Toward a canon of the pain and analgesia literature: a citation analysis

A bibliometric search of citation classics in anesthesiology

BACKGROUND

Articles cited counts are catalogued and help identify landmark papers. This study provides a citation classics of anesthesiology literature using the framework of subspecialties to provide a review of well-developed areas of research in anesthesiology.

METHODS

A comprehensive list of the most-cited articles in anesthesia was compiled using a bibliometric database and general search terms such as "anesthesia" as well as subspecialty-specific search terms. Queries were reviewed for relevance to anesthesiology practice, categorized by subspecialty, and ranked according to their citation counts.

RESULTS

The database resulted in 2519 articles published between 1945 and 2008. The specialty areas most represented were chronic pain medicine (11%), pharmacology (9%), and pain sciences (9%).

CONCLUSIONS

This citations classic allows for advances in anesthesiology and its subspecialties to be highlighted as well to provide useful manuscripts to guide patient care, direct future research, and serve as sources for future academic pursuit.

The most influential articles in critical care medicine

Purpose

The study aimed to examine query strategies that would provide an exhaustive search method to retrieve the most referenced articles within specific categories of critical care.

Material and Methods

A comprehensive list of the most cited critical care medicine articles was generated by searching the Science Citation Index Expanded data set using general critical care terms keywords such as “critical care,” critical care journal titles, and keywords for subsubjects of critical care.

Results

The final database included 1187 articles published between 1905 and 2006. The most cited article was referenced 4909 times. The most productive search term was intensive care. However, this term only retrieved 25% of the top 100 articles. Furthermore, 662 of the top 1000 articles could not be found using any of the basic critical care search terms. Sepsis, acute lung injury, and mechanical ventilation were the most common areas of focus for the articles retrieved.

Conclusion

Retrieving frequently cited, influential articles in critical care requires using multiple search terms and manuscript sources. Periodic compilations of most cited articles may be useful for critical care practitioners and researches to keep abreast of important information.

Citation classics in critical care medicine

OBJECTIVE

The number of citations an article receives after its publication reflects its impact on the scientific community. Our purpose was to identify and examine the characteristics of the most frequently cited articles in the field of critical care medicine.

DESIGN

The 74 top-cited articles in critical care journals were identified by a computer search using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to present) and the Web of SCIENCE. The 45 top-cited critical care articles in all other biomedical journals were identified using the database SciSearch (1974 to present) with the key word "Critical Care".

RESULTS

The most cited articles received 3402 and 2860 citations, respectively. The citation classics in critical care journals were published between 1968 and 1999 in six high-impact journals, led by Critical Care Medicine (37 articles), followed by the Journal of Trauma (21), and American Journal of Respiratory and Critical Care Medicine (9). Seventy articles were original publications, two were reviews or guidelines, and two were editorials. The top 45 classic articles in non-critical care journals were published in 13 different journals, led by the New England Journal of Medicine (11 articles), followed by JAMA and Lancet (6 articles each). The United States of America contributed most of the classic articles. Pathophysiology of the lung, sepsis and scoring systems were the primary focus of classic publications.

CONCLUSIONS

Our analysis gives a historical perspective on the scientific progress of critical care medicine and allows for recognition of important advances in this specialty.

Pain management in the opioid-dependent patient

The opioid-dependent patient presents great challenges for pain management. These challenges are not limited to potential addictive behaviors. In contrast to the profound pain relieving effects of acute opioid intake, chronic opioid intake can promote a counterintuitive state of enhanced pain sensitivity. Multiple biologic mechanisms inducing opioid tolerance and hyperalgesia have recently been elucidated. The potential hyperalgesic state accompanying opioid dependence complicates pain management somewhat for acute pain and cancer pain, but it especially does so for chronic pain. Guidelines for treatment of opioid dependence in the pain patient are proposed. Treatment oriented toward the long term requires limit setting and psychologic support that go beyond simple medication management.