Patient-centred approach for improved analgesic use in ongoing musculoskeletal pain

Research Question: How to optimise the benefits of analgesic medicines for people with ongoing musculoskeletal pain, following a patient-centred approach? Background: Ongoing Musculoskeletal Pain affects over 20 million people in the UK and significantly impacts on healthcare worldwide. National guidelines for managing ongoing musculoskeletal pain prioritise the development of self-management strategies. Evidence suggests that nearly half (40-50%) of the people with ongoing pain do not receive the benefits expected from analgesic medicines. National guidelines for the management of ongoing musculoskeletal pain endorse the development of interventions that aim to improve the use of analgesic medicines by integrating clinical recommendations with patient beliefs and preferences on whether, when, and how medicines are to be taken. Despite expert recommendations on pharmacological management of ongoing musculoskeletal pain, patients experience reduced activity, independence, employability, and quality of life. Prescription of non-recommended analgesics, absence of shared decision-making or patient empowerment, poor understanding of painful conditions or the purpose of prescribed medicines, and lack of realistic expectations on medication efficacy and side-effects are some of the reasons cited for suboptimal benefits from analgesics. It is still unclear what approaches improve medicine use by people with ongoing musculoskeletal pain and what mechanisms drive it. More research is needed into how people can adopt behaviours (e.g., adherence, patient-clinician concordance, self-titration) that optimise benefits from analgesic medicines, which can lead to adherence to medicines and other treatments, reduction of unnecessary healthcare visits, and increase of return-to-work rates. Project Aims: The project primarily aims to understand how people with ongoing musculoskeletal pain use pain-relieving medicines. Such inference will aid the development of a future intervention to help people use medicines more effectively and achieve better management outcomes. Project Objectives: The project will investigate: what works in terms of analgesic medicines, for whom, why and in what context? how stakeholders in ongoing musculoskeletal pain management think optimised medicines use can be achieved, Methods: The project includes two work packages, to be completed within 2-years (60%FTE), and its methods follow the Medical Research Council 2021 guidance on developing and evaluating complex interventions. Work Package 1: A rapid realist review following a pragmatic approach will provide the evidence on what interventions or approaches, what mechanisms (enablers/barriers, population types, biopsychosocial factors), and what contextual factors (environment/circumstances) impacting the optimal use of analgesic medicines in people with ongoing musculoskeletal pain. Work Package 2: A qualitative study will interview different stakeholders (patients, their families or carers, clinicians) associated with the management of ongoing musculoskeletal pain to confirm, dispute or refine the evidence acquired in Work Package 1. Impact: The project will increase our insight on what behavioural mechanisms drive use of analgesic medicines by people with ongoing musculoskeletal pain, and what barriers or enablers can be targeted by future, appropriately tailored interventions that can maximise the benefits of analgesic medicines, which can improve the quality of life of millions of people with ongoing musculoskeletal pain and reduce the cost of existing care practices.