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.