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Are therapists working in chronic pain evidence based? It seemed a simple question at the time

Awareness is strong that it is no longer adequate to provide healthcare grounded exclusively on clinical experience without a clear demonstration of a highquality research evidence base. Evaluation of how successfully we are in achieving this goal is a priority across all healthcare disciplines. This paper explores whether therapists are evidence based in their beliefsabout pain treatment, and presents a structured review of the evidence base for certain chronic pain interventions. The study used secondary data from a larger study to compare what therapists in the UK endorsed as important treatments for chronic pain against the current evidence obtained from published systematic reviews. The study revealed that therapists had widely diverse endorsement patterns that seemed evidence based for certain treatments but not for others. This is consistent with recent literature stressing that not all health issues can be dealt with through simple cause-and-effect equations, and that the evidence base for best practice must be explored with an awareness of the complex interrelationships of dynamic political, social and cultural environments. The range of treatment beliefs seen in this study could be taken as support thattherapists are, either tacitly or overtly, aware of the need to seek evidence for treatment effectiveness within a wider scope than that traditionally offered by the biomedical model. Complex adaptive systems theory may offer insight and guidance aboutways to work with this diversity of practice in a positive manner that seeks to use conflicting opinions as a generative force for creative problem solving and contextually reflective intervention. The findings served to provoke many questions that shouldbe more carefully scrutinised before any conclusions about evidence-based practice are drawn.

Author(s): Cary A Brown, Mark A Pinnington

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