Background/Purpose: Lower back pain (LBP) and osteoarthritis (OA) are the most frequent musculoskeletal disorders in the general population significantly impacting patients’ quality of life. An adequate pain management is key. General practitioners (GPs) are the front-line decision-makers in the French primary care system. In France, paracetamol remains a first-line analgesic in LBP and OA, according to the national guidelines. Few data on the real-world paracetamol prescriptions in LBP and OA are available.

Methods: This observational retrospective cohort study using the IQVIA electronic medical records database aimed to identify the paracetamol prescription patterns in patients with LBP and OA in real-world GP practice. Prescription data of approximately 1,200 GPs and27,559 patients were analyzed. Patients aged more than 18 years old with a registered diagnosis of LBP and OA and a paracetamol prescription during a GP consultation over a 10-month period were included in the analyses.

Results: A total of 18,677 LBP and 8,882 OA patients were included. In more than 90% of these patients, the paracetamol prescriptions were not preceded by any other analgesic for the same diagnosis within the previous month. Paracetamol was mainly prescribed alone (57% LBP, 78% OA). The most frequent associations were NSAIDs and grade II analgesics. Fewer NSAID prescriptions were observed in older patients and in patients with hypertension, heart failure and renal insufficiency in both LBP and OA. Treatment discontinuation at Month 1 was the most frequent event (67% LBP and 52% OA). In case of treatment restart, paracetamol was prescribed again in 57% LBP and 81% OA patients. At Month 3, 78% LBP and 71% OA patients discontinued treatment.

Conclusion: Paracetamol remains a pivotal analgesic prescribed first line in both LBP and OA from the time of initiation and during follow-up. It is the treatment of a given acute painful episode, with high proportion of treatment discontinuations after a short treatment duration. It is the analgesic of choice for recurrent pain and a satisfactory option for physicians in managing older patients and patients with comorbidities and risk factors.

References: 1. Blyth FM et al ., Am J Public Health. 2019 Jan;109(1):35–40. 2. Sprangers MA et al., J Clin Epidemiol. 2000 Sep;53(9):895–907. 3. Thakral M et al., J Gerontol A Biol Sci Med Sci. 2019 Apr 23;74(5):733–41. 4. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. The Lancet. 2019 Apr 27;393(10182):1745–59. 5. Goode AP et al., Curr Rheumatol Rep. 2013 Jan 11;15(2):305. 6.Gourmelen J et al, Ann Readapt Med Phys 2007;50:640-4. 7. Haute Autorite de Santé (HAS). Prise en charge du patient présentant une lombalgie commune. Published March 27, 2019. Accessed August 4, 2022. https://www.has-sante.fr/jcms/c_2961499/fr/prise-en-charge-du-patient-presentant-une-lombalgie-commune. 8. Haute Autorite de Santé (HAS) MG. Arthrose : le paracétamol en 1re intention lors des crises douloureuses. Published June 4, 2019. Accessed August 4, 2022. https://www.has-sante.fr/jcms/pprd_2974704/fr/arthrose-le-paracetamol-en-1re-intention-lors-des-crises-douloureuses

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-is-paracetamol-prescribed-in-low-back-pain-and-osteoarthritis-in-france-paracetamol-prescription-patterns-in-the-real-world-general-practice/