Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data

Abstract

BackgroundPrimary care pharmacological management of new musculoskeletal conditions is not consistent, despite guidelines which recommend prescribing basic analgesics before higher potency medications such as opioids or non-steroidal inflammatory drugs (NSAIDs).The objective was to describe pharmacological management of new musculoskeletal conditions and determine patient characteristics associated with type of medication prescribed.MethodsThe study was set within a UK general practice database, the Consultations in Primary Care Archive (CiPCA). Patients aged 15 plus who had consulted for a musculoskeletal condition in 2006 but without a musculoskeletal consultation or analgesic prescription in the previous 12 months were identified from 12 general practices. Analgesic prescriptions within two weeks of first consultation were identified. The association of socio-demographic and clinical factors with receiving any analgesic prescription, and with strength of analgesic, were evaluated.Results3236 patients consulted for a new musculoskeletal problem. 42% received a prescribed pain medication at that time. Of these, 47% were prescribed an NSAID, 24% basic analgesics, 18% moderate strength analgesics, and 11% strong analgesics. Increasing age was associated with an analgesic prescription but reduced likelihood of a prescription of NSAIDs or strong analgesics. Those in less deprived areas were less likely than those in the most deprived areas to be prescribed analgesics (odds ratio 0.69; 95% CI 0.55, 0.86). Those without comorbidity were more likely to be prescribed NSAIDs (relative risk ratios (RRR) compared to basic analgesics 1.89; 95% CI 0.96, 3.73). Prescribing of stronger analgesics was related to prior history of analgesic medication (for example, moderate analgesics RRR 1.88; 95% CI 1.11, 3.10).ConclusionOver half of patients were not prescribed analgesia for a new episode of a musculoskeletal condition, but those that were often received NSAIDs. Analgesic choice appears multifactorial, but associations with age, comorbidity, and prior medication history suggest partial use of guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-418) contains supplementary material, which is available to authorized users.

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

“…The possible association between low nSES and increased odds of opioid prescription is in agreement with Ndlovu et al's study finding that higher neighborhood deprivation was associated with higher risk of opioid prescription. 26 Ndlovu 26 also found that the majority of patients received no pharmacologic therapy, much the same as this study. However, this study presents contrast with the findings of Joynt et al 15 , which noted low nSES was associated with a 24% decrease in odds of opioid prescription.…”

“…In particular, lower nSES was associated with a lower likelihood of patient's receiving an opioid prescription, independent of race. In contrast, Ndlovu et al 26 found the opposite effect; that higher levels of neighborhood deprivation was associated with higher likelihood of strong analgesic (mostly opioid) therapy. Thus, patients living in postal codes with more poverty were more likely to receive an opioid.…”

“…Thus, patients living in postal codes with more poverty were more likely to receive an opioid. 26 Given the conflicting nature of the evidence available, the frequency of back pain and the potential poor prognostic implications of early opioid use, we sought to determine whether nSES, independent of race, is associated with type of pain treatment provided for new back pain visits in primary care.…”

Medication prescribing quality in Australian primary care patients with chronic kidney disease

“…A study in Canada reported that almost 10% of patients were prescribed NSAIDs despite patients' high risk for renal and cardiovascular complications (28). Another study in the UK on patients with moderate to severe CKD reported 5.7% NSAID use (29). Given that some NSAIDs are also available over the counter, their use is likely to be higher than the estimates reported here using general practice prescription data.…”

Efficacy and safety of guaifenesin for upper back, neck, and shoulder pain: a Phase II proof-of-concept, multicenter, placebo-controlled, repeat-dose, parallel-group study

“…In addition, pharmacologic options, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), are used to manage musculoskeletal pain, and muscle relaxants may be used to manage muscle pain, stiffness, and spasm 14–17. Although there are many skeletal muscle relaxants, systemically active products are generally available with prescription and are associated with well-documented adverse effects such as somnolence, dizziness, weakness, and dry mouth 17…”