Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Bedson, John; Chen, Ying; Hayward, Richard A.; Ashworth, Julie; Walters, Kate; Dunn, Kate M.; Jordan, Kelvin P. (2016)
Publisher: Wolters Kluwer
Journal: Pain
Languages: English
Types: Article
Subjects: Musculoskeletal pain, Analgesic, Opioid, Long-term care, Research Paper, Prescriptions, Trends, R1
Abstract Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational database study (Clinical Practice Research Datalink, 190 practices). Participants (?18 years) were prescribed an opioid for a musculoskeletal condition (no opioid prescribed in previous 6 months), and issued ?2 opioid prescriptions within 90 days (long-term episode). Opioids were divided into short- and long-acting noncontrolled and controlled drugs. Annual incidence of long-term opioid episodes was determined, and for those still in a long-term episode, the percentage of patients prescribed each type 1 to 2 years, and >2 years after initiation. Annual denominator population varied from 1.25 to 1.38 m. A total of 76,416 patients started 1 long-term episode. Annual long-term episode incidence increased (2002-2009) by 38% (42.4-58.3 per 10,000 person-years), remaining stable to 2011, then decreasing slightly to 55.8/10,000 (2013). Patients prescribed long-acting controlled opioids within the first 90 days of long-term use increased from 2002 to 2013 (2.3%-9.9%). In those still in a long-term opioid episode (>2 years), long-acting controlled opioid prescribing increased from 3.5% to 22.6%. This study has uniquely shown an increase in prescribing long-term opioids to 2009, gradually decreasing from 2011 in the United Kingdom. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • [1] Bedson J, Belcher J, Martino OI, Ndlovu M, Rathod T, Walters K, Dunn KM, Jordan KP. The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study. Eur J Pain 2013;17:434-43.
    • [2] BNF. British national formulary. London: BMJ Group, 2014.
    • [3] Boudreau D, Von Korff M, Rutter CM, Saunders K, Ray GT, Sullivan MD, Campbell CI, Merrill JO, Silverberg MJ, Banta-Green C, Weisner C. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf 2009;18:1166-75.
    • [4] Care Quality Commission. The safer management of controlled drugs, Annual report 2012. 2013. Available at: http://www.cqc.org.uk/sites/ default/files/documents/cdar_2012.pdf. Accessed September 19, 2015.
    • [5] Chevalier P, Smulders M, Chavoshi S, Sostek M, LoCasale R. A description of clinical characteristics and treatment patterns observed within prescribed opioid users in Germany and the UK. Pain Manag 2014; 4:267-76.
    • [6] Department of Health. Controlled drugs (supervision of management and use) regulations 2013. 2013. Available at: https://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/214915/ 15-02-2013-controlled-drugs-regulation-information.pdf. Accessed September 19, 2015.
    • [7] Department of Health (England) and the Devolved Administrations. Drug misuse and dependence: UK guidelines on clinical management. London: Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive, 2007.
    • [8] Dowd A. Some PCTs recommend GPs limit prescriptions to 28 days. BMJ 2011;342:d2410.
    • [9] Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M. Opioid prescriptions for chronic pain and overdose. Ann Intern Med 2010; 152:85-92.
    • [10] Edwards JJ, Jordan KP, Peat G, Bedson J, Croft PR, Hay EM, Dziedzic KS. Quality of care for OA: the effect of a point-of-care consultation recording template. Oxford: Anonymous Rheumatology, 2014.
    • [11] Fay MP, Tiwari RC, Feuer EJ, Zou Z. Estimating the average annual percent change for disease rates without assuming constant change. Biometrics 2006;62:847-54.
    • [12] Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ 2006;174:1589-94.
    • [13] Gallagher AM, Puri S, Van Staa T. Linkage of the General Practice Research Database (GPRD) with other data sources. Pharmacoepidemiol Drug Saf 2011;20:S230-231.
    • [14] Green DJ, Bedson J, Blagojevic-Burwell M, Jordan KP, van der Windt D. Factors associated with primary care prescription of opioids for joint pain. Eur J Pain 2013;17:234-44.
    • [15] Gregory S. General practice in England: an overview. The King's Fund, 2009. Available at: http://www.kingsfund.org.uk/sites/files/kf/generalpractice-in-england-overview-sarah-gregory-kings-fund-september2009.pdf. Accessed November 27, 2015.
    • [16] Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and wellbeing: a World Health Organization Study in Primary Care. JAMA 1998; 280:147-51.
    • [17] Hamunen K, Paakkari P, Kalso E. Trends in opioid consumption in the Nordic countries 2002-2006. Eur J Pain 2009;13:954-62.
    • [18] Health and Social Care Information Centre. Numbers of patients registered at a GP practice-April 2014. 2014. Available at: http://www.hscic.gov.uk/ catalogue/PUB13932. Accessed November 27, 2015.
    • [19] Health and Social Care Information Centre. Read codes. 2015. Available at: http://systems.hscic.gov.uk/data/uktc/readcodes. Accessed September 19, 2015.
    • [20] Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ. Validation and validity of diagnoses in the General Practice Research Database: a systematic review. Br J Clin Pharmacol 2009;69:4-14.
    • [21] Jordan K, Kadam U, Hayward R, Porcheret M, Young C, Croft P. Annual consultation prevalence of regional musculoskeletal problems in primary care. BMC Musculoskelet Disord 2010;11:144.
    • [22] Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335-51.
    • [23] Lanza F, Chan F, Quigley E. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol 2009;104:728-38.
    • [24] Lawson D, Sherman V, Hollowell J. The general practice research database. Q J Med 1998;91:445-52.
    • [25] Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CWC, Day RO, McLachlan AJ, Ferreira ML. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015;350:h1225.
    • [26] Manchikanti L, Fellows B, Ailinani H, Pamapti P. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Phys 2010; 13:401-35.
    • [27] Muller S, Bedson J, Mallen CD. The association between pain intensity and the prescription of analgesics and non-steroidal anti-inflammatory drugs. Eur J Pain 2012;16:1014-20.
    • [28] National Cancer Institute. Joinpoint regression program. 2015. Available at: http://surveillance.cancer.gov/joinpoint/. Accessed September 19, 2015.
    • [29] Ndlovu M, Bedson J, Jones PW, Jordan KP. Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskelet Disord 2014;15:1-11.
    • [30] NICE. Osteoarthritis care and management in adults: NICE clinical guideline 177. 2014. Available at: http://www.nice.org.uk/nicemedia/live/ 14383/66527/66527.pdf. Accessed September 16, 2015.
    • [31] Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, Schoelles KM. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev 2010;1:CD006605.
    • [32] Office of National Drug Control Policy. Epidemic: responding to America's prescription drug abuse crisis. 2011. Available at: http://www. whitehouse.gov/sites/default/files/ondcp/issues-content/prescriptiondrugs/rx_abuse_plan.pdf. Accessed September 19, 2015.
    • [33] ONS. Mid-year population estimates for the UK 2014. 2015. Available at: http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-foruk-england-and-wales-scotland-and-northern-ireland/mid-2014/midyear-population-estimates-for-the-uk-2014.html. Accessed November 27, 2015.
    • [34] Parsells Kelly J, Cook SF, Kaufman DW, Anderson T, Rosenberg L, Mitchell AA. Prevalence and characteristics of opioid use in the US adult population. PAIN 2008;138:507-13.
    • [35] Prescribing and Medicines Team Health and Social Care Information Centre. Prescriptions dispensed in the community England 2004-14. 2015. Available at: http://www.hscic.gov.uk/catalogue/PUB17644/presdisp-com-eng-2004-14-rep.pdf. Accessed April 4, 2016.
    • [36] Ruscitto A, Smith BH, Guthrie B. Changes in opioid and other analgesic use 1995-2010: repeated cross-sectional analysis of dispensed prescribing for a large geographical population in Scotland. Eur J Pain 2015;19:59-66.
    • [37] Saunders K, Dunn KM, Merrill J, Sullivan MD, Weisner C, Brennan Braden J, Psaty BM, Von Korff M. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med 2010;4:310-15.
    • [38] Smith BH, Torrance N. Epidemiology of neuropathic pain. Pain Manag 2011;1:87-96.
    • [39] Stannard C. Opioid prescribing in the UK: can we avert a public health disaster? Br J Pain 2012;6:7-8.
    • [40] Tate AR, Beloff N, Al-Radwan B, Wickson J, Puri S, Williams T, Van Staa T, Bleach A. Exploiting the potential of large databases of electronic health records for research using rapid search algorithms and an intuitive query interface. J Am Med Inform Assoc 2014;21:292-8.
    • [41] The Advisory Council on the Misuse of Drugs. Misuse of drugs act 1971. 1971. Available at: http://www.legislation.gov.uk/ukpga/1971/38/pdfs/ ukpga_19710038_en.pdf. Accessed September 19, 2015.
    • [42] UK Statutory Instruments. The misuse of drugs regulations. 2001. Available at: http://www.legislation.gov.uk/uksi/2001/3998/made. Accessed September 19, 2015.
    • [43] Von Korff M, Saunders K, Thomas Ray G, Boudreau D, Campbell C, Merrill J, Sullivan MD, Rutter CM, Silverberg MJ, Banta-Green C, Weisner C. De facto long-term opioid therapy for noncancer pain. Clin J Pain 2008; 24:521-7.
    • [44] WHO. Daily defined dose: definition and general considerations. 2014. Available at: http://www.whocc.no/ddd/definition_and_general_considera/. Accessed September 19, 2015.
    • [45] Williams T, van Staa T, Puri S, Eaton S. Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource. Ther Adv Drug Saf 2012;3:89-99.
    • [46] Zin CS, Chen LC, Knaggs RD. Changes in trends and pattern of strong opioid prescribing in primary care. Eur J Pain 2014;18:1343-51.
  • No related research data.
  • Discovered through pilot similarity algorithms. Send us your feedback.

Share - Bookmark

Cite this article