Evidence-Based Pain Management: The Need for Change

Abstract

Major advances in the management of pain, over the last 40 years, have been made through extensive research, rapid technological growth, and pharmacological advancements. Together, these factors have contributed to enhanced medical knowledge, the development of new theories, a better understanding of pain mechanisms, and the widespread introduction of new pain-relieving interventions. Despite all these advances for pain, as with advances in other areas of health care, we have little knowledge about how different treatments compare in terms of overall effectiveness and safety. Treatment regimens are often based on prescriber preference, or on traditional, ritualistic, non-evidence-based practice, rather than on scientific fact. It has been estimated that only 15% of medical interventions currently in use are based on solid evidence (Smith, 1991). Textbooks, which are perceived as reliable sources of information, may be inaccurate and they quickly become outdated (Antman et al., 1992). It is difficult for clinicians to keep up with current research findings, because of the growing number of biomédical journals. There appear to be discrepancies between the recommendations of so-called experts and information from up-to-date systematic reviews, which suggests that the "experts" need improved access to up-to-date information (Milne & Chambers, 1993). With all this, it is hardly surprising that pain continues to be underestimated, inadequately assessed, and poorly controlled.