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contributors. Contributors conducted searches and summarised the new literature, and had
no influence on the content or the decisions on inclusion or exclusion of material.
Review of the evidence
This document is a revision of the second edition of Acute Pain Management: Scientific
Evidence published in 2005. Therefore most of the new evidence included in the third edition
has been published from January 2005 onwards. Evidence‐based guidelines have been
published in the areas of acute back and musculoskeletal pain, and recommendations relevant
to the management of acute pain were drawn directly from these.
Levels of evidence
Levels of evidence were documented according to the NHMRC designation (NHMRC 1999) and,
as for the second edition of this document, clinical practice points have been added.
Levels of evidence
I Evidence obtained from a systematic review of all relevant randomised controlled trials.
II Evidence obtained from at least one properly designed randomised controlled trial
III‐1 Evidence obtained from well‐designed pseudo‐randomised controlled trials (alternate allocation or
some other method)
III‐2 Evidence obtained from comparative studies with concurrent controls and allocation not
randomised (cohort studies), case‐controlled studies or interrupted time series with a control
group
III‐3 Evidence obtained from comparative studies with historical control, 2 or more single‐arm studies,
or interrupted time series without a parallel control group
IV Evidence obtained from case series, either post‐test or pre‐test and post‐test
Clinical practice points
Recommended best practice based on clinical experience and expert opinion
Key messages
These levels of evidence were also used for the Key Messages. However, it was felt that there
should be an indication of how the Key Messages in this third edition related to those in the
previous edition. The system used by Johnston et al (Johnston et al, 2003) to reflect the
implications of new evidence on clinical recommendations was therefore reviewed and
adapted. The letters N, U, S, W, Q and R were used in the Key Messages to indicate New,
Unchanged, Strengthened, Weakened, Qualified and Reversed respectively – see table below.
Review and Revision of Key Messages
APPENDIX B Unchanged The new evidence is consistent with the data used to formulate the original key
New evidence leads to new key message(s).
New
message. The key message in the original report remains unchanged.
The new evidence is consistent with the data used to formulate the original key
Strengthened
message. The key message in the original report remains unchanged or expanded.
The level of evidence and/or content of the key message in the original report has
been strengthened to reflect this additional evidence.
Weakened The new evidence is inconsistent with the data used to inform the original key
message(s). However, the new evidence does not alter the key message but
weakens the level of evidence.
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