Analgesia
As far as medication is concerned
- paracetamol is the first line medication (although there is limited evidence regarding its efficacy)
- if paracetamol alone does not provide sufficient pain control offer
- non steroidal anti-inflammatory drugs (NSAIDs) and/or
- weak opioids
- consider potential benefits and risks of these medications and patient preference when prescribing medications
- if NSAIDs or COX-2 inhibitors are prescribed to people over age 45 years consider the need to prescribe a proton pump inhibitor (PPI)
- consider co-prescribing a laxative with opioids to counteract the constipating effect of opioids, as straining to defaecate may aggravate back pain
- aim for the lowest dose required for relief of symptoms
- when prescribing opioids, short-acting agents given at regular intervals rather than on a pain-contingent basis is recommended
- evidence suggests that NSAIDS have some effect for short-term pain relief compared with placebo, but there are no benefits compared to paracetamol, narcotic analgesics or muscle relaxants