1. 2005;8;73-86Evidence Synthesis and Development of Guidelines in Interventional Pain Management
   An Invited Review
   Laxmaiah Manchikanti, MD, Salahadin Abdi, MD, PhD, and Linda F. Lucas, MD.

Background: The past decade has been marked by unprecedented interest in evidence-based medicine and various types of avenues that can provide valid and reliable information about healthcare, including clinical practice guidelines.  Thus, healthcare decisions are purportedly and increasingly being made on research-based evidence rather than on expert opinion or clinical experience alone.  The methods describing evidence synthesis or development of guidelines in interventional pain management are scarce.

Objective: To describe the methods of evidence synthesis and development of guidelines in interventional pain management in practical terms.

Description: This review sought to provide an understanding of evidence-based medicine, the importance and synthesis of clinical practice guidelines, and the variety of issues related to rating the quality of individual articles, understanding narrative and systematic reviews, grading the strength of the body of evidence, searching for evidence, and finally, the analytical preparation of guidelines, with a focus on interventional pain management. 

Conclusion: Evidence synthesis and development of guidelines in interventional pain management is a complex and difficult task.  It is emphasized that practice guidelines are not intended as standards or absolute requirements.  Consequently, practice guidelines may be adapted, modified, or rejected, according to the clinical needs and constraints of each practitioner and patient.

Keywords:  Interventional pain management, evidence synthesis, clinical guidelines, evidence-based medicine, pragmatic or practical clinical trials, randomized trials, observational studies