the plural of pain is evidence?

My sister passed along a link to an MSNBC article on treating a disease called complex regional pain syndrome in children; astute readers might go "hey, isn't that what you have?" and yes, it is.

But treating CRPS in kids is a bit of a different ballgame, and experts in the small field finally got together for a pediatric CRPS conference to discuss the very simple fact that almost all of the information about treating severe chronic pain in children is anecdotal; the evidence-based data simply isn't there. Put very simply, the combination of the rarity of CRPS in children and the rarity of pediatric pain management specialists has led to scattershot approaches for treatment based on individual physician experience, rather than any conclusive data.

Now, anyone who caught Daniel and I going back and forth in the comments of this post knows that I'm not the strongest proponent of evidence-based medicine. While I think it has its place, I also think that people place entirely too much credence in it, and sometimes the anecdotal is the more important - or, in the BMJ article, is as firmly established as laws of gravity and thus we don't need to toss someone out of a plane without a parachute to understand what will happen. But the flip side is equally true; a common saying around my place of work is that the plural of anecdote is not ambien. Hoping, praying, or just blindly believing that what works for one patient can be extrapolated out to all patients is a recipe for insuring that patients do not receive the best care possible.

So it's heartening to see, in the face of all the controversy over pain management clinics and doctors and the necessity of tightly scheduled pain medications, pediatric physicians holding a conference and setting the foundation for actually gathering the evidence-based knowledge necessary to give the best possible treatment to their young patients.

Comments

[Daniel Goldberg]

Hey, I agree completely. And I also agree that some (much?) of what passes for EBM is poorly done, and is reliant on hoary old notions of objectivity and science that smacks more of scientism than of science. I see EBM as more of a commitment to engage some of the most difficult problems of induction and evidence, e.g., what counts as good evidence? How do we find better and worse pieces of evidence?

But recognizing the ineluctable subjectivity of scientific practice need not imply a refusal to commit to EBM; it just means we ought to think differently about what it is we're trying to measure and, perhaps more importantly, how we go about doing so -- and also even whether measurement is appropriate or even possible as a means of evidence acquisition.

Great post!