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Worsening trends in analgesics recommended for spinal pain in primary care

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Abstract

Purpose

Limited evidence exists on secular trends of analgesics for spinal pain. We investigated general practitioner’s (GP) recommendations of analgesic medicines for spinal pain and investigated characteristics associated with their recommendation.

Methods

We accessed data on spinal pain consultations from the Bettering the Evaluation and Care of Health (BEACH) database, a nationally representative database on GP activity in Australia. Data extracted included consultation details and management provided. Medicines recommended were grouped as simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics or neuropathic pain medicines. Multivariate logistic regression determined if patient characteristics and GP characteristics were associated with medication recommendations.

Results

We analysed BEACH data for 9100 GPs who managed 39,303 patients with spinal pain between 2004 and 2014. Over the decade, analgesic recommendations increased. After accounting for patient and GP characteristics, there was a significant increase in the rate single-ingredient opioid analgesics [annual relative increase of 6% (RR 1.06 (95% CI 1.05–1.07), P < 0.001)] and neuropathic pain medicines [annual relative increase of 19% (RR 1.19 (95% CI 1.16–1.22), P < 0.001)] were recommended; and a significant decrease in the rate NSAIDs were recommended [annual relative decrease of 4% (RR 0.96 (95% CI 0.95–0.97), P < 0.001)]. Logistic regression identified several patient and GP characteristics associated with medicine recommendations, e.g. stronger opioids were less likely recommended for Indigenous patients [odds ratio 0.15 (95% CI 0.04–0.56)].

Conclusions

GP’s analgesic recommendations for spinal pain have become increasingly divergent from guideline recommendations over time.

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References

  1. Bardin LD, King P, Maher CG (2017) Diagnostic triage for low back pain: a practical approach for primary care. Med J Aust 206:268–273

    Article  PubMed  Google Scholar 

  2. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19:2075

    Article  PubMed  PubMed Central  Google Scholar 

  3. National Institute for Health and Care Excellence. Low back pain in adults: early management. Manchester: National Institute for Health and Clinical Excellence; 2009. Available at https://www.nice.org.uk/guidance/CG88?UNLID=1066938131201641552359

  4. Qaseem A, Wilt TJ, McLean RM, Forciea M (2017) Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline form the American College of Physicians. Ann Intern Med 147:478–491

    Google Scholar 

  5. Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, Andersen MØ, Fournier G, Højgaard B, Jensen MB, Jensen LD, Karbo T, Kirkeskov L, Melbye M, Morsel-Carlsen L, Nordsteen J, Palsson TS, Rasti Z, Silbye PF, Steiness MZ, Tarp S, Vaagholt M (2017) National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. doi:10.1007/s00586-017-5099-2 (Epub ahead of print)

  6. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH et al (2015) Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 14:162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Britt H, Miller GC, Henderson J, Bayram C, Valenti L, Harrison C et al. A decade of Australian general practice activity 2004–05 to 2013–14. General practice series no. 37. Sydney University Press. 2014. Available at http://purl.library.usyd.edu.au/sup/9781743324233

  8. Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P et al (2016) Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet 387:1644

    Article  PubMed  Google Scholar 

  9. Roxburgh A, Bruno R, Larance B, Burns L (2011) Prescription of opioid analgesics and related harms in Australia. MJA 195:280

    PubMed  Google Scholar 

  10. Deyo RA, Von Korff M, Duhrkoop D (2015) Opioids for low back pain. BMJ 350:g6380

    Article  PubMed  Google Scholar 

  11. Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L et al (2014) General practice activity in Australia 2013–14. General practice series no. 36. Sydney: Sydney University Press. Available at http://purl.library.usyd.edu.au/sup/9781743324219

  12. Britt H, Miller GC, Bayram C (2007) The quality of data on general practice: a discussion of BEACH reliability and validity. Aus Fam Phys 36:36

    Google Scholar 

  13. Britt H (1997) A new coding tool for computerised clinical systems in primary care-ICPC plus. Aust Fam Phys 26:S79

    Google Scholar 

  14. Australian Bureau of Statistics (2008) Australian standard geographical classification. Australian Institute of Health and Welfare, Canberra

    Google Scholar 

  15. Australian Bureau of Statistics (2013) Socio-economic indexes for areas (SEIFA) 2011 ABS Catalogue no. 2033.0.55.001. Commonwealth of Australia, Canberra

  16. Classification Committee of the World Organisation of Family Doctors (1998) International Classification of Primary Care (ICPC-2). 2nd ed. Oxford: Oxford University Press

  17. WHO Collaborating Centre for Drug Statistics Methodology (2013) Guidelines for ATC classification and DDD assignment 2014. 17th ed. Oslo, Norway: Norwegian Institute of Public Health. p 1–286

  18. Britt H (1998) Reliability of central coding of patient reasons for encounter in general practice, using the International Classification of Primary Care. Inform Prim Care 3–7

  19. Statistical Analysis System (SAS) proprietary software. Version 94 Cary: SAS Institute Inc. 2013

  20. Ndlovu M, Bedson J, Jones PW, Jordan KP (2014) Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskel Dis 15:418

    Article  Google Scholar 

  21. Deyo RA, Smith DH, Johnson ES, Donovan M, Tillotson CJ, Yang X et al (2011) Opioids for back pain patients: primary care prescribing patterns and use of services. J Am Board Fam Pract 24:717

    Article  Google Scholar 

  22. Mafi JN, McCarthy EP, Davis RB, Landon BE (2013) Worsening trends in the management and treatment of back pain. JAMA Intern Med 173:1573

  23. Kao MCJ, Minh LC, Huang GY, Mitra R, Smuck M (2015) Trends in ambulatory physician opioid prescription in the United States, 1997–2009. PMR 6:575

  24. Pfizer Australia (2013) Product information: Lyrica® (Pregabalin) West Ryde: Pfizer Australia Pty Ltd

  25. Jensen CE, Riis A, Petersen KD, Jensen MB, Pedersen KM (2017) Economic evaluation of an implementation strategy for the management of low back pain in general practice. Pain 158:891–899

    Article  PubMed  Google Scholar 

  26. Michaleff ZA, Harrison C, Britt H, Lin CW, Maher CG (2012) Ten-year survey reveals differences in GP management of neck and back pain. Eur Spine J 21:1283

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank all the GPs participating in the BEACH program and all the members of the BEACH team. SM has an Australian National Health and Medical Research Council (NHMRC) postgraduate scholarship. CM has an NHMRC Principal Research Fellowship. CL has an NHMRC Career Development Fellowship. AM is the Program Director, Australian NHMRC Centre for Clinical Research Excellence in Medicines and Ageing.

Author contributions

CL, CM and SM conceived the project. All authors contributed to the study design. LV and HB accessed BEACH database. LV extracted data and completed analysis. QL conducted the regression analyses. SM drafted the manuscript. All authors contributed and approved the final manuscript.

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Authors and Affiliations

  1. The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2052, Australia

    Qiang Li

  2. Family Medicine Research Centre, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia

    Lisa Valenti & Helena Britt

  3. Faculty of Pharmacy and Centre for Education and Research on Ageing, The University of Sydney and Concord Hospital, Sydney, NSW, 2006, Australia

    Andrew J. McLachlan

  4. Musculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia

    Stephanie Mathieson, Christopher G. Maher & Chung-Wei Christine Lin

Authors
  1. Stephanie Mathieson
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  2. Lisa Valenti
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  3. Christopher G. Maher
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  4. Helena Britt
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  5. Qiang Li
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  6. Andrew J. McLachlan
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  7. Chung-Wei Christine Lin
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Corresponding author

Correspondence to Stephanie Mathieson.

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Conflict of interest

No conflicts of interest to declare. The authors were responsible for the content and writing of the paper. Declarations of interest include the organisations that supported the BEACH program for one or more years during 2004–2014; SM, CM, AM and CL are investigators on the PRECISE trial (ACTRN12613000530729) which is an investigator-initiated trial evaluating pregabalin for sciatica funded by the National Health and Medical Research Council of Australia and in kind support provided by Pfizer Australia; and CM, AM and CL were investigators on the PACE trial (ACTRN 12609000966291) which was an investigator-initiated trial evaluating paracetamol for acute low back pain funded by the National Health and Medical Research Council of Australia and GlaxoSmithKline. Funding: The BEACH program 2001-14 was funded under research agreements/competitive Grants from: Australian Government Department of Health (1998–2004, 2007–2014); Sanofi-Aventis Australia Pty Ltd AstraZeneca Pty Ltd (Australia); Bayer Australia Ltd; Novartis Pharmaceuticals Australia Pty Ltd; Janssen-Cilag Pty Ltd; Seqirus (Australia) Pty Ltd; Abbott Australasia Pty Ltd; Merck, Sharp and Dohme (Australia) Pty; Wyeth Australia Pty Ltd; Pfizer Australia; NPS MedicineWise Ltd; GlaxoSmithKline Australia Pty Ltd; Roche Products Pty Ltd. Funding organisations had no editorial control over any aspect of this article. SM received project funding from the Chiropractic Association of Australia (NSW) to assist spinal pain data acquisition.

Electronic supplementary material

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586_2017_5178_MOESM1_ESM.pdf

Online Appendix Table 1 The proportion (%) each medicine category contributed to the yearly total of medicine recommendation rate for spinal pain problems managed by GPs in Australia between 2004 and 2014 (PDF 13 kb)

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Mathieson, S., Valenti, L., Maher, C.G. et al. Worsening trends in analgesics recommended for spinal pain in primary care. Eur Spine J 27, 1136–1145 (2018). https://doi.org/10.1007/s00586-017-5178-4

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  • DOI: https://doi.org/10.1007/s00586-017-5178-4

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