Evidence map›Paper›PMID 28639074›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2018

Worsening trends in analgesics recommended for spinal pain in primary care.

Stephanie Mathieson, Lisa Valenti, Christopher G Maher, Helena Britt, Qiang Li, Andrew J McLachlan, Chung-Wei Christine Lin

Abstract read
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In one paragraph

Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Antidepressants for low back pain and spine-related leg pain.The Cochrane database of systematic reviews · 2025
    Pooled it
  2. Pooled it
  3. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018
    Pooled it
  4. Article
  5. Article
  6. Article
  7. Article
  8. Analgesia for non-specific low back pain.BMJ (Clinical research ed.) · 2024
    Article
  9. Article
  10. Article
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. Effects of pregabalin on spinal fusion.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2020
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Stephanie MathiesonMusculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia. stephanie.mathieson@sydney.edu.au.
Lisa ValentiFamily Medicine Research Centre, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia.
Christopher G MaherMusculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia.
Helena BrittFamily Medicine Research Centre, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia.
Qiang LiThe George Institute for Global Health, University of New South Wales, Sydney, NSW, 2052, Australia.
Andrew J McLachlanFaculty of Pharmacy and Centre for Education and Research on Ageing, The University of Sydney and Concord Hospital, Sydney, NSW, 2006, Australia.
Chung-Wei Christine LinMusculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeLimited evidence exists on secular trends of analgesics for spinal pain. We investigated general practitioner's (GP) recommendations of analgesic medicines for spinal pain and investigated characteristics associated with their recommendation.

methodsWe accessed data on spinal pain consultations from the Bettering the Evaluation and Care of Health (BEACH) database, a nationally representative database on GP activity in Australia. Data extracted included consultation details and management provided. Medicines recommended were grouped as simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics or neuropathic pain medicines. Multivariate logistic regression determined if patient characteristics and GP characteristics were associated with medication recommendations.

resultsWe analysed BEACH data for 9100 GPs who managed 39,303 patients with spinal pain between 2004 and 2014. Over the decade, analgesic recommendations increased. After accounting for patient and GP characteristics, there was a significant increase in the rate single-ingredient opioid analgesics [annual relative increase of 6% (RR 1.06 (95% CI 1.05-1.07), P < 0.001)] and neuropathic pain medicines [annual relative increase of 19% (RR 1.19 (95% CI 1.16-1.22), P < 0.001)] were recommended; and a significant decrease in the rate NSAIDs were recommended [annual relative decrease of 4% (RR 0.96 (95% CI 0.95-0.97), P < 0.001)]. Logistic regression identified several patient and GP characteristics associated with medicine recommendations, e.g. stronger opioids were less likely recommended for Indigenous patients [odds ratio 0.15 (95% CI 0.04-0.56)].

conclusionsGP's analgesic recommendations for spinal pain have become increasingly divergent from guideline recommendations over time.

Indexed as

Practice Patterns, Physicians'Primary Health CareAnalgesicsBack PainDrug PrescriptionsHumansRetrospective StudiesSpineAnalgesicsClinical practice guidelinesNeuropathic pain medicinesOpioid analgesicPrimary careSpinal pain

Identifiers

PMID28639074

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.