Clinician’s Perspectives on the Management of Musculoskeletal Pain in India: Insights into the Use of NSAIDs and Aceclofenac-Paracetamol Combination Therapy

Abstract

Background: Pharmacological management of osteoarthritis (OA) and related musculoskeletal conditions often involves non-steroidal anti-inflammatory drugs (NSAIDs), either alone or in combination with paracetamol, to enhance efficacy and tolerability. Aceclofenac, a widely used NSAID, has gained clinical importance due to its balanced efficacy and safety profile. Objective: The present study gathers clinicians’ perspectives on the management of musculoskeletal pain in India, with a focus on the use of NSAIDs and aceclofenac-paracetamol combination therapies, particularly aceclofenac, in osteoarthritis and rheumatoid arthritis. Methods: This cross-sectional study was carried out using a 24-item questionnaire to gather insights from clinicians across India. The survey focused on clinical experiences, clinician preferences, and observations regarding the use of both monotherapy and combination therapy in managing musculoskeletal pain. Particular attention was given to preferred treatment options, especially NSAIDs alone or in combination with paracetamol. The collected responses were analysed using descriptive statistics. Results: Around 60% of participants reported that the most affected age group with low back pain was 40–50 years. A large majority (83.56%) indicated that knee joint involvement was the predominant site of osteoarthritis in clinical practice, with 81% identifying joint pain and swelling as the most frequent presentation. For osteoarthritis management, 69% of respondents preferred NSAIDs and paracetamol combination therapy as the first-line approach. Among NSAIDs, aceclofenac was the most widely favoured option, reported by 78% of participants, while the aceclofenac–paracetamol combination was strongly preferred by 86.89% for managing arthritic pain. Additionally, 90.8% of respondents perceived aceclofenac to be associated with fewer gastrointestinal side effects. Furthermore, 62% acknowledged the comprehensive advantages of aceclofenac in rheumatoid arthritis, including effective pain and inflammation reduction, chondroprotective potential, and superior synovial joint penetration. Conclusion: The study found that low back pain and knee osteoarthritis were the most common musculoskeletal presentations, especially among middle-aged adults. NSAID–paracetamol combinations, particularly aceclofenac, were strongly preferred for their effectiveness and safety profile. Clinicians also emphasized lifestyle modification as a key adjunct to pharmacological therapy in managing musculoskeletal pain.