General practitioners' decision-making strategies in the pharmacological treatment of musculoskeletal pain: A qualitative interview study.
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| Titel: | General practitioners' decision-making strategies in the pharmacological treatment of musculoskeletal pain: A qualitative interview study. |
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| Autoren: | Kornder N; Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany., Hill VJ; Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany., Groffebert SN; Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany., Becker A; Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany., Viniol A; Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany., Lindner N; Department of Primary Care, Philipps-Universität Marburg, Marburg, Germany. |
| Quelle: | The European journal of general practice [Eur J Gen Pract] 2025 Dec; Vol. 31 (1), pp. 2536764. Date of Electronic Publication: 2025 Aug 01. |
| Publikationsart: | Journal Article |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Informa Healthcare Country of Publication: England NLM ID: 9513566 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1751-1402 (Electronic) Linking ISSN: 13814788 NLM ISO Abbreviation: Eur J Gen Pract Subsets: MEDLINE |
| Imprint Name(s): | Publication: London : Informa Healthcare Original Publication: [Amersfoort, The Netherlands] : Mediselect Pub., c1995- |
| MeSH-Schlagworte: | Musculoskeletal Pain*/drug therapy , General Practitioners*/psychology , Practice Patterns, Physicians'* , Clinical Decision-Making*, Humans ; Qualitative Research ; Female ; Male ; Middle Aged ; Germany ; Adult ; Analgesics, Opioid/therapeutic use ; Interviews as Topic ; Physician-Patient Relations ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Chronic Pain/drug therapy ; Decision Making ; Pain Management/methods ; Attitude of Health Personnel ; Primary Health Care ; Dipyrone/therapeutic use ; Analgesics/therapeutic use |
| Abstract: | Background: 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. Objectives: This study explored GPs' decision-making strategies when prescribing for musculoskeletal pain and identified clinical challenges. Methods: 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. Results: 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. Conclusion: 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. |
| References: | Front Psychiatry. 2022 Apr 25;13:864389. (PMID: 35546935) Dtsch Arztebl Int. 2024 Nov 15;121(23):757-763. (PMID: 39356103) Pain Res Manag. 2003 Winter;8(4):189-94. (PMID: 14679412) Br J Gen Pract. 2023 Jul 27;73(733):e623-e633. (PMID: 37012078) Schmerz. 2023 Dec;37(6):461-466. (PMID: 35861889) BMJ Open. 2023 Oct 29;13(10):e074380. (PMID: 37899160) Fam Pract. 2010 Dec;27(6):676-83. (PMID: 20671000) BMC Geriatr. 2011 Jul 14;11:35. (PMID: 21752299) Mayo Clin Proc. 2009 Jul;84(7):613-24. (PMID: 19567715) Fam Pract. 2023 Feb 9;40(1):68-74. (PMID: 35747902) JAMA. 2013 Nov 27;310(20):2191-4. (PMID: 24141714) BMC Musculoskelet Disord. 2010 Jul 02;11:144. (PMID: 20598124) J Gen Intern Med. 2006 Jun;21(6):652-5. (PMID: 16808752) BMC Fam Pract. 2015 Apr 14;16:48. (PMID: 25884340) J Pain Palliat Care Pharmacother. 2004;18(2):7-28. (PMID: 15257972) JAMA Netw Open. 2024 Apr 1;7(4):e246026. (PMID: 38602675) |
| Contributed Indexing: | Keywords: General practitioners; Musculoskeletal pain; analgesic prescribing; shared decision-making |
| Substance Nomenclature: | 0 (Analgesics, Opioid) 0 (Anti-Inflammatory Agents, Non-Steroidal) 6429L0L52Y (Dipyrone) 0 (Analgesics) |
| Entry Date(s): | Date Created: 20250801 Date Completed: 20250801 Latest Revision: 20250806 |
| Update Code: | 20250806 |
| PubMed Central ID: | PMC12320255 |
| DOI: | 10.1080/13814788.2025.2536764 |
| PMID: | 40748038 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Background: 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.<br />Objectives: This study explored GPs' decision-making strategies when prescribing for musculoskeletal pain and identified clinical challenges.<br />Methods: 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.<br />Results: 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.<br />Conclusion: 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. |
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| ISSN: | 1751-1402 |
| DOI: | 10.1080/13814788.2025.2536764 |