title: Nine-year trajectory of purchases of prescribed pain medications before and after in-patient interdisciplinary rehabilitation for chronic musculoskeletal disorders: a prospective, cohort, register-based study of 4,365 subjects.
abstract: OBJECTIVE
  To investigate whether an interdisciplinary rehabilitation for chronic musculoskeletal disorders is associated with changes in the purchase of prescribed pain medication.
  
  
  METHODS
  Prospective register-based study.
  
  
  METHODS
  Employees in the public sector (n = 4,365) who participated in the rehabilitation programme between 1996 and 2009.
  
  
  METHODS
  The changes in annual purchases of prescribed pain medication were measured for a 9-year exposure window, starting from 4 years before the start date of rehabilitation and ending 5 years after this date.
  
  
  RESULTS
  Purchases of prescribed pain medication increased throughout the follow-up in all medication groups. The steepest increase was observed for analgesics, antidepressants, and hypnotics and sedatives. The growth rate of annual purchase, however, slowed significantly following the year of the start of rehabilitation for analgesics (annual growth rate (rate ratio) before and after rehabilitation 1.27 and 1.04, respectively, difference in trend p < 0.001); antidepressants (rate ratio 1.17 and 1.09, p = 0.005); and muscle relaxants (rate ratio 1.31 and 1.01, p < 0.001). For anxiolytics, and hypnotics and sedatives, no differences were observed in the trends of annual purchase before and after rehabilitation.
  
  
  CONCLUSIONS
  Rehabilitation was associated with a slowing increase in purchases of prescribed pain medication amongst rehabilitants. This may be a reflection of the positive effect that rehabilitation has on the need for pain medication.
authors.affiliation: Department of Physical and Rehabilitation, Turku University Hospital, FI-20521 Turku, Finland. mikhail.saltychev@gmail.com, mikhail.saltychev@tyks.fi.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Saltychev
authors.forename: Katri
authors.initials: K
authors.lastname: Laimi
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015984:Causality; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000534:rehabilitation*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000534:rehabilitation*; D010147:Pain Measurement; D055656:Prescriptions / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries
chemical_list: D000700:Analgesics; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D009465:Neuromuscular Agents