Abstract:
Rationale, aims, and objectives: Portenoy and Foley’s 1986
landmark study “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 study. In
the first “exploration” period (1986-1996), the index study 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 study 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 study.
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.
Keywords: Opioid Epidemic; Bibliometrics; Analgesics; Drug
Prescriptions; Practice Patterns,
Physicians’ (MeSH)