From the Guidelines
Acetaminophen and ibuprofen are recommended as first-line treatments for shoulder pain, with dosages of 325-650mg every 4-6 hours for acetaminophen and 400-800mg every 6-8 hours for ibuprofen, as they have been shown to be effective in reducing pain and inflammation 1. When considering medications for shoulder pain, it's essential to weigh the benefits and risks of each option.
- Over-the-counter medications such as acetaminophen and ibuprofen are often recommended due to their efficacy and relatively low risk of side effects, as noted in the guidelines for adult stroke rehabilitation and recovery 1.
- For patients with severe pain or those who do not respond to over-the-counter medications, prescription NSAIDs like meloxicam or celecoxib may be considered, but their use should be carefully monitored due to potential side effects, as discussed in the use of nonsteroidal antiinflammatory drugs: an update for clinicians 1.
- Additionally, botulinum toxin injections can be useful for reducing severe hypertonicity in hemiplegic shoulder muscles, and a trial of neuromodulating pain medications may be reasonable for patients with clinical signs and symptoms of neuropathic pain, as recommended in the guidelines for adult stroke rehabilitation and recovery 1.
- It's crucial to use these medications as directed and to be aware of potential side effects, such as stomach irritation with NSAIDs, and to consult a healthcare provider if pain persists or is accompanied by other concerning symptoms. Key considerations for medication use include:
- Starting with the lowest efficacious dose and escalating only if necessary
- Choosing medications with the best safety profile
- Monitoring for potential side effects and adjusting treatment accordingly
- Considering nonpharmacological approaches, such as physical therapy and heat/cold therapy, as initial treatments or adjuncts to medication, as suggested in the use of nonsteroidal antiinflammatory drugs: an update for clinicians 1.
From the FDA Drug Label
Mild to moderate pain:400 mg every 4 to 6 hours as necessary for relief of pain. The medication that can help alleviate shoulder pain is ibuprofen (PO), which can be taken at a dose of 400 mg every 4 to 6 hours as necessary for relief of pain 2.
- Key points:
- The dose should not exceed 3200 mg total daily dose.
- Patients should be monitored for potential increased risk when taking higher doses.
- Ibuprofen tablets should be taken with meals or milk if gastrointestinal complaints occur.
From the Research
Medications for Shoulder Pain
The following medications can help alleviate shoulder pain:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 3, 4
- Acetaminophen (paracetamol) 3, 4
- Corticosteroids (oral, subacromial injection, or intra-articular injection) 3, 5, 6
- Opioid analgesics 3
- Hyaluronic acid injections (such as NASHA) for shoulder osteoarthritis 7
Specific Uses and Efficacy
- Ibuprofen has been shown to improve pain severity and functional activity in patients with rotator cuff-related shoulder pain 4
- Acetaminophen has been shown to improve physical and environmental domains of quality of life in patients with rotator cuff-related shoulder pain 4
- Corticosteroid injections have been shown to have a small benefit over placebo in some trials for rotator cuff disease, but the effect may be small and not well-maintained 6
- Hyaluronic acid injections have been shown to reduce shoulder pain on movement and improve patient global assessment in patients with symptomatic glenohumeral osteoarthritis 7