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A different approach to pain

NICE guidance

When to refer

Assessment

module menu icon NICE guidance

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module menu icon NICE guidance

NICE GUIDANCE

The National Institute for health and Care Excellence (NICE) has produced guidance for the management of different types of pain.

Click on each of the tabs below for a brief summary of what the NICE guidance recommends.

MILD-TO
MODERATE PAIN
LOW
BACK PAIN
TENSION
HEADACHE

Analgesia – mild-to-moderate pain4

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 (without sciatica)5

  • 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

Headaches in over 12s6
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

P
Ibuprofen 400mg

For customers wanting fast and effective pain relief, you can recommend Nurofen Express Liquid Capsules.

Nurofen Express starts to get to work within 8 minutes* and lasts up to 8 hours**

*Refers to absorption
**Based on a 400mg dose

P
Ibuprofen 200mg + Paracetamol 500mg

For the temporary relief of mild-to-moderate pain you can recommend Nuromol Pain Relief. It is especially suitable for pain that has not been relieved by ibuprofen or paracetamol alone.

1 x Nuromol Pain Relief 200mg/500mg film coated tablet was significantly more effective than combinations of paracetamol and codeine† up to 12 hours and is not known to cause addiction7

†paracetamol 1000mg + codeine 30mg

A different approach to pain

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