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These results, combined with existing clinical experience, provide evidence that dihydrocodeine is a viable alternative to methadone as a maintenance treatment for opiate dependence. Indirect comparisons with other studies show dihydrocodeine (and methadone) to be superior to placebo.

Objectives Musculoskeletal disorders (MSDs) account for the greatest burden of years lived with disability globally. To prevent disability, good-quality services need to be commissioned appropriate for local need. We analysed data collected systematically from a new musculoskeletal service serving 70% of the population of Scotland to evaluate: age- and sex-specific occurrence; anatomical distribution; impact and effect on work ability. Methods A new centralised telephone-based triage for people with musculoskeletal disorders was set up in Scotland in 2015. Available to most of the population aged > 16 years, (over 3 million people), data were collected systematically on to a database detailing: anatomical site, nature of onset, duration, impact/risk (modified STarT score), deprivation level and, for those in employment, sickness absence. Results Data were available from 219,314 new callers, 2015–18. Calls were more frequently from women (60%), increased with age until the eighth decade and 66% reported symptoms which had been present >6 weeks. Callers were more likely living in more deprived areas in each age band between 20–64 years and tended to have higher-impact symptoms. The majority (53%) of callers were in employment and 19% of these were off sick because of their symptoms. Sickness absence was more common amongst those with highest-impact/risk scores from deprived areas with more acute symptoms. Discussion Large-scale systematic data collection for MSDs emphasises the size and impact of the burden amongst adults aged >16 years. A socio-economic gradient is evident in terms of prevalence and impact of MSDs, particularly for sickness absence.

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