Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management, Part I: Introduction and General Considerations

Evidence-based medicine, systematic reviews, and guidelines are part of modern interventionalpain management. As in other specialties in the United States, evidence-based medicine appearsto motivate the search for answers to numerous questions related to costs and quality of healthcare as well as access to care. Scientific, relevant evidence is essential in clinical care, policy-making, dispute resolution, and law. Consequently, evidence based practice brings together pertinent,trustworthy information by systematically acquiring, analyzing, and transferring research findingsinto clinical, management, and policy arenas. In the United States, researchers, clinicians, professional organizations, and government are looking for a sensible approach to health care withpractical evidence-based medicine. All modes of evidence-based practice, either in the form of evidence-based medicine, systematic reviews, meta-analysis, or guidelines, evolve through a methodological, rational accumulation, analysis, and understanding of the evidentiary knowledge thatcan be applied in clinical settings.Historically, evidence-based medicine is traceable to the 1700s, even though it was not explicitlydefined and advanced until the late 1970s and early 1980s. Evidence-based medicine was initiallycalled “critical appraisal” to describe the application of basic rules of evidence as they evolve intoapplication in daily practices. Evidence-based medicine is defined as a conscientious, explicit, andjudicious use of current best evidence in making decisions about the care of individual patients.Evidence-based practice is defined based on 4 basic and important contingencies, which includerecognition of the patient’s problem and construction of a structured clinical question, thoroughsearch of medical literature to retrieve the best available evidence to answer the question, criticalappraisal of all available evidence, and integration of the evidence with all aspects and contextsof the clinical circumstances.Systematic reviews provide the application of scientific strategies that limit bias by the systematicassembly, critical appraisal, and synthesis of all relevant studies on a specific topic. While systematic reviews are close to meta-analysis, they are vastly different from narrative reviews and healthtechnology assessments.Clinical practice guidelines are systematically developed statements that aim to help physiciansand patients reach the best health care decisions. Appropriately developed guidelines incorporatevalidity, reliability, reproducibility, clinical applicability and flexibility, clarity, development througha multidisciplinary process, scheduled reviews, and documentation. Thus, evidence-based clinicalpractice guidelines represent statements developed to improve the quality of care, patient access,treatment outcomes, appropriateness of care, efficiency and effectiveness and achieve cost containment by improving the cost benefit ratio. Part 1 of this series in evidence-based medicine, systematic reviews, and guidelines in interventional pain management provides an introduction andgeneral considerations of these 3 aspects in interventional pain management.Key words: Evidence-based medicine, systematic reviews, clinical guidelines, narrative reviews, health technology assessments, grading of evidence, recommendations, grading systems,strength of evidence.