Clinical recommendation	Evidence rating	References
Acetaminophen is the first-line treatment for most mild to moderate acute pain.	A	8, 18
Ibuprofen and naproxen (Naprosyn) are good, first-line NSAIDs for mild to moderate acute pain based on effectiveness, adverse effect profile, cost, and over-the-counter availability.	A	12, 13
Cyclooxygenase-2 selective NSAIDs are second-line medications for mild to moderate pain based on their similar effectiveness to nonselective NSAIDs and greater costs.	A	13
Celecoxib (Celebrex) alone and an NSAID plus a proton pump inhibitor have the same probability of causing gastrointestinal complications in those at high risk.	B	26, 27
Full opioid agonists may be used if opioids combined with acetaminophen or NSAIDs are insufficient to control moderate to severe pain.	A	14, 15, 31
Tramadol (Ultram) is less effective than hydrocodone/acetaminophen and is a second-line medication for the treatment of moderate to severe pain.	B	16, 39