The drugs are most useful in alleviating pain from inflammatory conditions, though they do not modify the inflammatory process. There is little to be gained from using slow-release formulations, except at night in patients with severe morning stiffness. They do not reduce the frequency of gastrointestinal adverse effects.
Topical preparations are relatively ineffective, and are expensive.
They sometimes provide symptomatic relief after acute soft-tissue injury. The risks of nonsteroidal drugs relate mainly to gastrointestinal adverse effects, especially gastrointestinal haemorrhage, so it is wise to start with the lowest dose of the least gastro-toxic drug. First choice for initial treatment in most conditions is Ibuprofen , which carries the lowest risk of provoking gut haemorrhage, and is cheapest. Start with 200 mg three times daily. If this is ineffective in high doses, then a drug associated with an intermediate risk can be introduced.