Shifting interpretations in evidence and guidance in pain and opioids research: A bibliometric analysis of a highly cited case series from 1986

Abstract

Rationale, Aims and Objectives Portenoy and Foley's 1986 landmark case series ‘Chronic use of opioid analgesics in non‐malignant pain: report of 38 cases’ has been reproached for opening the floodgates of opioid prescribing for chronic non‐cancer pain and the attendant harms. This influential article has been cited over 500 times in the scientific literature over the last four decades. This study seeks to understand the impact of Portenoy and Foley's article on subsequent discussions and research about opioids. Methods We conducted a multi‐method bibliometric analysis of all citations of this article from 1986 through 2019 using quantitative relational and qualitative content analysis to determine how uses and interpretations of this case series and associated prescribing guidance have changed over time, in relationship to the evolution of the North American opioid crises. Results Using time series analysis, we identified three periods with distinct interpretations and uses of the index article. In the first ‘exploration’ period (1986–1996), the index article was well‐received by the scientific community and motivated further study of the effects of opioids. In the second ‘implementation’ period (1997–2003, coinciding with the release of OxyContin®), this case series was used as evidence to support widespread prescribing of opioid analgesics, even while it was recognized that long‐term effects had not yet been evaluated. The third ‘reassessment’ period (2004–2019) focused on how opioid‐related harms had been overlooked, and in many cases, these harms were directly attributed to this article. Conclusion These changes in interpretation demonstrate shifting currents of the use and mobilization of evidence regarding pain and opioids, and how these currents both impact and are impacted by clinical practices and major sociohistorical phenomena such as the opioid crisis. Researchers and clinicians must account for these shifting dynamics when developing and interpreting scientific knowledge, including in the form of clinical practice guidelines.

How policy problems and solutions travel in the scientific literature: An international scientometric analysis of the French Model of opioid use disorder care

“…All retrieved full-text articles were examined to ensure that the index study was indeed cited. Following the procedures of other scientometric analyses, 37,38 we included documents that used a clear scientific methodology, including both quantitative and qualitative methodologies; documents that were published in a peer-reviewed academic publication including opinion pieces; and documents that identified and summarized already published primary research studies with a clear scientific provenance and purpose such as narrative reviews and book chapters. Opinion pieces that were published in nonpeer-reviewed journals and websites were excluded.…”

“…We collected location and year of publication to explore where and when the content in the index study has travelled in citing (first-order) studies. We collected relevant content data and additional available citation metadata that have been used in other scientometric analyses [38][39][40] to explore how the index study has travelled across jurisdictions (Table 1).…”

“…We defined location as the countries of the affiliated institutes of authors citing the index study, following published studies with similar bibliometric methods. 37,38 No distinction was made based on the author order. For example, an article by authors affiliated with the United States and France was included in both US and France categories.…”

“…This is important for characterizing the nature and role of the citation to the index article. 38 We determined the sign of the text citing the index study by reading the surrounding text, aims and key discussion points for the study. If an article agreed, confirmed, supported or promoted the content of the index study to another context it was considered affirmative.…”

“…Dissemination of inaccurate facts undermines the scientific argument and foundation of the research being reported and, moreover, may distort and amplify false information. 42,43 Following previous comparable analysis, 38 we categorized data or claims presented in the text citing the index study as 'factually accurate' if they aligned with data or claims in the index study. We judged the data or claim as 'factually inaccurate' if the text included any extraneous, contrasting, assumed or misleading information regarding the index study (e.g., inaccurate percentages of buprenorphine misuse or overdose reductions, conflating buprenorphine regulations with methadone regulations or discussing neonatal opiate withdrawal from buprenorphine which was not discussed in the index study).…”