December 9, 2022

“Promising results” for low-dose naltrexone as a painkiller — Pain News Network

By Pat Anson, PNN Editor

Low-dose naltrexone (LDN) continues to be increasingly recognized by the medical community as a treatment for certain types of chronic pain.

In a review of 47 studies of off-label use of LDN, researchers at the University of Kansas Medical Center found ‘promising results’ that naltrexone improves pain and function and reduces symptom severity in patients with chronic inflammatory or centralized pain. However, most studies were small and larger clinical trials are needed to demonstrate the effectiveness of LDN.

“Although the results look promising, more well-controlled studies are needed before formal recommendations can be made,” said lead author Adam Rupp, DO, who will present his discoveries this week at the annual meeting of American Society of Regional Anesthesia and Pain Medicine (ASRA) in Orlando, Florida.

Naltrexone is an inexpensive generic drug that is only approved by the Food and Drug Administration as a drug addiction treatment. In doses of 50 mg, naltrexone blocks opioid receptors in the brain and decreases the desire to take opiates or alcohol.

But at lower doses of 5 mg or less, patients with fibromyalgia, interstitial cystitis, intractable pain and other chronic diseases have found LDN to be an effective pain reliever. But because LDN is prescribed “off label” for pain, much of the evidence supporting LDN is anecdotal.

It’s not entirely clear how naltrexone works, but LDN proponents believe the drug helps modulate the immune system, reduce inflammation, and boost the production of endorphins, the natural pain reliever of the body. LDN is not recommended for people currently taking opioid medications because it blocks opioid receptors and can lead to withdrawal.

In their review of the literature, Rupp and colleagues found that LDN improved physical function, sleep, mood, fatigue, and quality of life in patients with complex regional pain syndrome (CRPS), fibromyalgia , diabetic neuropathy, Crohn’s disease, rheumatoid arthritis and low back pain. . In patients with Crohn’s disease, improvements were also noted in the appearance of the colon during colonoscopies.

Side effects from LDN were minimal, most often consisting of vivid dreams, headache, diarrhea, and nausea. Most side effects resolved with continued use of LDN.

“The evidence from this review supports the off-label use of LDN for a variety of chronic conditions.
inflammatory or centralized pain conditions. However, it is clear that high-quality controlled studies focusing on administration, dosage and follow-up time are needed before formal recommendations can be made,” Rupp said.

“Despite the current paucity of high-quality evidence in the literature, LDN continues to offer promising results in symptom management in patients with chronic or central inflammatory pain.”

Because LDN is not recommended as a pain treatment by the FDA or professional medical societies, patients interested in trying it often encounter doctors who refuse to prescribe it or are unaware of it. The LDN Research Trust includes a list of LDN-friendly doctors and pharmacies on its website.