This is suitable as a first line choice for most people with mild to moderate pain. Although customers could potentially purchase this from places other than a pharmacy (eg, a supermarket), they would miss out on the expert advice you could provide them.

If paracetamol does not provide the customer with appropriate pain relief, the next step would be to replace it with ibuprofen. Again, customers could potentially purchase this from places other than a pharmacy but would not reap the benefits of advice from the pharmacy team.

Combining ibuprofen and paracetamol will provide the customer with stronger pain relief. This can be recommended by the pharmacy team.

This is currently done by alternating doses of paracetamol and ibuprofen or taking them concomitantly; however, this can cause patient confusion and result in possible under/overdosing.

If the addition of ibuprofen does not provide appropriate pain relief, it should be replaced with an alternative NSAID. This step would have to be managed by the customer's GP. Currently there are no alternative oral NSAIDs available OTC to manage general pain relief (oral diclofenac was reclassified from P to POM in 2015).

This step involves the addition of a weak opioid such as codeine, at a full therapeutic dose (60mg codeine four times a day), which would again need to be managed by the customer's GP. However, there are codeine-based products available OTC (lower dose 8mg codeine) as combination therapy that customers might ask for, such as co-codamol (paracetamol and codeine). These products can only be used for three days and now carry a warning on-pack that they can cause addiction.