Factors influencing general practitioners’ prescribing choices for
patients with chronic low back pain: a discrete choice experiment
Abstract
Background and aims: Opioids are commonly prescribed to patients with
chronic low back pain (LBP) despite risks of harms. We conducted a
discrete choice experiment (DCE) to determine factors contributing to a
general practitioner’s (GP’s) decision to prescribe either an opioid or
an NSAID to a patient with chronic LBP. Methods: GPs recruited through
an online survey distributed in Australia were presented with 12
questions that represented hypothetical clinical scenarios of a patient
with chronic LBP. The clinical scenario varied by two patient
attributes; LBP with or without referred leg pain (sciatica) and
comorbidities. Participants chose their preferred alternative either an
opioid, NSAID or neither (“opt-out”). Each alternative varied by three
clinical attributes: the type of opioid or NSAID, the degree of pain
reduction and number of adverse events. Results: 210 GPs participated in
the survey. Overall, GPs preferred to prescribe an NSAID (45.2%, 95%
CI 38.7% to 51.7%) over an opioid (28.8%, 95% CI 23.0% to 34.7%).
However, there was no difference between the type of NSAID or opioid
preferred. Patient attributes of comorbidities (zero, one, two or
three), and the presence of referred leg pain (sciatica) did not
influence prescribing preferences, nor did clinical attributes of pain
reduction and adverse events. Conclusions: GPs prefer to prescribe an
NSAID over an opioid for a patient with chronic LBP. This preference
appeared fixed and was not changed by clinical (drug type, degree of
pain reduction or number of adverse events) or patient attributes
(comorbidities or presence of referred leg pain).