Shaping better health
REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Paediatric Joint Formulary

10.3 Pain and inflammation in musculoskeletal disorders

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10.3 Pain and inflammation in musculoskeletal disorders

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
  • 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, cyclo-oxygenase 2 (COX-2) inhibitors or opioids

NSAIDs should be used at the lowest effective dose and long term use should be avoided.

Ibuprofen (TLS Green)

Diclofenac (TLS Amber No SCP)

Naproxen (TLS Amber No SCP)

Mefenamic acid (TLS Amber No SCP)

  • Menorrhagia / dysmenorrhoea

Indometacin (TLS Amber No SCP)

  • Higher incidence of side effects in children, only to be used when other NSAIDs have failed

Etoricoxib (TLS Amber No SCP)

Ketorolac (TLS Amber No SCP)

Meloxicam (TLS Red)

  • For use by anaesthetic staff only