Limitations
The index study is only one of several seminal articles discussing
opioid treatment for chronic non-cancer pain that preceded the opioid
crisis. Therefore, our study does not capture the entire picture of
interpretations and reinterpretations of scientific knowledge
concurrently with the dynamics of the opioid crisis. Similar
examinations of other seminal articles would provide a more
comprehensive view. Furthermore, citing articles were only collected
from WoS. While this database is commonly used for bibliometric
analyses, a similar study using other databases such as Scopus or Google
Scholar may have yielded different outcomes and thus alternative
conclusions.
The coding of the citing articles would be subject to the biases and
idiosyncratic interpretations of the reviewers. We aimed to mitigate
these effects by using clear coding schema and coding independently and
in duplicate. However, there is still the possibility of the coding
procedure introducing unknown biases to this study.
Conclusion:
This systematic analysis of 511 articles citing Portenoy and Foley’s
1986 study demonstrates the winding evolution of its interpretation and
related impact on pain and opioid scholarship. A time-series analysis
identified three distinct periods of interpretation of the index study
which we labelled as periods of exploration, implementation, and
reassessment. These periods of interpretation align well with inflection
points identified by other studies and with major sociohistorical
phenomena related to pain management and opioid prescribing. This
illustrates both the fluidity of scientific interpretation in pain
medicine and research, and the importance of sociohistorical context to
this interpretation. Practitioners and researchers should be attuned to
this shifting nature of interpretation to better develop, critically
evaluate, and apply scientific knowledge.