Pain medicine : the official journal of the American Academy of Pain Medicine
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The best evidence should inform all clinical decisions, but physicians cannot realistically keep up with all of the literature. Two types of preprocessed evidence that can help busy clinicians incorporate evidence into everyday medical decision-making are systematic reviews and clinical practice guidelines. However, conclusions of systematic reviews and recommendations of evidence-based clinical practice guidelines should not be accepted at face value. ⋯ This article discusses what factors distinguish a high-quality systematic review. It also examines the difference between systematic reviews and clinical practice guidelines, and what factors distinguish a high-quality guideline. A separate article discusses how to interpret and apply systematic reviews and clinical practice guidelines, particularly when evidence is weak or inconclusive, or when different systematic reviews or guidelines are discordant.
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Systematic reviews and clinical practice guidelines are useful tools for bringing evidence into pain practice. However, even when their conclusions or recommendations appear valid, interpreting and applying systematic reviews and clinical practice guidelines in everyday practice is not always straightforward. ⋯ Other challenges to using systematic reviews and clinical practice guidelines in pain practice include the need to make decisions about pain interventions when evidence is weak or inconclusive, and the increasing and confusing presence of discordant systematic reviews and clinical practice guidelines. This article discusses how to evaluate applicability and clinical relevance of systematic reviews and clinical practice guidelines, and provides a framework for approaching clinical decisions when evidence is weak or conflicting.
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The primary objective of this study was to identify veterans affairs (VA) primary care clinicians' attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates. ⋯ High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.
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Review
A systematic review of opioid conversion ratios used with methadone for the treatment of pain.
Review and analyze the evidence base comprising methadone conversion methods and associated dosing ratios for the treatment of pain. ⋯ There was no evidence to support the superiority of one method of rotation to methadone over another. Patients may be successfully rotated to methadone despite discrepancies between rotation ratios initially used and those associated with stabilization. Further research is needed to identify patient-level factors that may explain the wide variance in successful methadone rotations.
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To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave. ⋯ Acute neck pain had a good prognosis for the majority of patients, but still a relatively high proportion of patients reported neck pain after 1-year follow-up. The advice given by the GP "to wait and see" was associated with recovery, and "referral" was associated with prolonged sick leave.