Is Relafen (nabumetone) 500mg effective for managing back pain in adult patients?

Is Relafen (Nabumetone) 500mg Effective for Back Pain?

Yes, nabumetone 500mg can provide relief for back pain, but the recommended starting dose is 1,000mg daily, not 500mg, and it should be considered a second-line option after topical NSAIDs. 1

Optimal Dosing for Back Pain

• The FDA-approved starting dose for nabumetone is 1,000mg taken once daily (typically at night), not 500mg 1
• Some patients may require 1,500-2,000mg daily for adequate symptom relief, though doses above 2,000mg have not been studied 1
• Patients weighing under 50kg may respond to lower doses, but 500mg is still below the recommended starting threshold 1
• A 500mg dose is likely subtherapeutic for most adults with back pain 1

Evidence for NSAIDs in Back Pain

• NSAIDs are slightly effective for short-term symptomatic relief in acute and chronic low back pain without sciatica, based on a Cochrane review of 65 studies involving over 11,000 patients 2
• NSAIDs provide approximately 10 points greater pain relief on a 100-point visual analogue scale compared to acetaminophen 2
• The American College of Physicians recommends oral NSAIDs as second-line therapy for back pain (after topical NSAIDs), with moderate-certainty evidence 2

Recommended Treatment Algorithm for Back Pain

First-Line Treatment

• Start with topical NSAIDs (with or without menthol gel) applied 3-4 times daily to the affected area 2, 3
• This provides the strongest evidence for pain relief while minimizing systemic gastrointestinal and cardiovascular risks 2, 3

Second-Line Treatment (If Topical NSAIDs Insufficient)

• Use oral NSAIDs such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily 2, 3
• Nabumetone 1,000mg once daily at bedtime is an alternative oral NSAID option 1
• Nabumetone has demonstrated comparable efficacy to naproxen 500mg/day and aspirin 3,600mg/day in clinical trials 1

Essential Non-Pharmacologic Measures

• Remain active and continue ordinary activities within pain limits—bed rest worsens outcomes 3
• Apply heat using heating pads for short-term relief 2, 3
• Consider supervised exercise therapy incorporating stretching and strengthening 3

Nabumetone-Specific Advantages

• Nabumetone is a non-acidic prodrug that may cause fewer gastrointestinal complications than traditional NSAIDs 4
• It preferentially inhibits COX-2 over COX-1, potentially reducing GI perforation, ulceration, and bleeding risk compared to nonselective NSAIDs 4
• Clinical trials show nabumetone is generally well tolerated with adverse effects similar to other NSAIDs (diarrhea, dyspepsia, headache, abdominal pain) 4, 5

Critical Warnings

• Assess cardiovascular and gastrointestinal risk factors before prescribing any NSAID 2
• Use the lowest effective dose for the shortest duration necessary 2, 1
• NSAIDs are associated with increased myocardial infarction risk, particularly COX-2 selective agents and most nonselective NSAIDs 2
• Monitor blood pressure, renal function (BUN, creatinine), and liver function if using NSAIDs beyond short-term 2

What NOT to Do

• Do not prescribe opioids for acute back pain—the American College of Physicians explicitly recommends against this due to opioid use disorder risk outweighing benefits 2
• Do not use 500mg nabumetone as monotherapy—this is half the recommended starting dose 1
• Do not add benzodiazepines or muscle relaxants routinely—evidence shows diazepam provides no additional benefit when added to NSAIDs for acute low back pain 6

When to Escalate Dose

• If 1,000mg nabumetone provides insufficient relief after observing initial response, increase to 1,500-2,000mg daily 1
• Nabumetone can be given once daily or divided into twice-daily dosing 1
• Reserve opioids only for severe, disabling pain uncontrolled by acetaminophen and NSAIDs 2