Analgesics (or painkillers) are commonly used to manage back pain. Analgesics include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics.
In the US, the UK and Australia, the clinical practice guidelines for management of low back pain recommend regular use of paracetamol as the first choice. When paracetamol provides insufficient pain relief, regular use of NSAIDs is recommended. The Australian guidelines note that oral opioids may be necessary to relieve severe back pain.
In 2009-10, the most common medications prescribed for back problems managed by GPs were (Table 1):
- paracetamol /high dose codeine (paracetamol/opioid analgesic combination containing 30mg of codeine)
- oxycodone (opioid analgesic)
- paracetamol.
Diazepam was also prescribed in the management of back problems by GPs. This medication belongs in the class of medications known as 'anxiolytics', which are often used in the clinical management of anxiety.
Table 1: Medications prescribed per 100 back problems managed by general practitioners, 2009-10
| Medication |
Rate per 100 back problems |
95% CI (a) |
| Opioid analgesic |
42.3 |
38.6–46.0 |
|
Paracetamol/high dose codeine (b) |
12.1 |
10.4–13.8 |
|
Oxycodone |
11.7 |
9.8–13.5 |
|
Tramadol |
8.2 |
6.8–9.7 |
|
Morphine sulphate |
3.4 |
2.5–4.2 |
|
Buprenorphine |
3.1 |
2.2–3.9 |
| Non-opioid analgesic |
9.4 |
7.9–10.9 |
|
Paracetamol |
8.9 |
7.5–10.4 |
|
Paracetamol/low dose codeine |
0.1 |
0.0–0.2 |
| NSAID (c) |
14.1 |
12.3–15.9 |
|
Diclofenac sodium systemic |
3.7 |
2.9–4.6 |
|
Naproxen |
2.0 |
1.3–2.8 |
|
Meloxicam |
4.0 |
3.2–4.9 |
| Anxiolytic (d) |
2.4 |
1.8–3.1 |
|
Diazepam |
2.3 |
1.6–2.9 |
(a) Shows the lower and upper limits of confidence interval. We can be 95% confident that the true value is within the interval.
(b) During the data period 2009–10, the supply of paracetamol/codeine combination analgesics containing 30mg of codeine required doctors' prescription, and these are reported under opioid analgesic. Paracetamol/codeine combination analgesics containing 15mg or less were available without prescription, and these are reported under non-opioid analgesic.
(c) Refers to non-steroidal anti-inflammatory drug.
(d) Refers to medicines used to relieve anxiety.
Notes
1. Information about general practice activities is collected through the Bettering the Evaluation and Care of Health (BEACH) survey. In BEACH surveys, problems managed at general practices are classified according to the second edition of the International Classification of Primary Care (ICPC-2). The ICPC-2 codes used for back problems were L02, L03, L84 and L86.
Source: Family Medicine Research Centre, University of Sydney analysis of BEACH survey 2009–10 data.