What nonsteroidal anti-inflammatory drug (NSAID) is recommended for managing pain and inflammation associated with a shoulder dislocation?

NSAID Selection for Shoulder Dislocation Pain Management

Naproxen is the preferred NSAID for managing pain and inflammation associated with shoulder dislocation due to its efficacy, safety profile, and longer duration of action. 1, 2

First-Line NSAID Selection

• Naproxen is recommended as the first-choice NSAID for shoulder dislocation pain management due to its evidence-supported efficacy and established safety profile 1
• Naproxen provides longer duration of action (12-17 hour half-life) compared to other NSAIDs, allowing for less frequent dosing and more consistent pain control 2
• For acute pain management in shoulder dislocation, naproxen's analgesic and anti-inflammatory properties effectively address both pain and associated inflammation 1

Dosing Recommendations

• Standard dosing for naproxen is 500mg initially, followed by 250mg every 6-8 hours as needed for pain management 2
• Maximum daily dose should not exceed 1250mg in the first day and 1000mg in subsequent days 2
• Naproxen should be taken with food to minimize gastrointestinal side effects 2

Alternative NSAID Options

• If naproxen is contraindicated or unavailable, alternative NSAIDs can be considered based on their efficacy and safety profile 1:
  • Ibuprofen: Appropriate for temporary painful conditions at doses of 400-600mg every 6-8 hours 1
  • Indometacin: Effective for acute pain with a short half-life, particularly useful for intense, short-term pain at 50mg three times daily 3
  • COX-2 selective inhibitors (celecoxib): Consider in patients with high gastrointestinal risk factors 1

Important Considerations and Precautions

• Avoid NSAIDs in patients with:

  • History of asthma, urticaria, or allergic reactions to aspirin or other NSAIDs 2
  • Active peptic ulcer disease or recent gastrointestinal bleeding 2
  • Severe renal or hepatic impairment 2
  • High cardiovascular risk or heart failure 1

• Caution should be exercised when using NSAIDs in:

  • Elderly patients (increased risk of adverse effects) 1
  • Patients on anticoagulants (increased bleeding risk) 2
  • Patients with hypertension (may worsen blood pressure control) 2

Important Clinical Consideration

• Recent evidence suggests that ibuprofen may impair capsulolabral healing after glenohumeral dislocation, potentially leading to persistent shoulder instability 4
• This finding supports using naproxen as the preferred NSAID option, as specific evidence regarding naproxen's effect on capsulolabral healing is not established 4

Multimodal Pain Management

• Consider combining NSAID therapy with:
  • Acetaminophen (paracetamol) for additional pain relief without increasing NSAID-related risks 5
  • Local ice application to reduce acute inflammation 6
  • Physical therapy once acute pain begins to subside 6

Monitoring and Follow-up

• Monitor for gastrointestinal symptoms, including dyspepsia, nausea, and abdominal pain 2
• Watch for signs of renal impairment, particularly in patients with pre-existing kidney disease 2
• Consider gastroprotective agents (proton pump inhibitors) in patients with high risk of gastrointestinal complications 1