evidence-based pain management
DESCRIPTION
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. What got me into EBM…. What is a double blind study? - PowerPoint PPT PresentationTRANSCRIPT
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Evidence-Based Pain Management
Sohail Bajammal, MBChB, MSc, FRCS(C), PhD(c)
Assistant Professor of Orthopaedics, Umm Al Qura UniversityConsultant Orthopaedic Surgeon, Al-Noor Specialist Hospital
February 23, 2010
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What got me into EBM….
What is a double blind study?
Two orthopaedic surgeonsreading an ECG
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Can I use EBM in orthopaedics?
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I will tell you
NOTHING about pain management
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I will show you how YOU can find
EVERYTHING about pain management
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Objectives
• What is EBM?• How to ask an answerable question?• How to search for an answer?• How to assess the quality of the evidence?
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GCC EBHC
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National & Gulf Center for EBHP
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Statistically speaking…
Half an hour presentation is shorter than 5 days workshop (p<0.05)
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What is EBM?
Clinical Circumstances
Clinical Circumstances
Research EvidenceResearch Evidence
Patients’ Preferences
Patients’ Preferences
Clinical ExpertiseClinical
Expertise
Haynes et al. BMJ 2002;324:1350
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5As of EBM
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Is this a good question?
What is the best treatment of acute back pain?
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Asking a good question (PICO)!
• Population• Intervention• Control• Outcome
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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
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How would you search for answers?
A. 50:50B. Ask the audienceC. Ask a friendD. Flip through a textbookE. Google it up!
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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)
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What’s wrong with googling?
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What’s wrong with googling?
• Reliability & credibility of source• Google Scholar is good
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So what to do?
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5S Hierarchy of EvidenceHaynes RB. Evid Based Med 2006;11:162-164
RCTs, Cohort, Case control, Case seriesRCTs, Cohort, Case control, Case series
Expert Opinion: Classical TextbooksExpert Opinion: Classical Textbooks
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Primary Sources
• Original articles• Through databases: MEDLINE, EMBASE• Using: PubMed, OVID• You have to retrieve and appraise the articles• Strength (pyramid) of evidence
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Pyramid of Evidence
http://library.downstate.edu/EBM2/2100.htm
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It’s time consuming
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Secondary Sources
Systematic ReviewsSystematic Reviews
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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
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How to search for “Syntheses”?
• Same databases: MEDLINE, EMBASE• Cochrane Library
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PubMed
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Cochrane Library
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Are all syntheses good?
• You still have to appraise the quality of these systematic reviews and meta-analyses
• It’s time consuming
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So what’s next?
Critically-Appraised Journal Articles & Abstracts
Critically-Appraised Journal Articles & Abstracts
Evidence-Based Guidelines & Textbooks
Evidence-Based Guidelines & Textbooks
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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)
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Summaries
• Evidence-based guidelines and textbooks
• Examples:– Clinical Evidence– National Guideline Clearinghouse– UptoDate
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http://clinicalevidence.bmj.com/
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http://www.guideline.gov/
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Systems
• This is the ultimate goal• Computerized decision support
• Too sophisticated for us to think about now
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All what we’ve talked about
Research EvidenceResearch Evidence
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To practice EBM, we need all the four
Clinical Circumstances
Clinical Circumstances
Research EvidenceResearch Evidence
Patients’ Preferences
Patients’ Preferences
Clinical ExpertiseClinical
Expertise
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We need…..
• To apply the evidence as it applies to our local hospitals
• To involve the patients actively in the decision making
• To have our own studies:– Different social, cultural, ethnic, and economical
backgrounds
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http://www.andrews-clinic-natural-therapies.co.uk/documents/54.html
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http://eapps.ngha.med.sa/ebm/
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http://ebmjeddah.info/
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This presentation is available online
www.uqu.edu.sa/ssbajammal
المحاضرات
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Thank [email protected]