A step-wise approach
A STEP-WISE APPROACH
NICE Guidelines for the management of mild to moderate pain9 (adults)
The National Institute for Health and Care Excellence (NICE) provides national evidence-based guidance and advice to improve health and social care. The following easy stepwise analgesics ladder was designed to guide healthcare professionals on when to step up and step down the level of pain relief, depending on a patient's individual experience of pain. This guidance is for prescribers, but could be used as a way of determining how to proceed with OTC recommendations.
In terms of OTC options, you can recommend paracetamol, ibuprofen, and combination products such as those containing codeine. A combination product may be recommended when acute moderate pain is not relieved by other analgesics such as paracetamol or ibuprofen alone.
*If the person is unable to take a NSAID, use a full therapeutic dose of a weak opioid, (e.g. codeine) where the dose doesn't exceed 240mg daily.
**If the person is unable to tolerate an NSAID, move straight to step 5 and add paracetamol to a weak opioid.
†Naproxen can only be recommended for period pains for women between the ages of 15-50 years OTC.
€¡Full dose of weak opioid such as codeine 60mg up to four times a day (prescription dose, not P)