title: Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain.
abstract: Despite dissuasive recommendations, intramuscular (i.m.) injections of NSAIDS are still a widespread treatment of acute pain in General Practice as well as among orthopaedic physicians. Most physicians argue that patients who are used to receive NSAIDS i.m. would insist on this application mode while being convinced of its therapeutic superiority for pain relief. Therefore, the aim of the study was to find out if patients' decision can be influenced towards an oral application by receiving a simple information leaflet. An information leaflet, providing information about the risks of NSAIDS particularly in case of i.m. application was provided to 161 patients with acute low back pain. Decision in favour or against i.m. application of NSAIDS was documented. Severity of disease was assessed by the Roland Morrison pain questionnaire and visual analogue scale (VAS) at the first visit and again 3-5 days later. From May to December 2004, 161 patients, visiting their GP (13 practices) with acute pain and demanding an injection were included in the study. After reading the information leaflet, 139 of the 161 (86.3%) patients decided for an oral application instead of receiving an injection of NSAIDS as in the past. This effect was statistically significant (P</=0.01). Of the initial 161 patients, 156 could be re-evaluated and no significant differences in the VAS and the Roland Morris Score between the patients with oral and i.m. application mode could be found. Only 2 patients of the 139 who decided for oral application indicated that they would opt for an i.m. injection next time. Our study demonstrates that patients' decision can be influenced even in case of severe pain by providing adequate information on a short information leaflet. The results should help to reduce physicians' fear of losing patients when not following their demand for i.m. injections and therefore enable a safer pain treatment.
authors.affiliation: Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany. thomas_rosemann@med.uni-heidelberg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Stefanie
authors.initials: S
authors.lastname: Joos
authors.forename: Thorsten
authors.initials: T
authors.lastname: Koerner
authors.forename: Marc
authors.initials: M
authors.lastname: Heiderhoff
authors.forename: Gunter
authors.initials: G
authors.lastname: Laux
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003657:Decision Making; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D012720:Severity of Illness Index
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal