Primary care approaches to musculoskeletal multiple-site joint pain pharmacological therapy: a survey of general practitioners.

Chronic multiple-site joint pain (MSJP) due to osteoarthritis and soft tissue disorders is common in people over 50 years old and associated with poor outcomes. This study examined current pharmacological approaches to MSJP management in primary care. One hundred and fifty general practitioners (GPs) attending an educational seminar participated in an electronic survey (mean response rate 96%). Most GPs reported treating multiple painful joints concurrently (78%) compared with focusing on a single joint (21%). The majority believed there was no difference in analgesia for different disorders when selecting paracetamol (84%), non-steroidal anti-inflammatory drugs (NSAID)/COX-2 inhibitors (57%) or opioids (70%). When optimising therapy, intra-class optimisation (increase NSAID dose 41%, change to another NSAID/COX-2 inhibitor 30%) was preferred to inter-class step up therapy (add opioid 23%, change to opioid 6%). For NSAID gastrointestinal intolerance, the preference was to add a gastro-protective agent (74%). There is a need to better characterise MSJP and examine optimal pharmacotherapy regimens.