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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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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Randomized Controlled Trial
A randomized controlled trial of the effects of a combination of static and dynamic magnetic fields on carpal tunnel syndrome.
To determine if a physics-based combination of simultaneous static and time-varying dynamic magnetic field stimulation to the wrist 4 hours/day for 2 months can reduce subjective neuropathic pain and influence objective electrophysiologic parameters of patients with carpal tunnel syndrome (CTS). ⋯ PEMF exposure in refractory CTS provides statistically significant short- and longterm pain reduction and mild improvement in objective neuronal functions. Neuromodulation appears to influence nociceptive-C and large A-fiber functions, probably through ion/ligand binding.
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Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management. ⋯ When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies.
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The application of continuous peripheral nerve block (CPNB) has been an important anesthetic tool in the management of combat soldiers wounded from current conflicts. Placing and maintaining CPNBs becomes a challenge in this patient population due to concomitant prophylactic and therapeutic anticoagulation. ⋯ This case highlights the application of simultaneous CPNB techniques in a patient with multiple extremity injuries receiving anticoagulant therapy.