Nonsteroidal Anti-Inflammatory Drugs in Chronic and Relapsing Musculoskeletal Pain: Pearls for Clinical Practice

Chronic pain represents a significant burden at both individual and societal levels. While paracetamol is widely used, its lack of anti-inflammatory activity makes it suboptimal for chronic inflammatory conditions. This narrative review examines the role of nonsteroidal anti-inflammatory drugs (NSAIDs) — the most globally prescribed medication class — in chronic pain management, with emphasis on best practices and recent advances.NSAIDs demonstrate established efficacy in reducing inflammation and pain; however, their potential for serious adverse effects warrants careful consideration, particularly in elderly populations. Both cardiovascular and gastrointestinal risks are relevant even with selective agents, and the elevated myocardial infarction risk within the first seven days of therapy underscores the need for caution even in short-term use.Sustained-release formulations offer pharmacokinetic advantages over immediate-release counterparts, maintaining therapeutic concentrations over 24 hours and improving adherence. Controlled-release technology further optimizes this profile by combining an initial rapid-onset phase with a prolonged maintenance phase. Chronic pain, whether neuropathic or osteoarticular, is best addressed through a multimodal therapeutic approach. Systematic analyses indicate no clinically meaningful differences in analgesic potency among most NSAIDs at equivalent doses; therefore, individualized prescribing based on drug adverse effect profile and patient comorbidities is essential.