Top

Published in:

01-11-2006 | Original Article

Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain

Authors: Thomas Rosemann, Stefanie Joos, Thorsten Koerner, Marc Heiderhoff, Gunter Laux, Joachim Szecsenyi

Published in: European Spine Journal | Issue 11/2006

Abstract

Despite dissuasive recommendations, intramuscular (i.m.) injections of NSAIDS are still a widespread treatment of acute pain in General Practice as well as among orthopaedic physicians. Most physicians argue that patients who are used to receive NSAIDS i.m. would insist on this application mode while being convinced of its therapeutic superiority for pain relief. Therefore, the aim of the study was to find out if patients’ decision can be influenced towards an oral application by receiving a simple information leaflet. An information leaflet, providing information about the risks of NSAIDS particularly in case of i.m. application was provided to 161 patients with acute low back pain. Decision in favour or against i.m. application of NSAIDS was documented. Severity of disease was assessed by the Roland Morrison pain questionnaire and visual analogue scale (VAS) at the first visit and again 3–5 days later. From May to December 2004, 161 patients, visiting their GP (13 practices) with acute pain and demanding an injection were included in the study. After reading the information leaflet, 139 of the 161 (86.3%) patients decided for an oral application instead of receiving an injection of NSAIDS as in the past. This effect was statistically significant (P≤0.01). Of the initial 161 patients, 156 could be re-evaluated and no significant differences in the VAS and the Roland Morris Score between the patients with oral and i.m. application mode could be found. Only 2 patients of the 139 who decided for oral application indicated that they would opt for an i.m. injection next time. Our study demonstrates that patients’ decision can be influenced even in case of severe pain by providing adequate information on a short information leaflet. The results should help to reduce physicians’ fear of losing patients when not following their demand for i.m. injections and therefore enable a safer pain treatment.

Arzneimittelkommission der deutschen Ärzteschaft (2003) Kreuzschmerzen - Arzneiverordnung in der Praxis. Deutscher Ärzteverlag, Köln

Becker A, Chenot JF, Niebling W, Kochen MM (2004) Guidelines for back pain. Z Orthop Ihre Grenzgeb 142(6):716–719PubMedCrossRef

Braun RN (1956) Diagnosis in everyday practice. Dtsch Med Wochenschr 81(31):1236–1238PubMedCrossRef

Brune K, Lanz B (1985) Pharmakokinetics of non-steroidal anti-inflammatory drugs. In: Bonta M, Bray MA, Parnham MJ (eds) Handbook of inflammation. Elsevier, Amsterdam, pp 413–449

Caudill-Slosberg MA, Schwartz LM, Woloshin S (2004) Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000. Pain 109(3):514–519PubMedCrossRef

DEGAM (2004) Leitlinie Kreuzschmerzen. Omnikron publishing, Köln

Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344(5):363–370PubMedCrossRef

Exner V, Keel P (2000) Measuring disability of patients with low-back pain—validation of a German version of the Roland & Morris disability questionnaire. Schmerz 14(6):392–400PubMedCrossRef

Frick S, Cerny A (2001) Necrotizing fasciitis due to Streptococcus pneumoniae after intramuscular injection of nonsteroidal anti-inflammatory drugs: report of 2 cases and review. Clin Infect Dis 33(5):740–744PubMedCrossRef

10.

Gonzalez-Urzelai V, Palacio-Elua L, Lopez-de-Munain J (2003) Routine primary care management of acute low back pain: adherence to clinical guidelines. Eur Spine J 12(6):589–594PubMedCrossRef

11.

Grass H, Schuff A, Bertram C, Rothschild MA (2004) Intramuscular application of diclofenac—case report and critical consideration of a therapeutic measure. Z Orthop Ihre Grenzgeb 142(4):489–492PubMedCrossRef

12.

Hoeffler D, Schwabe U (2002) Letale Fasciitits necroticans nach gleichzeitiger i.m. Injektion von Diclofenac und Dexamethason. Arzneiverordnungen Prax (2):13

13.

Kenny T, Wilson RG, Purves IN et al (1998) A PIL for every ill? Patient information leaflets (PILs): a review of past, present and future use. Fam Pract 15(5):471–479PubMedCrossRef

14.

Koes BW, van Tulder MW, Ostelo R, Kim BA, Waddell G (2001) Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 26(22):2504–2513PubMedCrossRef

15.

Macfarlane J, Holmes W, Gard P, Thornhill D, Macfarlane R, Hubbard R (2002) Reducing antibiotic use for acute bronchitis in primary care: blinded, randomised controlled trial of patient information leaflet. BMJ 324(7329):91–94PubMedCrossRef

16.

Mayrink M, Mendonca AC, da Costa PR (2003) Soft-tissue sarcoma arising from a tissue necrosis caused by an intramuscular injection of diclofenac. Plast Reconstr Surg 112(7):1970–1971PubMedCrossRef

17.

Pirmohamed M, James S, Meakin S et al (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329(7456):15–19PubMedCrossRef

18.

Roberts L, Little P, Chapman J, Cantrell T, Pickering R, Langridge J (2002) The back home trial: general practitioner-supported leaflets may change back pain behavior. Spine 27(17):1821–1828PubMedCrossRef

19.

Rotman-Pikielny P, Levy Y, Eyal A, Shoenfeld Y (2003) Pyomyositis or “injectiositis”—Staphylococcus aureus multiple abscesses following intramuscular injections. Isr Med Assoc J 5(4):295–296PubMed

20.

Schabitz WR, Berger C, Knauth M, Meinck HM, Steiner T (2001) Hypoxic brain damage after intramuscular self-injection of diclofenac for acute back pain. Eur J Anaesthesiol 18(11):763–765PubMedCrossRef

21.

Scheppokat KD (2004) Medical errors and iatrogenic injury—results of 173 Schlichtungsstellen proceedings in general practice. Z Arztl Fortbild Qualitatssich 98(6):509–514PubMed

22.

Scheppokat KD (2005) Learning from the experiences as physician member of a German Schlichtungsstelle. Ther Umsch 62(3):185–190PubMedCrossRef

Title: Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain
Authors: Thomas Rosemann
Stefanie Joos
Thorsten Koerner
Marc Heiderhoff
Gunter Laux
Joachim Szecsenyi
Publication date: 01-11-2006
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 11/2006
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-006-0068-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2006

Comments on “Discriminative validity and responsiveness of the Oswestry disability index among Japanese outpatients with lumbar conditions”

Announcements

Danish version of the Oswestry disability index for patients with low back pain. Part 2: Sensitivity, specificity and clinically significant improvement in two low back pain populations

Outcome scores in spinal surgery quantified: excellent, good, fair and poor in terms of patient-completed tools

Reliability and responsiveness of the Dutch version of the Neck Disability Index in patients with acute neck pain in general practice

Danish version of the Oswestry Disability Index for patients with low back pain. Part 1: Cross-cultural adaptation, reliability and validity in two different populations