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MEDICATION-PRESCRIBING PATTERNS IN PRIMARY CARE PATIENTS WITH NEUROPATHIC LOW BACK-RELATED LEG PAIN

The Society for Back Pain Research (SBPR) 2018 Meeting, Groningen, The Netherlands, 15–16 November 2018.



Abstract

Background

Medication prescribing patterns for patients with neuropathic low back-related leg pain (LBLP) in primary care are unknown.

Purpose

To estimate the proportion of patients prescribed pain medications, describe baseline characteristics of patients prescribed neuropathic pain (NP) medication and estimate the proportion of LBLP patients with refractory NP.

Methods

General practice electronic medical and prescribing records of a large (n=609), prospective, primary-care cohort of LBLP patients were analysed. Cases of NP were identified using the self-report version of the NP scale, Leeds Assessment for Neurological Symptoms and Signs (score of ≥12 indicates possible NP) (n=293). Patients with leg pain intensity ≥ 5 (mean of three 0–10 NRSs) or <30% reduction in disability (RMDQ 0–23) at 4-months compared to baseline and who were prescribed ≥ 2 NP medications were considered to have refractory NP.

Results

82% (223/273) of patients with NP were prescribed at least one pain medication; 29% (80/273) of patients were prescribed one first-line NP medication (for example Amitriptyline). Patients who were prescribed NP medication(s) had higher leg pain intensity and disability. There was evidence that patients improved with (61%, 41/67) and without (75%, 76/102) having been prescribed NP medication. Few patients (4%, 7/169) met the criteria for refractory NP suggesting that the scale of the problem in primary care is limited.

Conclusion

Patients with NP were commonly prescribed pain medication, under a third were prescribed NP medication and many patients improved without such medication. Future research is needed to determine the effectiveness of NP medication.

No conflicts of interest

Sources of funding: Sarah Harrisson is a Clinical Doctoral Fellow funded through a National Institute for Health Research (NIHR) Research Professorship awarded to Nadine Foster (NIHR-RP-011-015). Nadine Foster is a NIHR Senior Investigator. Kika Konstantinou is supported by a Higher Education Funding Council for England/ National Institute for Health Research Senior Clinical Lectureship. The views expressed in this publication are those of the author(s), not necessarily those of the NHS, NIHR or the Department of Health and Social Care. This work relates to an Education and Continued Professional Development (level 2) award by the Musculoskeletal Association of Chartered Physiotherapists to Sarah Harrisson (June 2016).