Business Model Can Help With Pain Relief Decisions After Surgery

Dr. Schug Interview with:
Professor Stephan A Schug MD FANZCA FFPMANZCA EDPZ 
Emeritus Professor and Honorary Senior Research Fellow
Anaesthesiology and Pain Medicine
Medical School  University of Western Australia  What is the background for this study?

Response: This paper is the result of applying a widely used tool in operations research, Multi-Criteria Decision Analysis (MCDA), to a medical problem, namely the use of parenteral analgesics in postoperative pain management. MCDA is a modelling approach which is aimed at achieving evidence-based decisions in settings of multiple conflicting criteria. It is commonly applied to decisions in politics and business; one of our co-authors is Lawrence D Phillips from the London School of Economics and Political Sciences, where he uses this methodology in these settings. However, there is increasing use of this methodology in medicine now, in particular in assessment of medicines with obviously conflicting criteria such as efficacy, adverse effects, safety and even price. The methodology has been applied to a number of medicine (eg psychoactive drugs) and considered by the European Medicines Agency (EMA). What are the main findings?

Response: This study applied MCDA for the first time to analgesic medicines and identified preferable parenteral analgesics for postoperative pain control based on the criteria efficacy, adverse effects, serious adverse effects and overdose toxicity. What should readers take away from your report?

Response: The most relevant findings of this study are in my opinion that a methodology, which scientists and clinicians are not familiar with, namely MCDA, can be applied to the assessment of medications, in this case parenteral analgesics, and provide an evidence-based ranking of such medications, based not only on one parameter of efficacy, but on multiple criteria for the various outcomes – overall 3 criteria for efficacy and 14 for safety. It represents therefore a very different perspective from the usual ranking of analgesic medications in a ‘league table’ based on number-needed-to-treat (NNT) only. What recommendations do you have for future research as a result of this work?

Response: This is one of a whole series of recent papers, which apply the methodology of MCDA to decision making in health care and in particular in quantitative modelling of the benefit-risk ratios of medications. I can well imagine that this methodology will find many applications in the setting of medicine and encourage other researchers to look at this interesting methods for decision making and apply it to areas they work in.

My disclosures are as per the disclosures in the paper.


Schug S, Pogatzki-Zahn E, Phillips LD, Essex MN, Xia F, Reader AJ, Pawinski R. Multi-Criteria Decision Analysis to Develop an Efficacy-Safety Profile of Parenteral Analgesics Used in the Treatment of Postoperative Pain. J Pain Res. 2020;13:1969-1977


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Last Updated on August 19, 2020 by