The association between pain intensity and the prescription of analgesics and non‐steroidal anti‐inflammatory drugs

Abstract

BackgroundIt is not known whether general practitioners (GPs) prescribe analgesic medication according to intensity of pain or a hierarchical prescribing regimen.AimsThe 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.MethodsThe PROG-RES study collected data on pain intensity in 428 patients aged ≥50 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.ResultsThe 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.ConclusionGPs 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.

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

“…Our study found less than half of new consulters for musculoskeletal pain received an analgesic. A previous study of those aged over 50 consulting in primary care for musculoskeletal pain, and who had not consulted in the previous 30 days, also reported that less than half were prescribed analgesics [ 17 ] and this is also similar to findings from studies focussed on neck and back pain [ 6 , 7 ] and on osteoarthritis [ 18 ]. It is feasible that GPs may be following guidelines that recommend the early use of exercise and other physical therapies with or without analgesia and further research is needed to determine if this is happening [ 1 , 19 ].…”

“…Rather than a patient’s previous consultation history for musculoskeletal conditions, it appeared that the clinician’s knowledge of previous analgesic medication affected their prescribing. A patient with a past history of prescribed pain medication was more likely to receive any analgesic and, particularly, stronger analgesic, as has been shown previously [ 17 ]. Clinicians will generally ask the patient about their medication use prior to consultation [ 20 ].…”

Trends in long-term opioid prescribing in primary care patients with musculoskeletal conditions: an observational database study

“… 16 , 30 This advice advocates incremental increases from analgesics such as paracetamol to stronger analgesics such as opioids. Previous studies suggest that approximately 50% of patients consulting with MSK pain will be prescribed an analgesic at first consultation, 10 , 27 of which 29% will be prescribed an opioid within 2 weeks. 29 …”

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“…High-efficacy opioids are used in case of severe pain these are morphine 26 , diamorphine 27 , buprenorphine 28 Adverse effect-Sedation, drowsiness, sleep disturbance, seizures, hyperalgesia and tolerance 29 , constipation, hallucinations 30 . …”