The use of painkillers (analgesic medication) has increased substantially in the general population over the last 20 years for a number of conditions such as arthritis and chronic pain. There has been evidence of increasing overuse, dependency and increasing effect on individuals lives taking these medications. There is increasing evidence that these medications can have substantial effects on both the physical and mental health of individuals taking these treatments. In many cases painkillers are started for short term use but many individuals continue on them for longer periods than initially planned by their health practitioner.
No recent study has determined the extent of these problems in the last few years in the UK. We propose to determine the amount of use of these medications within the health service and the range of doses taken by individuals. We will also determine the effects of these medications on the physical and mental health of individuals such as the risk of heart disease, stroke, depression, attempted suicide, and anxiety disorders. Finally, we will assess how many individuals are needing to take these medications for continuous long-term use.
The information from this study will inform health practitioners and public health services of the current problems of excessive painkiller use both in terms of dosage and duration of treatment. The benefit of this study will be to clarify the potential problems of these medications on both the physical health and mental health of individuals in both short and long-term use.
The use of analgesic medication has increased in recent years including both non-opioid (e.g. paracetamol, non-steroidal anti-inflammatory medication), opioid medication (e.g. codeine based products, morphine, oxycodone, tramadol), cannabis based medicines, and the gabapentinoids (gabapentin, pregabalin). The prescription of analgesic medication is increasing in a range of areas of health care especially musculoskeletal disorders such as osteoarthritis, and non-cancer chronic pain. There is a gap in our understanding of these medicines as to firstly, the current extent of prescribing of strong analgesic medication and use, and secondly the impact of these medications on a range of adverse health outcomes. We will use CPRD Gold and Aurum data to determine which patients have received prescribed analgesic medication between the study dates of 1 January 1997 and 31st March 2020.
We will compare these individuals against a comparative control group comprising individuals that are not prescribed analgesic medication matched on a ratio 1:3 on the basis of gender, age, and social deprivation. We will use descriptive statistics to report, the monthly incidence and prevalence of analgesic medication use stratified by age and sex, the monthly daily dispensed dosage per 1000 patients and the annual supply days. For the purpose of incidence / prevalence calculation we will base our calculation on the use of denominator files within CPRD. We will measure the mean daily dose of each analgesic medication user and determine the annual incidence standardised to the age and sex distribution of adverse events. We will compare these results against the total monthly practice?level dispensing data of individuals over 18 years of age. The calculation of incident monthly prescriptions for analgesic use will exclude existing prevalent monthly medication. Proportional hazard modelling will be used to compare the risk of adverse events. Cox regression will be used to produce unadjusted and adjusted hazard ratios.
1. The incidence and prevalence of analgesic medicine use: non-opioids (paracetamol, non-steroidal anti-inflammatory medication), opioid medication (e.g. codeine-based products, morphine, oxycodone, tramadol), cannabis based medicines, and the gabapentinoids.
2. The levels and trends of prescribing and long-term use of these medicines.
3. Adverse outcomes on both physical health (e.g. mortality, cardiovascular disease, cerebrovascular disease, respiratory disease) and mental health disorders (anxiety disorders, depression, psychotic disorders, attempted suicide/ deliberate self-harm).
4. Comorbid substance misuse.
5. Primary care contact time.
Daniel Mackay - Chief Investigator - University of Glasgow
Robert Pearsall - Corresponding Applicant - LANARKSHIRE
Barbara Nicholl - Collaborator - University of Glasgow
David Blane - Collaborator - University of Glasgow
Frederick Ho - Collaborator - University of Glasgow
Jill Pell - Collaborator - University of Glasgow
HES Admitted Patient Care;Mental Health Services Data Set (MHSDS);ONS Death Registration Data;Practice Level Index of Multiple Deprivation