Drug Therapy
Advise paracetamol at regular intervals for simple backache.
Substitute NSAIDs (eg ibuprofen or diclofenac) as second line
treatment if paracetamol does not provide adequate pain control.
Consider replacement with paracetamol-weak opioid compound (eg.
codydramol or coproxamol) if neither paracetamol nor NSAIDs provide
adequate pain control.
Consider adding a short course (less than 1 week) of a muscle
relaxant (eg. diazepam) if the above treatments do not provide
adequate pain control.
Avoid narcotics such as morphine, pethidine and pentazocine if
possible, and do not use for more than
2 weeks.
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Paracetamol
and paracetamol-weak opioid compounds prescribed at regular
intervals effectively reduce low back pain. Comparisons of
effectiveness to NSAIDs are inconsistent.
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NSAIDs prescribed
at regular intervals effectively reduce simple backache.
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Different NSAIDs
are equally effective for the reduction of simple backache.
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NSAIDs are
less effective for the reduction of nerve root pain.
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NSAIDs can have
serious adverse effects particularly at high doses and in the
elderly. Ibuprofen, followed by diclofenac, has the lowest
risk of gastrointestinal complications.
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Paracetamol-weak
opioid compounds may be effective alternatives when
paracetamol or NSAIDs alone do not give adequate pain control.
Adverse effects include constipation and drowsiness.
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Muscle relaxants
effectively reduce acute back pain.
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Comparisons of
effectiveness between muscle relaxants and NSAIDs are
inconsistent. There are no comparisons to paracetamol.
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Muscle relaxants
have significant adverse effects including drowsiness and
potential physical dependence even after relatively short
courses (i.e. one week).
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Strong opioids
appear to be no more effective in relieving low back pain
symptoms than safer analgesics such as paracetamol, htmlirin or
other NSAIDs. (C)
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Strong opioids
have significant adverse effects such as decreased reaction
time, clouded judgement, drowsiness and potential physical
dependence. (C)
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