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Chronic low back pain management — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsChronic low back pain managementGPhC CRA

A 58-year-old man with chronic low back pain is currently taking regular paracetamol 1 g four times daily with limited benefit. He asks the pharmacist for advice on stronger pain relief. He has no other medical conditions and takes no other medications. What is the most appropriate next step?

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Correct answer: A — Refer to the GP for assessment and discussion of multimodal pain management including exercise, physiotherapy, and consideration of appropriate pharmacotherapy

NICE CG59 and NG59 recommend a multimodal approach to chronic low back pain, with emphasis on exercise, physiotherapy, and psychological support. Simply escalating analgesics without a comprehensive assessment is not recommended. The GP can assess for underlying causes, consider whether the pain has neuropathic features, and develop an appropriate management plan. OTC escalation to higher-dose opioids without GP input is inappropriate for chronic pain.

Reference: NICE NG59 Low Back Pain; BNF