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Evidence-Based Pain Management: An Orthopaedic Perspective

Join Dr. Sohail Bajammal, MD, MSc, FRCS(C), PhD(c), as he explores the vital role of Evidence-Based Medicine (EBM) in orthopaedics, particularly in pain management. This presentation will guide attendees through understanding EBM, formulating effective clinical questions, and evaluating the quality of evidence. Discover practical strategies for searching and assessing evidence, as well as the importance of synthesizing research findings to inform clinical practice. Gain insights into how EBM can enhance patient care in pain management without delving into specific management techniques.

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Evidence-Based Pain Management: An Orthopaedic Perspective

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  1. Evidence-Based Pain Management Sohail Bajammal, MBChB, MSc, FRCS(C), PhD(c) Assistant Professor of Orthopaedics, Umm Al Qura University Consultant Orthopaedic Surgeon, Al-Noor Specialist Hospital February 23, 2010

  2. What got me into EBM…. What is a double blind study? Two orthopaedic surgeons reading an ECG

  3. Can I use EBM in orthopaedics?

  4. I will tell you NOTHINGabout pain management

  5. I will show you how YOU can find EVERYTHINGabout pain management

  6. Objectives • What is EBM? • How to ask an answerable question? • How to search for an answer? • How to assess the quality of the evidence?

  7. GCC EBHC

  8. National & Gulf Center for EBHP

  9. Statistically speaking… Half an hour presentation is shorter than 5 days workshop (p<0.05)

  10. What is EBM? Research Evidence Patients’ Preferences Clinical Expertise Clinical Circumstances Haynes et al. BMJ 2002;324:1350

  11. 5As of EBM

  12. Is this a good question? What is the best treatment of acute back pain?

  13. Asking a good question (PICO)! • Population • Intervention • Control • Outcome

  14. Is this a good question? • In adult patients younger than 50 years old with acute low back pain, does bedrest reduce the risk of recurrence of pain within one year compared with physiotherapy? • P: Adult patients <50yr with acute LBP • I: Bedrest • C: Physiotherapy • O: Recurrence of pain within one year

  15. How would you search for answers? • 50:50 • Ask the audience • Ask a friend • Flip through a textbook • Google it up!

  16. What’s wrong with textbooks? • Textbooks are excellent for the principles and basic knowledge • Usually single authored chapters • Likely biased, author’s opinion • Not peer-reviewed • Outdated (at least 4 years)

  17. What’s wrong with googling?

  18. What’s wrong with googling? • Reliability & credibility of source • Google Scholar is good

  19. So what to do?

  20. 5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164 RCTs, Cohort, Case control, Case series Expert Opinion: Classical Textbooks

  21. Primary Sources • Original articles • Through databases: MEDLINE, EMBASE • Using: PubMed, OVID • You have to retrieve and appraise the articles • Strength (pyramid) of evidence

  22. Pyramid of Evidence http://library.downstate.edu/EBM2/2100.htm

  23. It’s time consuming

  24. Secondary Sources Systematic Reviews

  25. Syntheses • The authors have done the work for you • Hopefully: • They asked a good question • They searched the literature systematically • They identified the studies and assessed their quality • This is called Systematic Review • If they did statistical combination of results, this is called Meta-analysis

  26. How to search for “Syntheses”? • Same databases: MEDLINE, EMBASE • Cochrane Library

  27. PubMed

  28. Cochrane Library

  29. Are all syntheses good? • You still have to appraise the quality of these systematic reviews and meta-analyses • It’s time consuming

  30. So what’s next? Evidence-Based Guidelines & Textbooks Critically-Appraised Journal Articles & Abstracts

  31. Synopses • Physicians with training in research methodology: • Read the articles • Assess their quality • Summarize them for you • Many journals: • ACP Journal Club • Database of Abstracts of Reviews of Effects (DARE)

  32. Summaries • Evidence-based guidelines and textbooks • Examples: • Clinical Evidence • National Guideline Clearinghouse • UptoDate

  33. http://clinicalevidence.bmj.com/

  34. http://www.guideline.gov/

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