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Of the references listed in the May 2009 retraction notice (Shafer, 2009), four were included in
the second edition of Acute Pain Management: Scientific Evidence along with a further two
publications that were not included in this list of retractions.
There are no precedents for how best to manage a problem such as this. However, the editors
responsible for the development of this third edition of Acute Pain Management: Scientific
Evidence decided against including any publications by the individuals affected by these
retractions when listed as first author on the papers. An assessment was made of each of the
meta‐analyses that cited affected articles. This was based upon the other papers included in INTRODUCTION
these meta‐analyses, other supporting evidence and independent consideration by an expert
in biostatistics. In some cases, although cited, the affected references were not actually
included in the meta‐analysis performed. In other cases, assessment indicated that the
strength of the evidence may be reduced because of the inclusion of affected publications.
Following the consensus that appeared to rapidly emerge among editors of the leading peer‐
reviewed journals in anaesthesiology and pain medicine despite initial concerns about meta‐
analyses that included this work (White et al, 2009), the editors of the third edition of Acute
Pain Management: Scientific Evidence felt that indiscriminately omitting all meta‐analyses
purely on the basis of inclusion of one or two of those papers would be to deny inclusion of
some important credible information in the document. Indeed, the purpose of meta‐analysis is
to aggregate results from the literature as a whole, thereby diluting the impact of any one
specific study.
Just prior to finalisation of this third edition of Acute Pain Management: Scientific Evidence, an
article was published in Anesthesiology in December 2009 (Marret et al, 2009) which examined
in detail the effect that excluding data obtained from the retracted articles would have on the
results of 14 systematic reviews (six quantitative and eight qualitative) in which they were
cited. Marret et al (2009) reanalysed the data after excluding results from affected articles and
concluded that withdrawal of these articles did not alter the conclusions of five out of the six
quantitative reviews (meta‐analyses): the sixth meta‐analysis has not been included in Acute
Pain Management: Scientific Evidence. Thus there was agreement with the assessments that
had already made about the validity of these meta‐analyses which included the retracted
articles. Marret et al (2009) concluded that meta‐analyses were ‘vulnerable’ if data from
retracted studies made up more than 30% of the total.
A footnote has been added to the relevant sections indicating the systematic reviews
(quantitative and qualitative) that included affected articles along with a summary of the
effect, if any, on the results obtained. Also, specific note has been made in the text of the third
edition of Acute Pain Management: Scientific Evidence where retraction of the affected papers
involved key messages that were published in the second edition. Should additional
information become available it will be added as needed before publication of this document.
Information that comes to light after publication will be posted as appropriate on the Acute
Pain Management: Scientific Evidence website.
INN drug names
This document uses the generic names of drugs that apply in Australia and New Zealand.
Where this differs from the International Nonproprietary Name (INN), the INN is given in
brackets on first use within each of the major sections.
Pam Macintyre
On behalf of the Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of
Pain Medicine
Acute pain management: scientific evidence ix
