title: A study of National Health Service management of chronic osteoarthritis and low back pain.
abstract: OBJECTIVE
  To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective.
  
  
  BACKGROUND
  Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care.
  
  
  METHODS
  Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients' records for three years from diagnosis ('newly diagnosed' patients) or for the most recent three years ('established' patients).
  
  
  RESULTS
  Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and 'newly diagnosed' patients were significantly more likely to visit their GP for pain management than 'established' patients. Although 'newly diagnosed' patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups.
  
  
  CONCLUSIONS
  This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use.
authors.affiliation: 1General Practitioner,Sloan Medical Practice,Sheffield,England.
authors.forename: Oliver R
authors.initials: OR
authors.lastname: Hart
authors.affiliation: 2Management Consultant,pH Associates,Marlow,England.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Uden
authors.affiliation: 3General Practitioner,Tynan Surgery,Tynan,Armagh,Northern Ireland.
authors.forename: James E
authors.initials: JE
authors.lastname: McMullan
authors.affiliation: 4General Practitioner,Sway Road Surgery,Morriston,Wales.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Ritchie
authors.affiliation: 5General Practitioner,Sothall Medical Practice,Sheffield,England.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Williams
authors.affiliation: 6Professor,Department of Population Science,University of Dundee,Dundee,Scotland.
authors.forename: Blair H
authors.initials: BH
authors.lastname: Smith
mesh_terms: D002908:Chronic Disease; D059350:Chronic Pain; D019468:Disease Management; D004739:England; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009660:Northern Ireland; D010003:Osteoarthritis / Q000150:complications / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation; D012189:Retrospective Studies; D012606:Scotland; D014852:Wales
keywords: referral and consultations