For chronic musculoskeletal pain in a patient with a history of ST-elevation myocardial infarction, which NSAID would be most appropriate?

• A. Diclofenac
• B. Naproxen
• C. Ibuprofen
• D. Indomethacin

Answer: (B)

When managing chronic musculoskeletal pain in someone with a history of STEMI, the aim is to relieve pain while minimizing cardiovascular risk. Naproxen is preferred because, among NSAIDs, it has the lowest associated risk of adverse cardiovascular events. It also tends to interfere less with aspirin’s antiplatelet effect than ibuprofen, which can blunt the cardioprotective action of aspirin. The other NSAIDs carry higher CV risks (diclofenac, indomethacin) or have notable interactions with antiplatelet therapy (ibuprofen) or more adverse effects, making them less suitable in a patient with prior myocardial infarction. In any case, NSAIDs should be used at the lowest effective dose for the shortest duration, and alternatives like acetaminophen or topical therapies can be considered if possible.