In a healthy adult with isolated shoulder pain and no contraindications (no peptic ulcer disease, severe renal or hepatic impairment, uncontrolled hypertension, pregnancy, or anticoagulant use), which is preferred for pain relief—naproxen or ibuprofen 800 mg—and what dosing regimen should be used?

Ibuprofen 800 mg for Shoulder Pain

For isolated shoulder pain in a healthy adult, ibuprofen 800 mg taken before bedtime is the preferred NSAID based on the most recent guideline evidence specifically addressing rotator cuff-related shoulder pain. 1

Recommended Dosing Regimen

• Administer ibuprofen 800 mg at bedtime rather than acetaminophen, as this approach specifically improves both pain control and sleep quality in patients with rotator cuff-related shoulder pain 1
• The bedtime dosing strategy addresses the common complaint of nocturnal shoulder pain that disrupts sleep and impairs recovery 1

Why Ibuprofen Over Naproxen for This Indication

• The American College of Radiology specifically recommends ibuprofen (not naproxen) for rotator cuff-related shoulder pain in their 2026 guidelines 1
• While naproxen is effective for various pain states and rheumatic conditions 2, the most recent shoulder-specific guideline evidence favors ibuprofen for this particular indication 1
• Naproxen would be preferred only if the patient has high cardiovascular risk, in which case naproxen or celecoxib are the safer NSAID choices 3

Important Safety Considerations

• Both NSAIDs carry similar risks: worsening kidney function in renal disease, hypertension, heart failure, and GI ulceration/bleeding 4
• Before starting any NSAID, measure blood pressure and screen for unrecognized chronic kidney disease in high-risk patients 3
• Monitor blood pressure and renal function after initiating therapy, particularly in patients on renin-angiotensin system blockers 3
• Consider empirically adding or increasing an antihypertensive agent of a different class in patients with pre-existing hypertension 3

Adjunctive Non-Pharmacologic Management

• Initiate gentle passive and active-assisted range-of-motion exercises immediately, focusing specifically on external rotation and abduction movements to prevent frozen shoulder 5, 1
• Consider low-level laser therapy, multimodal care (heat/cold, joint mobilization), or cervicothoracic spine manipulation if cervical spine involvement is present 6
• Avoid overhead pulley exercises, as they encourage uncontrolled abduction and can worsen shoulder pathology 5, 1

When to Escalate Care

• If no improvement after 3-4 weeks of conservative management with ibuprofen and exercises, consider ultrasound evaluation, subacromial corticosteroid injection, MRI without contrast, or orthopedic referral 1
• Early mobilization is mandatory—do not delay movement, as this is essential to prevent adhesive capsulitis, particularly in women over 50 years 1