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Review: Chronic pain in the neonate: a research design connecting Ancient Delphi to the modern ‘Dutch Polder’

The authors of this paper provide an excellent comparative overview for those interested in the use of expert consensus to marshal the best evidence in order to define clinical problems, to identify their causes, and to describe their signs and symptoms. Moreover, their example of chronic pain in neonates demonstrates very effectively the need for such strategies. It reminds us that, despite the elevated position of randomised controlled trials within the hierarchy of evidence-based practice, there are many areas of care where the complexities and ambiguities of the clinical problem faced means that trials and meta-analyses of trials cannot, on their own, provide answers sufficient to guide practice. Despite the far less elevated status of expert opinion, it is evident from this paper that it remains a core strategy for the production of meaningful and operationalisable evidence. This suggests that the role of expert consensus can be even wider than that identified by the authors, including the development of protocols and pathways of care founded on the knowledge gathered on definition, aetiology and symptomatology. In their comparative analysis of three methods of expert consensus, the Delphi method, the nominal group technique (NGT) and consensus development conferences (CDC), two of the main lines of contrast that they identify are, first, whether the experts physically come together (NGT and CDC), or whether they use information technology to deliberate at a distance (Delphi) and second, if they do come together, do they do so on the basis of a prestructured synopsis of the state of play (CDC), or do they take a take tabula rasa approach (NGT)? The authors’ comprehensive analysis of the pros and cons of each approach means that they have produced a very useful resource for those considering the use of expert consensus as a method, but are unsure of the best way to go about it. While at the end of the day they chose the Delphi method as the most appropriate strategy to address the problematic of chronic pain in neonates, this should not be taken to apply to all cases requiring expert consensus. Rather, a degree of methodological liberalism is appropriate.