Low Doses of Naltrexone May Provide More Pain Treatment Options
A PPM Brief
Naltrexone, an opiate antagonist indicated for the treatment of alcohol and opioid dependence, continues to grow in its use for the treatment of fibromyalgia and other chronic pain conditions, including chronic fatigue or myalgic encephalomyelitis (ME/CFS).
Jarred W. Younger, PhD, director of the neuroinflammation, pain, and fatigue lab at the University of Alabama in Birmingham, recently commented on the medication’s potential for providing a low-cost, nonaddictive opioid alternative for patients living with chronic pain. Low-dose naltrexone (LDN) may lower pain sensitivity over time in comparison to opioids, he said in a Medscape article.1
While the low-dose version of naltrexone must be specially compounded and is not currently approved by FDA, around one-tenth of the usual substance abuse treatment dose (4.5 mg/day) has been found to reduce pain.1 LDN has also reduced both self-reported pain and objective markers of inflammation and disease severity in several inflammatory conditions,2 and shown benefit for those with fibromyalgia, according to previous studies by Dr. Younger.3 He hopes to conduct clinical trials of LDN specifically on ME/CFS in the future.1
While LDN has been well tolerated in Dr. Younger’s studies, he noted the common adverse effects of vivid dreams in about 20% of patients, with a small group experiencing anxiety or having trouble sleeping. He advised that practitioners should take care in combining naltrexone with other opioid analgesics, despite the lack of interaction, and patients should use caution when combining with alcohol.1
