Techniques, Technology and Tekne: The Ethical Use of Guidelines in the Practice of Interventional Pain Management

Abstract

his issue of Pain Physician is dedicated to the dissemination of reviews and guidelines that are evidencebased, and that seek to provide, by definition, some level of direction in the specific actions of interventional pain practice. The work upon which these guidelines are structured focused upon the pathologic bases of particular pain disorders and syndromes, the techniques and technologies that constitute specific therapeutic interventions, and the outcomes that such interventions produce in representative populations. In many ways, this information affords theoretical knowledge (of various pain pathologies and techniques of diagnosis and intervention), empirical information (regarding the outcomes of these interventions), and contextual focus (by grounding outcomes’ evidence to particular patient-characteristics and specifics). This provides a framework for the decisional processes that shape the clinical practice of pain medicine. I argue that guidelines (and the decisional processes they facilitate) must be built upon a progressively revised understanding of pain, recognition and appreciation of its effects, and acknowledgment of the capacities and limitations of contemporary medicine. From a practical standpoint, such clinical guidelines could provide a sustain