General practitioners’ decision-making strategies in the pharmacological treatment of musculoskeletal pain: A qualitative interview study
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Taylor & Francis
Abstract
Background: Musculoskeletal pain is a leading reason for primary care visits and often requires
pharmacological treatment. Despite rising prescription rates for non-opioid analgesics in Germany,
little is known about GPs’ broader prescribing behaviour beyond opioid-related discussions.
Understanding how GPs navigate pain management is key to supporting evidence-based
prescribing.
Objectives: this study explored GPs’ decision-making strategies when prescribing for
musculoskeletal pain and identified clinical challenges.
Methods: a qualitative study using semi-structured interviews was conducted with 15 GPs from
central and Northern hesse, Germany. Participants were purposively recruited via a regional
practice network. interviews were analysed using Braun and clarke’s thematic analysis, applying a
combined deductive–inductive approach.
Results: Five major themes emerged: (1) prescribing approaches, (2) medication preferences, (3)
doctor–patient relationship, (4) addressing psychosomatic factors, and (5) support needs. GPs
preferred cautious prescribing, favouring metamizole and NsaiDs over opioids. chronic pain was
viewed as complex and required individualised, multimodal treatment and shared decision-making.
Decision-making strategies were mainly shaped by guidelines like the WhO analgesic ladder and
personal clinical experience; other guidelines were rarely mentioned. the doctor–patient
relationship was considered essential, particularly in chronic pain contexts. challenges included
managing psychosomatic aspects and aligning treatment expectations.
Conclusion: GPs’ prescribing decisions are shaped by a combination of clinical judgement, patient
dynamics, and systemic factors. the findings highlight the need for practical support tools that
are integrated into daily workflows and emphasise shared decision-making, especially for chronic
pain management. these insights can inform future interventions aimed at optimising prescribing
practices in primary care.
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Except where otherwise noted, this item's license is described as Attribution 4.0 International