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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 .

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 .

Do not offer paracetamol alone for managing low back pain .

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

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