17th August 2020

A 52-year-old woman attends pain clinic

A 52-year-old woman attends pain clinic. She has a history of chronic lower back pain and sciatica. She currently takes regular paracetamol 1g QDS, tramadol 100mg QDS and ibuprofen 400mg TDS, but is increasingly struggling to manage the pain, which is preventing her from working as a receptionist. She describes intermittent burning pains beginning in her lower back, which radiate down both her legs. She was previously taking codeine 60mg QDS (which was replaced with tramadol six months ago) and has never taken any other types of painkillers.

Which of the following would be the most appropriate next treatment option for this patient (including the dose)?

Select the SINGLE most appropriate option from the list below. Select ONE option only.