Untangling Clinical Practice Guidelines for Chronic Pain, with Jason Busse, DC, PhD

In an interview with HCPLive, Jason Busse, DC, PhD, professor in the Departments of Anesthesia and Health Research Methods, Evidence and Impact at McMaster University, discusses his upcoming 2024 CCR East presentation on the discrepancies and contradictions across guidelines regarding the management of chronic pain.

Busse pointed to a recent review of clinical practice guidelines for interventional procedures in chronic spine pain management that revealed 21 guidelines with no consistency in recommendations. Similarly, guidelines for opioids vary widely, with Centers for Disease Control and Prevention (CDC) advocating for their use based on perceived benefits exceeding harms, while other organizations, such as the US Department of Defense and Veterans Affairs, strongly advise against them. This inconsistency creates a challenging landscape for practitioners and patients to navigate.

Practitioners may gravitate towards guidelines aligning with their existing beliefs, contributing to high variability in care practices. The absence of a unified and evidence-based guideline further exacerbates this issue.

“It has been a real failing of the research community in terms of providing all of this chaos out there,” he said.

It is crucial for clinicians to scrutinize guideline development processes, distinguishing between consensus-based and evidence-based guidelines. Busse emphasized evidence-based guidelines are preferred for their rigorous synthesis of evidence and less likelihood of providing misleading recommendations compared to consensus-based ones.

Conflicts of interest among guideline developers can bias recommendations, underscoring the importance of transparency and accountability in guideline development.

“The recommendation presented should be easily traced back and supported by the evidence that's been synthesized and by an explicit exploration of patient values and preferences,” Busse said. “So, when you're developing a clinical practice guideline, you should not make recommendations on the basis of evidence alone. We need to understand how patients value the evidence for benefits the evidence for harms in order to make a recommendation that's going to be accountable to patients.”

A forthcoming project led by Dr. Andrea Darzi from McMaster University aims to appraise the trustworthiness of divergent guidelines, providing valuable insights into guideline reliability and helping clinicians make more informed decisions.

Disclosures: Busse has no disclosures to report.