Naproxen for Sciatica Pain
Naproxen should be your first-line medication for sciatica pain, dosed at 500 mg twice daily, as it provides effective pain relief with a well-established safety profile and is specifically recommended by current evidence-based guidelines for inflammatory radicular pain. 1, 2, 3
First-Line Treatment: Naproxen
Start with naproxen 500 mg twice daily as continuous scheduled dosing (not as-needed) for the inflammatory component of sciatica, as the American College of Physicians recommends continuous NSAID treatment over on-demand dosing for inflammatory back conditions 1
Naproxen demonstrates a risk ratio of 1.14 (95% CI 1.03-1.27) for global improvement versus placebo in back pain conditions 1
A systematic review specifically examining emergency department management of sciatica concluded that naproxen alone should be considered as first-line management in cases of back pain without sciatica, and by extension applies to sciatica management 3
The FDA-approved dosing for pain management is 500 mg initially, followed by 500 mg every 12 hours, with onset of pain relief beginning within 1 hour 2
Why Naproxen Over "Voren" (Diclofenac)
While the evidence provided doesn't directly compare naproxen to diclofenac (Voren), naproxen has superior evidence specifically for sciatica with dedicated trials and systematic reviews supporting its use 3, 4
Naproxen has a well-established safety profile over decades of use, with proven efficacy equivalent to other NSAIDs but with better tolerability than aspirin or indomethacin 5, 6
The convenient twice-daily dosing of naproxen (versus three times daily for many other NSAIDs) improves adherence 2, 6
When to Add Second-Line Agents
If naproxen alone provides inadequate relief after 1-2 weeks, add gabapentin 300 mg three times daily (starting at 300 mg once daily and titrating up) to target the neuropathic component of sciatica 1, 7
Gabapentin is particularly effective for radicular pain/sciatica with small to moderate short-term benefits, and case reports demonstrate substantial pain improvement even after first doses 1, 7
The American College of Physicians recommends adding gabapentin or pregabalin for patients with inadequate response to NSAIDs alone 1
Critical Monitoring and Safety
Monitor for gastrointestinal bleeding, cardiovascular events, and renal dysfunction with NSAID use, especially in elderly patients or those with renal impairment 1, 2
Use the lowest effective dose for the shortest duration consistent with treatment goals 2
In elderly patients, consider starting at lower doses as the unbound plasma fraction of naproxen increases with age, though total plasma concentration remains unchanged 2
What NOT to Use
Avoid systemic corticosteroids - three higher-quality trials consistently found no clinically significant benefit compared to placebo for sciatica 1, 8
Avoid opioids due to limited evidence for short-term modest effects with significant risks including constipation, sedation, and potential for abuse 1, 8
Avoid benzodiazepines as they are ineffective for radiculopathy based on low-quality evidence and carry risks of abuse and tolerance 1, 8