Evidence map›Paper›PMID 29880563›Full record

Trial reportBMJ open2018

Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial.

Tomi Ashaye, Natalia Hounsome, Dawn Carnes, Stephanie J C Taylor, Kate Homer, Sandra Eldridge, Anne Spencer, Anisur Rahman, Jens Foell, Martin R Underwood and 1 more

Open access · goldAbstract readMulticenter StudyPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 3 pooled it
8.0field-weighted citation impact, top 2% of its field
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

39 citing papers in PubMed, 3 syntheses or guidelines pooled it, 80 citations in OpenAlex.

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  7. A home-based EEG neurofeedback treatment for chronic neuropathic pain-a pilot study.Frontiers in pain research (Lausanne, Switzerland) · 2025
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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

11 authors at 4 institutions in 1 country.

Tomi AshayeBarts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Natalia HounsomeCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.ORCID 0000-0003-4460-2495
Dawn CarnesCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Stephanie J C TaylorCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Kate HomerCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Sandra EldridgeCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Anne SpencerExeter Medical School, University of Exeter, Exeter, Devon, UK.
Anisur RahmanCentre for Rheumatology Research, University College London, London, UK.
Jens FoellCentre for Primary Care and Public Health, Queen Mary University of London, London, UK.
Martin R UnderwoodClinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
COPERS Study Team (ISRCTN 24426731).
Queen Mary University of London · GBUniversity College London · GBUniversity of Exeter · GBUniversity of Warwick · GB

Funding

Department of Health RP-PG-0707-10189
6 · The paper itself

Abstract

objectiveTo establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs.

designSecondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients with chronic musculoskeletal pain (ISRCTN 24426731).

setting25 general practices and two community musculoskeletal services in the UK (London and Midlands).

participants703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial.

main outcome measuresAnonymised prescribing data over 12 months extracted from GP electronic records.

resultsOf the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 per year. A total of 3319 opioid prescriptions were issued over the study period, of which 53% (1768/3319) were for strong opioids (tramadol, buprenorphine, morphine, oxycodone, fentanyl and tapentadol). The mean number of opioid prescriptions per patient prescribed any opioid was 8.0 (SD=7.9). A third of patients on opioids were prescribed more than one type of opioid; the most frequent combinations were: codeine plus tramadol and codeine plus morphine. The cost of opioid prescriptions per patient per year varied from £3 to £4844. The average annual prescription cost was £24 (SD=29) for patients prescribed weak opioids and £174 (SD=421) for patients prescribed strong opioids. Approximately 40% of patients received >3 prescriptions of strong opioids per year, with an annual cost of £236 per person.

conclusionsLong-term prescribing of opioids for chronic musculoskeletal pain is common in primary care. For over a quarter of patients receiving strong opioids, these drugs may have been overprescribed according to national guidelines. TRIAL REGISTRATION NUMBER: ISRCTN24426731; Post-results.

Indexed as

Analgesics, OpioidChronic PainCohort StudiesDrug PrescriptionsFemaleHumansMaleMiddle AgedMusculoskeletal PainPractice Patterns, Physicians'Primary Health CareUnited KingdomAnalgesics, Opioidchronic paincostopioidsprescribingprimary care

Identifiers

PMID29880563
PMCPMC6009475
OpenAlexW2807131419

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.