J. Bedson - Academia.edu (original) (raw)

Papers by J. Bedson

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, but ha... more Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, but have potentially serious side effects when prescribed in patients with cardiovascular disease (CVD). The MHRA and NICE issued directives between 2004 and 2008 relating to their use in patients with CVD, which stipulated that NSAIDs, especially Cox-2’s, should be used with caution in CVD patients to prevent potential adverse events. Our aim was to determine trends in NSAIDs prescribing from 2002-2010 in patients with and without CVD and ascertain if patterns of prescribing changed following the issuance of the MHRA/NICE guidance. Methods This was an observational database study of patients aged ≥18 undertaken in 11 practices contributing to the Consultations in Primary Care Archive (2002-2010). All NSAIDs were grouped into three categories (basic, Cox-2 and topical NSAIDs). Study duration was divided into quarterly time periods, on a seasonal basis from 1st quarter 2002 to 4th quarter 2010....

Background Recent trends and future projections in the population burden of osteoarthritis and pr... more Background Recent trends and future projections in the population burden of osteoarthritis and primary joint arthroplasty rates across Europe point to a growing challenge for population health and health services. However there are few studies on whether the rate of new cases presenting to primary care is also increasing, and no published national studies in the UK. Objectives To determine the temporal trend in annual consultation incidence of clinical OA in UK primary care between 1992–2013. Methods We used the Clinical Research Practice Datalink (CPRD), a nationally representative database of primary care electronic health records (650 practices, 5 million population) to estimate the annual consultation incidence of clinical OA. To allow for known variation in codes used in primary care for coding osteoarthritis we using established Read codelists to define a new case of clinical OA as a recorded diagnosis of OA or, in adults aged over 45 years, a recorded non-specific peripheral ...

Rheumatology, 2019

, p ¼ 0.50). Radiographic knee osteoarthritis was also significantly associated with lower percen... more , p ¼ 0.50). Radiographic knee osteoarthritis was also significantly associated with lower percentage lean mass (-0.27 z-score (-0.50,-0.04, p ¼ 0.021) and grip strength (-0.39 z-score (-0.58,-0.21), p < 0.001). The combination of radiographic osteoarthritis and knee pain was associated with lower percentage lean mass (-0.75 z-score (-1.03,-0.48), p < 0.001), grip strength (-0.48 z-score (-0.72,-0.23), p < 0.001) and a reduction in gait speed (-0.26 z-score (-0.50,-0.02), p < 0.04). Conclusion: We observed that the occurrence of knee pain predicted lower future muscle mass, radiographic osteoarthritis predicted lower future muscle mass and strength and the combination (knee pain and radiographic osteoarthritis) predicted lower future muscle mass, strength and function. These findings suggest that those individuals with co-existent evidence of knee pain and radiographic osteoarthritis are at particular risk of adverse muscle outcomes and, if our results are replicated elsewhere, these individuals should be targeted with interventions to ameliorate this decline in muscle mass, strength and function.

International Journal of Geriatric Psychiatry, 2019

ObjectivesTo describe the current literature on pain assessment and pain treatment for community‐... more ObjectivesTo describe the current literature on pain assessment and pain treatment for community‐dwelling people with dementia.MethodA comprehensive systematic search of the literature with narrative synthesis was conducted. Eight major bibliographic databases were searched in October 2018. Titles, abstracts, and full‐text articles were sequentially screened. Standardised data extraction and quality appraisal exercises were conducted.ResultsThirty‐two studies were included in the review, 11 reporting findings on pain assessment tools or methods and 27 reporting findings on treatments for pain.In regard to pain assessment, a large proportion of people with moderate to severe dementia were unable to complete a self‐report pain instrument. Pain was more commonly reported by informal caregivers than the person with dementia themselves. Limited evidence was available for pain‐focused behavioural observation assessment.In regard to pain treatment, paracetamol use was more common in commun...

Rheumatology, 2017

Objective. To determine recent trends in the rate and management of new cases of OA presenting to... more Objective. To determine recent trends in the rate and management of new cases of OA presenting to primary healthcare using UK nationally representative data. Methods. Using the Clinical Practice Research Datalink we identified new cases of diagnosed OA and clinical OA (including OA-relevant peripheral joint pain in those aged over 45 years) using established code lists. For both definitions we estimated annual incidence density using exact person-time, and undertook descriptive analysis and age-period-cohort modelling. Demographic characteristics and management were described for incident cases in each calendar year. Sensitivity analyses explored the robustness of the findings to key assumptions. Results. Between 1992 and 2013 the annual age-sex standardized incidence rate for clinical OA increased from 29.2 to 40.5/1000 person-years. After controlling for period effects, the consultation incidence of clinical OA was higher for successive cohorts born after the mid-1950s, particularly women. In contrast, with the exception of hand OA, we observed no increase in the incidence of diagnosed OA: 8.6/ 1000 person-years in 2004 down to 6.3 in 2013. In 2013, 16.4% of clinical OA cases had an X-ray referral. While NSAID prescriptions fell from 2004, the proportion prescribed opioid analgesia rose markedly (0.1% of diagnosed OA in 1992 to 1.9% in 2013). Conclusion. Rising rates of clinical OA, continued use of plain radiography and a shift towards opioid analgesic prescription are concerning. Our findings support the search for policies to tackle this common problem that promote joint pain prevention while avoiding excessive and inappropriate health care.

Journal of clinical epidemiology, Aug 8, 2016

To establish the association between prior knee-pain consultations and early diagnosis of knee os... more To establish the association between prior knee-pain consultations and early diagnosis of knee osteoarthritis (OA) by weighted cumulative exposure (WCE) models. Data were from an electronic health care record (EHR) database (Consultations in Primary Care Archive). WCE functions for modeling the cumulative effect of time-varying knee-pain consultations weighted by recency were derived as a predictive tool in a population-based case-control sample and validated in a prospective cohort sample. Two WCE functions ([i] weighting of the importance of past consultations determined a priori; [ii] flexible spline-based estimation) were comprehensively compared with two simpler models ([iii] time since most recent consultation; total number of past consultations) on model goodness of fit, discrimination, and calibration both in derivation and validation phases. People with the most recent and most frequent knee-pain consultations were more likely to have high WCE scores that were associated wi...

BMC Musculoskeletal Disorders, 2014

Background: Primary care pharmacological management of new musculoskeletal conditions is not cons... more 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.

Family practice, Jul 23, 2018

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, but have potentia... more Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, but have potential side effects in patients with cardiovascular disease (CVD). To determine trends in NSAIDs prescribing between 2002 and 2010 in patients with CVD, and ascertain whether prescribing patterns changed following publication of major national (the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Clinical Excellence (NICE)) guidance to GPs. This was an observational database study of adult patients in 11 practices (Staffordshire, England). NSAIDs were categorised into basic, COX-2 and topical. Study duration was divided on a quarterly basis from 2002-quarter-1 to 2010q4. CVD patients were identified using pre-defined Read Codes recorded in the two years prior to each quarter. Quarterly prevalence was determined. Times of significant changes in prescribing trends were determined using Joinpoint Regression, and compared to dates of the five ma...

Osteoarthritis and Cartilage, 2019

Objective: To investigate trends in gabapentinoid prescribing in patients with osteoarthritis (OA... more Objective: To investigate trends in gabapentinoid prescribing in patients with osteoarthritis (OA). Methods: Patients aged 40 years and over with a new OA diagnosis recorded between 1995 and 2015 were identified in the Clinical Practice Research Datalink (CPRD) and followed to first prescription of gabapentin or pregabalin, or other censoring event. We estimated the crude and age-standardised annual incidence rates of gabapentinoid prescribing, stratified by patient age, sex, geographical region, and time since OA diagnosis, and the proportion of prescriptions attributable to OA, or to other conditions representing licensed and unlicensed indications for a gabapentinoid prescription. Results: Of 383,680 newly diagnosed OA cases, 35,031 were prescribed at least one gabapentinoid. Irrespective of indication, the annual age-standardised incidence rate of first gabapentinoid prescriptions rose from 1.6 [95% confidence interval (CI): 1.3, 2.0] per 1000 person-years in 2000, to 27.6 (26.7, 28.4) in 2015, a trend seen across all ages and not explained by length of follow-up. Rates were higher among women, younger patients, and in Northern Ireland, Scotland and the North of England. Approximately 9% of first prescriptions could be attributed to OA, a further 13% to comorbid licensed or unlicensed indications. Conclusion: Gabapentinoid prescribing in patients with OA increased dramatically between 1995 and 2015. In most cases, diagnostic codes for licensed or unlicensed indications were absent. Gabapentinoid prescribing may be attributable to OA in a significant proportion but evidence for their effectiveness in OA is lacking. Further research to investigate clinical decision making around prescribing these expensive and potentially harmful medicines is recommended.

European Journal of Pain, 2012

BMC Musculoskeletal Disorders, 2008

Background: Studies have suggested that the symptoms of knee osteoarthritis (OA) are rather weakl... more Background: Studies have suggested that the symptoms of knee osteoarthritis (OA) are rather weakly associated with radiographic findings and vice versa. Our objectives were to identify estimates of the prevalence of radiographic knee OA in adults with knee pain and of knee pain in adults with radiographic knee OA, and determine if the definitions of x ray osteoarthritis and symptoms, and variation in demographic factors influence these estimates. Methods: A systematic literature search identifying population studies which combined x rays, diagnosis, clinical signs and symptoms in knee OA. Estimates of the prevalence of radiographic OA in people with knee pain were determined and vice versa. In addition the effects of influencing factors were scrutinised. Results: The proportion of those with knee pain found to have radiographic osteoarthritis ranged from 15-76%, and in those with radiographic knee OA the proportion with pain ranged from 15%-81%. Considerable variation occurred with x ray view, pain definition, OA grading and demographic factors Conclusion: Knee pain is an imprecise marker of radiographic knee osteoarthritis but this depends on the extent of radiographic views used. Radiographic knee osteoarthritis is likewise an imprecise guide to the likelihood that knee pain or disability will be present. Both associations are affected by the definition of pain used and the nature of the study group. The results of knee x rays should not be used in isolation when assessing individual patients with knee pain.

BMC Musculoskeletal Disorders, 2007

Annals of the Rheumatic Diseases, 2013

Annals of the Rheumatic Diseases, 2003

The British journal of general practice : the journal of the Royal College of General Practitioners, 2001

Little is known about the contribution of over-the-counter (OTC) aspirin to cardiovascular prophy... more Little is known about the contribution of over-the-counter (OTC) aspirin to cardiovascular prophylaxis. To investigate this, a two-phase cross-sectional study was carried out in nine general practices in North Staffordshire. In the first phase, all patients with cardiovascular disease (CVD) were identified from computer searches using morbidity registers and drug searches. The search also identfied the subgroup receiving prescribed prophylactic aspirin. In the second phase, a questionnaire was posted to all patients with CVD who were not on prescribed aspirin to establish their current use of OTC aspirin. Overall, 69% of the CVD group used aspirin, with 26% of aspirin being OTC. OTC aspirin use was more common in those aged under 65 years, men, and the more affluent. Also, there were significant differences in OTC aspirin use between the various practices. This study shows that a considerable amount of aspirin is used OTC in those with CVD. Its use is influenced by several factors t...

Traditionally the management of any chronic condition starts with its diagnosis. The labelling of... more Traditionally the management of any chronic condition starts with its diagnosis. The labelling of disease can be beneficial in terms of defining appropriate treatment such as in coronary artery disease. However, sometimes it may be detrimental such as when x-rays are used to diagnose lumbar spondylosis leading to patients inappropriately limiting their activity. Chronic knee pain in the elderly is another example where applying labels is problematical. A common diagnosis in this situation is osteoarthritis, but this label can be applied in two ways: as a radiological diagnosis, or as a clinical one. The x-ray diagnosis, however, does not equate with the clinical syndrome, and vice versa. In addition, diagnosing knee pain as osteoarthritis does not necessarily help in management, since a patient's debility is more dependent upon their clinical signs and symptoms than the presence of radiographic osteoarthritis, and by the same token its clinical counterpart. GPs are consistent in their management of knee pain, but in attempting to diagnose the pain as osteoarthritis, these plans can alter and become more dependent on the actual diagnosis than the clinical picture. As a result management may well diverge from what the current best evidence supports. Diagnosis for diagnosis sake, should therefore be discouraged, and chronic knee pain gives us one example of why this is the case. GPs would be better placed to manage this condition if it was considered more as a regional pain syndrome, perhaps defining it simply as 'chronic knee pain in older people'. This example suggests that there is a pressing need in primary care to carefully consider in chronic disease when it is appropriate to be definitive in diagnosis such that when using disease specific labels, there is definite benefit for the patient and doctor.

European Journal of Pain

Background: One-fifth of primary care attendees suffer chronic noncancer pain, with musculoskelet... more Background: One-fifth of primary care attendees suffer chronic noncancer pain, with musculoskeletal conditions the leading cause. Twelve percent of patients with chronic noncancer pain are prescribed strong opioids. Evidence suggests long-term opioid use is related to hypogonadism in men, but the relationship in women is unclear. Our aim was to investigate reproductive dysfunction in women prescribed long-term opioids for musculoskeletal pain. Methods: We undertook a matched (matched 1:1; for year of birth, year of start of follow-up and practice) cohort study of women aged 18-55 years old, with musculoskeletal pain and an opioid prescription in the Clinical Practice Research Datalink (a primary care database) between 2002 and 2013. Long-term opioid users (≥90 days) were compared with short-term opioid users (<90 days) for four reproductive conditions (abnormal menstruation, low libido, infertility and menopause) using Cox proportional hazards models. Results: A total of 44,260 women were included; the median cohort age at baseline was 43 years (Interquartile Range 36-49). Long-term opioid use was associated with an increased risk of altered menstruation (hazard ratio 1.13 95% CI 1.05-1.21) and with an increased risk of menopause (hazard ratio 1.16 95% CI 1.10-1.23). No significant association was found for libido (hazard ratio 1.19 95% CI 0.96-1.48) or infertility (hazard ratio 0.82 95% CI 0.64-1.06). Conclusions: The risk of menopause and abnormal menstruation was increased in long-term opioid users. This has implications for clinicians as reproductive dysfunction will need to be considered when prescribing long-term opioids to women with musculoskeletal conditions. Significance: This is a large-scale cohort examining the relationship between long-term opioid use and reproductive dysfunction using a UK national primary care database. There is an increased risk of reproductive dysfunction associated with long-term opioid use.