10.4 Pain and inflammation in musculoskeletal disorders
|First line drugs||Second line drugs||Specialist drugs||Secondary care drugs|
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)
Specific indications: (TLS Blue)
- Menorrhagia / dysmenorrhoea
- For use by anaesthetic staff only
Recommended: (TLS Green)
Ibuprofen 5% gel - use should be reviewed after 14 days
Alternative: (TLS Blue)
Piroxicam 0.5% gel
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