LDN as an Alternative to Opioids for Chronic Pain

The widespread increase in addiction to opioid medications and the serious consequences of this increase have been well publicized in recent years. Chronic pain affects many Americans who may also struggle with substance abuse. For patients who suffer from chronic pain who also struggle with an addiction to opioids, it can be difficult to find a medication that is both effective and non-addictive. Healthcare providers often use a multimodal approach that involves using different types of medications together to manage pain. Low dose naltrexone is a treatment that has shown benefits in clinical trials for chronic pain patients with a corresponding low incidence of side effects.

Low Dose Naltrexone

Naltrexone is an FDA approved medication that is available in 25mg and 50mg dosages. It is prescribed to help individuals struggling with addiction to opioids or alcohol. Research over the past several years has significantly expanded the potential uses of low dose naltrexone to include chronic pain, multiple sclerosis, fibromyalgia, certain skin diseases, and more. LDN has no addictive potential and few side effects making it a promising treatment for chronic pain if it is shown to be effective. At lower doses, naltrexone has a completely different effect compared to the full 50mg dosage. The lower dosages used to manage chronic pain have ranged from 0.5mg to 4.5mg.

Low dose naltrexone meets what are sometimes referred to as the four L’s –

  1. Low side effect profile
  2. Low risk
  3. Low cost
  4. Low dose

Patients who are given LDN for treating chronic pain must be made aware that more is not better when it comes to this medication. The therapeutic effects occur within a specific dosage window and do not increase above a certain threshold. This is different from an opioid medication where an increased dosage will lead to increased effects. The one main side effect that is reported is insomnia and vivid dreams. If this side effect presents, often clinicians will recommend taking LDN in the morning instead of at night.

Types of Pain

Low dose naltrexone is being studied as a treatment for chronic pain but not acute pain. For acute pain LDN has not yet been shown to be effective. Acute pain is what happens when you get a cut or a burn – it is limited to the injury and usually resolves as it heals. Chronic pain is different because it is consistent and is not necessarily related to an injury – although it can originate with an injury. When it is related to an injury, chronic pain can result from an altered nervous system that continues to send pain signals when they are no longer needed. Chronic pain can also develop as the result of an illness or be unrelated to an injury or illness. Migraines, for example, can be considered a type of chronic pain.  

Downsides of Opioids

Besides the addictive potential of opioids, there is also the risk of the body becoming acclimated to a particular dosage of an opioid medication. With long-term use of opioids, the central nervous system can become used to a dosage that then stops being effective. Once the body is acclimated to a dosage, chronic pain returns and a higher dosage is required to provide pain relief. The higher dosage can lead to increased side effects and more severe dependence. Due to the widespread concerns about opioid addiction, many healthcare providers are more hesitant to prescribe them for chronic pain.

A Multimodal Treatment Regimen

Many healthcare providers who work with patients with chronic pain use a multimodal approach to pain management. The medications used can depend on the type of pain and its causes. For nerve pain as with fibromyalgia, a nerve pain medication like gabapentin or pregabalin may be used. Tricyclic antidepressants may be prescribed as well for patients with peripheral neuropathic pain. Non-pharmacological approaches can also be a part of a treatment plan to provide additional pain relief. These types of therapies can be especially beneficial for patients dealing with long-term chronic pain.

Among the pharmacological treatments that are available for pain, many are either addictive or have a variety of side effects. As discussed, LDN has few side effects while also proving to be effective in preliminary clinical trials and case studies. The trials that have been conducted show that LDN can effectively reduce chronic pain for many patients. In some cases studies it has been shown that even when the patient reported effects of pain reduction are less than 30%, most patients choose to continue using LDN due to its low cost and low incidence of side effects.

Orofacial pain involves the muscles in the jaw and other parts of the face. Chronic facial pain is one application of LDN that is already in use by dentists. Pain of the face and mouth can be managed while avoiding the use of addictive medications.

Low dose naltrexone works in a unique way on opioid receptors to reduce pain without the use of opioids. Its use may help patients using opioids to treat chronic pain reduce their opioid use and improve their quality of life.

Compounding Low Dose Naltrexone

Currently low dose naltrexone must be made by a compounding pharmacy. The higher dosages available from retail pharmacies do not work the same as the lower dosage and as such can not be used for managing chronic pain. Dosages of 1.5mg, 3mg, and 4.5mg are commonly compounded. For more information on compounded LDN you can contact us here.

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The Use of Low Dose Naltrexone in the Management of Chronic Pain – Practical Pain Management

Antidepressants in the Treatment of Neuropathic Pain – Basic and Clinical Pharmacology & Toxicology

Low-Dose Naltrexone Examined for Orofacial Pain Treatment – Dentistry Today

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