The National Institute for health and Care Excellence (NICE) has produced guidance for the management of different types of pain.
Check below for a brief summary of what the NICE guidance recommends.
MILD-TO MODERATE PAIN
Analgesia – mild-to-moderate pain
For adults and children aged over 16 years, a stepwise strategy for managing mild-to-moderate pain is recommended:
Step 1- paracetamol should be used
Step 2- paracetamol should be substituted with ibuprofen or, if ibuprofen is unsuitable, a weak opioid (such as codeine)
Step 3- paracetamol should be added to ibuprofen or the weak opioid
Step 4- paracetamol should be continued and ibuprofen replaced with an alternative non-steroidal anti-inflammatory drug (NSAID)
Step 5- a weak opioid should be started in addition to paracetamol and/or an NSAID
LOW BACK PAIN
Low back pain (without sciatica)
- Offer an NSAID such as ibuprofen, if there are no contraindications
- An NSAID should be used at the lowest effective dose for the shortest possible time
- If an NSAID is contraindicated, not tolerated or ineffective, offer codeine with or without paracetamol, taking into account the risk of opioid dependence and adverse effects such as constipation
- DO NOT offer paracetamol alone for managing low back pain
- DO NOT routinely offer opioids for managing acute low back pain
- DO NOT offer opioids for managing chronic low back pain
TENSION HEADACHE
Headaches in over 12s
Acute treatment of tension-type headache
- Consider aspirin, paracetamol or an NSAID for the acute treatment of tension-type headache, taking into account the person’s preference, comorbidities and risk of adverse events
- Because of the association with Reye’s syndrome, preparations containing aspirin should not be offered to under 16s
- DO NOT offer opioids for the acute treatment of tension-type headache
Assessment
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Really interesting!