Research Gaps in Practice Guidelines for Acute Postoperative Pain Management in Adults: Findings From a Review of the Evidence for an American Pain Society Clinical Practice Guideline
Significant gaps exist in available evidence to guide clinical practice in acute postoperative management.
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Methodological shortcomings of previous postoperative pain studies need to be addressed in future research including study design, methods, surgical models, and standardized outcome measures.
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The value of future research where there is limited evidence is unclear and future research priorities need to be clarified.
Abstract
Acute postoperative pain is a common clinical condition that, when poorly controlled, can result in a number of significant negative consequences. The American Pain Society commissioned an evidence-based guideline on the management of postoperative pain to promote evidence-based, safe, and effective perioperative pain management. An interdisciplinary panel developed 31 key questions and inclusion criteria to guide the evidence review. Investigators reviewed 6556 abstracts from multiple electronic databases up to November 2012, an updated evidence review to October 2014, and key references suggested by expert reviewers. More than 800 primary studies not included in a systematic review and 107 systematic reviews were included. Despite a large body of evidence, a number of critical research gaps were identified where only low-quality or insufficient evidence was found to help guide clinical practice recommendations. This report identifies evidence gaps including optimal methods and timing of perioperative patient education, nonpharmacological modalities, combinations of analgesic techniques, monitoring of patient response to treatment, techniques for neuraxial and regional analgesia, and organizational care delivery models. Recommendations to help guide the design of future perioperative studies are offered.
Perspective
Acute postoperative pain is a common clinical condition requiring an evidence-based, planned, and multimodal approach. Despite the plethora of published evidence, much of it is weak and key questions remain unanswered. Researchers are encouraged to work together to produce strong evidence to help guide clinical decisions in perioperative pain management.
Key words
Acute pain
postoperative pain
research gaps
evidence-based guideline
systematic review
Cited by (0)
The authors declare no funding for this work. Debra Gordon discloses receiving honoraria for advisory boards in the past 3 years from Pacira, Zogenix and Janssen. Kathleen Sluka received research grants from Medtronic, Inc. and Gruenenthal; is a consultant for DJO, Inc. and Bayer; receives book royalties from IASP Press; and Volunteers as Secretary of the American Pain Society and for the Program Committee, Terminology Task Force, and Endorsements Task Force for the International Association for the Study of Pain. No other authors have conflicts of interest to declare.
