Lose Dose Naltrexone for Chronic Pain
Low dose naltrexone can by a very effective treatment for sufferers of chronic pain. And if you live long enough, you will likely have some degree of chronic pain. In recent years I have had much success using low dose naltrexone in my patients that suffer from chronic pain. These patients typically have degenerative joint pain or pain related to autoimmune disorders, Â but some of them have chronic pelvic and abdominal pain related to surgery and chronic inflammatory conditions.
I don’t recall one patient not obtaining at least some relied of their pain.
What is Naltrexone?
Naltrexone is a medication approved in 1984 by the FDA and is use in the treatment of alcohol and opioid dependence and works by reducing cravings and feeling of euphoria associated with substance use disorders. The dose for treating alcohol and opioid dependence is 50 mg daily. Â It has been used off label for other conditions including HIV during the mid 1980s.
Naltrexone works by blocking opioid receptors we have throughout our tissues.
At lower doses however, naltrexone has a paradoxical effects on opioid receptors. Low dose naltrexone provides a brief blockade of the opioid receptors followed by an adaptive increase in our endogenous endorphins and enkephalins. Increase in endorphins leads to an up regulation of the immune system, and thus low dose naltrexone is being used more and more in the treatment of autoimmune disorders. This paradoxical effect of low dose naltrexone is not seen at the higher 50 mg dose.
What is Considered Low Dose Naltrexone?
The use of naltrexone at doses ranging from 1.5 mg to 4.5 mg is generally considered as low dose naltrexone (LDN). Besides leading to an increase in endorphins and enkephalins, low dose naltrexone inhibits pro-inflammatory cytokines, interacts with nuclear opioid growth factor receptor leading to DNA synthesis, blocks opioid receptors in the gastrointestinal tract providing relief leading to improvement in Crohn’s disease.
The net effect of low dose naltrexone are the following:
- promote healing.
- inhibits cell growth.
- reduces inflammation.
- augments the immune system.
- provides a senses of well-being.
- provides a natural analgesia.
Low Dose Naltrexone and Other Medical Conditions
Based on the mechanisms of actions, low dose naltrexone has the potential to be repurposed for use in the treatment of a wide-range of medical disorders. It is being studied in the treatment of :
- cancer
- fibromyalgia
- multiple sclerosis
- Crohn’s and ulcerative colitis
- weight loss
- fertility
- inflammation.
How to Use Low Dose Naltrexone
Typically LDN is started at 1.5 mg daily and gradually increased to 4.5 mg but many patient will see results with the 1.5 mg or 3.0 mg dose. I typically increase the dose monthly. Â When it comes to medications, more is not necessarily better, and the same is true even with low dose naltrexone.
Every patient seems to have a “sweet spot” in terms of the dose. I have had patient responds better to 1.5 mg or 3.0 mg rather than the higher dose of  4.5 mg dose. In addition to patients with chronic musculoskeletal pain, I have used LDN in patients as adjunct in the treatment of their ulcerative colitis, autoimmune thyroid disease, and rheumatoid arthritis.
It is will tolerated and I have not had any patient complain of any side effects. As of now I have around 20 patients using it. Low dose naltrexone is not available commercially as retail pharmacies only carry the 50 mg dose, but LDN can be obtained through compounding pharmacies. A 30 day supply in Columbus, Ohio runs about $45.
REFERE CES:
The LDN Book: Volume 1: How a Little Known Drug Could Revolutionize Treatment for Autoimmune Diseases, Cancer, Autism, Depression, and More; Linda Elsegood, editor. Chelsea Green Publisher, White River Junction, Vermont, 2016.
Kim, Phillip and Fishman, Michael: Low-Dose Naltrexone for Chronic Pain: Update and Systematic Review. Current Pain Headache Reports, 2020, Aug 26;24(10):63
