NPR: Low Dose Naltrexone Can Help Some with Chronic Pain

[drusso]

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In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain

Naltrexone, commonly used for opioid and alcohol use disorders, may also help patients with chronic pain — when prescribed in microdoses. But few doctors or patients seem to know about it.

www.npr.org

"Those patients may report that this is indeed a game changer," Vrooman says. "It may truly help them with their activities, help them feel better." So how does it work? Scientists think that for many chronic pain patients, the central nervous system gets overworked and agitated. Pain signals fire in an out-of-control feedback loop that drowns out the body's natural pain-relieving systems. They suspect that low doses of naltrexone dampen that inflammation and kick-start the body's production of pain-killing endorphins — all with relatively minor side effects."

 

[Ducttape]

my N of roughly 30 has resulted in zero patients with long term benefit.

but, experience is at best level 5 evidence. and Vrooman's "study" is the same.

we need real clinical research.

 

[TheLoneWolf]

my N of roughly 30 has resulted in zero patients with long term benefit.

but, experience is at best level 5 evidence. and Vrooman's "study" is the same.

we need real clinical research.

But did you go low enough in dose as the article suggested?

 

[myrandom2003]

CBD cream and naltrexone at 4.5mg is the new miracle compound with some special K for those who can pay

 

[drusso]

CBD cream and naltrexone at 4.5mg is the new miracle compound with some special K for those who can pay

The tincture works better than the cream. Tinctures are magic...

 

[VA Hopeful Dr]

The tincture works better than the cream. Tinctures are magic...

Real doctors use poultices

 

[SeniorWrangler]

I’ve had good results in selected fibromyalgia patients, sometimes at even lower doses than 4.5 mg. This is anecdotal but I had tried many other treatments without much benefit previously.

 

[lobelsteve]

Go to 2:45

 

[SommeRiver]

Oh God LDN...Never saw it work in fellowship. BS.

 

[callmeanesthesia]

Anecdotally unimpressed. I read some of the (very limited) data in fellowship and was also unimpressed. Any actual controlled trial data on it?

 

[kstarm]

Have one patient that it was a home run on, neuropathic pain after a gunshot wound and PTSD. A few others that I don't think it has made much difference based on function and other medication use, but they swear it helps and ask for refills. A number of others without any benefit and it gets stopped.

 

[oreosandsake]

does placebo work better than LDN? Naltrexone can possibly reverse the placebo effect so that tells you something.

4.5mg... and then people talking about ultra low doses? I think homeopathic remedy doses is next

 

[lobelsteve]

50mg.

Take 1/4 pill qd.

Cheap, only side effect is vivid dreams.

Some data showing promise, limited studies. Mostly single source.

For a condition based on 2 internet surveys, no adequate medication to treat, no objective data to identify FMS as a disease, my treatment algorithm for FMS:

1. exercise
2. exercise
3. exercise
4. Lyrica/Cymbalta/Savella
5. SMR not soma.
6. Naltrexone.
7. Since the accpetance of new clinical criteria and the opiate epidemic- I do not start new FMS on Ultram unless FT gainful employed.

 

[Orin]

It's a better placebo because it's precisely 4.5 mg!

I haven't had any clear wins with it, but I use it intermittently as above.

 

[soccrwz]

how are you getting this filled?

 

[deleted993114]

Have one patient that it was a home run on, neuropathic pain after a gunshot wound and PTSD. A few others that I don't think it has made much difference based on function and other medication use, but they swear it helps and ask for refills. A number of others without any benefit and it gets stopped.

I had my NPs try it about 6-7 years ago. It didn’t work. However, it was used for the dx of fibromyalgia, so take it with a grain of salt.

 

[lobelsteve]

I had my NPs try it about 6-7 years ago. It didn’t work. However, it was used for the dx of fibromyalgia, so take it with a grain of salt.

It is a common error. You need 4.5 to 12.5 mg of naltrexone combined with a dash of pepper. Salt inactivates the beneficial effects of naltrexone.

 

[Baron Samedi]

1. exercise
2. exercise
3. exercise
4. Lyrica/Cymbalta/Savella
5. SMR not soma.
6. Naltrexone.
7. Since the accpetance of new clinical criteria and the opiate epidemic- I do not start new FMS on Ultram unless FT gainful employed.

Agree 100% with your algorithm with the addition of a sleep study in step 1

 

[soccrwz]

Fibroguide, exercise, exercise, exercise, weight loss

 

[Multimodal]

[

50mg.

Take 1/4 pill qd.

Cheap, only side effect is vivid dreams.

Some data showing promise, limited studies. Mostly single source.

For a condition based on 2 internet surveys, no adequate medication to treat, no objective data to identify FMS as a disease, my treatment algorithm for FMS:

1. exercise
2. exercise
3. exercise
4. Lyrica/Cymbalta/Savella
5. SMR not soma.
6. Naltrexone.
7. Since the accpetance of new clinical criteria and the opiate epidemic- I do not start new FMS on Ultram unless FT gainful employed.

This is essentially my algorithm too but I rx aquatherapy in a warm pool first ....then #4 and #5 and lastly naltrexone. If I see a patient that tells me they have burning pain from just clothes contacting their skin or even air blowing on them, I consider LDN earlier on. I always use 4.5mg QHS and have had only 1 patient on 9mg but it worked well in her case. I have been and continue to be skeptical about LDN but I keep seeing substantial improvements in the type of patient I mentioned above. In the 2 years I have been using LDN, I probably have Rx'd it to over 200 patients and have had quite a lot of them tell me that it has been "life changing".

This stuff could be hocus pocus, but at least it seems to work and it's not an opioid. 🙂

 

[epidural man]

Anecdotally unimpressed. I read some of the (very limited) data in fellowship and was also unimpressed. Any actual controlled trial data on it?

It's all about the glia!

One controlled study that I know of (attached). I also attached a case series I like in CRPS.

Look - Dumbo needed a feather to fly - lets give these FM patients a feather (LDN).

 

[Ducttape]

please consider the possibility that giving them any pill will reinforce the notion that they do not have to actively commit to making themselves better, even if it naloxone...

 

[epidural man]

please consider the possibility that giving them any pill will reinforce the notion that they do not have to actively commit to making themselves better, even if it naloxone...

I don't disagree...

But also, Nadal thinks that picking his nose and rubbing his butt before each serve helps him win points. And he wins points. Maybe there is something to that.

 

[SeniorWrangler]

please consider the possibility that giving them any pill will reinforce the notion that they do not have to actively commit to making themselves better, even if it naloxone...

Just telling people to exercise if they don’t feel able to exercise is a waste of time, though.

 

[Ducttape]

I believe in the power of reinforcement.

also, ive heard enough times "they told me not to exercise because it would make my fibro worse"...

 

[painfree23]

how do you usually prescribe it? where do patients get it from? dosage?