If there are Red flag symptoms and signs that may suggest a serious underlying cause, admit or refer urgently for specialist assessment
What is pain? Pain may be defined as an unpleasant sensory or emotional experience associated with actual or potential tissue damage. Controlling pain, whether acute or chronic, is a difficult task as pain is a very subjective phenomenon; what might be painful to one person may not be painful to another.
The successful drug management of pain relies on selecting the appropriate drug at the correct dosage and balancing efficacy against adverse effects. For this reason, the World Health Organization introduced the concept of the ‘analgesic ladder’ (scale that describes an ascending order of drug therapy to match the degree of pain). The Analgesic Ladder: −
The National Insititute of Health and Care Excellence (NICE) give guidelines for pharmaceutical management of low back pain. Please see here and for more details other sections of this page.
Prescribe oral NSAIDs for low back pain at the lowest effective dose for the shortest possible period of time.
Consider weak opioids (with or without paracetamol) for managing acute low back pain only if an
NSAID is contraindicated, not tolerated or has been ineffective.
Non-opioid analgesics (e.g. Aspirin, Paracetamol, non-steroidal anti-inflammatory drugs (e.g. Ibuprofen). If anticipation of pain can be abolished, it may not be necessary to step up to morphine derived drugs (opioid). Paracetamol and Ibuprofen are available from chemists without a prescription. Follow the suggested dosage. You should not take Ibuprofen of you are allergic to Aspirin, suffer stomach ulcers or suffer asthma exacerbated by non steroidal drugs such as Ibuprofen. –
Mild opioids (e.g. codeine): Codeine/ Dihdrocodeine/ Tramadol - effective for the relief of mild-to-moderate pain but is too constipating for long-term use. Your doctor may give you a combination of paracetamol and codeine, which can be very effective. The main side-effects of all opioids are nausea, vomiting, constipation, drowsiness, and, in larger doses, shallow breathing and low blood pressure.
Strong opioids: Useful for moderate-to-severe pain, particularly of organ origin. These are reserved for inpatient treatment and will not be prescribed for people leaving hospital unless discussed with a senior Emergency Department doctor.
The first is Bandolier, which is an Oxford University Evidence Based Medicine - Pain web site. Evidence Based medicine is what underlies all good practice in NHS and non-NHS healthcare practice in the UK.
The second is the NICE guidelines on back pain management. The National Institute for health & Care Excellence (NICE) is what underlies all NHS medical practice as it is evidence based. Please see below PDF of guidelines for pharmaceutical management of low back pain.
Long term pain over 6 months is usually described as chronic pain. Please watch this video to help you gain an overview of how pain management is tailored to your individual situation and requirements. Often this includes lifestyle changes with the patient playing an active role in their own management as well as medication and other effective interventions.
The respected organisation, The Arthritis Research UK (www.arthritisresarchuk.org now www.versuarthritis.org) says that CBD and omega 3 oils can be considered as a self-help pain and condition management. There specific advice is below.
CBD is type of cannabinoid – a natural substance extracted from the cannabis plant and often mixed with an oil (such as coconut or hemp) to create CBD oil. It does not contain the psychoactive compound called tetrahydrocannabidiol (THC) which is associated with the feeling of being ‘high’.Research in cannabinoids over the years suggests that they can be effective in treating certain types of chronic pain such as pain from nerve injury, but there is currently not enough evidence to support using cannabinoids in reducing musculoskeletal pain. We welcome further research to better understand its impact and are intently following developments internationally.CBD oil can be legally bought as a food supplement in the UK from heath food shops and some pharmacies. However, CBD products are not licensed as a medicine for use in arthritis by MHRA (Medicines and Healthcare products Regulatory Authority) or approved by NICE (National Institute for Health and Care Excellence) or the SMC (Scottish Medicines consortium).We know anecdotally from some people with arthritis, that CBD has reduced their symptoms. If you’re considering using CBD to manage the pain of your arthritis, it’s important to remember it cannot replace your current medicines, and it may interact with them, so please do not stop/start taking anything without speaking to a healthcare professional.
Fish oils are rich in omega-3 essential fatty acids, which have strong anti-inflammatory properties. Fish liver oil is also a rich source of vitamin(a strong antioxidant) and vitamin (which is important for maintaining healthy joints).Evidence suggests that fish body oil can improve the symptoms of rheumatoid arthritis. Unconfirmed evidence also suggests a combination of fish body and liver oils might also be useful in the long term, particularly in reducing the use of non-steroidal anti-inflammatory drugs (NSAIDS. There isn’t enough evidence for the use of fish liver oil for.Omega-3 fatty acids also play a role in lowering cholesterol and triglyceride levels in your blood, so they can reduce the risk of heart disease and stroke in people with inflammatory arthritis.In the UK, dietary guidelines recommend eating two portions of fish a week, including one oily. Fish oil is considered to be well tolerated at this dose. However, certain environmental chemicals such as methylmercury and polychlorinated biphenyls (PCBs) can contaminate fish supplies and there’s a concern that taking very high doses of fish oil can cause a build-up of these chemicals in the body. At the correct doses, side-effects are usually minor and uncommon.A build up of toxins due to use of omega 3 from fish can be completely overcome now buy using algal oil derived omega 3 – which is the source of all omega 3 essential fatty acids.
Please see this video to help you understand more about the level of pain you are feeling, from the problem you have, say sciatica for example - one patients pain maybe a lot less, or a lot more, than another patient. This is because we all experience pain in slightly different ways. To help us understand your pain, you may be asked to rate your pain on a visual scale of 0 to 10 faces – 0 being a very happy face and 10 being a very sad face or rank your pain verbally, as no pain, mild pain, moderate pain, severe pain and unbearable pain. Or even a simple number scale from 0 to 10. This is done each time the patient presents for assessment and treatment and helps both the patient to see their progress and the healthcare practitioner.