According to recent research published in The Journal of Pain Research, the long-term use of a COX-2 selective nonsteroidal anti-inflammatory drug, Celecoxib provides a significant efficacy and excellent safety for chronic pain management among the patients at increased CV (cardiovascular) risk. According to the International Association for the Study of Pain, chronic pain is defined as "pain that continues beyond normal tissue healing time, which is supposed to be three months". Individuals with chronic pain have disturbed quality of life and face difficulty in doing day-to-day activities. The medications which used extensively to manage chronic pain are COX2-selective and nonselective (ns) nonsteroidal anti-inflammatory drugs (NSAIDs). Various NSAIDs associated with the risk of adverse CV and gastrointestinal (GI) differently.

A robust data on the relative CV and GI tolerability profiles of currently present NSAIDs was assembled from two randomized controlled trials (PRECISION and CONCERN) and an individual patient data meta-analysis in 2017. The CONCERN explains Celecoxib was correlated with rare adverse GI-tract events than Naproxen, and the PRECISION illustrates all the medications, Celecoxib, Naproxen and Ibuprofen showed similar CV-event rates, but Celecoxib exhibited better GI tolerability than any other drug. Further, as per meta-analysis, no notable difference was seen in the acute myocardial infarction rate between Celecoxib and ns-NSAIDs, but the only COX2-selective NSAID which exhibited a lower risk of adverse CV and GI events as compared to ns-NSAIDs was Celecoxib.

All this information regarding the relative tolerability of different NSAIDs were used in this analysis to update the treatment algorithm. The choice about whether to manipulate NSAID and which one should be on the basis of the patient's risk of producing adverse GI and CV events. Upper and lower-GI-tract events required to be considered. Out of all COX2-selective NSAIDs, Celecoxib showed better lower-GI-tract tolerability than ns-NSAIDs and a proton-pump inhibitor. Additionally, on the report of the latest data, the long-term use of 200 mg/day Celecoxib may be suitable for subjects at extended CV risk.