Recommended Dosage of Naproxen for Back Pain
For back pain, the recommended dose of naproxen is 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as needed, with a maximum daily dose of 1250 mg on the first day and 1000 mg on subsequent days. 1
Dosing Guidelines
Initial Dosing
- First dose: 500 mg naproxen
- Subsequent dosing options:
- 500 mg every 12 hours (twice daily)
- 250 mg every 6-8 hours (3-4 times daily)
- Maximum daily dose:
- First day: 1250 mg
- Subsequent days: 1000 mg
Formulation Considerations
Naproxen is available in different formulations, which are not necessarily bioequivalent 1:
- Naproxen tablets
- Naproxen sodium tablets (more rapidly absorbed, preferred for acute pain)
- Naproxen delayed-release tablets
- Naproxen suspension
Evidence Supporting Naproxen for Back Pain
NSAIDs, including naproxen, are considered first-line medication options for back pain along with acetaminophen 2. Clinical evidence shows that NSAIDs are more effective for pain relief than acetaminophen, providing approximately 10 points greater improvement on a 100-point visual analog pain scale 2.
For acute back pain, NSAIDs demonstrate moderate short-term benefits with a weighted mean difference of -8.39 points on a 0-100 point scale compared to placebo 2.
For chronic back pain, NSAIDs show low-quality evidence of effectiveness compared to placebo, with a mean difference in pain intensity of -3.30 on a 0-100 visual analog scale 3.
Special Dosing Considerations
Elderly Patients
- Consider lower doses in elderly patients
- The unbound plasma fraction of naproxen increases in elderly patients, though total plasma concentration remains unchanged 1
- Use the lowest effective dose as a prudent approach 1
Patients with Renal or Hepatic Impairment
- Lower doses should be considered 1
- Naproxen is not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1
Safety Considerations
When prescribing naproxen for back pain:
- Assess cardiovascular and gastrointestinal risk factors before prescribing 2
- Use the lowest effective dose for the shortest period necessary to minimize adverse events 2
- Consider co-administration with a proton-pump inhibitor in higher-risk patients 2
- Be aware that NSAIDs are associated with:
- Gastrointestinal risks
- Renovascular risks
- Potential increased risk for myocardial infarction 2
Combination Therapy Considerations
Adding muscle relaxants to naproxen for back pain:
- Evidence does not support significant additional benefit when combining naproxen with muscle relaxants such as orphenadrine or methocarbamol 4
- Similarly, adding diazepam to naproxen does not improve functional outcomes or pain compared to naproxen alone 5
Duration of Therapy
For acute back pain, short-term use is generally recommended. Most clinical trials evaluating NSAIDs for back pain were short in duration, with only 6 of 51 trials in one review lasting longer than 2 weeks 2.
For chronic back pain, naproxen may be used for longer periods, but the evidence for long-term efficacy and safety is limited 2. When treating patients with naproxen for extended periods, the lowest effective dose should be used.