Barriers and facilitators to reducing paracetamol use in low back pain: A qualitative study

Thomas Patterson; Paula R Beckenkamp; Justin Turner; Danijela Gnjidic; Barbara Mintzes; Carol Bennett; Lisa Bywaters; Ornella Clavisi; Melissa Baysari; Manuela Ferreira; Paulo Ferreira

doi:10.1016/j.msksp.2023.102856

Barriers and facilitators to reducing paracetamol use in low back pain: A qualitative study

Musculoskelet Sci Pract. 2023 Oct:67:102856. doi: 10.1016/j.msksp.2023.102856. Epub 2023 Sep 6.

Authors

Affiliations

¹ The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia. Electronic address: tpat9766@uni.sydney.edu.au.
² The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia.
³ University of Montreal, Faculty of Pharmacy, Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada.
⁴ The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, A15, Science Rd, Camperdown, NSW, 2006, Australia.
⁵ Painaustralia, Unit 6/42 Geils Ct, Deakin ACT, 2600, Australia.
⁶ Consumer Services for Musculoskeletal Australia, 263-265 Kooyong Rd, Elsternwick, VIC, 3185, Australia.
⁷ The University of Sydney, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW, 2006, Australia.
⁸ The University of Sydney, Sydney Musculoskeletal Health and the Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, St Leonards, NSW 2064, Australia.

PMID: 37696066
DOI: 10.1016/j.msksp.2023.102856

Abstract

Background: Paracetamol is widely used for low back pain (LBP), but research questions its efficacy and safety. Patient education booklets have been explored for promoting deprescribing, but barriers and facilitators specific to LBP deprescribing remain unexamined.

Objective: To identify contextual factors facilitating and obstructing successful deprescribing of paracetamol for LBP after receiving an educational booklet.

Study design: This study is part of an uncontrolled cohort feasibility study (CEASE NOW) in the community, recruiting from Musculoskeletal Australia and painaustralia.

Patient sample: Twenty-four participants with acute, sub-acute, or chronic LBP, self-reporting paracetamol consumption, were included.

Methods: Thematic content analysis was used to analyze qualitative data on barriers and facilitators. Data were categorized by deprescribing outcomes: i) successful deprescribing, ii) attempted but failed, or iii) no attempt. Semi-structured telephone interviews were conducted within one week after each participant completed the one-month follow-up.

Results: Successful deprescribing was facilitated by supportive healthcare professionals, willingness, high self-efficacy, fear of future illness, and diverse strategies for deprescribing plans. Barriers included unsupportive healthcare professionals and fear of flare-ups. Participants not attempting deprescribing believed it unnecessary, perceived it as effortful, unquestioningly trusted healthcare professionals, and lacked risk awareness.

Conclusions: Support from healthcare professionals, patient willingness, perceived necessity, risk awareness, effort, and varied strategies influence deprescribing outcomes for LBP patients using paracetamol. Addressing these factors is crucial when designing interventions to promote safe and effective deprescribing in LBP management.

Keywords: Analgesics; Barriers; Consumer; Deprescribing; Education; Facilitators; Low back pain; Paracetamol; Qualitative.

MeSH terms

Acetaminophen* / therapeutic use
Health Personnel
Humans
Low Back Pain* / drug therapy
Qualitative Research
Self Report

Substances

Acetaminophen