Summary of findings
Portenoy and Foley’s study has been cited more than 500 times, placing
it amongst the most commonly cited articles from 1986. These citations
have not only been sustained over a period of four decades, but the
annual number of citations has continued to increase in recent years
demonstrating the continued and profound impact of this article on pain-
and opioid-related scholarship and practice. Besides these gross
measures of impact, we identified three distinct periods in which the
index study was interpreted and used by the scientific and clinical
communities. Building on Geels’ sociotechnical analysis of the societal
embedding of psychotropic
medications,41we can frame these three periods periods more specifically as waves ofexploration , implementation , and reassessment(Table 3). This framing emphasizes the importance of sociohistorical
context in determining how the index study has been interpreted. An
understanding of this process is important to both practitioners and
researchers as we attempt to interpret scientific evidence to best
inform prescribing practices and research agendas.