Naproxen for pain treatment in the clinical practice
Keywords:
naproxen, back pain, migraine, tension-type headache, cardiovascular risk factorsAbstract
Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) with proofed therapeutic effectivity for acute and chronic pain. It has a moderate anti-inflammatory activity and not higher risk of gastrointestinal side effects as compared with the classical nonselective CoX inhibitors. The analgesic effect is fast – around 30 minutes after per oral intake. The halflife is long, so it may be taken 2 times daily. Naproxen and naproxen sodium have equal pharmacological efficacy.
The most common pain syndromes in neurological practice are back pain and headache. Naproxen is a classical drug for treatment of back pain. There are publications for good effect on acute and chronic back pain. Migraine attacks are also reason for acute pain, frequently treated with NSAID. Naproxen reduces the central sensitization during the migraine attack, the pain, nausea, photophobia and phonophobia. The good therapeutic efficacy was reason for testing a combined tablet of sumatriptan and naproxen sodium for migraine attack. The combination is more effective than each of the drugs separately. Prophylactic use of naproxen may decrease the frequency of migraine attacks. Naproxen is also effective for treatment of episodic tension-type headache.
Both selective and nonselective CoX-2 inhibitors increase the risk of acute myocardial infarction, but the degree of risk varies between different NSAID. Naproxen is the most safe NSAID for patients with cardiovascular risk factors, that’s why it is a drug of first choice for these patients. There are no data that low doses naproxen impairs the antiaggregant effects of aspirin, in patients using it for prophylaxis of cerebrovascular disease. However, it is better to take naproxen 2 hours after aspirin intake. It is important to know that naproxen prolongs the prothrombin time and increases the risk of bleeding in patients on anticoagulant therapy.
In conclusion naproxen is well studied NSAID in the neurological practice and is used for treatment of nociceptive pain in patients with headache and back pain. It is also a drug of first choice for patients with cardiovascular risk factors. It should be used with caution for patients using prophylaxis with antiaggregant or anticoagulants.
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