PROSPECT methodology for developing procedure‐specific pain management recommendations: an update

Abstract

SummaryThe procedure‐specific postoperative pain management (PROSPECT) working group develops evidence‐based pain management recommendations. PROSPECT methodology is unique and rigorous. However, several limitations were recognised that needed to be addressed, and several new factors were identified that improved PROSPECT methodology. The aim of this article is to present updated PROSPECT methodology for development of recommendations for procedure‐specific pain management, focusing on the methodological revisions we will implement. In future, included randomised clinical trials will need to be prospectively registered on a publicly accessible clinical trials database and the study design, including the primary outcome in the registration, should coincide with that in the published manuscript. Placebo‐controlled studies in which the analgesic intervention of interest is solely paracetamol, non‐steroidal anti‐inflammatory drugs, cyclo‐oxygenase‐2‐specific inhibitors or opioids will not be included. Studies comparing one drug in a particular class with another in the same class will also not be included. Future projects will use the Cochrane Collaboration risk of bias tool for quality of reporting of methodology and results. A modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach will be used for grading of level of evidence and strength of recommendations. Finally, the updated PROSPECT methodology addresses several other limitations and implements new factors that all add rigour and transparency to developing procedure‐specific pain management recommendations.

Use of Muscle Relaxants for Acute Postoperative Pain: A Practical Review

“…Studies evaluating single-dose administration do not provide any clinically meaningful information because of the relatively short half-life of muscle relaxants (eg, terminal half-life to be 3 hours 47 ). Another noteworthy observation is that for some studies, although the differences in pain scores were statistically significantly lower in the muscle relaxant groups, they were not clinically meaningful (ie, the differences between the study group and the comparator group were less than 10 mm/100-mm scale or less than 1/10 scale 24 ).…”

“…In addition, the use of acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2-specific inhibitors in the comparator group was also recorded, because these simple analgesics are considered as basic components of an optimal multimodal analgesic strategy. 3 , 24 A change of more than 10 mm on the 100-mm visual analogue scale or one in the 10 points numerical rating score was defined as clinically relevant. 24 …”

“… 3 , 24 A change of more than 10 mm on the 100-mm visual analogue scale or one in the 10 points numerical rating score was defined as clinically relevant. 24 …”

Ethnicity, socio‐economic deprivation and postpartum outcomes following caesarean delivery: a multicentre cohort study

“…Post-caesarean pain scores (assessed using a visual analogue scale) has suggested a MCID of 10/100 to be significant [29]. Similarly, the PROSPECT methodology uses an MCID of 1/10 using a numeric rating scale [30].…”

Developing and Implementing Postoperative Pain Management Guidelines for Breast Cancer Surgery: A Leadership Perspective

“…Additionally, research has pointed out significant gaps in existing guidelines, highlighting the urgency for the development of comprehensive guidelines. It is also recommended that these guidelines be periodically reviewed and updated, incorporating the latest evidence and best practices to maintain their relevance and effectiveness in clinical settings [27].…”