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APPENDIX B
PROCESS REPORT
This is the third edition of the document Acute Pain Management: Scientific Evidence. The first
edition was written by a multidisciplinary committee headed by Professor Michael Cousins and
published by the National Health and Medical Research Council (NHMRC) in 1999. The second
edition was written by multiple contributors and a working party chaired by Dr Pam
Macintyre. It was approved by the NHMRC and published by the Australian and New Zealand
College of Anaesthetists (ANZCA) and its Faculty of Pain Medicine (FPM) in 2005. It was also
endorsed by other major organisations – the International Association for the Study of Pain
(IASP), the Royal College of Anaesthetists (United Kingdom), the Australasian Faculty of
Rehabilitation Medicine, the Royal Australasian College of Physicians, the Royal Australasian
College of Surgeons, the Royal Australian and New Zealand College of Psychiatrists and the
Australian Pain Society – and recommended to its members by the American Academy of Pain
Medicine.
In accord with the NHMRC requirement that guidelines should be revised as further evidence
accumulates, and as there has been has been a continuing and large increase in the quantity of
information available about acute pain management, it was seen as timely to reassess the
available evidence. ANZCA and the FPM therefore again took responsibility as an ‘external
body’ for revising and updating the document – this third edition.
Since the second edition was published in 2005, a sizeable amount of new evidence relating to
the management of acute pain has been published. The aim of this third edition is, as with the
first two editions, to combine a review of the best available evidence for acute pain
management with current clinical and expert practice, rather than to formulate specific clinical
practice recommendations. Accordingly, the document aims to summarise, in a concise and
easily readable form, the substantial amount of evidence currently available for the
management of acute pain in a wide range of patients and acute pain settings using a variety
of treatment modalities. It aims to assist those involved in the management of acute pain with
the best current (up to August 2009) evidence‐based information.
It is recognised that while knowledge of current best evidence is important, it plays only a part
in the management of acute pain for any individual patient and more than evidence is needed
if such treatment is to be effective.
Evidence‐based medicine has been defined as ‘the conscientious, explicit and judicious use of
current best evidence in making decisions about the care of individual patients’ and that it
must ‘integrate research evidence, clinical expertise and patient values’ (Sackett et al, 1996).
APPENDIX B patient as part of the treating and decision‐making team, taking into account their values,
Therefore evidence, clinical expertise and, importantly, patient participation (ie including the
concerns and expectations) are required if each patient is to get the best treatment. The
information provided in this document is not intended to over‐ride the clinical expertise of
health care professionals. There is no substitute for the skilled assessment of each individual
patient’s health status, circumstances and perspectives, which health care practitioners will
then use to help select the treatments that are relevant and appropriate to that patient.
This report provides examples of the decision‐making processes that were put in place to deal
with the plethora of available evidence under consideration.
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