A 38-year-old carpenter with several weeks of dull left shoulder pain; which medication is most helpful at this stage, in addition to rest and ice?

• A. Ibuprofen.
• B. Acetaminophen.
• C. Amitriptyline.
• D. Codeine.

Answer: (A)

When shoulder pain has an inflammatory component from a musculoskeletal strain or overuse, an agent that reduces inflammation along with pain is most helpful alongside rest and ice. Ibuprofen is a nonsteroidal anti-inflammatory drug, so it lowers prostaglandin production and decreases inflammation as well as pain. Acetaminophen can relieve pain but doesn’t tackle inflammation as effectively. Amitriptyline isn’t a first-line choice for acute inflammatory pain and is used more for chronic or neuropathic pain. Codeine provides opioid analgesia but carries more risk and is not preferred for straightforward musculoskeletal pain when an anti-inflammatory option is available.