Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK.
Eur J Pain. 2012 Aug;16(7):1014-20. doi: 10.1002/j.1532-2149.2011.00107.x. Epub 2012 Jan 19.
It is not known whether general practitioners (GPs) prescribe analgesic medication according to intensity of pain or a hierarchical prescribing regimen.
The aim of this study was to assess the association of strength of pain-relief medication prescribed by the GP with the strength of previous prescription and pain level.
The PROG-RES study collected data on pain intensity in 428 patients aged ≥50 years with non-inflammatory musculoskeletal pain during a consultation with their GP. Prescriptions for analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were identified on the day of the consultation and in the previous year and were classified as basic, moderate or strong analgesic or NSAID. Regression models were used to assess the association of strength of analgesia and prescription of a NSAID with the strength of previous prescription and the level of pain.
The majority of patients were not prescribed medication for their pain at the index consultation, but had such a prescription the previous year. There was an association between strength of analgesic and intensity of pain: more intense pain resulted in a stronger drug. This association was attenuated by adjustment for prescribed analgesia in the previous year. There was no association between intensity of pain and NSAID prescription, but previous NSAID prescription predicted another such prescription.
GPs do not always issue prescriptions for musculoskeletal pain. In cases where a prescription is issued, this is more strongly influenced by previous prescriptions than the patient's pain level. GPs adopt an individualized approach to the treatment of musculoskeletal pain in older adults.
目前尚不清楚全科医生（GP）是根据疼痛强度还是分层处方方案开具止痛药物。
本研究旨在评估 GP 开具的止痛药物强度与之前的处方强度和疼痛程度之间的关系。
PROG-RES 研究在 GP 就诊时收集了 428 名年龄≥50 岁、患有非炎症性肌肉骨骼疼痛患者的疼痛强度数据。在就诊当天和前一年确定了镇痛药和非甾体抗炎药（NSAIDs）的处方，并将其分为基础、中度或强镇痛药或 NSAIDs。回归模型用于评估镇痛强度和 NSAIDs 处方与之前的处方强度和疼痛程度之间的关系。
大多数患者在就诊时没有开具疼痛药物，但在前一年有这样的处方。镇痛药的强度与疼痛强度之间存在关联：疼痛越剧烈，药物越强。这种关联在调整前一年开具的镇痛药后减弱。疼痛强度与 NSAIDs 处方之间没有关联，但之前的 NSAIDs 处方预示着另一个这样的处方。
GP 并不总是为肌肉骨骼疼痛开具处方。如果开具处方，这更多地受到之前处方的影响，而不是患者的疼痛程度。GP 对老年患者的肌肉骨骼疼痛采用个体化治疗方法。
