What should the doctor do when pain fails to respond to ‘analgesic’ doses of aspirin or paracetamol? The cause of the pain may suggest an appropriate substitute or adjuvant remedy. Pain associated with inflammation, for instance, may respond to aspirin in ‘anti-inflammatory’ doses (4–5g daily) or to another non-steroidal anti-inflammatory drug1. Other measures include the avoidance of precipitating factors and the use of heat, ice, rest, splinting or manipulation. If anxiety or depression are contributing to pain, help with these may be more effective than a stronger analgesic.
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