BMJ  2008;336:142-145 (19 January), doi:10.1136/bmj.39401.699063.BE (published 4 December 2007)

Research

Influences on older people’s decision making regarding choice of topical or oral NSAIDs for knee pain: qualitative study

¹ Centre for Health Sciences, Barts and The London, Queen Mary University of London, London E1 2AT, ² Peninsula College of Medicine and Dentistry (Primary Care), Royal Cornwall Hospital, Truro TR1 3LJ

Objective To explore the factors that influence older people’s decision making regarding use of topical or oral ibuprofen for their knee pain.

Design Qualitative interview study nested within a randomised controlled trial and a patient preference study that compared advice to use oral or topical non-steroidal anti-inflammatory drugs (NSAIDs) for knee pain in older people.

Setting 11 general practices.

Participants 30 people aged 50 with knee pain.

Results Participants’ decision making was influenced by their perceptions of the associated risk of adverse effects, presence of other illness, nature of their pain, advice received, and practicality. Although participants’ understanding of how the medications worked was sometimes poor their decision making about the use of NSAIDs seemed logical and appropriate. Participants’ model for treatment was to use topical NSAIDs for mild, local, and transient pain and oral NSAIDs for moderate to severe, generalised, and constant pain (in the absence of other more serious illness or risk of adverse effects). Participants showed marked tolerance and normalisation of adverse effects.

Conclusion Participants had clear ideas about the appropriate use of oral and topical NSAIDs. Taking such views into account when prescribing may improve adherence, judgment of efficacy, and the doctor-patient relationship. Tolerance and normalisation of adverse effects in these patients indicate that closer monitoring of older people who use NSAIDs might be needed.

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This article has been cited by other articles:

• Spinewine, A. (2008). The challenge of safer prescribing. BMJ 336: 956-957 [Full text]  
• Dieppe, P. (2008). Osteoarthritis of the knee in primary care. BMJ 336: 105-106 [Full text]