An oral NSAID with the usual provisos is recommended by NICE for low back pain, or a weak opioid with or without paracetamol if a NSAID is contraindicated, not tolerated or ineffective. Paracetamol should not be used alone, nor should SSRIs, SNRIs, TCAs or anticonvulsants. Opioids should not be offered routinely or provided in chronic cases.

Sciatica requires a different approach because it is neuropathic in nature. A choice of amitriptyline, duloxetine, gabapentin or pregabalin should be offered initially, with a switch made if the initial treatment is ineffective or not tolerated. Tramadol may be taken if acute rescue therapy is needed, or capsaicin cream if the pain is localised and the patient wishes or needs to avoid oral formulations.

Among the treatments that NICE states should not be used, unless under the direction of a specialist, are morphine, various anticonvulsants, cannabis extract, capsaicin patches, and long-term tramadol.

The Clinical Knowledge Summary on sciatica states that a short course of benzodiazepine (e.g. low dose diazepam for five days) is an option if the individual has muscle spasm. This is based on a US clinical guideline, but NICE is not keen, highlighting the poor evidence base and highrisk nature of the drug class.