Taking Care

Abstract

Musculoskeletal complaints form a common problem in the general population. A 2006 study into self-reported chronic complaints of the musculoskeletal system found a prevalence of around 40%. When asked whether any musculoskeletal pain had been experienced over the past 14 days, around 60% of respondents answered yes.1 It is unsurprising, therefore, that musculoskeletal disorders form the most common reason for consulting the general practitioner (GP) in the Netherlands. In 2001 the incidence of musculoskeletal disorders in GP practices was 267 per 1000 patients, and the prevalence 397 per 1000. These increased with age, with an estimated incidence of 350 per 1000 and prevalence of 600 per 1000 in patients over 75 years of age. In the UK, musculoskeletal problems account for 14% of all primary care consultations, and each year at least a quarter of the registered population consult their GP for a musculoskeletal complaint. The types and severity of complaints presented vary greatly. The majority are mild and self-limiting in nature, but chronic conditions such as osteoarthritis are also common. The one common feature that these various musculoskeletal disorders share is that their most burdensome component is pain. Depending on the type of complaint presented, there are various treatment options available to the GP. Non-pharmaceutical interventions, such as physiotherapy, tend to be targeted at improving function and reducing fear of movement. In many cases, the GP will also wish to prescribe an analgesic aimed at reducing the pain associated with the complaint. Treatment guidelines recommend a stepped approach to such analgesic therapy. Paracetamol is recommended as a first step, as it is effective in many painful conditions and is considered relatively safe. When paracetamol fails, GPs can prescribe non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are a group medicines with analgesic, anti-inflammatory and anti-pyretic properties. They inhibit the action of the cyclooxygenase (COX), which is a central enzyme in the synthesis of prostaglandins.