BNSSG Adult Joint Formulary
10.4 Pain and inflammation in musculoskeletal disorders
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| First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Non-steroidal anti-inflammatory drugs
Link to BNF Non-steroidal anti-inflammatory drugs
- See MHRA guidance on Cardiovascular Safety of Cox-2 inhibitors and non-selective NSAIDs
- Please also refer to NICE guidance CG177 and NICE guideline NG100
- Healthcare professionals should consider offering paracetamol for pain relief in addition to core treatments; regular dosing may be required. Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs, cyclooxygenase 2 (COX-2) inhibitors or opioids.
- The combination of a NSAID and low-dose aspirin can increase the risk of gastrointestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.
- NSAIDs should be used at the lowest effective dose and long term use should be avoided.
Ibuprofen (TLS Green)
Naproxen (TLS Green)
Alternatives: (TLS Blue)
Diclofenac
Indometacin
Nabumetone
Specific indications: (TLS Blue)
Mefenamic acid
- Menorrhagia / dysmenorrhoea
Ketorolac
- For use by anaesthetic staff only
Meloxicam
Etodolac
Celecoxib
Etoricoxib
Topical NSAIDs
Recommended: (TLS Green)
Ibuprofen 5% gel - use should be reviewed after 14 days
Alternative: (TLS Blue)
Piroxicam 0.5% gel
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