Kornder Nele, Hill Victoria Jessica, Groffebert Sophia Naomi, Becker Annette, Viniol Annika, Lindner Nicole
Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany.
Eur J Gen Pract. 2025 Dec;31(1):2536764. doi: 10.1080/13814788.2025.2536764. Epub 2025 Aug 1.
Musculoskeletal pain is a leading reason for primary care visits and often requires pharmacological treatment. Despite rising prescription rates for non-opioid analgesics in Germany, little is known about GPs' broader prescribing behaviour beyond opioid-related discussions. Understanding how GPs navigate pain management is key to supporting evidence-based prescribing.
This study explored GPs' decision-making strategies when prescribing for musculoskeletal pain and identified clinical challenges.
A qualitative study using semi-structured interviews was conducted with 15 GPs from Central and Northern Hesse, Germany. Participants were purposively recruited via a regional practice network. Interviews were analysed using Braun and Clarke's thematic analysis, applying a combined deductive-inductive approach.
Five major themes emerged: (1) prescribing approaches, (2) medication preferences, (3) doctor-patient relationship, (4) addressing psychosomatic factors, and (5) support needs. GPs preferred cautious prescribing, favouring metamizole and NSAIDs over opioids. Chronic pain was viewed as complex and required individualised, multimodal treatment and shared decision-making. Decision-making strategies were mainly shaped by guidelines like the WHO analgesic ladder and personal clinical experience; other guidelines were rarely mentioned. The doctor-patient relationship was considered essential, particularly in chronic pain contexts. Challenges included managing psychosomatic aspects and aligning treatment expectations.
GPs' prescribing decisions are shaped by a combination of clinical judgement, patient dynamics, and systemic factors. The findings highlight the need for practical support tools that are integrated into daily workflows and emphasise shared decision-making, especially for chronic pain management. These insights can inform future interventions aimed at optimising prescribing practices in primary care.
肌肉骨骼疼痛是基层医疗就诊的主要原因，通常需要药物治疗。尽管德国非阿片类镇痛药的处方率不断上升，但对于全科医生在阿片类药物相关讨论之外更广泛的处方行为知之甚少。了解全科医生如何进行疼痛管理是支持循证处方的关键。
本研究探讨了全科医生在开具肌肉骨骼疼痛处方时的决策策略，并确定了临床挑战。
对来自德国黑森州中部和北部的15名全科医生进行了一项使用半结构化访谈的定性研究。通过区域医疗网络有目的地招募参与者。采用布劳恩和克拉克的主题分析法，运用演绎 - 归纳相结合的方法对访谈进行分析。
出现了五个主要主题：（1）处方方法，（2）药物偏好，（3）医患关系，（4）解决身心因素，以及（5）支持需求。全科医生倾向于谨慎处方，比起阿片类药物更喜欢安乃近和非甾体抗炎药。慢性疼痛被视为复杂问题，需要个体化、多模式治疗和共同决策。决策策略主要受世界卫生组织镇痛阶梯等指南和个人临床经验的影响；很少提及其他指南。医患关系被认为至关重要，尤其是在慢性疼痛情况下。挑战包括处理身心方面问题和调整治疗期望。
全科医生的处方决策受到临床判断、患者动态和系统因素的综合影响。研究结果凸显了需要将实用支持工具融入日常工作流程，并强调共同决策，尤其是对于慢性疼痛管理。这些见解可为未来旨在优化基层医疗处方实践的干预措施提供参考。
