Low-Dose Naltrexone Offers New Hope for Pain Sufferers

Chronic pain can take a heavy toll.

Source: Aaron-Blanco-Tejedor/Unsplash

According to some estimates, chronic pain affects up to 40 percent of Americans_.[1] It can have an adverse impact on mood, relationships, job performance, and overall quality of life, taking an enormous toll on the lives of millions of people.

The Cleveland Clinic describes chronic pain as prolonged pain that is ongoing and usually lasts longer than six months. It can continue even after the injury or illness that caused it has healed or gone away, as pain signals continue to remain active in the nervous system for weeks, months, or years._[2] Treating chronic pain can be frustrating for clinicians, patients, and families, and this frustration can be further compounded by hesitation to prescribe opioids for pain, particularly in recent years.

When most of us hear the drug naltrexone, we think of the pharmaceutical intervention used to treat drug and alcohol addiction. But new research has shown that chronic pain patients can be helped by daily use of less than a tenth of that amount.

By blocking the euphoric and sedative effects of opioids such as heroin, morphine, and others, naltrexone binds and blocks opioid receptors and reduces and suppresses opioid cravings._[3] When naltrexone is used to treat addiction in pill form, it's usually prescribed at around 50 mg. In the past few years, however, there's been a large increase in promising new studies published on the efficacy of low-dose naltrexone in the treatment of chronic pain conditions, including fibromyalgia, complex regional pain syndrome, orofacial pain, and other inflammatory, musculoskeletal conditions.

Bruce Vrooman, associate professor at Dartmouth's Geisel School of Medicine and author of a recent review of low-dose naltrexone research_[4], states that when treating some patients with complex chronic pain conditions, low-dose naltrexone (LDN) can be a game-changer. “When it comes to treating some patients with complex chronic pain, low-dose naltrexone appears to be more effective and well-tolerated than the big-name opioids that dominated pain management for decades,” Vrooman shares. “It may truly help patients with their activities and make them feel better.”_[5]

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._[6]

Elizabeth Hatfield of the University of Michigan explains that low-dose naltrexone targets the glial cells that keep the nervous system sensitized, thereby reducing the pain threshold and the sensitivity of the nervous system over time. Traditional pain management has focused on treating the injury or trauma site, but low-dose naltrexone works on the overactive nervous system._[7]

In simpler terms, chronic pain has more to do with how our body transmits pain to the brain than the actual injury, and patients with hyperalgesia—an acquired sensitivity to pain—often need some kind of intervention for relief in order to function in their daily lives. While opiates have historically been successful in dampening the sensitivity of pain receptors, it has been noted that they also come with significant risks for increased tolerance and overdose. LDN is much safer, it’s not addictive, and providers are much more open to prescribing less risky medications.

Is LDN a cure? Can it treat severe pain?

The short answer is no. Severe injuries and much cancer-related and post-surgical pain still require treatment that is aimed at treating acute pain, often in the form of non-steroidal anti-inflammatories (NSAIDs), acetaminophen, or opiate pain relievers, with medical guidance. And while recent years have been very challenging for the medical community and patients through the lens of what has been termed the “opiate crisis,” inroads have been made to begin addressing the issue of persistent, chronic pain with different modalities.

As recently as February 2022, the Centers for Disease Control and Prevention (CDC) began tackling practical clinical considerations for addressing the needs of the chronic pain population in light of the strict opiate prescribing policies that began in 2016._[8] Discussions continue about racial/ethnic disparities and inequities about how pain is perceived, valued, and appropriately treated, in addition to the importance of patient/provider communication and validation of appropriate use of opiates for some patients.

Takeaways

Management of pain isn’t easy, and It’s not a one-size-fits-all approach. Pain can be grueling, hard, and emotional, and the best outcomes happen when there is honest communication between well-informed patients and their doctors. No one wants to see people suffer. Yet no one wants to learn about the unintended consequences of overdoses and death. It’s important to weigh the risks, benefits, and realistic expectations of treating pain appropriately and effectively. LDN may be a viable part of that regimen.

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Until recently, the benefits of LDN were not well known, and because naltrexone has been compounded in larger 50 mg amounts to treat addictions, it was hard to find pharmacies to compound smaller 1-4.5 mg amounts. But that appears to be changing as the benefits of LDN for chronic pain patients become more widely known, and increasing pharmacies are filling lower-dose prescriptions.

If you are a patient dealing with long-term chronic and persistent pain, it may be worth discussing the benefits and drawbacks of low-dose naltrexone with your doctor.