Analgesic prescribing for musculoskeletal complaints in the ambulatory care setting after the introduction and withdrawal of cyclooxygenase-2 inhibitors.

OBJECTIVE: To evaluate the analgesic prescribing patterns for musculoskeletal complaints in a nationally representative sample of ambulatory care visits over a dynamic period of pharmaceutical treatments.

DESIGN: Sequential cross-sectional analysis of complex probabilistic survey data with multivariable logistic regression analysis.

SETTING: National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey 1999 to 2005.

PARTICIPANTS: Visits to ambulatory care physicians in the United States from 1999 to 2005 with the reason for visit being a musculoskeletal complaint.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Prescribing of cyclooxygenase-2 (COX-2) inhibitors, nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs), opiate analgesics, nonnarcotic analgesics, and adjuvant analgesic medications for visits related to musculoskeletal complaints.

RESULTS: There were 41,804 visits for musculoskeletal complaints, representing 789 million visits from 1999 to 2005 in the weighted analyses. Prescribing for any nonsteroidal anti-inflammatory drugs (NSAIDs) remained relatively stable from 1999 to 2005. It appears that COX-2 inhibitors were substituted for nsNSAIDs initially. After safety concerns arose and select COX-2 inhibitors were withdrawn, there were sharp increases in prescribing of nsNSAIDs and nonnarcotic analgesics. Opiate analgesics and adjuvant analgesics increased in usage over the study period, although apparently not in substitution for NSAIDs.

CONCLUSIONS: COX-2 inhibitors may have been prescribed as substitutes for nsNSAIDs initially, but nsNSAID prescriptions returned to prior levels by 2005 as COX-2 inhibitor prescriptions declined. An increase in nonnarcotic analgesic prescribing in 2005 may have been caused by a class effect concern for NSAIDs. Prescribing of opiate analgesics and adjuvant analgesics increased over the study period, although apparently not in substitution for NSAIDs.