Non-steroidal anti-inflammatory drugs (NSAIDs) for musculoskeletal pain.

### What you need to know A 65 year old patient has been troubled with intermittent low back pain for years, for which you prescribed ibuprofen 400 mg up to three times daily as needed. For the past four months, persistent knee pain, not associated with stiffness, has limited his mobility. He is overweight, physically inactive, and has recently been diagnosed with hypertension. Paracetamol has had little benefit. He asks if taking ibuprofen regularly might ease his knee pain. NSAIDs are commonly used for pain management. They reduce inflammation and pain by reducing the activity of cyclo-oxygenase (or COX) enzymes and inhibiting prostaglandin synthesis.1 The National Institute for Health and Care Excellence (NICE) guidelines recommend NSAIDs as first line analgesics for low back pain and sciatica2 and osteoarthritis.3 They are also used for musculoskeletal pain from acute injury. In England there were about 11.5 million prescriptions for oral NSAIDs in 2018.4 In the US around 60% of patients with osteoarthritis or chronic low back pain are prescribed NSAIDs, based on analysis of records in a claims database in 2008.5 ### Search strategy We searched PubMed (NLM database) and the Cochrane Library with the terms “non-steroidal anti-inflammatory drugs” OR “NSAIDs” AND “spinal pain” OR …