Undertreated pain is a worldwide problem and much of the published research behind so-called evidence-based pain management practices cannot be trusted. “Journals, conferences, and websites in the pain management field are growing at an alarming rate – and much of the information presented is often erroneous or misleading,” according to a recent review by the editor of Pain Treatment Topics (Pain-Topics.org), Stewart B. Leavitt, MA, PhD.

According to Leavitt, healthcare providers and others, including medical journalists and the public, need to understand that 1) all medical research is imperfect, and 2) the ways in which research is reported can make matters worse. For example, editors of prominent medical journals have disclosed that they are inundated by submissions describing poorly conducted research studies, as well as by reports of potentially good studies that are so incomplete and confusing that they are nearly worthless. They concede that they end up publishing deficient research reports because so much of the work from which they must choose is of poor quality.

Critics of medical literature in general have asserted that many wrong, or at least unreliable, therapeutic answers are being generated due to biased studies, representing small numbers of patients, and using inappropriate analyses. Investigations of reputable medical journals, spanning many years, have found startling faults:

>> In one examination, nearly one-third of the randomly assessed research articles reported either exaggerated or false claims.

>> In various other investigations, up to 90% of all articles in the journals examined contained errors ranging from omissions of crucial information to significant design flaws affecting their validity.

>> Abstracts accompanying journal articles often receive the greatest attention by readers; yet, an extensive review of articles chosen randomly from major medical journals found that up to 68% of the abstracts contained data that were inconsistent with or absent from the main body of the articles.

Furthermore, as one prominent investigator has asserted, research studies can be designed and/or interpreted in ways that make essentially ineffective therapies look like lifesavers or, conversely, underrate genuinely helpful treatments as being only marginally beneficial. He went so far as to claim that for most research-study designs and settings it is more likely for the findings and subsequent efficacy claims to be false rather than true.

In reality, even the most effective pain therapies would suffer a progressive dilution of impact during their travels from success in clinical studies to benefits in everyday practice. For example, a therapy demonstrated as 100% efficacious in controlled trials would most likely help only a small percentage of patients – surprisingly, as few as 1% of patients, according to some experts.

Leavitt concludes that healthcare providers, the news media, and the public need to be more skeptical about what they read in journals, hear at conferences, or see posted on the Internet. For example, it must be remembered that any single investigation, no matter how significant or convincing, provides only a partial picture of what has been discovered or is yet to be revealed about a particular pain treatment.

The overwhelming amount of pain management publications and lack of time to assess them pose serious problems. Plus, many healthcare providers and medical journalists are not trained in the critical appraisal of medical research. However, it is essential that they at least become aware of how the potential for biases, flawed study designs, faulty data analyses, and inappropriate reporting methods can lead to untrustworthy conclusions that ultimately may affect patient care.

Pain Treatment Topics and the associated Pain-Topics.org website provide open and free access to noncommercial, evidence-based clinical news, information, research, and education on the causes and effective treatment of the many types of pain conditions. The project is independently produced, and currently supported by an unrestricted educational grant from Covidien/Mallinckrodt Inc., St. Louis, MO, a manufacturer of opioid analgesic products.

Source: Pain Treatment Topics