Flaws Found in Interventional Treatment Guidelines

Flaws Found in Interventional Treatment Guidelines – Pain Medicine News – by Harry Fortuna – Mar 2020

Assessors were unable to give full votes of confidence to any of the four recently evaluated interventional guidelines created by major North American pain medicine societies.

Of further concern,

• only half of the sample studied was found to be of high methodological quality, and
• none of the guidelines surveyed adeptly involved all stakeholders such as patients, providers and payors.

researchers from the University of Toronto assessed the standards from

1. American Pain Society (APS; Spine 2009), 
2. American Society of Interventional Pain Physicians (ASIPP; Pain Physician 2013),
3. International Association for the Study of Pain (IASP; Pain 2013), 
4. Canadian Pain Society (CPS; Pain Res Manag).

The CDC guideline was not included because the CDC isn’t “major North American pain medicine societies,” a classification that points out the CDC should never have been involved in this heavily-biased guideline.

…reviewed and rated all four guidelines according to 23 items across the six quality domains:

1. scope and purpose,
2. stakeholder involvement,
3. the rigor of development,
4. clarity of presentation,
5. applicability and
6. editorial independence

“Currently there is no agreed-to standard to create guidelines, which leads to a common disagreement,” said Timothy Deer, MD

In that way, the guidelines are a reflection of the priorities and opinions of the societies who make them, and therefore subject to the same insights and, unfortunately, blind spots of their views.

“What surprised us was that the evidence was looked at differently by different guidelines. The same sort of results was interpreted differently based on who the reviewers were,” Dr. Bhatia said.

Lower Scores Than Expected

The APS guidelines scored below 50% for both stakeholder involvement and applicability, but over 90% for the rigor of development.

ASIPP scored 100% for Scope and Purpose but 0% for Editorial Purpose, “because the editor of the journal where the guideline was published was actually the first author on that paper,” Dr. Bhatia explained

Although the guidelines’ scores would indicate that most are sound, “what we found that there were some glaring loopholes in the way guidelines have been done,” he said.

He also stressed that future guideline development needs to include all relevant stakeholders.

No opioid guidelines by any society have involved pain patients for more than window dressing.

Hopefully, “we will have patients, we will have payors, and we will have policymakers in addition to physicians,” he said.

Having “payors” involved in guideline writing indicates that the cost concerns of the insurance industry play a part in deciding our pain treatments.

That he didn’t even try to hide it shows it’s a widely accepted truth in the industry.

He also noted that no two reviewers interpreted a particular set of guidelines the same way,