Naproxen for Carpal Tunnel Syndrome
NSAIDs, including naproxen, are not effective for carpal tunnel syndrome and should not be used as anti-inflammatory treatment for this condition. 1, 2
Evidence Against NSAID Use in Carpal Tunnel
The highest quality evidence directly addressing your question comes from a randomized, double-blind, placebo-controlled trial that specifically compared NSAIDs to other treatments for carpal tunnel syndrome. This study found no significant reduction in symptom scores with NSAID therapy (tenoxicam 20 mg daily) compared to placebo at both 2 and 4 weeks. 2 In contrast, corticosteroids showed dramatic improvement, reducing the global symptom score from 27.9 to 10.0 over 4 weeks. 2
A comprehensive systematic review in American Family Physician explicitly states that "nonsteroidal anti-inflammatory drugs, diuretics, and vitamin B6 are not effective therapies" for carpal tunnel syndrome. 1
Why NSAIDs Don't Work
Carpal tunnel syndrome is a compression neuropathy, not primarily an inflammatory condition. 1, 3 The pathophysiology involves elevated pressure within the carpal tunnel compressing the median nerve, which explains why decompression strategies (surgical or corticosteroid-mediated) work while anti-inflammatory agents do not. 3
What Actually Works Instead
For mild to moderate carpal tunnel syndrome, offer these evidence-based alternatives:
- Wrist splinting - First-line conservative therapy 1
- Local corticosteroid injection - Provides relief for more than one month and delays need for surgery at one year 1
- Oral corticosteroids - Prednisolone 20 mg daily for 2 weeks, then 10 mg daily for 2 weeks showed significant benefit 2
- Physical therapy and therapeutic ultrasound 1
For severe cases or failure of conservative therapy after 4-6 months, surgical decompression should be offered. 1
Critical Pitfall to Avoid
Do not prescribe naproxen or any NSAID expecting therapeutic benefit for carpal tunnel syndrome symptoms. 1, 2 While one small pilot study showed naproxen 500 mg twice daily reduced pain scores, it performed worse than topical lidocaine patches and the study lacked a placebo control. 4 This contradicts the higher-quality placebo-controlled evidence showing no benefit. 2
Cardiovascular Considerations
If the patient has cardiovascular disease and you were considering naproxen for a different indication (not carpal tunnel), naproxen is the preferred NSAID over more COX-2 selective agents due to lower cardiovascular risk. 5 However, this is irrelevant for carpal tunnel syndrome where NSAIDs have no proven efficacy. 1, 2