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updated content has been incorporated with the content of the previous version of the
document.
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). INTRODUCTION
Therefore evidence, clinical expertise and, importantly, patient participation (ie including the
patient as part of the treating and decision‐making team, taking into account their values,
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
healthcare professionals. There is no substitute for the skilled assessment of each individual
patient’s health status, circumstances and perspectives, which healthcare professionals will
then use to help select the treatments that are relevant and appropriate to that patient.
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 the acute phase of these conditions were drawn directly from these.
For more details on the review of the evidence see Appendix B, Process Report.
Levels of evidence
Levels of evidence were documented according to the NHMRC designation (NHMRC, 1999).
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, two 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
Key messages for each topic are given with the highest level of evidence available to support
them, or with a symbol indicating that they are based on clinical experience or expert opinion.
In the key messages, Level I evidence from the Cochrane Database is identified. Levels of
evidence were documented according to the NHMRC designation and, as for the second
edition of this document, clinical practice points have been added.
It was felt that there should be an indication of how the key messages in this third edition
related to those in the second edition. The system used by Johnston et al (Johnston et al, 2003)
to reflect the implications of new evidence on clinical recommendations was therefore
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