From the Guidelines
Naproxen (250-500mg twice daily) is often considered a good initial option for many patients with chronic pain due to its balanced efficacy and cardiovascular safety profile. When managing chronic pain, it's essential to consider individual factors, including the specific condition, patient's medical history, and risk factors 1. According to the CDC clinical practice guideline for prescribing opioids for pain, topical NSAIDs are recommended for patients with osteoarthritis affecting a single or a few joints near the surface of the skin, while systemic NSAIDs or duloxetine can be used for patients with osteoarthritis pain in multiple joints or incompletely controlled pain with topical NSAIDs 1.
Some key points to consider when prescribing NSAIDs for chronic pain management include:
- Using the lowest effective dosage and shortest duration needed to minimize risks, particularly in older persons and patients with cardiovascular comorbidities, chronic renal failure, or previous gastrointestinal bleeding 1
- Considering cyclooxygenase-2 inhibitors or NSAIDs with proton pump inhibitors for patients with gastrointestinal comorbidities but without current or previous gastrointestinal bleeding to minimize risk 1
- Monitoring patients for side effects, such as gastrointestinal bleeding, kidney damage, and cardiovascular events, and adjusting treatment as needed 1
- Taking NSAIDs with food to reduce stomach irritation and considering concomitant use of proton pump inhibitors for those at higher risk of GI complications
It's also important to note that moderate-quality evidence demonstrates small improvements in chronic low back pain with NSAIDs and with duloxetine 1. Additionally, NSAIDs can be effective for temporomandibular disorder pain that is not sufficiently improved with nonpharmacologic interventions 1. Regular follow-up with a healthcare provider is essential for adjusting treatment as needed and ensuring the best possible outcome for patients with chronic pain.
From the Research
NSAID Options for Chronic Pain Management
- The choice of nonsteroidal anti-inflammatory drug (NSAID) for chronic pain management depends on various factors, including the patient's medical history, current health status, and potential risks associated with each medication 2, 3, 4.
- Studies have compared the safety and efficacy of different NSAIDs, such as celecoxib, ibuprofen, and naproxen, in patients with osteoarthritis and rheumatoid arthritis 2, 3, 4.
Comparison of NSAIDs
- Celecoxib has been found to be noninferior to ibuprofen and naproxen in terms of cardiovascular safety, with a lower risk of gastrointestinal events compared to ibuprofen and naproxen 2.
- Ibuprofen has been associated with a significant increase in systolic blood pressure and a higher incidence of new-onset hypertension compared to celecoxib 3.
- Naproxen has been found to have a similar risk profile to celecoxib, with a lower risk of gastrointestinal events compared to ibuprofen 2, 4.
Alternative Options
- Low-dose naltrexone has been studied as a potential treatment for chronic pain, with some studies suggesting its effectiveness in reducing symptoms related to chronic pain conditions such as fibromyalgia and inflammatory bowel conditions 5, 6.
- The mechanism of low-dose naltrexone appears to be modulation of neuro-inflammation, specifically the modulation of glial cells and release of inflammatory chemicals in the central nervous system 6.