Management of older adults consulting in GP surgery practices with back pain in UK Clinical Practice Research Datalink Aurum: population based study

The management of older adults with back pain in GP surgery practices is currently not well understood. We aimed to describe this and investigate if there are factors associated with variability in treatment. Using primary care records from UK Clinical Practice Research Datalink Aurum, we observed 594,559 adults aged 50 years and older with an index consultation for back pain between 1 January 2015 to 31 July 2018 over 18-months follow-up. Main outcome measures were time to first referral to (i) radiology, (ii) physiotherapy, (iii) exercise, physical activity programmes and musculoskeletal clinics and services, (iv) other clinics and services for further assessment, and (v) pain medication prescriptions. The majority of patients received pain medication prescriptions following a back pain diagnosis (n = 381,829; 64.2%), but not referrals to radiology (n = 23,712; 4.0%), physiotherapy (n = 2,856; 0.5%), exercise, physical activity programmes and musculoskeletal clinics and services (n = 22,182; 3.7%) or other clinics and services for further assessment (n = 20,755; 3.5%). The probability of referrals or prescriptions at index consultation were (i) 2.6%, (ii) 0.3%, (iii) 1.7%, (iv) 1.3% and (v) 56.4% respectively. Opioids in combination with paracetamol or ibuprofen were most commonly prescribed (n = 151,390, 25.5%), followed by non-topical non-steroidal anti-inflammatory drugs (n = 127,164, 21.4%) and non-combination opioids dosage forms (n = 101,713, 17.1%). We observed large variability in the management of back pain within practice regions, age groups and socioeconomic status for all outcomes with the exception of pain medication prescriptions which showed little variation within factors of interest. Older patients presenting to GP surgery practices with back pain are typically prescribed pain medications, with few referred for imaging, further therapy or assessment. Among non-pharmacological treatments, there exist differences by practice region, age, and socioeconomic status. Future work is needed to explore reasons for these differences, and to develop new clinical guidelines or tools to facilitate the standardisation of managing back pain in older adults within GP surgery practices in the UK.