CURRENT RECOMMENDATIONS FOR PAIN MITIGATION STRATEGIES
The transparent development of guidelines for industry stakeholders is an important process. For this project, we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process, which is an internationally recognized approach to developing guidelines in healthcare. Examples of this approach are available from the World Health Organization , the American College of Physicians , The Agency for Healthcare Research and Quality , and the US Centers for Disease Control and Prevention .
The rationale for choosing the GRADE approach is the transparency and inclusivity of diverse and informed perspectives that the process brings to guideline development. The process acknowledges the importance of scientific evidence and the potential for bias in scientific information. Importantly, the GRADE process explicitly includes transparent articulation of the ethical and non-ethical values and preferences that created the recommendations. A key concept in recommendations is that, while scientific evidence is global, decisions are local. The concept that scientific evidence is global means that if the same approach to searching, extracting, and analyzing the data from relevant studies were employed by others, then they would reach the same conclusions about the effects of the interventions. However, decision making is local because it is informed by local challenges, values, and preferences as well as by other limitations of a particular review process.
As a means of illustrating the idea of global evidence and local decisions, a good example relates to the use of wildlife culling as a method of control for countries that have wildlife reservoirs of tuberculosis in livestock. In the United Kingdom and New Zealand, wildlife are important reservoirs for tuberculosis (e.g., possums in New Zealand and badgers in the United Kingdom). Evidence that culling is an effective approach may be similar; however, the decision to employ culling is influenced by local values and preferences. In New Zealand, the possum is a feral species, and widespread opposition to culling the species is not observed. Indeed, culling is viewed positively by livestock producers and conservationists, as it would protect both native and domestic species. However, in the United Kingdom, culling of badgers is viewed negatively and is not employed due to local opposition to the approach. Therefore, although the evidence for culling is similar, the decisions differ based on local preferences.
Not only are recommendations local, they can be time specific and have an expiration date. Because recommendations involve scientific evidence, values, and preferences, the balance of benefits, harms, and resources change over time, and thus, recommendations should not be viewed as standing for all time. As such, the recommendations made by the panel are relevant to the current state of knowledge and resource availability. Timelines for revision and factors that might influence changes in the recommendations are included. The GRADE tables presented in the report should be used to understand the recommendations. The summary recommendations are the following:
The panel’s current position is a strong recommendation against the use of a CO2/O2 general anesthesia mixture for pain mitigation during castration in piglets between 1 and 28 days old.
The panel’s current position is a weak recommendation for the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain mitigation during castration in piglets between 1 and 28 days old.