NICE guideline NG59 on lower back pain includes recommendations around non-drug and drug approaches. In terms of pharmacotherapy, the first-line approach is to try NSAIDs. Prescribing should again reflect the patient's health status and comorbidities, with €ongoing monitoring of risk factors, and the use of gastroprotective treatment€.22

In terms of what should be offered, it says:

·       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.

In addition, it recommends against using opioids, antidepressants or anti-epileptics:

·       Do not routinely offer opioids for managing acute low back pain;

·       Do not offer opioids for managing chronic low back pain;

·       Do not offer SSRIs, SNRIs or tricyclic antidepressants for managing low back pain;

·       Do not offer anticonvulsants for managing low back pain.