Archived Comments for:
Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data
The frequency of musculoskeletal problems and related pain medication
Thomas Frese, Department of General Practice, Medical Faculty, University of Leipzig, Germany
17 March 2015
Ndlovu et al. provide interesting data regarding the prescription of analgesic medications for consultations due to a new musculoskeletal problem in a routine general practice setting [1]. The frequency of musculoskeletal problems as reason for encounter was reported with 38.6 per 1,000 patients [1]. This seems to be extremely low and maybe attributed to the strong exclusion criteria applied in the current work. This impression is supported by the comparison to cross-sectional European studies and our own data that found frequencies of musculoskeletal problems from 14.3 to 22.0% of all reasons for encounter in general practice [2, 3, 4, unpublished data from the SESAM 2 study].
The Epidemiological data in Family Practice (Extended Version) provide insight into the drug prescription regarding musculoskeletal problems in a Dutch general practice setting [5]. These data were analyzed using similar inclusion criteria as Ndlovu et al. (ICPC 2-codes L01 to L29, office encounters only, patients aged 15 years and over, period of two weeks for co-medication, 1 year observation period) and also the modified revised hierarchical analgesic categorization model [1, 6].
11,148 male and 15,025 female patients consulted for a new musculoskeletal problem (male 169.7 and female 215.0 per 1,000 patient years). From a total of 353 different drugs prescribed, 85 analgesics were ordered with 7258 prescriptions. According to Ndlovu et al. and the results of other groups, who stated that more than half the patients consulting for a new episode of a musculoskeletal condition were not prescribed pain medication [1], at least 72.2% of the patients received no prescription of analgesics in the initial contact for musculoskeletal problems. 64.6% of the prescribed drugs were NSAIDs, 31.2% basic analgesics, but only 3.2% moderate strength analgesics, and 1.0% strong analgesics. These findings are in principal accordance to the results reported by Ndlovu and colleagues but the prescription rates for moderate strength and strong analgesics were abundantly lower in the analyzed Epidemiological data in Family Practice.
However, it is often difficult to compare the results from different general practice data sources. Especially in the mentioned context it should be kept in mind that general practice studies are often based on a small number of participating general practitioners and that there is a high variation among different general practitioners regarding prescription of analgesics and patient characteristics [1, 7]. Also a regional variation of pain management, as reported for back pain [8], may limit the detailed comparability of the study results. The fact that not all variables that do influence analgesic prescribing can be taken into account in a study was properly highlighted by Ndlovu and colleagues. Future research should take greater account of the comparability to the results of previous studies.
References 1 Ndlovu M, Bedson J, Jones PW, Jordan KP. Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskelet Disord. 2014; 15:418; doi: 10.1186/1471-2474-15-418. 2 Mansson J, Nilsson G, Strender LE, Björkelund C. Reasons for encounters, investigations, referrals, diagnoses and treatments in general practice in Sweden--a multicentre pilot study using electronic patient records. Eur J Gen Pract. 2011; 17(2): 87-94. 3 Moth G, Olesen F, Vedsted P. Reasons for encounter and disease patterns in Danish primary care: Changes over 16 years. Scand J Prim Health Care. 2012; 30(2):70-75. 4 Laux G, Kühlein T, Gutscher A, Szecsenyi J. Versorgungsforschung in der Hausarztpraxis - Ergebnisse aus dem CONTENT Projekt 2006–2009. München: Urban & Vogel; 2010; page 14. 5 World Organization of National Colleges of Physicians. ICPC-2-R: International Classification of Primary Care with CDROM (Oxford Medical Publications). 2nd ed. Oxford: University Press; 2005. 6 Bedson J, Belcher J, Martino OI, Ndlovu M, Rathod T, Walters K, Dunn KM, Jordan KP. The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study. European Journal of Pain, 2013;17:43-443. 7 Frese T, Klauss S, Herrmann K, Sandholzer H. Children and adolescents as patients in general practice - the reasons for encounter. J Clin Med Res. 2011; Jul 26;3(4):177-82; doi: 10.4021/jocmr597w. 8 Ehrlich GE. Back pain. J Rheumatol 2003; 67:26-31.
The frequency of musculoskeletal problems and related pain medication
17 March 2015
Ndlovu et al. provide interesting data regarding the prescription of analgesic medications for consultations due to a new musculoskeletal problem in a routine general practice setting [1].
The frequency of musculoskeletal problems as reason for encounter was reported with 38.6 per 1,000 patients [1]. This seems to be extremely low and maybe attributed to the strong exclusion criteria applied in the current work. This impression is supported by the comparison to cross-sectional European studies and our own data that found frequencies of musculoskeletal problems from 14.3 to 22.0% of all reasons for encounter in general practice [2, 3, 4, unpublished data from the SESAM 2 study].
The Epidemiological data in Family Practice (Extended Version) provide insight into the drug prescription regarding musculoskeletal problems in a Dutch general practice setting [5]. These data were analyzed using similar inclusion criteria as Ndlovu et al. (ICPC 2-codes L01 to L29, office encounters only, patients aged 15 years and over, period of two weeks for co-medication, 1 year observation period) and also the modified revised hierarchical analgesic categorization model [1, 6].
11,148 male and 15,025 female patients consulted for a new musculoskeletal problem (male 169.7 and female 215.0 per 1,000 patient years). From a total of 353 different drugs prescribed, 85 analgesics were ordered with 7258 prescriptions. According to Ndlovu et al. and the results of other groups, who stated that more than half the patients consulting for a new episode of a musculoskeletal condition were not prescribed pain medication [1], at least 72.2% of the patients received no prescription of analgesics in the initial contact for musculoskeletal problems. 64.6% of the prescribed drugs were NSAIDs, 31.2% basic analgesics, but only 3.2% moderate strength analgesics, and 1.0% strong analgesics. These findings are in principal accordance to the results reported by Ndlovu and colleagues but the prescription rates for moderate strength and strong analgesics were abundantly lower in the analyzed Epidemiological data in Family Practice.
However, it is often difficult to compare the results from different general practice data sources. Especially in the mentioned context it should be kept in mind that general practice studies are often based on a small number of participating general practitioners and that there is a high variation among different general practitioners regarding prescription of analgesics and patient characteristics [1, 7]. Also a regional variation of pain management, as reported for back pain [8], may limit the detailed comparability of the study results. The fact that not all variables that do influence analgesic prescribing can be taken into account in a study was properly highlighted by Ndlovu and colleagues. Future research should take greater account of the comparability to the results of previous studies.
References
1 Ndlovu M, Bedson J, Jones PW, Jordan KP. Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskelet Disord. 2014; 15:418; doi: 10.1186/1471-2474-15-418.
2 Mansson J, Nilsson G, Strender LE, Björkelund C. Reasons for encounters, investigations, referrals, diagnoses and treatments in general practice in Sweden--a multicentre pilot study using electronic patient records. Eur J Gen Pract. 2011; 17(2): 87-94.
3 Moth G, Olesen F, Vedsted P. Reasons for encounter and disease patterns in Danish primary care: Changes over 16 years. Scand J Prim Health Care. 2012; 30(2):70-75.
4 Laux G, Kühlein T, Gutscher A, Szecsenyi J. Versorgungsforschung in der Hausarztpraxis - Ergebnisse aus dem CONTENT Projekt 2006–2009. München: Urban & Vogel; 2010; page 14.
5 World Organization of National Colleges of Physicians. ICPC-2-R: International Classification of Primary Care with CDROM (Oxford Medical Publications). 2nd ed. Oxford: University Press; 2005.
6 Bedson J, Belcher J, Martino OI, Ndlovu M, Rathod T, Walters K, Dunn KM, Jordan KP. The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study. European Journal of Pain, 2013;17:43-443.
7 Frese T, Klauss S, Herrmann K, Sandholzer H. Children and adolescents as patients in general practice - the reasons for encounter. J Clin Med Res. 2011; Jul 26;3(4):177-82; doi: 10.4021/jocmr597w.
8 Ehrlich GE. Back pain. J Rheumatol 2003; 67:26-31.
Competing interests
There are no competing interests.