What is the recommended treatment for a generally healthy adult patient aiming to reduce inflammation and promote healing?

Treatment for Reducing Inflammation and Promoting Healing in Healthy Adults

For a generally healthy adult aiming to reduce inflammation and promote healing, start with NSAIDs at maximum tolerated doses for 2-4 weeks, with naproxen 500 mg twice daily or ibuprofen 1800 mg/day in divided doses as first-line options. 1

First-Line Treatment: NSAIDs

NSAIDs are the cornerstone of anti-inflammatory therapy for healthy adults. The most recent expert consensus (2025) recommends initiating NSAIDs/COXIBs at maximum tolerated and approved dosages for 2-4 weeks as first-line treatment 1. This approach prioritizes rapid inflammation reduction while monitoring for response.

Specific NSAID Options and Dosing

No single NSAID is definitively superior, so selection should be based on individual tolerability and contraindications 1:

• Naproxen: 375-1100 mg/day in two divided doses (commonly 500 mg twice daily) 1
• Ibuprofen: 1800 mg/day in divided doses 1
• Diclofenac: Starting at 150 mg/day in divided doses, maintenance 75-100 mg/day 1
• Indomethacin: 150 mg/day in divided doses 1, 2
• Celecoxib (COX-2 selective): 200-400 mg/day in divided doses 1
• Meloxicam: 15 mg/day in one dose 1

Treatment Duration Strategy

Evaluate response at 2-4 weeks after initiation 1. If the first NSAID provides insufficient benefit or is not tolerated, trial another NSAID before considering alternative approaches 1. With sufficient response at 12 weeks, consider switching to on-demand treatment or dose tapering 1.

Critical Safety Monitoring

Baseline Assessment Required

Before starting NSAIDs, obtain baseline blood pressure, BUN, creatinine, liver function studies (alkaline phosphatase, LDH, SGOT, SGPT), CBC, and fecal occult blood 1, 3. Repeat monitoring every 3 months during long-term use 1, 3.

High-Risk Populations Requiring Caution

Age ≥60 years significantly increases risk for renal, GI, and cardiac toxicities 1, 2, 3:

• Renal toxicity risk: Age ≥60, compromised fluid status, concomitant nephrotoxic drugs 1
• GI toxicity risk: Age ≥60, history of peptic ulcer disease, significant alcohol use (≥2 drinks/day), high-dose NSAIDs for prolonged periods 1
• Cardiac toxicity risk: History of cardiovascular disease or risk factors 1

Mandatory Discontinuation Criteria

Stop NSAIDs immediately if 1, 3:

• BUN or creatinine doubles 1, 3
• Hypertension develops or worsens 1, 3
• Liver function tests increase to 3× upper limit of normal 1, 3
• Peptic ulcer or GI hemorrhage occurs 1

Gastrointestinal Protection

For high-risk patients, add proton pump inhibitors or consider COX-2 selective inhibitors 1, 3. COX-2 inhibitors (celecoxib, etoricoxib) are associated with lower incidence of GI side effects and do not inhibit platelet aggregation, though renal side effects remain similar 1.

Important Contraindications and Warnings

Never combine multiple NSAIDs simultaneously - this increases adverse effects without additional benefit 2. Avoid NSAIDs in pregnancy after 20 weeks gestation due to risk of fetal renal dysfunction and premature ductus arteriosus closure 4.

Avoid systemic glucocorticoids for routine inflammation management in healthy adults, as guidelines strongly recommend against their use due to toxicity concerns 1.

When NSAIDs Fail

If two NSAIDs are tried in succession without efficacy, use another approach to analgesia 1. For specific inflammatory conditions (not general inflammation), second-line options may include biologics or other disease-modifying agents, but this requires specialist evaluation 1.

Adjunctive Measures

Physical therapy is strongly recommended for musculoskeletal inflammation, with active supervised exercise preferred over passive modalities 1. Taking NSAIDs with food may minimize gastrointestinal side effects 3.

Common Pitfalls to Avoid

• Do not use indomethacin in elderly patients - it reduces coronary blood flow and carries higher risk 2
• Do not assume all NSAIDs are equivalent - individual response varies, requiring therapeutic trials 1
• Do not ignore early warning signs - GI bleeding, hepatotoxicity, and renal injury can occur without warning symptoms 4
• Do not exceed maximum daily acetaminophen dose of 4g/day if combining with NSAID therapy 1