Safety of long-term NSAID use in patients with musculoskeletal pain

Chronic musculoskeletal pain is a leading cause of medical consultation and disability. Nonsteroidal anti-inflammatory drugs (NSAID) remain essential for symptomatic control; however, long-term use is associated with gastrointestinal, cardiovascular, and renal risks, particularly in patients with comorbidities and polypharmacy. The safety of chronic NSAID use is reviewed from an integrated clinical perspective, highlighting risk identification, cumulative exposure, and the importance of periodic monitoring. A practical risk stratification approach is proposed to individualize prescribing and optimize the risk–benefit balance in patients with chronic musculoskeletal pain.