What are the recommended analgesic options for managing acute abdominal pain in primary care?

For managing acute abdominal pain in primary care, a full clinical assessment should precede the provision of regular analgesia for continuous pain ¹. It is generally recommended to avoid combination analgesics as first-line treatment, preferring single-constituent analgesics to allow independent titration ¹. Fixed-dose combination analgesics with low-dose opioids (e.g., codeine 8 mg plus paracetamol 500 mg) are not more effective than paracetamol alone and can cause opioid side effects ¹.

For specific causes of acute abdominal pain:

• Gallstones (Biliary Colic): Most symptomatic gallstone attacks are self-limiting and can often be managed in primary care with appropriate analgesia ³. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ketoprofen, or indomethacin have analgesic effects and can reduce the risk of acute cholecystitis ³. If an opioid is required, buprenorphine may be preferred as it appears to contract the sphincter of Oddi less than morphine ³.
• Dysmenorrhoea (Menstrual Pain): For primary dysmenorrhoea, a nonsteroidal anti-inflammatory drug (NSAID) should be offered unless contraindicated ⁴. Paracetamol can be offered if NSAIDs are contraindicated, not tolerated, or if the response to an NSAID is insufficient ⁴. Hormonal contraceptives can be considered as an alternative first-line treatment if the woman does not wish to conceive ⁴. A combination of an NSAID (or paracetamol) and hormonal contraception may be considered if individual treatments are insufficient ⁴. Non-drug measures like local heat application and transcutaneous electrical nerve stimulation (TENS) may also help ⁴.
• Bowel Colic due to Constipation: Certain causes of colicky pain, such as bowel colic due to constipation, may be treatable in primary care ².

It is important to note that these recommendations apply to acute pain. For chronic primary pain in individuals aged 16 years and over, non-steroidal anti-inflammatory drugs, opioids, and paracetamol should not be initiated ⁷.