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Pharmaceutical management in simple low back pain

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Pharmacological treatment

  • paracetamol:
    • regular paracetamol is the first option
    • if regular paracetamol alone is insufficient (and taking account of individual risk of side effects and patient preference), offer NSAIDs and/or weak opioids
  • NSAIDS
    • consider risk of side effects, especially in older people and those at increased risk of side effects
    • offer treatment with a standard oral NSAID/ COX-2 inhibitor
      • co-prescribe a PPI for people over 45
  • weak opioids:
    • consider risk of opioid dependence and side effects
    • examples of weak opioids are codeine and dihydrocodeine
  • tricyclic antidepressants:
    • consider if other medications are insufficient
      • start at a low dose and increase up to the maximum antidepressant dosage until:
        • therapeutic effect is achieved or
        • unacceptable side effects prevent further increase
  • strong opioids:
    • consider for short-term use to people in severe pain
    • consider risk of opioid dependence and side effects
    • examples of strong opioids are buprenorphine, diamorphine, fentanyl, oxycodone and tramadol (high dose)
    • consider referral for specialist assessment for people who may require prolonged use of strong opioids

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.

Reference:

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