Analgesic prescribing in people with polymyalgia rheumatica: a retrospective cohort study in the Clinical Practice Research Datalink
Helen Twohig, David Jenkinson, James Bailey, Samantha Hider, Ian C Scott, Sara MullerAbstract
Objectives
To report primary care prescribing rates of analgesics in people with PMR treated with glucocorticoids, overall and stratified by age, sex and deprivation.
Methods
A sample of > 43,000 individuals aged ≥50 years, with a coded PMR diagnosis January 2010-March 2022, prescribed glucocorticoids within 21 days of first PMR diagnosis code, was constructed in CPRD Aurum. Prescriptions for ‘all analgesics’, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids and amitriptyline were defined as prevalent (pre-PMR diagnosis), incident (at diagnosis), or late (post-diagnosis, still glucocorticoid-treated), reported overall and stratified by age/sex/deprivation.
Results
Whilst they were receiving glucocorticoids for PMR, 56.1% of participants were prescribed an analgesic. Opioids were the most frequently co-prescribed analgesics, followed by NSAIDs. Opioid prescribing was commoner in females than males, at older ages, and in more deprived areas. Amitriptyline and gabapentinoids were less commonly prescribed but followed the same sex and deprivation trends as opioids. NSAID prescribing was lower with older age, higher for males than females and did not vary with deprivation.
Conclusion
Analgesics are frequently co-prescribed with glucocorticoids in people with PMR despite lack of evidence of effectiveness and risks of adverse events. This evidences an unmet need for better pain management in PMR. The identified variation in prescribing of opioids and gabapentinoids by gender/deprivation is consistent with prescribing data for the general population and people with other painful musculoskeletal conditions and suggests that psychosocial-cultural factors affect pain and pain management in patients being treated for PMR. This needs further exploration to address inequalities and reduce iatrogenic harm.