Objectives Clinical practice guidelines for regional musculoskeletal conditions recommend non-pharmacological interventions such as education and management addressing physical activity as first-line care. Prescription of opioids for non-cancer pain is discouraged due to their limited benefits and potential for short- and longer-term harms. The objective of this study was to examine general practitioner (GP) prescription of opioids for people with low back, neck, shoulder and knee pain over a five-year period (2014-2018 inclusive).
Method This is a longitudinal analysis from the POpulation Level Analysis Reporting (POLAR) database in Victoria, Australia. Patients who consulted with a GP face-to-face and had a diagnosis of atraumatic low back (aged 18 years and over), and/or neck, shoulder and/or knee pain (aged 45 years and over) were included. Eligible prescriptions were categorised as weak single ingredient (e.g., codeine), strong single ingredient (e.g. tapentadol, morphine) and opioids combined with another medicine (e.g., codeine and ibuprofen). We examined number (%) patients with opioids prescribed within one year of diagnosis and longitudinal changes over five years by opioid type and body region.
Results For patients with low back pain, 36% (23,772/65,612) had at least one opioid prescription within one year of diagnosis. Opioids were prescribed for about a quarter of those with neck (2,371/8,974, 26.4%), shoulder (4,486/18,253, 24.6%) and knee (6,729/25,264, 26.6%) symptoms. Weak opioids with or without other medicines were most common for patients with low back (59.9% of those with a prescription), neck (61.2%) and shoulder (59.7%) pain. Strong single ingredient opioids were most common for those with knee pain (54.3%). Relatively few patients were prescribed multiple opioid types (6.8% low back, 4.5% neck, 4.5% shoulder, 5.4% knee). There was no change in the proportion of patients prescribed any type of opioid over the five-year study period but there was a 1.9% (95% CI 1.5 to 2.3) annual increase in the proportion of tapentadol prescriptions.
Conclusions GPs commonly prescribe opioids for people with regional musculoskeletal pain, with higher rates observed for people with low back pain and higher rates of strong opioids for people with knee pain. These rates did not change appreciably over five years and are likely to indicate low value care for many people with associated financial and environmental costs. Identification of multi-faceted strategies to reduce opioid prescription for regional musculoskeletal pain are needed.
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