1. The Research Question
How often do patients with musculoskeletal (MSK) complaints newly treated with NSAIDs, subsequently consult their GP because of an adverse drug reaction (ADR)?
AR Koffeman, AR van Buul, VE Valkhoff, GW ‘t Jong, PJE Bindels, J van der Lei, MCJM Sturkenboom, PAJ Luijsterburg, SMA Bierma-Zeinstra
Why is this important?
GPs frequently treat MSK complaints with NSAIDs
The occurrence of serious NSAID-related ADRs has been studied extensively
Less known about the incidence of non-serious ADRs in primary care and resulting health care utilization in the form of GP consultations

2. What the Researchers Did
Population/Subjects
16, 626 adult patients newly treated with an NSAID by their GP because of a MSK complaint
Design
Cohort study performed within a large electronic healthcare database
Basic Method/Intervention
Manual assessment of the electronic medical record of included patients for the duration of NSAID use (with a maximum of 2 months), to determine whether the GP was reconsulted because of an adverse event
Causality assessment to estimate the likelihood that the adverse events was causally related to the use of the NSAID

3. What the Researchers Found
995 (6%) consulted their GP because of at least one adverse event
In total 1271 adverse events were presented by these 995 patients
The most frequent adverse events presented were dyspepsia (31.3%), dyspnea (12%) and skin reactions (11%)
After causality assessment, 215 adverse events were classified a likely ADR, 515 as a possible ADR
This means that 4% of patients prescribed an NSAID for the treatment of a MSK complaint, subsequently consulted their GP because of a likely or possible ADR

4. What This Means for Clinical Practice
In primary care patients with MSK complains treated with NSAIDs, one in 25 were found to reconsult their GP because of a possible or likely ADR
The true incidence of ADRs is likely to be higher, as not all patients suffering from an ADR will consult their GP; some may choose to discontinue NSAID treatment without further consultation
GPs should address not only the risk of serious ADRs when discussing treatment options for MSK complaints with their patients, but also our finding of reconsultation for non-serious ADRs
Although these non-serious ADRs are less harmful to the patient, they lead to an increase in primary health care utilization and may outweigh the benefits of NSAID treatment for many patients