Understanding general practitioners’ prescribing choices to patients with chronic low back pain: a discrete choice experiment

Abstract

Background Although NSAIDs are recommended as a first line analgesic treatment, opioids are very commonly prescribed to patients with low back pain (LBP) despite risks of harms. Aim This study aimed to determine factors contributing to general practitioners’ (GPs’) prescribing choices to patients with chronic LBP in a primary care setting. Method This discrete choice experiment (DCE) presented 210 GPs with hypothetical scenarios of a patient with chronic LBP. Participants chose their preferred treatment for each choice set, either the opioid, NSAID or neither. The scenarios varied by two patient attributes; non-specific LBP or LBP with referred leg pain (sciatica) and number of comorbidities. The three treatment attributes also varied, being: the type of opioid or NSAID, degree of pain reduction and number of adverse events. The significance of each attribute in influencing clinical decisions was the primary outcome and the degree to which GPs preferred the alternative based on the number of adverse events or the amount of pain reduction was the secondary outcome. Results Overall, GPs preferred NSAIDs (45.2%, 95% CI 38.7–51.7%) over opioids (28.8%, 95% CI 23.0–34.7%), however there was no difference between the type of NSAID or opioid preferred. Additionally, the attributes of pain reduction and adverse events did not influence a GP’s choice between NSAIDs or opioids for patients with chronic LBP. Conclusion GPs prefer prescribing NSAIDs over opioids for a patient with chronic low back pain regardless of patient factors of comorbidities or the presence of leg pain (i.e. sciatica).