What are the recommended analgesic options for managing acute abdominal pain in primary care?

For managing acute abdominal pain in primary care, a full clinical assessment should precede the provision of regular analgesia for continuous pain NICE CKS. It is generally recommended to avoid combination analgesics as first-line treatment, preferring single-constituent analgesics to allow independent titration NICE CKS. Fixed-dose combination analgesics with low-dose opioids (e.g., codeine 8 mg plus paracetamol 500 mg) are not more effective than paracetamol alone and can cause opioid side effects NICE CKS.

For specific causes of acute abdominal pain:

• Gallstones (Biliary Colic): Most symptomatic gallstone attacks are self-limiting and can often be managed in primary care with appropriate analgesia NICE CKS. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ketoprofen, or indomethacin have analgesic effects and can reduce the risk of acute cholecystitis NICE CKS. If an opioid is required, buprenorphine may be preferred as it appears to contract the sphincter of Oddi less than morphine NICE CKS.
• Dysmenorrhoea (Menstrual Pain): For primary dysmenorrhoea, a nonsteroidal anti-inflammatory drug (NSAID) should be offered unless contraindicated NICE CKS. Paracetamol can be offered if NSAIDs are contraindicated, not tolerated, or if the response to an NSAID is insufficient NICE CKS. Hormonal contraceptives can be considered as an alternative first-line treatment if the woman does not wish to conceive NICE CKS. A combination of an NSAID (or paracetamol) and hormonal contraception may be considered if individual treatments are insufficient NICE CKS. Non-drug measures like local heat application and transcutaneous electrical nerve stimulation (TENS) may also help NICE CKS.
• Bowel Colic due to Constipation: Certain causes of colicky pain, such as bowel colic due to constipation, may be treatable in primary care NICE CKS.

It is important to note that these recommendations apply to acute pain. For chronic primary pain in individuals aged 16 years and over, non-steroidal anti-inflammatory drugs, opioids, and paracetamol should not be initiated NICE NG193.