Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Pain Res. 2014 Apr 11;7:199-210. doi: 10.2147/JPR.S60842. eCollection 2014.
Over the past 2 decades, many new techniques and drugs for the treatment of acute pain have achieved widespread use. The main aim of this study was to assess the progress in their implementation using scientometric analysis. The following scientometric indices were used: 1) popularity index, representing the share of articles on a specific technique (or a drug) relative to all articles in the field of acute pain; 2) index of change, representing the degree of growth in publications on a topic compared to the previous period; and 3) index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on specific topics (ten techniques and 21 drugs) were assessed during four time periods (1993-1997, 1998-2002, 2003-2007, and 2008-2012). In addition, to determine whether the status of routine acute pain management has improved over the past 20 years, we analyzed surveys designed to be representative of the national population that reflected direct responses of patients reporting pain scores. By the 2008-2012 period, popularity index had reached a substantial level (≥5%) only with techniques or drugs that were introduced 30-50 years ago or more (epidural analgesia, patient-controlled analgesia, nerve blocks, epidural analgesia for labor or delivery, bupivacaine, and acetaminophen). In 2008-2012, promising (although modest) changes of index of change and index of expectations were found only with dexamethasone. Six national surveys conducted for the past 20 years demonstrated an unacceptably high percentage of patients experiencing moderate or severe pain with not even a trend toward outcome improvement. Thus, techniques or drugs that were introduced and achieved widespread use for acute pain management within the past 20 years have produced no changes in scientometric indices that would indicate real progress and have failed to improve national outcomes for relief of acute pain. Two possible reasons for this are discussed: 1) the difference between the effectiveness of old and new techniques is not clinically meaningful; and 2) resources necessary for appropriate use of new techniques in routine pain management are not adequate.
在过去的 20 年中，许多新的技术和药物已广泛用于治疗急性疼痛。本研究的主要目的是使用科学计量学分析评估其应用进展。使用了以下科学计量学指标：1）流行指数，表示特定技术（或药物）的文章占急性疼痛领域所有文章的比例；2）变化指数，表示与前一时期相比，某一主题出版物的增长程度；3）预期指数，表示顶级 20 种期刊上关于某一主题的文章数量与 PubMed 收录的所有（>5000 种）生物医学期刊上的文章数量之比。评估了四个时期（1993-1997 年、1998-2002 年、2003-2007 年和 2008-2012 年）中特定主题（十种技术和二十一种药物）的出版物。此外，为了确定过去 20 年来常规急性疼痛管理的状况是否有所改善，我们分析了旨在代表全国人口的调查，这些调查反映了报告疼痛评分的患者的直接反应。到 2008-2012 年，仅在 30-50 年前或更早引入的技术或药物的流行指数达到了可观的水平（≥5%）（硬膜外镇痛、患者自控镇痛、神经阻滞、分娩或分娩时的硬膜外镇痛、布比卡因和对乙酰氨基酚）。在 2008-2012 年，仅发现地塞米松的变化指数和预期指数具有有希望（尽管适度）的变化。过去 20 年进行的六次全国性调查显示，有相当比例的患者经历中度或重度疼痛，甚至没有改善结果的趋势。因此，在过去 20 年中引入并广泛用于急性疼痛管理的技术或药物并未导致科学计量学指标的实际进展，也未能改善全国缓解急性疼痛的效果。对此有两种可能的解释：1）新旧技术的有效性差异在临床上无意义；2）在常规疼痛管理中适当使用新技术所需的资源不足。
