Help patients tackle mild to moderate pain

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Published by TDP on February 3, 2023

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

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

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