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.
Highlights
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)
Least commonly affected was the hip (6%), with other or unspecified regions accounting for 26% (Table 1). 13% had a recent history of consulting for a musculoskeletal problem, albeit not within the previous 12 months, and 16% had received pain medication 12–24 months before their 2006 consultation
This study has shown that more than half the patients consulting for a new episode of a musculoskeletal condition were not prescribed pain medication
Summary
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). Guidelines for the management of painful musculoskeletal conditions advocate a holistic approach incorporating education, psychological, physical, and surgical interventions administered in a step-wise fashion [1,2]. In 2003, the World Health Organisation (WHO) offered health care professionals guidance on the use of analgesia in low back pain that is applicable to musculoskeletal conditions in general [1] This advice constituted an analgesic ladder, whereby doctors were encouraged to use basic analgesics in the first instance (e.g. paracetamol), step up to using non-steroidal anti-inflammatories if basic analgesics did not control the pain, and where appropriate as a third step, use opioid analgesics such as codeine. This advice has been widely disseminated and is currently reflected in the NICE guidelines for managing osteoarthritis [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
