title: Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data.
abstract: BACKGROUND
  Primary care pharmacological management of new musculoskeletal conditions is not consistent, despite guidelines which recommend prescribing basic analgesics before higher potency medications such as opioids or non-steroidal inflammatory drugs (NSAIDs).The objective was to describe pharmacological management of new musculoskeletal conditions and determine patient characteristics associated with type of medication prescribed.
  
  
  METHODS
  The study was set within a UK general practice database, the Consultations in Primary Care Archive (CiPCA). Patients aged 15 plus who had consulted for a musculoskeletal condition in 2006 but without a musculoskeletal consultation or analgesic prescription in the previous 12 months were identified from 12 general practices. Analgesic prescriptions within two weeks of first consultation were identified. The association of socio-demographic and clinical factors with receiving any analgesic prescription, and with strength of analgesic, were evaluated.
  
  
  RESULTS
  3236 patients consulted for a new musculoskeletal problem. 42% received a prescribed pain medication at that time. Of these, 47% were prescribed an NSAID, 24% basic analgesics, 18% moderate strength analgesics, and 11% strong analgesics. Increasing age was associated with an analgesic prescription but reduced likelihood of a prescription of NSAIDs or strong analgesics. Those in less deprived areas were less likely than those in the most deprived areas to be prescribed analgesics (odds ratio 0.69; 95% CI 0.55, 0.86). Those without comorbidity were more likely to be prescribed NSAIDs (relative risk ratios (RRR) compared to basic analgesics 1.89; 95% CI 0.96, 3.73). Prescribing of stronger analgesics was related to prior history of analgesic medication (for example, moderate analgesics RRR 1.88; 95% CI 1.11, 3.10).
  
  
  CONCLUSIONS
  Over half of patients were not prescribed analgesia for a new episode of a musculoskeletal condition, but those that were often received NSAIDs. Analgesic choice appears multifactorial, but associations with age, comorbidity, and prior medication history suggest partial use of guidelines.
authors.forename: Mehluli
authors.initials: M
authors.lastname: Ndlovu
authors.forename: John
authors.initials: J
authors.lastname: Bedson
authors.forename: Peter W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK. k.p.jordan@keele.ac.uk.
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D059408:Pain Management / Q000379:methods* / Q000592:standards; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal