- Prescribing Advice for GPs - https://www.prescriber.org.uk -

Analgesia

The safety of NSAIDs is under constant review at the moment following the concerns raised by the withdrawal of some of the newer COX-II Selective NSAIDs. The MHRA review has already been reported on this site.

All interventions made by the NHS, including prescribing drugs, involves an assessment of the risks of the intervention and the likely benefits. The spotlight on NSAID safety has made us all aware of the gastro-intestinal, renal and cardio-vascular risks associated with all NSAIDs.

It is therefore timely to consider a greater use of analgesics that are not NSAIDs. Using a stepped approach to analgesia with Paracetamol as a core component would be a rational approach in all conditions that are not inflammatory for the majority of the time, for example osteoarthritis.

Action: Where analgesia is required for uncomplicated pain, use the following ladder approach before considering NSAIDs or other alternative treatments.

  1. Paracetamol 500mg tablets, Two four times a day when required
  2. Co-codamol 8/500mg tablets, Two four times a day when required
  3. Co-dydramol 10/500mg tablets, Two four times a day when required
  4. Co-codamol 30/500mg tablets, Two four times a day when required

Note: This approach does not apply to complicated pain, for example Rheumatoid Arthritis, Cancer Pain and Trigeminal Neuralgia