Is naproxen (nonsteroidal anti-inflammatory drug, NSAID) effective for treating back pain?

From the Guidelines

Naproxen is a reasonable option for back pain relief, but its use should be judicious due to potential gastrointestinal and cardiovascular risks. According to the American College of Physicians and the American Pain Society guideline 1, nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen are effective for pain relief, but clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy.

When using naproxen for back pain, the recommended dose is 220-500 mg every 8-12 hours as needed, not exceeding 1000 mg per day for over-the-counter use or 1500 mg for prescription strength. It is essential to start with the lowest effective dose and take with food to minimize stomach irritation. Naproxen works by reducing inflammation and blocking pain signals through inhibition of prostaglandin production.

Key considerations for naproxen use include:

• Assessing cardiovascular and gastrointestinal risk factors before prescribing NSAIDs
• Recommending the lowest effective doses for the shortest periods necessary
• Considering strategies for minimizing adverse events in higher-risk patients, such as co-administration with a proton-pump inhibitor
• Monitoring for potential benefits and harms, including aberrant drug-related behaviors with long-term use

For optimal back pain management, combining naproxen with gentle stretching, proper posture, application of heat or ice, and adequate rest is recommended. If pain is severe, persists beyond 10 days, or is accompanied by fever, weakness, or numbness in the legs, consultation with a healthcare provider is necessary. Additionally, individuals with kidney problems, heart conditions, stomach ulcers, or those taking blood thinners should speak with their doctor before using naproxen, as should pregnant women or those taking other medications 1.

From the FDA Drug Label

CLINICAL STUDIES General Information Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout Improvement in patients treated for rheumatoid arthritis was demonstrated by a reduction in joint swelling, a reduction in duration of morning stiffness, a reduction in disease activity as assessed by both the investigator and patient, and by increased mobility as demonstrated by a reduction in walking time In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartum episiotomy and uterine contraction pain and dysmenorrhea. Onset of pain relief can begin within 1 hour in patients taking naproxen and within 30 minutes in patients taking naproxen sodium Analgesic effect was shown by such measures as reduction of pain intensity scores, increase in pain relief scores, decrease in numbers of patients requiring additional analgesic medication, and delay in time to remedication. The analgesic effect has been found to last for up to 12 hours

The FDA drug label does not directly answer the question of using naproxen for back pain. However, based on the information provided, naproxen can be used for pain relief and has been studied in patients with mild to moderate pain secondary to various conditions.

• The recommended dose for pain relief is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
• The initial total daily dose should not exceed 1250 mg of naproxen, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2. It is essential to consult a healthcare professional to determine the appropriate dosage and treatment plan for back pain, as the FDA label does not explicitly address this condition.

From the Research

Naproxen for Back Pain

• Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to treat back pain 3, 4, 5, 6.
• Studies have shown that naproxen can be effective in relieving pain and improving functional outcomes in patients with acute low back pain 4, 5.
• A randomized clinical trial found that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen did not improve functional outcomes or pain at 1-week follow-up in patients with acute low back pain 4.
• Another study found that naproxen sodium effectively relieves pain across multiple types of pain models and has a favorable benefit-risk profile compared to other available pharmacological treatment options for non-specific low back pain 5.
• A review of current treatment options for low back pain found that NSAIDs, including naproxen, may be superior to placebo for reducing pain in acute and chronic low back pain, but should be used with caution in people who may be at greater risk of experiencing adverse events 6.

Comparison with Other Medications

• A study compared the efficacy of tramadol-acetaminophen tablets with non-steroidal anti-inflammatory drugs (NSAIDs) in low back pain patients with depression and found that tramadol-acetaminophen was effective in reducing low back pain and had a prophylactic antidepressant effect 7.
• Another study found that paracetamol provides no additional benefit for acute low back pain, and opioids have an established profile of harms 6.
• Muscle relaxants may be superior to placebo for reducing pain in acute low back pain, but their comparative efficacy to NSAIDs and other analgesics remains unknown 6.

Safety and Efficacy

• Naproxen should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 3.
• The balance of evidence indicates that NSAIDs, including naproxen, have a favorable benefit-risk profile when compared to other available pharmacological treatment options for non-specific low back pain 5.
• Patients should be informed of the potential risks and benefits of naproxen and other medications for low back pain, and treatment should be tailored to the individual patient's needs and preferences 3, 6.