[Dr.Vad]

Highlights

Initial treatment of musculoskeletal pain should include nonpharmacologic therapy, including physical therapy, heat/cold, and orthotics.

For patients who fail conservative therapy for musculoskeletal pain, NSAIDs may be chosen as a next step. Naproxen is probably the NSAID associated with the lowest risk for thrombosis.

Patients with a history of gastrointestinal tract bleeding or who are at high risk for bleeding who require analgesia should be prescribed acetaminophen first. For these patients who require NSAID therapy, proton-pump inhibitors have been demonstrated to reduce the risk for recurrent gastrointestinal tract bleeding among patients receiving low-dose aspirin.

Ibuprofen, but not rofecoxib, acetaminophen, or diclofenac, appears to reduce the physiologic efficacy of aspirin in preventing thrombosis. Current recommendations call for delaying ibuprofen dosing until at least 30 minutes after taking aspirin or at least 8 hours prior to aspirin dosing.

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