Mild to moderate pain in adults

Mild to moderate pain of various origins not requiring opioids. First-line: paracetamol or NSAIDs when appropriate.

ICD-10 R5213 drugs

Also known as: Mild pain, Moderate pain

Drugs used for this condition

ADexketoprofenFirst line · Non-steroidal anti-inflammatory drugs, propionic acid derivativesDexketoprofen 25 mg orally or 50 mg IM/IV is first-line therapy for acute mild-to-moderate pain: postoperative pain, dental pain, primary dysmenorrhea, musculoskeletal pain. Cochrane review Barden 2009 (10 RCTs, n=2155) showed NNT=3.2 for 20–25 mg in postoperative pain – comparable to other NSAIDs. Advantage of dexketoprofen is faster onset (30 minutes vs 60 minutes for ibuprofen and paracetamol). Maximum daily dose 75 mg (three 25 mg doses). Treatment course should not exceed 7 days.
ADiclofenacFirst line · Non-steroidal anti-inflammatory drugs (NSAIDs)Diclofenac 50 mg 2–3 times daily or 75 mg twice daily is one of the most effective NSAIDs for pain of various origins. Maximum daily dose 150 mg. Surpasses ibuprofen in analgesic potency. Short course of 5–7 days is preferred. If prolonged use is needed, cardiovascular and gastrointestinal risk must be assessed.
AIbuprofenFirst line · Non-steroidal anti-inflammatory drugs (NSAIDs)Ibuprofen 200–400 mg every 6–8 hours is one of the most studied NSAIDs for mild to moderate pain. Maximum OTC daily dose is 1200 mg, up to 2400 mg under medical supervision. Superior to paracetamol for inflammatory pain. Taking with food reduces dyspepsia risk.
AKetoprofenFirst line · Non-steroidal anti-inflammatory drug, propionic acid derivativeKetoprofen covers acute mild to moderate pain in adults: musculoskeletal, dental, and primary dysmenorrhoea. That is how the AEMPS Fastum label frames its indications. The rule common to every NSAID applies: the smallest dose for the shortest time, because the risk of ulcer, perforation and bleeding rises with both dose and duration. The label lists the combinations that raise that risk: a second NSAID or high-dose salicylates, anticoagulants, antiplatelet drugs, SSRIs and systemic corticosteroids. The second weak point is the kidney: in older patients, in dehydration and alongside a diuretic, an ACE inhibitor or a sartan, ketoprofen can drop filtration as far as acute injury. With lithium and methotrexate the label calls for level monitoring and blood counts.
ALornoxicamFirst line · Non-steroidal anti-inflammatory drug, oxicamThe AEMPS Lornoxicam Rapid Meiji label states the indication tightly: short-term symptomatic relief of acute mild to moderate pain in adults. After the first day the daily dose stays at or below 16 mg, and in renal or hepatic impairment dosing drops to once daily. Food delays absorption and cuts it by roughly 20%, so in acute pain the tablet does not go down with a meal. The interaction section lists what real prescriptions carry all the time: another NSAID and an antiplatelet drug raise gastrointestinal bleeding risk, a corticosteroid raises ulcer and bleeding risk, a quinolone antibiotic raises seizure risk. Lithium, methotrexate, ciclosporin and tacrolimus call for level monitoring or renal function checks.
AParacetamolFirst line · Anilides. Analgesics and antipyreticsMild to moderate pain is a core indication. Adults: 500–1000 mg every 4–6 hours, up to 4 g/day in healthy adults, up to 3 g/day in the elderly, chronic alcohol users, or malnourished patients. Paracetamol is less effective than NSAIDs for inflammatory pain (osteoarthritis, dysmenorrhea) but is preferred in patients with NSAID contraindications: peptic ulcer, anticoagulants, renal failure, heart failure, aspirin-exacerbated respiratory disease.
BAceclofenacSecond line · NSAID, acetic acid derivative, COX-1/COX-2 inhibitorUsed in acute pain (dental, postoperative, musculoskeletal) in courses up to 7 days. Dose 100 mg twice daily. Effective in dysmenorrhea.
BEtoricoxibSecond line · Selective COX-2 inhibitor (coxib)Used in acute pain (dental, postoperative, musculoskeletal) in courses up to 8 days. Dose 90–120 mg once daily. Efficacy is comparable to ibuprofen 600 mg four times daily with better GI tolerability.
BTapentadolSecond line · Opioid analgesic with dual mechanismIn acute moderate-to-severe pain (postoperative, musculoskeletal), the immediate-release form is used at 50–100 mg every 4–6 hours. Course is limited to a few days to prevent dependence. Not first-line – paracetamol and adequate NSAID dosing come first.
BTramadolSecond line · Other opioidsTramadol is a step-2 WHO-ladder opioid analgesic, effective for moderate pain when paracetamol and NSAIDs are insufficient. For mild pain it is not the first choice; non-opioids come first. It carries real risks: dependence and withdrawal, serotonin syndrome (especially with antidepressants), a lowered seizure threshold, and nausea. Use it as a short course at the lowest effective dose.
CCaffeineAdd-on therapy · Psychostimulant, xanthine derivativeCaffeine does not relieve pain by itself but strengthens an analgesic – that is what the Spanish combinations Cafiaspirina and Actron Compuesto rest on. The Cochrane review by Derry and colleagues (2014) pooled 20 studies in 7238 participants: adding 100 mg of caffeine or more to paracetamol or ibuprofen increased the share of patients with good pain relief by roughly 5 to 10 percent compared with the analgesic alone. The gain is small but real, and for some people it turns «almost helped» into «helped». Two caveats. First, caffeine from a tablet adds to coffee and energy drinks, and the daily limit from the 2015 EFSA assessment – 400 mg for adults, 200 mg in pregnancy – is easy to exceed without noticing. Second, combination analgesics taken often produce medication overuse headache.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit