Indian Journal of Pain (Jan 2019)
Consensus on evidence and experience: Future road map for framing guidelines
Abstract
The approach to management of any patient is justified when based on evidence rather than experiences. However, there may be a class of patients for whom experience-based approach shows much better results. This article is an analysis of evidence-based guidelines versus experience-based approach. Although the protocols and guidelines deduced from evidence-based medicine appear infallible, the essential loopholes in standardization of this approach include turning a blind eye to the facts that publications may be company sponsored, with secondary gains intended, unfit for all socioeconomic strata, with a flaw in the review process itself, and many more. It would not be an overstatement that the experience of clinicians may be seriously ignored when adhering to evidence-based guidelines alone. A thorough knowledge of the subject based on the evidence, clinical experience, and clinical acumen together plays a vital role in prescribing the treatment to an individual. While framing the clinical practice guidelines, the role of an experienced clinician also needs to be highlighted. A proposed road map to formulation of the Indian Pain Practice guidelines should be such that an equal emphasis is given to expert opinion as well study-based evidence-based medicine. Among several other aspects, it is also emphasized that practitioners with more than 7 years of experience with dedicated pain practice will be sought for and considered as experts.
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