Evidence Grading

Literature Search

This guideline is based on a systematic evidence review evaluating literature published on Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management. The literature search included systematic reviews, randomized control trials, meta-analysis, observational studies, and protocols and/or guidelines for pain and/or opioids. The search included literature from January 1, 2010, through February 8, 2016.

The databases searched include PubMed and Cochrane. The search was limited to only studies in the English language and using human subjects. Other exclusions included cancer pain, migraine pain, palliative and end-of-life. The search included assessment, treatment and management of specific types of pain, specific modalities and specific medication classes (see below). General categories are assessment of, treatment of and management of pain.

In addition to the literature searches, work group members and ICSI staff obtained articles through individual searches. Those reviewed by the work group were included in the guideline where appropriate.

Literature Search Terms

 GRADE Methodology

In recent years, ICSI has transitioned to using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology as a way to systematically review the evidence and develop recommendations. After gathering the evidence through our literature searches (detailed above), we found a paucity of systematic reviews and randomized controlled trials (RCTs), making the application of GRADE methodology challenging. As an evolving field, there is still much about pain treatment, particularly use of opioids, that remains unstudied or understudied. Given this, GRADE methodology could not be applied to this document. Instead, the work group used the best available evidence to reach consensus recommendations. For each recommendation, the relevant resources used to support that recommendation are noted.