Analgesic Prescribing in Medically Complex Adult Outpatients Aged ≥40 Years: A Hierarchical Analysis of Comorbidity-Associated Patterns
5 affiliations
- 1Department of Clinical Practice, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
- 2Department of Pharmacy Practice, College of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- 3Department of Pharmaceutical Care, Northern Borders Cluster, Rafha Centeral Hospital, Rafha 76321, Saudi Arabia
- 4Emergency and Intensive Care Department, College of Nursing, Northern Border University, Arar 73213, Saudi Arabia
- 5Department of Respiratory Therapy, Mohammed Al-Mana College for Medical Sciences, Dammam 34222, Saudi Arabia
Abstract
Background/Objectives: Selecting appropriate analgesic therapy in patients with multimorbidity is increasingly challenging because clinicians must balance pain management against comorbidities, polypharmacy, and medication-related risks. However, evidence describing how analgesic prescribing patterns vary across patients with different multimorbidity profiles in routine outpatient practice remains limited. This retrospective cross-sectional study examined associations between multimorbidity and prescribing patterns across paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids, and identified clinical characteristics associated with different hierarchical analgesic exposure groups among adults aged ≥40 years in Saudi Arabia. Methods: Electronic health record data were analyzed for adults aged ≥40 years attending multiple clinics in the Eastern Region of Saudi Arabia between January 2020 and December 2021. Analgesic exposure at the index outpatient visit was classified using a hierarchical framework into mutually exclusive paracetamol-only, NSAID-priority, opioid-priority, or non-use groups. Multinomial logistic regression was performed to identify clinical characteristics associated with assignment to the hierarchical analgesic exposure groups. Results: Among 41,083 patients, 29,383 (71.5%) received at least one analgesic prescription at the index visit. The NSAID-priority group was the largest exposure category, followed by opioid-priority and paracetamol-only groups. Hierarchical analgesic prescribing patterns differed across patient clinical profiles, with prescribing observed across patients with cardiovascular, metabolic, gastrointestinal, respiratory, and neuropsychiatric disorders. In adjusted analyses, arthritis-related disease was associated with slightly higher odds of NSAID-priority assignment, whereas ischemic heart disease, gastritis-related disease, and respiratory disorders were associated with lower odds of NSAID-priority assignment. Constipation and urinary incontinence were associated with lower odds of opioid-priority assignment. Conclusions: Analgesic prescribing was common among medically complex adult outpatients aged ≥40 years, and hierarchical prescribing patterns differed across patient clinical and comorbidity profiles. The hierarchical framework provided a pragmatic approach for characterizing prescribing across major analgesic classes while accounting for concurrent exposure. Most disease-specific associations were attenuated after multivariable adjustment, and the remaining associations were generally modest in magnitude. Owing to the cross-sectional design and absence of detailed treatment-indication and pain-related information, these findings represent prescribing associations and should not be interpreted as evidence of causal prescribing decisions or treatment appropriateness.
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BibTeX
@article{alqurain2026analgesic,
title = {{Analgesic Prescribing in Medically Complex Adult Outpatients Aged ≥40 Years: A Hierarchical Analysis of Comorbidity-Associated Patterns}},
author = {Aymen Ali Alqurain and Abdulkarim Alshammari and Faten Alhomoud and Farah Kais Alhomoud and Abdulkhaliq J. Alsalman and Mohammad Kanan Alshammari and Hassan Al Gharash and Abdullah Jawad Alshawaf},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208013},
url = {https://www.mdpi.com/2077-0383/15/20/8013},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Analgesic Prescribing in Medically Complex Adult Outpatients Aged ≥40 Years: A Hierarchical Analysis of Comorbidity-Associated Patterns
AU - Aymen Ali Alqurain
AU - Abdulkarim Alshammari
AU - Faten Alhomoud
AU - Farah Kais Alhomoud
AU - Abdulkhaliq J. Alsalman
AU - Mohammad Kanan Alshammari
AU - Hassan Al Gharash
AU - Abdullah Jawad Alshawaf
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208013
UR - https://www.mdpi.com/2077-0383/15/20/8013
AB - Background/Objectives: Selecting appropriate analgesic therapy in patients with multimorbidity is increasingly challenging because clinicians must balance pain management against comorbidities, polypharmacy, and medication-related risks. However, evidence describing how analgesic prescribing patterns vary across patients with different multimorbidity profiles in routine outpatient practice remains limited. This retrospective cross-sectional study examined associations between multimorbidity and prescribing patterns across paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids, and identified clinical characteristics associated with different hierarchical analgesic exposure groups among adults aged ≥40 years in Saudi Arabia. Methods: Electronic health record data were analyzed for adults aged ≥40 years attending multiple clinics in the Eastern Region of Saudi Arabia between January 2020 and December 2021. Analgesic exposure at the index outpatient visit was classified using a hierarchical framework into mutually exclusive paracetamol-only, NSAID-priority, opioid-priority, or non-use groups. Multinomial logistic regression was performed to identify clinical characteristics associated with assignment to the hierarchical analgesic exposure groups. Results: Among 41,083 patients, 29,383 (71.5%) received at least one analgesic prescription at the index visit. The NSAID-priority group was the largest exposure category, followed by opioid-priority and paracetamol-only groups. Hierarchical analgesic prescribing patterns differed across patient clinical profiles, with prescribing observed across patients with cardiovascular, metabolic, gastrointestinal, respiratory, and neuropsychiatric disorders. In adjusted analyses, arthritis-related disease was associated with slightly higher odds of NSAID-priority assignment, whereas ischemic heart disease, gastritis-related disease, and respiratory disorders were associated with lower odds of NSAID-priority assignment. Constipation and urinary incontinence were associated with lower odds of opioid-priority assignment. Conclusions: Analgesic prescribing was common among medically complex adult outpatients aged ≥40 years, and hierarchical prescribing patterns differed across patient clinical and comorbidity profiles. The hierarchical framework provided a pragmatic approach for characterizing prescribing across major analgesic classes while accounting for concurrent exposure. Most disease-specific associations were attenuated after multivariable adjustment, and the remaining associations were generally modest in magnitude. Owing to the cross-sectional design and absence of detailed treatment-indication and pain-related information, these findings represent prescribing associations and should not be interpreted as evidence of causal prescribing decisions or treatment appropriateness.
SN - 2077-0383
ER -