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The impact of a self-management app for musculoskeletal conditions on prescribing for pain management: A synthetic control study in English primary care
ABSTRACT
Background:
Musculoskeletal (MSK) conditions such as arthritis and back pain affect nearly a third of the UK population and are a leading cause of primary care consultations and work absence. Despite limited evidence of long-term benefit, strong opioids remain commonly prescribed for MSK-related pain, raising concerns about safety and appropriateness. Digital self-management tools are increasingly promoted to support patients and reduce reliance on pharmacological treatments. However, evidence of their system-level impact, particularly on prescribing behaviour, remains limited.
Objective:
To evaluate the impact of a digital self-management app for MSK conditions on prescribing trends for pain management in English primary care. By focusing on prescribing as a system-level outcome, we aimed to assess whether the app’s integration into care pathways is associated with measurable reductions in prescribing, notably in opioid use
Methods:
We conducted a retrospective observational study using prescribing data from the OpenPrescribing database (April 2021 to December 2024). Thirteen integrated care systems (ICSs) that commissioned the app (intervention ICS) were compared with 24 ICSs that did not (non-intervention ICS). Prescribing rates for five drug categories commonly used for MSK conditions were calculated per 10,000 MSK-population. A generalised synthetic control method was used to estimate causal effects by constructing counterfactual trends for intervention ICS. Subgroup and sensitivity analyses explored the influence of app uptake and alternative definitions of intervention start dates.
Results:
Prescribing rates for MSK-related medications declined nationally over the study period, with intervention ICSs consistently showing lower rates than non-intervention ICS, except for paracetamol. Compared to the counterfactual, intervention ICS had a 1.43% lower proportion of strong opioids prescribed over the first 24 months post-rollout (95% CI: -2.46% to -0.40%). This effect was more pronounced in the second year and in ICSs with higher app uptake. Prescribing rates for other drug categories showed negative trends but did not reach statistical significance.
Conclusions:
Our findings indicate a modest but significant system-level impact of the app on prescribing behaviour. This effect aligns with national initiatives such as NHS England’s, Action Plan for Addictive Medicines, the Medicines Improvement Programme and NICE guidance discouraging opioid use for chronic pain. Although the app was not designed to directly influence prescribing, its integration into care pathways and emphasis on self-management may contribute to broader shifts in clinical practice. While attribution is challenging in system-level analyses, these results strengthen the evidence base for digital MSK care and may inform future commissioning and service planning aimed at promoting safer, more effective pain management in primary care.
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