Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data (original) (raw)
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Journal of Pain Research, 2010
To study the prescription of oral analgesics for musculoskeletal pain by primary care physicians over a 5-year period in Sweden. Design: A retrospective automatic database review of patient records at four primary health care centers. All prescriptions of NSAIDs, weak opioids, and coprescriptions of gastroprotecting medications to patients with musculoskeletal were retrieved for the period January 1, 2004 to November 11, 2008. Results: A total of 27,067 prescriptions prescribed to 23,457 patients with musculoskeletal pain were analyzed. Of all prescriptions, NSAIDs were the most commonly prescribed analgesic comprising 79%, tramadol was the second most commonly prescribed analgesic comprising 9%, codeine the third most (7%), and dextropropoxyphene the fourth (5%). The proportion of NSAIDs and weak opioids and the proportion of the different weak opioids prescribed showed no change over time. The proportion of nonselective and selective NSAIDs prescribed changed; Coxib prescriptions decreased from 9% to 4% of all analgesics prescribed in 2004-2007 with no change in 2008. Conclusion: NSAIDs were found to be the dominant class of analgesic prescribed by primary care physicians to patients diagnosed as musculoskeletal pain. No change was observed in the proportion of NSAID and weak opioid prescription over the period studied. Prescription of selective Coxibs decreased and was less than 4% in 2008. The impact on gastrointestinal and cardiovascular adverse effects associated with the extensive prescription of NSAIDS for musculoskeletal pain warrants further analysis.
Analgesic prescribing trends in musculoskeletal disorders
International Journal of Basic & Clinical Pharmacology, 2018
Background: Musculoskeletal disorders like osteoarthritis, rheumatoid arthritis, bursitis, backache, tendinitis, cervical spondylitis etc. are very commonly encountered in orthopaedic practice and are generally treated with various analgesic drugs. There are number of non-steroidal anti-inflammatory drugs (NSAIDs), opiod analgesics and also fixed dose combination (FDC) of analgesics available for the treatment of such disorders with some advantages and disadvantages of these drugs. Since few studies are there on utilization of analgesic drugs in the orthopaedic practice, this study was undertaken to determine the current prescribing trends for these disorders.Methods: It was record based observational study carried out at NKP salve institute of medical sciences, Nagpur. A total of 200 prescriptions of patients reported to orthopaedic outpatient department, with presenting complaints of musculoskeletal disorder and rheumatological conditions like osteoarthritis, rheumatoid arthritis,...
European Journal of Pain, 2012
Background: It is not known whether general practitioners (GPs) prescribe analgesic medication according to intensity of pain or a hierarchical prescribing regimen. Aims: The aim of this study was to assess the association of strength of pain-relief medication prescribed by the GP with the strength of previous prescription and pain level. Methods: The PROG-RES study collected data on pain intensity in 428 patients aged Ն50 years with non-inflammatory musculoskeletal pain during a consultation with their GP. Prescriptions for analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were identified on the day of the consultation and in the previous year and were classified as basic, moderate or strong analgesic or NSAID. Regression models were used to assess the association of strength of analgesia and prescription of a NSAID with the strength of previous prescription and the level of pain. Results: The majority of patients were not prescribed medication for their pain at the index consultation, but had such a prescription the previous year. There was an association between strength of analgesic and intensity of pain: more intense pain resulted in a stronger drug. This association was attenuated by adjustment for prescribed analgesia in the previous year. There was no association between intensity of pain and NSAID prescription, but previous NSAID prescription predicted another such prescription. Conclusion: GPs do not always issue prescriptions for musculoskeletal pain. In cases where a prescription is issued, this is more strongly influenced by previous prescriptions than the patient's pain level. GPs adopt an individualized approach to the treatment of musculoskeletal pain in older adults.
2010
Opioid analgesics are used routinely in managing acute musculoskeletal pain. However, physicians often hesitate to use them for chronic pain, such as that seen in rheumatoid arthritis, osteo- arthritis, osteoporosis, and low back pain. Starting the patient at a low dose and progressively titrating upward for pain relief minimizes the adverse effects. The fear that prescribing opioid analgesics for chronic pain will engender addiction is not supported by experience. Opioid analgesics are not first-line therapy for chronic pain; they should be used with other medications, such as nonopioid analgesics, anti-inflammatory drugs, muscle relaxants, antidepressants, anticon- vulsants, topical preparations, and sleeping pills. A comprehensive pa- tient assessment and an addiction history are essential. Consultation with a specialist in pain management often is helpful. (J Musculoskel Med. 2010;27:142-148)
International Journal of Basic and Clinical Pharmacology, 2016
Background: WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately. Nonsteroidal anti-inflammatory drugs are a group of drugs that are commonly prescribed for the treatment of fever associated with pain and inflammation. The objective was to assess the prescribing pattern of NSAIDs in fever patients. Along with this, we looked at the clinical indications for prescribing and the pattern of prescribing with respect to use of generic or trade names. Methods: This observational study was conducted in a tertiary care teaching hospital in Malappuram district of Kerala, India by extracting data of inpatients retrospectively from medical records for a six-month period. The reported prevalence of NSAID use in previous study was 20%, with a relative precision of 18% the sample size required was 500. The data was analyzed and expressed as absolute numbers and/or percentages. Results: Out of these 500 patients, Dengue fever was the most common diagnosis (86.6%) followed by Typhoid (2.8%) and Leptospirosis (2.4%). Among these, 392 (78.4%) received any of the NSAIDs. The most commonly prescribed drug was Paracetamol (77.04%). Among to the prescriptions, 91.7% were prescribed with generic names. As concomitant medications, antibiotics were prescribed at 21.2% cases, gastro protective agents were prescribed to 24.23% and vitamins were prescribed in 72.6% cases. Conclusions: This study has shown that the prescribing, usage and preferences of NSAIDs practiced rationally. No over use, under use or misuse of drugs was noticed.
International Journal of Anatomy Radiology and Surgery, 2016
Introduction: Non steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications for musculoskeletal conditions. Gastroprotective agents are co-prescribed in patients using NSAIDs for long time as they are associated with gastrointestinal complications. To promote rational drug use, it is important to assess drug use pattern using the World Health Organization (WHO) drug use indicators. Aim: To determine the pattern of utilization of NSAIDs and gastroprotective agents in patients with musculoskeletal pain in Physical Medicine and Orthopedics Departments using WHO prescribing indicators. Materials and Methods: 108 case records of inpatients with musculoskeletal pain, satisfying the inclusion criteria, were analyzed prospectively for pattern of use of NSAIDs and gastroprotective agents .The data collected was analyzed for prescribing indicators, complementary indicators and other factors influencing the pattern of NSAIDs use. Descriptive statistics was u...
Norsk Epidemiologi, 2009
Study objectives: To analyse the general practitioners' (GPs') prescribing patterns for NSAIDs, muscle relaxants, opioids, compound analgesics with codeine, and plain analgesics, issued for: chronic muskuloskeletal pain, arthritis/osteoarthritis, back pain, headache, casualties, malignancies, and unspecific pain. Design: A prospective prescription study of analgesics due to painful conditions in the county of Møre & Romsdal, Norway. Setting: A one month survey where more than 95% of the GPs participated and recorded all patient contacts, prescriptions, and diagnoses issued to patients 20 years and over. Participants: 156 GPs. Main results: The prescribing rates increased with patients' age to the age group 70-79 years. 64% of all prescriptions were for females, who also received more drugs per prescription than males. With increasing patients' age, the average amount of drugs issued per prescription increased, more prescriptions were repeat, and more were issued during indirect GP-patient contacts. The paracetamol/codeine analgesic was the most frequently prescribed drug, 37.6%, followed by NSAIDs (34.6%) and muscle relaxants (21.8%). Plain analgesics were only issued in 2.8% of the cases. Chronic musculoskeletal pain was the most common diagnostic indication (39.2%, for which NSAIDs were most frequently prescribed), followed by arthritis/ osteoarthritis (18.7%), and back pain (18.0%). Conclusion: The appropriateness of the GPs prescribing practice for pain often is open to question, and this especially refers to the widespread use of NSAIDs for chronic musculoskeletal pain in the elderly, the frequent use of muscle relaxants for chronic musculoskeletal pain in middle aged women, and the prolonged use of compound analgesics for almost all diagnoses. Plain paracetamol should probably be prescribed more often for pain in general practice.
Journal of Pain Research
Background: Musculoskeletal pain is one of the most complex and debilitating types of pain. Although different pharmacologic treatments are available, very few studies have explored the predictors for opioid analgesics prescription to manage this type of pain. Objective: The aim of this study was to explore the predictors for opioid prescription in patients with acute musculoskeletal pain in Saudi Arabia. Methods: This was a single-center, retrospective chart review of adult patients (≥18 yrs.) with an acute nociceptive musculoskeletal pain at a university-affiliated medical center in Riyadh, Saudi Arabia. Cancer patients and those with chronic neuropathic pain were excluded. Patients' age, gender, number of comorbidities, duration of pain management, number of clinic visits for pain, and Numeric Pain Rating Scale (NPRS) scores at rest and with normal activities were collected. Multiple logistic regression was conducted to examine the relationship between the type of musculoskeletal pain and the prescription of opioid analgesics controlling for NPRS score on activity, age, gender, number of comorbidities, duration of pain treatment, and number of clinic visits for pain. Results: The mean age of the 227 patients, who met the inclusion criteria, was 39 years and 68% of them were male. Sixty-three percent of the patients were prescribed opioid analgesics, and 61% of them had shoulder pain, 29% had back pain, and 10% had lower extremity pain (eg, hip, thigh, lower leg, knee, ankle, and foot pain). Tramadol was the most commonly prescribed opioid analgesic (82%), followed by codeine (13%). Ninety-seven percent of patients who were prescribed non-opioid analgesics had shoulder pain. Patients with shoulder pain had lower odds of receiving opioid analgesics (OR=0.019, P<0.0001, 95% CI=0.004-0.081) in comparison to their counterparts who had lower extremity or back pains. Moreover, the higher the pain score on activity was, the higher odds of receiving opioid analgesics (OR=1.317, P<0.0001, 95% CI=1.029-1.685). Conclusion: Future studies should explore the impact of different opioid prescribing policies to improve the quality of patient care and reduce the unnecessary prescribing of opioids for patients with non-cancer musculoskeletal pain.
BMJ open, 2018
To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs. Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731). 25 general practices and two community musculoskeletal services in the UK (London and Midlands). 703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial. Anonymised prescribing data over 12 months extracted from GP electronic records. Of the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. A total of 3319 opioid prescriptions were issued over the study period, of which 53% (1768/3319) w...
Osteoarthritis and Cartilage, 2020
Background: Although opioid analgesics are not generally recommended for treatment of knee osteoarthritis (OA), they are frequently used. We sought to determine the association between medical comorbidities and self-reported opioid analgesic use in these patients. Methods: This cross-sectional study recruited patients referred to two provincial hip and knee clinics in Alberta, Canada for consideration of total knee arthroplasty. Standardized questionnaires assessed demographic (age, gender, income, education, social support, smoking status) and clinical (pain, function, total number of troublesome joints) characteristics, comorbid medical conditions, and non-surgical OA management participants had ever used or were currently using. Multivariable Poisson regression with robust estimate of the standard errors assessed the association between comorbid medical conditions and current opioid use, controlling for potential confounders. Results: 2,127 patients were included: mean age 65.4 (SD 9.1) years and 59.2% female. Currently used treatments for knee OA were: 57.6% exercise and/or physiotherapy, 61.1% NSAIDs, and 29.8% opioid analgesics. In multivariable regression, controlling for potential confounders, comorbid hypertension (RR 1.18, 95% CI 1.02e1.37), gastrointestinal disease (RR 1.31, 95% CI 1.07e1.60), depressed mood (RR 1.25, 95% CI 1.05e1.48) and a higher number of troublesome joints (RR 1.04 per joint, 95% CI 1.00e1.09) were associated with opioid use, with no association found with having ever used recommended non-opioid pharmacological or non-pharmacological treatments. Conclusions: In a large cohort of patients with knee OA, of 12 comorbidities assessed, comorbid hypertension, gastrointestinal disease, and depressed mood were associated with current use of opioid analgesics, in addition to total burden of troublesome joints. Improved guidance on the management of painful OA in the setting of common comorbidities is warranted.