Analgesic prescribing for musculoskeletal conditions before and during the COVID-19 pandemic

Background

Musculoskeletal (MSK) conditions are common, painful and disabling. Patients can usually be managed in primary care, which provides access to clinical assessment and core treatments including supported self-management, physiotherapy, and analgesia. The COVID-19 pandemic led to an abrupt change in the way primary care is accessed and delivered. These changes have potential to impact how care for MSK symptoms is provided. Without access to diagnostic investigations or the option to refer, we hypothesised that analgesic prescribing may increase. Whilst pharmacological therapy may improve symptoms, there is potential for adverse events, especially in more vulnerable patient groups. National primary care data was used to describe changes in prescribing patterns for patients with MSK conditions pre- and peri- pandemic.

The approach

Code lists for musculoskeletal conditions were derived and prevalent and incident consultations determined. Prevalent (prescriptions for ongoing musculoskeletal consultations) and incident (prescriptions for new musculoskeletal consultations) for analgesia, classified as per existing criteria, were matched to within 14 days of a consultation. Trends are presented descriptively.

Findings

The proportion of patients with a prevalent MSK consultation prescribed any analgesic increased from 27.72% in February 2020 to 38.15% in April 2020. The trend then begins to return to pre-pandemic levels. The increase in prescribing in the first 2 months of the pandemic was most evident for non-steroidal anti-inflammatories and strong opioids. Prescribing trends for incident consultations were similar.

Implications

Patients presenting in primary care with musculoskeletal conditions were prescribed proportionally more analgesia in the first part of the pandemic. This is likely because there were fewer non-medical treatment options available or that only patients with more severe pain were consulting. A limitation of the study is that over-the-counter medications were not captured. Prescribers should remain alert to the longer-term risks of analgesic prescribing, particularly in future pandemics / waves of COVID-19.

Statement of funding (if appropriate): Musculoskeletal pain during the COVID-19 pandemic: an observational study of UK national primary care electronic health records is funded by FOREUM (Foundation for Research in Rheumatology)