Naproxen Dosage for Shoulder Pain
For shoulder pain, naproxen should be used at a starting dose of 500 mg twice daily, with the lowest effective dose used for the shortest duration possible to minimize adverse effects. 1
Recommended Dosing Regimen
- Initial dose: 500 mg twice daily (morning and evening) 1
- Maximum daily dose: 1000 mg (should not exceed this for pain management) 1
- Duration: Short-term use (days to weeks) is preferred over long-term continuous use 2
Evidence-Based Considerations
Naproxen is an effective non-steroidal anti-inflammatory drug (NSAID) for treating shoulder pain, with clinical trials demonstrating efficacy comparable to other NSAIDs and treatments:
- Studies comparing naproxen to indomethacin for shoulder periarthritis showed both drugs significantly reduced pain, though they had limited effect on objective measurements of mobility 3, 4
- Naproxen 1000 mg daily has shown similar efficacy to celecoxib 400 mg daily in managing acute shoulder pain 5
Safety Considerations
When prescribing naproxen for shoulder pain, consider these important safety factors:
- GI risk: Higher in elderly patients, those with history of peptic ulcer disease, and with concomitant use of corticosteroids or anticoagulants 6, 2
- CV risk: All NSAIDs carry cardiovascular risk; use the lowest effective dose for the shortest duration 6
- Renal function: Use with caution in patients with renal impairment; dosage adjustment may be necessary 1
Risk Mitigation Strategies
- For patients with increased GI risk, consider adding a proton pump inhibitor 6, 2
- For patients with cardiovascular disease, use with caution and consider alternative treatments if appropriate 6
- For elderly patients (≥75 years), consider topical NSAIDs as a safer alternative 6
- Monitor for adverse effects, especially in high-risk patients 2
Treatment Algorithm
- First-line approach: Consider topical NSAIDs for localized shoulder pain (especially in elderly or those with comorbidities) 2
- Second-line approach: Oral naproxen 500 mg twice daily 1
- For patients with GI risk factors: Add a proton pump inhibitor 6
- For patients with CV risk factors: Consider using the lowest effective dose (250 mg twice daily) or alternative analgesics 6
- For inadequate response: After 2-4 weeks, reassess and consider alternative treatments such as physical therapy, corticosteroid injections, or referral to specialist 6
Common Pitfalls to Avoid
- Exceeding the recommended maximum daily dose of 1000 mg for pain management 1
- Prolonged continuous use without reassessment of benefits and risks 2
- Failing to consider patient-specific risk factors (age, comorbidities, concomitant medications) 6
- Not providing gastroprotection for high-risk patients 6
- Using NSAIDs with increasing COX-2 selectivity in patients with cardiovascular disease when other options would suffice 6
By following these evidence-based recommendations, naproxen can be effectively and safely used to manage shoulder pain while minimizing potential adverse effects.