What are the current guidelines for the pharmacological management of thoracic back pain in adults?

Current guidelines for the pharmacological management of thoracic back pain in adults:

There are no specific UK NICE guidelines dedicated solely to thoracic back pain pharmacological management; however, the principles for managing back pain generally apply. For adults with thoracic back pain, pharmacological treatment should be cautious and aligned with low back pain and sciatica guidelines, as thoracic back pain is less commonly addressed separately.

Oral non-steroidal anti-inflammatory drugs (NSAIDs) may be considered for managing thoracic back pain, taking into account the person's risk factors such as gastrointestinal, liver, and cardio-renal toxicity, and using the lowest effective dose for the shortest possible period of time.

Paracetamol alone is not recommended for managing back pain.

Weak opioids may be considered only if NSAIDs are contraindicated, not tolerated, or ineffective, and only for acute pain; opioids are not recommended for chronic back pain.

Gabapentinoids, other antiepileptics, oral corticosteroids, benzodiazepines, and antidepressants (including SSRIs, SNRIs, and tricyclics) are not recommended for managing back pain due to lack of evidence of benefit and potential harm.

Shared decision-making with the patient about the risks and benefits of pharmacological treatments is essential.

Non-pharmacological treatments and self-management should be prioritized alongside any pharmacological approach.

In summary, pharmacological management of thoracic back pain in adults should primarily involve cautious use of NSAIDs, avoidance of paracetamol alone, limited use of weak opioids only when necessary, and avoidance of gabapentinoids, antidepressants, and other agents without proven benefit.

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