Pharmaceutical management in simple low back pain

Pharmacological management of low back pain

• consider oral NSAIDs for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person's risk factors, including age
  
• when prescribing oral NSAIDs for low back pain, think about appropriate clinical assessment, ongoing monitoring of risk factors, and the use of gastroprotective treatment
  
• prescribe oral NSAIDs for low back pain at the lowest effective dose for the shortest possible period of time
  
• consider weak opioids (with or without paracetamol) for managing acute low back pain only if an NSAID is contraindicated, not tolerated or has been ineffective
  
• 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
  
• do not offer selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors or tricyclic antidepressants for managing low back pain
  
• do not offer gabapentinoids or antiepileptics for managing low back pain

For NICE guidance regarding management of chronic pain (pain that lasts for more than 3 months) then see linked item.

Reference:

• 1. NICE (July 2026).Low back pain - Early management of persistent non-specific low back pain