What is the most appropriate NSAID regimen for a patient with a history of gastric ulcer and coronary artery disease presenting with mild to moderate back pain?

In patients with a history of gastric ulcers and coronary artery disease requiring pain management, selecting an appropriate nonsteroidal anti-inflammatory drug (NSAID) regimen is crucial to minimize gastrointestinal risks while effectively managing pain. The combination of naproxen with omeprazole is particularly beneficial in this scenario.

Naproxen is an NSAID that effectively alleviates pain and inflammation. However, it is associated with gastrointestinal side effects, especially in patients with prior gastric ulcers. By pairing naproxen with omeprazole, a proton pump inhibitor, the risk of gastrointestinal irritation and ulceration is significantly reduced. Omeprazole works by decreasing stomach acid production, helping to protect the gastric lining from potential damage caused by NSAIDs.

Additionally, this regimen is also considered more suitable for patients with coronary artery disease, as alternatives like selective COX-2 inhibitors (e.g., celecoxib) may carry cardiovascular risks, and other NSAIDs, like indomethacin, can be more irritative to the gastrointestinal tract. By choosing naproxen in combination with omeprazole, the regimen addresses both the management of pain and the prevention of potential gastrointestinal complications effectively.