Is Ibuprofen (Nonsteroidal Anti-Inflammatory Drug) or Meloxicam (Nonsteroidal Anti-Inflammatory Drug) more effective for managing shoulder pain?

Ibuprofen vs Meloxicam for Shoulder Pain

For shoulder pain, start with ibuprofen 1200 mg daily, as it has the best safety profile among NSAIDs and provides effective analgesia for musculoskeletal pain. 1

Evidence-Based Approach

First-Line Treatment Strategy

• Begin with ibuprofen at 1200 mg daily (400 mg three times daily), which is identified as the lowest-risk NSAID for gastrointestinal complications 1
• Ibuprofen demonstrated superior improvement in pain severity and functional activity for rotator cuff-related shoulder pain compared to acetaminophen in a head-to-head trial 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

When to Consider Meloxicam

• Switch to meloxicam 7.5-15 mg once daily if:

  • Patient requires chronic NSAID therapy beyond 2-4 weeks 3, 4
  • Patient has GI risk factors (age >60, prior ulcer history, concurrent aspirin use) 1
  • Patient prefers once-daily dosing for better compliance 3, 4

• Meloxicam is COX-2 preferential at lower doses, providing comparable anti-inflammatory efficacy to traditional NSAIDs with significantly fewer GI adverse events (30% vs 45% with naproxen) 3, 5

• In osteoarthritis trials, meloxicam 7.5-15 mg daily showed efficacy equivalent to diclofenac 100 mg daily but with GI tolerability comparable to placebo 4

Critical Safety Considerations

Gastrointestinal Risk Management

• Ibuprofen at 1200 mg daily has the lowest GI bleeding risk among NSAIDs 1
• At 2400 mg daily, ibuprofen's GI risk increases to match intermediate-risk NSAIDs 1
• Meloxicam causes ulcers in <1% of patients over 18 months versus 1.1% with naproxen 5, 6
• Consider adding a proton pump inhibitor if patient has ≥2 risk factors: age >60, prior ulcer, concurrent aspirin, high-dose NSAID 1

Dosing Algorithm

For acute shoulder pain (<2 weeks):

• Start ibuprofen 1200 mg daily (400 mg TID) 1
• If inadequate response, increase to 2400 mg daily (800 mg TID) 1
• Consider adding acetaminophen up to 4000 mg daily for enhanced analgesia 7

For chronic shoulder pain (>2-4 weeks):

• Switch to meloxicam 7.5 mg once daily 3, 4
• Increase to meloxicam 15 mg daily if needed after 2 weeks 4
• Meloxicam maintains efficacy over 18 months with only 3.9% discontinuation due to GI events 6

Common Pitfalls to Avoid

• Do not start with meloxicam for acute pain - ibuprofen's superior safety profile at standard doses makes it the preferred initial choice 1
• Do not use ibuprofen 2400 mg daily long-term without gastroprotection in high-risk patients, as GI bleeding risk equals other NSAIDs 1
• Do not assume meloxicam is "safer" at all doses - while COX-2 preferential at 7.5 mg, this selectivity decreases at 15 mg 3
• If 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 7