Management of Shoulder Pain with NSAIDs

Introduction to NSAID Therapy

The American College of Rheumatology recommends starting with ibuprofen 1200 mg daily for shoulder pain, as it has the best safety profile among NSAIDs and provides effective analgesia for musculoskeletal pain 1, 2
Ibuprofen at 1200 mg daily is identified as the lowest-risk NSAID for gastrointestinal complications, making it a preferred initial choice for patients with shoulder pain 1, 2

For acute shoulder pain, start with ibuprofen 1200 mg daily (400 mg three times daily), which has a lower GI bleeding risk compared to other NSAIDs 1, 2
If ibuprofen 1200 mg daily provides inadequate relief after 1-2 weeks, increase to 2400 mg daily (800 mg three times daily), though this higher dose carries GI risk comparable to other NSAIDs like diclofenac and naproxen 1, 3, 4
Consider adding a proton pump inhibitor if a patient has ≥2 risk factors: age >60, prior ulcer, concurrent aspirin, high-dose NSAID, to reduce the risk of gastrointestinal complications 3

Ibuprofen at 1200 mg daily has the lowest GI bleeding risk among NSAIDs, but at 2400 mg daily, its GI risk increases to match intermediate-risk NSAIDs 1, 2, 3
If a patient takes aspirin for cardiovascular protection, ensure ibuprofen is taken ≥30 minutes after aspirin or ≥8 hours before to avoid negating aspirin's antiplatelet effect 5

Do not start with meloxicam for acute pain - ibuprofen's superior safety profile at standard doses makes it the preferred initial choice 1, 3, 4
Do not use ibuprofen 2400 mg daily long-term without gastroprotection in high-risk patients, as GI bleeding risk equals other NSAIDs 1, 3