What are the current guidelines for the pharmacological management of acute low back pain in primary care?

For the pharmacological management of acute low back pain in primary care, NICE recommends using the lowest effective dose of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, for the shortest possible duration, if there are no contraindications ¹.

If NSAIDs are contraindicated, not tolerated, or ineffective, consider short-term use of codeine with or without paracetamol, taking into account the risks of dependence and adverse effects ¹.

Do not offer paracetamol alone for managing low back pain ¹.

Opioids, benzodiazepines, gabapentinoids, antiepileptics, and antidepressants are not recommended for acute low back pain ¹.