NSAIDs are widely used compounds in the management of several acute and chronic pain syndromes. NSAIDs induce their action by blocking the cyclooxygenase enzymes, cox-1 and cox-2, during the conversion of arachidonic acid to prostaglandins. Conventional NSAIDs inhibit both cox isoforms and are therefore at risk of serious complications as gastrointestinal irritation, postoperative bleeding, renal failure, water and sodium retention and hepatic failure. The newest cox-2 specific inhibitors are equally effective. Additionally they have superior safety and tolerability profile. The effects of cox-2 specific inhibitors have been assessed and have proved useful in the management of several acute and chronic pain syndromes such as osteoarthritis, rheumatoid arthritis, primary dysmenorrhea and low back pain. Also they have many advantages when used in a multimodal therapy during the perioperative period because they have opiod sparing action and provide adequate pain control without side effects. They are also used successfully in the management of cancer pain at all three steps on the analgesic ladder in combination with opioids and other adjuvant analgesics.