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

Article English OPEN
Ndlovu, Mehluli ; Bedson, John ; Jones, Peter W ; Jordan, Kelvin P (2014)
  • Publisher: Springer Nature
  • Journal: BMC Musculoskeletal Disorders (vol: 15)
  • Related identifiers: doi: 10.1186/1471-2474-15-418, pmc: PMC4295256
  • Subject: Research Article | Analgesia | Orthopedics and Sports Medicine | Primary health care | Musculoskeletal | Medical records | R1

Background Primary 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. Methods The 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. Results 3236 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). Conclusion Over 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 material The online version of this article (doi:10.1186/1471-2474-15-418) contains supplementary material, which is available to authorized users.
  • References (41)
    41 references, page 1 of 5

    1. Ehrlich GE: Back pain. J Rheumatol 2003, 67:26-31.

    2. NICE 2008, Osteoarthritis: The Care and Management of Osteoarthritis in Adults, NICE Clinical guideline 59. London: National Institute for Health and Clinical Excellence;

    3. Curatolo M, Bogduk N: Pharmacologic pain treatment of musculoskeletal disorders: current perspectives and future prospects. Clin J Pain 2001, 17:25-32.

    4. Maniadakis N, Gray A: The economic burden of back pain in the UK. Pain 2000, 84:95-103.

    5. Kroenke K, Krebs EE, Bair JM: Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Psychiatry 2009, 31:206-219.

    6. Michaleff ZA, Harrison C, Britt H, Lin CW, Maher CG: Ten-year survey reveals differences in GP management of neck and back pain. Eur Spine J 2012, 21:1283-1289.

    7. Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, Fahridin S, Harrison C, Latimer J: Low back pain and best practice care. a survey of general practice physicians. Arch Intern Med 2010, 70:271-277.

    8. Jordan KP, Clarke AM, Symmons DPM, Flemming DF, Porcheret P, Kadam UT, Croft P: Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases. Br J Gen Pract 2007, 57:7-14.

    9. Porcheret M, Hughes R, Evans D, Jordan KP, Whitehurst T, Ogden H, Croft P: Data quality of general practice electronic health records: the impact of a program of assessments, feedback and training. J Am Med Inform Assoc 2004, 11:78-86.

    10. Jordan KP, Kadam UT, Hayward R, Porcheret M, Young C, Croft P: Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord 2010, 11:144.

  • Metrics
    No metrics available
Share - Bookmark