What are the appropriate analgesic options for managing pain in patients with acute fractures in primary care?

For managing pain in patients with acute fractures in primary care, the appropriate analgesic options depend on the patient's age, pain severity, and frailty status.

• Adults (16 years and over): For mild pain, offer oral paracetamol. For moderate pain, offer oral paracetamol combined with codeine. For severe pain, intravenous paracetamol supplemented with intravenous morphine titrated to effect is recommended, though intravenous opioids should be used with caution in frail or older adults. Non-steroidal anti-inflammatory drugs (NSAIDs) may be considered to supplement pain relief except in frail or older adults, where NSAIDs are not recommended.
• Children (under 16 years): For mild to moderate pain, offer oral ibuprofen, oral paracetamol, or both. For moderate to severe pain, intranasal or intravenous opioids are appropriate, with intravenous opioids preferred if intravenous access is established.
• Regular pain assessment using an age-appropriate pain scale is essential to guide analgesic management.
• In all cases, consider non-pharmacological measures such as immobilisation and splinting to aid pain control.

These recommendations align with NICE guidance on non-complex fractures and general analgesia principles in primary care.