Anti-Inflammatories After Shoulder Surgery or Injury: What You Need to Know

By Eric J. Sanders, MD – Shoulder and Elbow Surgeon at Texas Orthopaedic Associates

If you’ve recently had a shoulder injury or surgery, chances are you’ve been prescribed—or considered taking—anti-inflammatory medications. These drugs, commonly known as NSAIDs (nonsteroidal anti-inflammatory drugs), are widely used to reduce pain, swelling, and inflammation, and can be an important part of your early recovery.

But not all pain medications are the same. Some carry risks if taken for too long or in combination with other medications. In this post, I’ll walk you through the different types of anti-inflammatories, how they work, and how to use them safely and effectively.

What Are Anti-Inflammatories?

NSAIDs work by blocking enzymes in the body called COX-1 and COX-2 (cyclooxygenases). These enzymes are involved in the production of prostaglandins—substances that trigger pain, swelling, and inflammation after tissue injury or surgery.

By reducing prostaglandins, NSAIDs can:

• Decrease pain

• Reduce swelling

• Improve mobility

• Help with post-operative stiffness or soreness

Common Types of Anti-Inflammatories

✅ Over-the-Counter (OTC) NSAIDs

MedicationBrand NameTypical UseIbuprofenAdvil, MotrinCommon for post-op pain, inflammationNaproxenAleveLonger-acting NSAID; fewer doses per day

✅ Prescription NSAIDs

MedicationBrand NameNotesMeloxicamMobicOnce-daily; longer-acting, moderate potencyCelecoxibCelebrexSelective COX-2 inhibitor; lower GI risk

How Tylenol (Acetaminophen) Is Different

Tylenol (acetaminophen) is not an anti-inflammatory. It helps reduce pain and fever, but it does not reduce swelling or inflammation.

Tylenol can be safely used in combination with NSAIDs for a multi-modal pain approach, especially in the early days after surgery. It’s also safer for the stomach and kidneys, but must be used carefully to avoid liver toxicity, especially if combined with alcohol or taken in high doses.

What Are Selective COX-2 Inhibitors?

Celebrex (celecoxib) is a selective COX-2 inhibitor, meaning it targets the COX-2 enzyme involved in inflammation but spares the COX-1 enzyme, which helps protect the stomach lining.

✅ Benefits:

• Lower risk of stomach ulcers and GI bleeding

• Effective for joint and soft tissue pain

• Often better tolerated for long-term use

⚠️ Risks:

• Potential cardiovascular risks (e.g., in patients with heart disease)

• Still poses a kidney risk when used long-term

Risks of Anti-Inflammatories: What You Should Know

1. Gastritis and Stomach Irritation

NSAIDs can irritate the stomach lining, especially if taken:

• Without food

• For multiple days in a row

• At high doses

❗ Risk of gastritis or ulcers:

• Short-term NSAID use (a few days): low risk

• Chronic use (>1 month): moderate risk

✅ How to lower the risk:

• Always take NSAIDs with food

• Avoid alcohol while using NSAIDs

• Consider taking an acid reducer, such as famotidine (Pepcid-AC) or omeprazole (Prilosec) to protect the stomach

📘 Famotidine (Pepcid-AC) is a histamine-2 blocker that reduces stomach acid and is often used as a protective companion to NSAIDs.

2. Kidney Dysfunction

NSAIDs reduce blood flow to the kidneys by interfering with prostaglandins that help regulate kidney function.

❗ Risk of kidney damage:

• Short-term NSAID use in healthy adults: Very low (~1–2%)

• Long-term or high-dose use, or in those with preexisting kidney disease: Up to 10% risk of reduced kidney function, may be reversible

  • For long term use, recommend kidney function labs every 4-6 months

Who should use caution:

• Adults over 65

• Patients with high blood pressure

• Patients with chronic kidney disease (CKD)

• Those taking diuretics or ACE inhibitors

Best Practices for Using Anti-Inflammatories After Shoulder Surgery

✅ Use NSAIDs for short-term inflammation control in the first 1–2 weeks
✅ Combine with Tylenol for improved pain relief
✅ Take with food and consider using Pepcid-AC or another antacid
✅ Avoid use in patients with history of ulcers or kidney issues
✅ Always follow your surgeon’s guidance on dosage and duration

Final Thoughts from Dr. Sanders

Anti-inflammatories are a valuable tool in managing pain and swelling after shoulder surgery or injury. When used properly, they can reduce discomfort and support early mobility. However, it’s important to balance their benefits with potential risks to the stomach, kidneys, and heart.

If you’re considering long-term use or have other medical conditions, speak with your doctor about which medications are safest for you—and whether protective medications like famotidine should be added.

Your recovery deserves a thoughtful, evidence-based approach—and your medications should support your healing, not complicate it.

Dr. Eric J. Sanders is a shoulder and elbow surgeon at Texas Orthopaedic Associates in Dallas and Plano. He specializes in advanced surgical care, evidence-based recovery, and personalized pain management strategies. Learn more about shoulder recovery here.