Development of Clinical Practice Guidelines in the Field of
Objective: IASP to develop guidelines for clinical
practice in order to provide members with evidenced-based information
for rational and best practice.
Background: Practice guidelines represent formalized
reviews of the existing literature on a given topic, which serve as a
background for evidence-based practice recommendations. The literature
review is a systematic, unbiased and transparent presentation of the
evidence. Expert panels scrutinize available literature on a given
topic, present evidence based on quality of studies, and recommend
guidelines for best clinical practice. The development of a guideline
should follow a specific scheme:
Ask a clinically relevant question
Analyze all available evidence objectively
Audience: Members of IASP and other healthcare
providers including patient organizations dealing with clinical
Areas for practice guideline:
Clinical practice management: i.e., a series of specific
evidence-based recommendations for handling a specific clinical
New technology or treatment: i.e., evidence-based recommendations
for new therapies or technologies in the pain area assessing utility,
safety and effectiveness.
Proposal for topics: Any member of IASP or any other
health organization may submit a proposal for the development of a
guideline on a certain topic. The proposal should contain the
a) Outline of problem, b) relevance to pain, c) impact of condition
(individual/society), d) degree of practice variation, e) current
evidence and its quality, f) have previous guidelines been developed or
published related to the topic, and g) the benefit of a new
guideline. The proposal should also include a budget proposal and
business plan for funding the guideline development.
IASP will convene a review panel to determine if the topic is
accepted for development of a guideline.
Who prepares the guidelines:
The IASP review panel upon acceptance of a proposal assigns a
specific person who will be responsible for assembling a task force of
5-10 persons to develop and author the guideline. Care should be taken
to avoid any sort of bias and to ensure diversity of members of the
panel (geographically and in terms of discipline). Members should have
recognized expertise in the area (e.g. authored clinical publications in
prestigious journals). In certain circumstances it will be necessary to
include non-IASP members in the task force. In case of a conflict of
interest, it is important to balance such by having task force members
with and without conflicts of interest. Any conflict of interest will be
disclosed in the guidelines. Certain guidelines may prepared together
with other organisations e.g. WHO.
The IASP Review Panel approves the task force. The guideline proposal
and the task force/author panel are communicated to the Cochrane Group
to ensure mutual information.
The IASP staff shall assist with administrative support, facilitation
of meetings and communication via a discussion forum; IASP may/should
also provide economic support to the task force.
Development plan for a guideline
- The clinical question
- Population: what type of pain group involved.
- The type of intervention (treatment/diagnostic procedure) the person
is exposed to.
- Outcome should be a clinically relevant one, e.g. pain reduction.
Surrogate markers such as a radiological measure should be avoided.
- Terms and databases
- Search terms, e.g., MeSH words for Medline search are helpful.
- Databases. These usually include MEDLINE, EMBASE and SCI. In certain
cases, additional databases may be needed and a medical librarian may be
helpful in assisting here.
- Inclusion and exclusion criteria of literature
- The task force develops criteria for including and excluding
articles. This is a crucial element and may differ from one topic to
- Subjects (in general only human studies).
- Intervention should be clear.
- Type of studies. If the literature is large, only class I studies
are examined. If the literature is limited, studies from lower classes
may be used. Only studies from peer-reviewed journal should be
- A time line showing major milestones and projected guideline
The task force submits the plan for the guideline development to the
appointed individual for the guideline, who may revise as
necessary. IASP staff allocate resources for the project.
Data review and analysis
Evaluate the quality and accuracy of the search (the full paper
should be read (not only the abstract)).
Collection of previous meta analyses should always be done.
Collection of reviews/overview is done from databases.
Evidence can be presented for a therapeutic and a diagnostic
Evidence for a therapeutic intervention.
Comparison (control group).
Completeness of follow-up, including drop out rate.
Masking in the study (investigator unaware of original treatment
assignment should determine the outcome).
Evidence for a diagnostic procedure.
Comparison (control group).
Valid reference standard (independent of the diagnostic test in
Masking in the study (investigator unaware of diagnostic test should
apply the reference standard to determine the true presence of the
Conclusion and recommendations
Summarize the evidence to the clinical question
Divide recommendation into categories: Level A, B, and C ratings
Consider recommendation for developing and developed countries
IASP should follow-up on value/impact of guideline
Guidelines authorized for a limited period (e.g. until new evidence
Title: IASP Guidelines on …….. Report of an IASP
Task force on…..
Analysis of evidence
Tables, algorithms, figures
Conflict of interest
The written guidelines should conform to the style of PAIN. The
length of the guideline should aim to not exceed 3000 words. The
Task Force submits the guidelines to the Review Panel for IASP
endorsement and to PAIN for possible publication. IASP will also
post the final guideline on its website and make it available to the
Supplementary material and literature:
Sackett, D L et al. Evidence-Based Medicine: How to Practice
and Teach EBM.
New York: Churchill Livingstone.1997
Hughes RAC et al. Guidance for the preparation of neurological
management guidelines by EFNS scientific task forces. Eur J Neurol 2001;
Brainin M et al. Guidance for the preparation of neurological management
guidelines by EFNS scientific task forces revised recommendations 2004.
Eur J Neurol 2004; 11:577-581.
American Academy of neurology Clinical Practice Guideline Process Manual
2004 Edition http://www.aan.com/go/practice/guideline