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Problems with Developments of Breakthrough Analgesics: Recent History via Scientometric Analysis

  • Darin J. Correll
    Affiliations
    The Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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  • Igor Kissin
    Correspondence
    Corresponding author at: 75 Francis St, Anesthesia, NH-224D, Boston, MA 02115. Tel.: +1 617 732 5052.
    Affiliations
    The Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
    Search for articles by this author
Published:April 03, 2019DOI:https://doi.org/10.1016/j.janh.2019.03.001

      Highlights

      • The intensity of research efforts directed at various pain-related molecular targets persistently increased for a very long time in each topic even without any success in the development of new analgesics.
      • Scientometric indices of NIH-supported studies are not better at predicting successes in the discovery of new analgesics than indices applied to all publications without regard to the category of support.
      • Orthodox thinking—both in research and research funding—might be the main reason for the absence of breakthrough analgesics.

      Abstract

      This study evaluated 13 specific topics representing molecular targets for pain during the period 1982-2016. The evaluation was performed by measuring research efforts via a scientometric approach on one hand and by assessing successful outcomes of these efforts, as indicated by the development of FDA-approved analgesics, on the other. A number of new analgesics were developed during this period, some of them with a completely novel mechanism of action. However, the main problems with approved drugs, as well as drug candidates, are relatively low levels of clinical superiority in effectiveness and narrow spectrum of action in different types of pain, compared to opioids or NSAIDs. The most interesting feature of the scientometric analysis of the 13 analgesic discovery topics is the long-lasting growth in the number of articles. The total number of all PubMed articles persistently increased over each of many 5-year periods in every topic even without any success in the development of new analgesics. Scientometric indices of NIH-supported studies are not better at predicting successes in the discovery of new analgesics than indices applied to all publications without regard to the category of support. Thus, even the highly valued NIH-based funding system did not demonstrate a clear advantage for discovery efforts centered on pain-related molecular targets. The evaluated research efforts did not result in breakthrough analgesics that could demonstrably affect the current use of opioids or NSAIDs. Orthodox thinking—both in research and research funding—might be the main reason for the absence of breakthrough analgesics.

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