Patients’ experiences of analgesic use for chronic musculoskeletal pain in primary care: An interview study in Germany

BACKGROUND: Chronic musculoskeletal pain is a leading cause of primary care consultations and presents challenges for analgesic prescribing across health systems. While pharmacological treatments are widely used, little is known about patients' experiences with non-opioid analgesics and their preferences for involvement in treatment decision-making. METHODS: This qualitative study used semi-structured interviews with 17 patients with chronic musculoskeletal pain recruited from primary care practices in Germany. Interviews were audio-recorded, transcribed verbatim, and analysed thematically following Braun and Clarke's approach using a combined inductive-deductive coding strategy. Coding was conducted by two researchers with iterative consensus discussions. A patient advisory board contributed to study design and interpretation. RESULTS: Analgesics were described as situational adjuncts rather than standalone treatments, with non-pharmacological strategies often prioritised. Participants expressed three orientations towards analgesics: accepting, cautious and explicitly multimodal. Non-opioid analgesics - particularly metamizole - were commonly used, while opioids played a minor role. Patients' decision-making processes ranged from autonomous to delegated and were shaped by trust in clinicians and symptom burden. Information about risks was inconsistently reported, and continuity of care was central to confidence in analgesic use. CONCLUSION: Analgesic use in chronic musculoskeletal pain is shaped by dynamic decision-making processes, trust and continuity of care. These findings highlight the importance of clear risk communication and relational continuity in supporting patient-centred analgesic management in primary care.