Australian Prescriber Podcast E198 - Choosing a nonsteroidal anti-inflammatory drug for pain
Sep 29, 2025
In this conversation, rheumatology advanced trainee Steph Hopkins and rheumatologist David Liew delve into the critical aspects of selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management. They explore the balance between risks and benefits, discussing the profiles of various NSAIDs in relation to conditions like osteoarthritis and cardiovascular risks. The duo also highlights the importance of considering individual patient needs, such as co-prescribing PPIs and addressing specific risks during pregnancy or for patients with renal issues.
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Where NSAIDs Truly Help
- NSAIDs are particularly effective for mild–moderate pain with an inflammatory component like osteoarthritis and axial spondyloarthropathy.
- They often outperform paracetamol and opioids for osteoarthritis and are first-line with physiotherapy for axial disease.
Prefer COX‑2 For High GI Risk
- Use COX-2 selective NSAIDs for patients at high gastrointestinal risk, such as older people or those with prior peptic ulcer disease.
- Remember COX-2 reduces but does not eliminate GI risk so monitor and mitigate accordingly.
COX‑2 Selectivity Is Not Absolute
- COX-2 selectivity is relative and COX-2 contributes to gastric mucosal maintenance, so COX-2 inhibitors still cause GI harm.
- Non-upper GI adverse effects are substantial and not prevented by PPIs.