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Pharmacy World and Science

, Volume 23, Issue 6, pp 232–236 | Cite as

Variability in prescribing for musculoskeletal pain in Finnish primary health care

  • Pekka Mäntyselkä
  • Esko Kumpusalo
  • Jorma Takala
  • Riitta Ahonen:
Article

Abstract

Objective: To assess primary care physicians' prescribing patterns for musculoskeletal pain in different diagnostic categories.Methods: The data were collected in 25 randomly selected health centres, in which a total of 28 physicians took part in the four‐week study. Physicians recorded all the medicines they prescribed for patients visiting due to pain. Visits resulting in a diagnosis of musculoskeletal disease or injury were included in this study.Results: Analgesics, including non‐steroidal anti‐inflammatory drugs (NSAIDs), were prescribed for 61% of the patients. NSAIDs were prescribed for 46%, topical analgesics for 15% and opioids for 4% of the patients. In general, ibuprofen was the most frequently prescribed drug but back and neck pains were most commonly treated with naproxen. No difference between patients' genders was observed in analgesic prescriptions. Prescribing was associated with patient's age, physician's view on priority of visit, diagnosis and intensity of pain. There was a large variation in prescribing patterns between individual physicians and between different areas of the country.Conclusion: NSAIDs are the prevailing treatment for musculoskeletal pain in Finnish primary health care. Different drugs are favoured according to the diagnosis. The large variability in prescribing patterns cannot be explained solely by the characteristics of pain or patients.

Analgesics Drug prescribing NSAID Pain Primary health care 

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REFERENCES

  1. 1.
    Mäntyselkä P, Kumpusalo E, Ahonen R, Kumpusalo A, Kauhanen J, Viinamaki H et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain 2001;89:175-80.Google Scholar
  2. 2.
    Cherkin DC, Wheeler KJ, Barlow W, Deyo RA. Medication use for low back pain in primary care. Spine 1998;23:607-14.Google Scholar
  3. 3.
    Mamlin LA, Melfi CA, Parchman ML, Cutierrez B, Allen D, Katz B et al. Management of osteoarthritis of the knee by primary care physicians. Arch Fam Med 1998;7:563-7.Google Scholar
  4. 4.
    van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128-56.Google Scholar
  5. 5.
    Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med 1991;115:787-96.Google Scholar
  6. 6.
    Garcia Rodriguez LA, Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994;343:769-72.Google Scholar
  7. 7.
    Langman MJ, Weil J, Wainwright P, Lawson D, Logan R, Murphy M et al. Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994;343:1075-8.Google Scholar
  8. 8.
    Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee.American College of Rheumatology. Arthritis Rheum 1995;38:1541-6.Google Scholar
  9. 9.
    Eccles M, Freemantle N, Mason J. North of England evidence based guideline development project: summary guideline for non-steroidal anti-inflammatory drugs versus basic analgesia in treating the pain of degenerative arthritis. The North of England Non-Steroidal Anti-Inflammatory Drug Guideline Development Group. BMJ 1998;317:526-30.Google Scholar
  10. 10.
    Carette S, Bell MJ, Reynolds WJ, Haraoui B, McCain G, Bykerk V et al. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. A randomized, double-blind clinical trial. Arthritis Rheum 1994;37:32-40.Google Scholar
  11. 11.
    Bradley CP. Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners. Br J Gen Pract 1992;42:454-8.Google Scholar
  12. 12.
    Hull FM, Westerman RF, Jonkers R. Comparison of prescribing habits of general practitioners in The Netherlands versus England and Wales. Pharmacoeconomics 1992;2:77-86.Google Scholar
  13. 13.
    WHO. International statitistical classification of diseases and related health problems, Vol. 1. Geneva: World Health Organisation, 1992.Google Scholar
  14. 14.
    National Agency for Medicines and Social Insurance Institution. Finnish statistics on medicines 1996. Helsinki: Social Insurance Institution, 1997.Google Scholar
  15. 15.
    van Tulder MW, Koes BW, Bouter LM, Metsemakers JF. Management of chronic nonspecific low back pain in primary care: a descriptive study. Spine 1997;22:76-82.Google Scholar
  16. 16.
    Bergman U, Andersen M, Vaccheri A, Bjerrum L, Wettermark B, Montanaro N. Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions. Eur J Clin Pharmacol 2000;56:269-72.Google Scholar
  17. 17.
    Cullen DJ, Seager JM, Holmes S, Doherty M, Wilson J, Garrud P et al. Pharmacoepidemiology of non-steroidal anti-inflammatory drug use in Nottingham general practices. Aliment Pharmacol Ther 2000;14:177-85.Google Scholar
  18. 18.
    Rokstad K, Straand J, Fugelli P. General practitioners' drug prescribing practice and diagnoses for prescribing: the More & Romsdal Prescription Study. J Clin Epidemiol 1997;50:485-94.Google Scholar
  19. 19.
    61 Health Statistics in the Nordic Countries 1999. Copenhagen: NOMESCO, 2001.Google Scholar
  20. 20.
    Ahonen R, Enlund H, Pakarinen V, Riihimaki S. A 1-year follow-up of prescribing patterns of analgesics in primary health care. J Clin Pharm Ther 1992;17:43-7.Google Scholar
  21. 21.
    Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ. Quantitative systematic review of topically applied non-steroidal anti-inflammatory drugs. BMJ 1998;316:333-8. 236 Pharmacy World & Science Volume 23 No. 6 2001Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Pekka Mäntyselkä
    • 1
  • Esko Kumpusalo
    • 1
  • Jorma Takala
    • 1
  • Riitta Ahonen:
    • 2
  1. 1.Department of Public Health and General PracticeUniversity of KuopioKuopioFinland
  2. 2.Department of Social PharmacyUniversity of KuopioFinland

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