Choosing a nonsteroidal anti-inflammatory drug for pain

Nonsteroidal anti-inflammatory drugs (NSAIDs) are useful for many conditions, frequently in preference to other therapies such as opioids. They play an important role in osteoarthritis, headache disorders, acute musculoskeletal injury, dysmenorrhoea and dental pain. In axial spondyloarthritis, they can modify disease and represent first-line therapy. Most NSAIDs have comparable efficacy for most conditions, despite their different pharmacodynamic effects. The pharmacokinetic profile of different NSAIDs might confer varying risks and advantages for acute or chronic conditions that influence their selection. NSAIDs have well-recognised adverse effects, including cardiovascular, renal and gastrointestinal risks. While these risks vary between NSAIDs, all of them confer some increased risk. Proton pump inhibitors reduce upper gastrointestinal complications but not lower gastrointestinal ones. Other important precautions relate to pregnancy and hypersensitivity reactions.