-mail: [email protected]