The Utilization of Low Dose Naltrexone for Chronic Pain

Poliwoda, Salomon; Noss, Bryant; Truong, Gia Thinh; Creech, Zachary A; Koushik, Sarang; Urits, Ivan; O, Viswanath

doi:10.1007/s40263-023-01018-3

Cited by 2 publications

(2 citation statements)

References 56 publications

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“… 1 In addition, effects on pain and chronic disease for a variety of diagnoses have been claimed for LDN. 2 , 3 LDN has been shown to produce enhanced opioid analgesia, reduced tolerance to opioids, 4 suppression of the release of proinflammatory substances from microglia, and inhibition of mast cells, which uninhibited can further stimulate microglia to release proinflammatory cytokines. 5 , 6 LDN dose is an important variable when considering effectiveness, with reports of patients responding to only very specific doses.…”

Section: Introductionmentioning

confidence: 99%

“… 28 When Mast Cell Activation Syndrome criteria are not fulfilled but mast cell involvement is possible, the [provisional] diagnosis MCAD, not otherwise specified, may be present. 3 , 29 Approximately 30% of patients (12/41), all of whom had hEDS, were diagnosed with MCAD, not otherwise specified. There is general recognition of the increased incidence of MCAD in hEDS.…”

Section: Introductionmentioning

confidence: 99%

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Effective Doses of Low-Dose Naltrexone for Chronic Pain – An Observational Study

Marcus,

Robbins,

Araki

et al. 2024

JPR

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Purpose Despite the availability of a wide variety of analgesics, many patients with chronic pain often experience suboptimal pain relief in part related to the absence of any medication to address the nociplastic component of common pain syndromes. Low-dose naltrexone has been used for the treatment of chronic pain, typically at 4.5 mg per day, even though it is also noted that effective doses of naltrexone for chronic pain presentations range from 0.1 to 4.5 mg per day. We performed an observational analysis to determine the range of effective naltrexone daily dosing in 41 patients with chronic musculoskeletal pain. Methods Charts of 385 patients, 115 males, 270 females, ages 18–92, were reviewed. Two hundred and sixty patients with chronic diffuse, symmetrical pain were prescribed a titrating dose of naltrexone to determine a maximally effective dose established by self-report of 1) reduction of diffuse/generalized and/or severity level of pain and/or 2) positive effects on mood, energy, and mental clarity. Brief Pain Inventory and PROMIS scales were given pre- and post-determining a maximally effective naltrexone dose. Results Forty-one patients met all criteria for inclusion, successfully attained a maximally effective dose, and completed a pre- and post-outcome questionnaire. Hormesis was demonstrated during the determination of the maximally effective dosing, which varied over a wide range, with statistically significant improvement in BPI. Conclusion The maximally effective dose of low-dose naltrexone for the treatment of chronic pain is idiosyncratic, suggesting the need for 1) dosage titration to establish a maximally effective dose and 2) the possibility of re-introduction of low-dose naltrexone to patients who had failed initial trials on a fixed dose of naltrexone.

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