Efficacy vs Effectiveness and Explanatory vs Pragmatic: Where Is the Balance Point in Pain Medicine Research?

Abstract

In this issue of Pain Medicine , there is a study by Cohen and colleagues that investigates the effect of procedural sedation on diagnostic and therapeutic outcomes for sacroiliac joint and sympathetic nerve block procedures [1]. They found that procedural sedation is associated with an increased rate of false positive blocks and had no significant effects on patient satisfaction or clinical outcomes at 1 month. Although this is a crucial issue relevant to the day-to-day practice of pain medicine, this elegantly designed study also broaches in a sophisticated manner the divide between explanatory and pragmatic trials. Their study design results in findings that are of high scientific quality and yet broadly applicable to routine interventional pain medicine care. Randomized trials can be broadly characterized as an effectiveness or efficacy trial, and the corresponding terms “pragmatic” vs “explanatory” are often used [2]. Pragmatic trials …