Research

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

BMJ 2008; 336 doi: 10.1136/bmj.39401.699063.BE (Published 17 January 2008)
Cite this as: BMJ 2008;336:142
  1. Dawn Carnes, research fellow1,
  2. Yasir Anwer, MSc student1,
  3. Martin Underwood, professor of general practice1,
  4. Geoff Harding, senior research fellow2,
  5. Suzanne Parsons, research fellow1
  6. on behalf of the TOIB study team
  1. 1Centre for Health Sciences, Barts and The London, Queen Mary University of London, London E1 2AT
  2. 2Peninsula College of Medicine and Dentistry (Primary Care), Royal Cornwall Hospital, Truro TR1 3LJ
  1. Correspondence to: M Underwood m.underwood{at}warwick.ac.uk
  • Accepted 7 November 2007

Abstract

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.

Footnotes

  • We thank Lynette Edwards for comments on earlier drafts of this paper and to all our interviewees for giving up their time for this study. Full details of the study team are given elsewhere.2

  • Contributors: DC conducted the qualitative preference data collection, led the analysis for this study element, contributed to the analysis of the adverse effects data, cowrote the first draft, and contributed to successive drafts. YA conducted the adverse effects interviews, participated in the analysis and interpretation of the qualitative adverse events study, and contributed to successive drafts of this paper. GH was one of the original applicants, designed and conducted the pilot qualitative study, was involved in the analysis of both the preference and adverse effects data, and contributed to successive drafts of this paper. MU was the principal investigator, was primarily responsible for the original grant application, took part in the design of the qualitative study, led the overall study team, and contributed to the interpretation of the data and to successive drafts of this paper. SP was one of the original applicants for the study, designed the qualitative study, contributed to the analysis of the preference data collection, led the analysis of the adverse effects data, and led the production of the first draft of this paper and contributed to successive drafts. SP is guarantor.

  • Funding: This study was commissioned by the NHS Health Technology Assessment Programme, project reference 01/09/02. Goldshield Pharmaceuticals supplied the starter packs of topical ibuprofen.

  • Competing interests: MU has received speaker fees from Pfizer, the manufacturers of celecoxib.

  • Ethical approval: Northern and Yorkshire multicentre research ethics committee (MREC 2/3/1).

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 7 November 2007

Rapid responses

THIS WEEK'S POLL

Read related article

See previous polls

BMJ most popular