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