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Analgesic pathway

These initial analgesic steps should be used initially.  Always also consider whether there may be an element of neuropathic pain and if so consider the use of the Neuropathic Pain Treatment Pathway.


Analgesic Ladder for Acute and Chronic Pain

Step 1

Simple and compound painkillers and nonsteroidal anti-inflammatory drugs.


Paracetamol 1g qds - used regularly.


NSAIDs such as ibuprofen.


Consider Non-drug Treatments such as TENS.


Step 2


Medication in STEP 1, plus


Consider adding weak opioids, such as tramadol or codeine phosphate.


If after these steps the pain has not settled, consider: 


  • Whether the pain is neuropathic (see Neuropathic Pain Treatment Pathway).
  • Whether referral to a multi-disciplinary Pain Clinic or another specialist is appropriate.
  • The use of stronger opioids.

Consider referral to specialist pain service.



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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]

Page updated 19/02/2016