ASIPP Practice Guidelines - Pain Physician

Manchikanti et al • ASIPP Practice Guidelines
74
shown in Fig. 5.
Thus, determining whether a service is worthwhile involves
a number of different issues. It involves not only knowing
whether the various components of the intervention are
effective, but also how much they cost and if the delivery
system is efficient. The preceding discussion concentrated
on trying to determine whether interventional techniques
in managing chronic pain could be shown to be effective
through a systematic review. To achieve this goal, numerous
relevant studies and reviews were reviewed for the
quality and application to the subject of interventional techniques
in chronic pain. Finally, the relative efficiency and
safety of the possible interventions, and then the cost, have
to be the key determinants. Table 16 shows various interventional
techniques in managing chronic pain classified
by evidence of effectiveness, as well as risk of side effects
and cost of the procedure.
CONCLUSION
The practice guidelines for interventional techniques in the
management of chronic pain were developed utilizing the
best available evidence combined with consensus. These
guidelines include discussions of the purpose, rationale,
and importance. The guidelines also have discussed the
importance of randomized controlled trials, the development
of type and strength of efficacy evidence and various
controversial aspects relating to guidelines. Chronic pain
and its epidemiology, as well as discussion of chronic pain
vs chronic pain syndrome, the pathophysiologic basis of
persistent pain, and the evaluation of the patient presenting
with chronic pain, have been discussed. Diagnostic
and therapeutic interventional techniques are discussed
extensively including all types of evidence available from
randomized clinical trials as well as some observational
studies. The levels of effectiveness for the most commonly
used interventions were developed based on review of diagnostic
and therapeutic interventional techniques. Additionally,
effectiveness evidence and an algorithmic approach
to managing a patient presenting with chronic spinal
pain were also developed.
ACKNOWLEDGMENTS
We would like to thank Bert Fellows, Denise Pratt, Tonie
Hatton, Vidyasagar Pampati, and many of the members of
the organization who have assisted in the preparation of
this manuscript.
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Pain Physician Vol. 4, No. 1, 2001