Help patients tackle mild to moderate pain

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Published by TDP on February 3, 2023

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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Help patients tackle mild to moderate pain

1 / 6

1) Which of the following statements about Nuromol Pain Relief is TRUE?

A. Nuromol Pain Relief releases ibuprofen and paracetamol simultaneously to deliver a combination effect

B. All of these

C. For mild-to-moderate pain not relieved by ibuprofen or paracetamol alone, you can recommend Nuromol Pain Relief

D. Nuromol Pain Relief provides statistically superior pain relief than a 1g paracetamol + 30mg codeine combination for up to 12 hours

2 / 6

2) What percentage of customers are seeking a better solution to treat or manage their pain?

A. 20%

B. 30%

C. 10%

D. 40%

3 / 6

3) Which of the following statements is FALSE?

A. A Cochrane review found the risk ratio for adverse events with paracetamol and ibuprofen to be comparable

B. A Cochrane review found ibuprofen to be more effective at relieving pain over 4-6 hours compared with paracetamol

C. NICE guidelines recommend that paracetamol alone can be offered for low back pain

D. Fast-acting ibuprofen formulations have a higher success rate than standard ibuprofen or paracetamol

4 / 6

4) Which of the following customers with back pain should be referred to their GP?

A. All of these

B. The pain is severe or getting worse over time

C. Back pain does not improve after treating it at home for a few weeks

D. The pain is stopping them doing their day-to-day activities

5 / 6

5) What is the maximum number of Ibuprofen 400mg Capsules/Tablets that an adult can take in a 24-hour period?

A. 4

B. 3

C. 6

D. 8

6 / 6

6) Which of the following analgesics is NOT recommended by NICE for the acute treatment of tension-type headache?

A. Codeine

B. Ibuprofen

C. Aspirin

D. Paracetamol

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