Low-dose Naltrexone Helps Treat Intractable Pain

November 16, 2022

Summary: Intractable pain is among the most challenging pain syndromes to treat. Quite often, doctors need to prescribe opioids to manage such pain. However, opioids cause many side effects. It now appears that one of the drugs used to treat substance abuse, Naltrexone, is quite good for managing intractable pain and works at a low dose. Moreover, low-dose naltrexone (LDN) therapy works even better when used with other drugs like anti-inflammatory medications and drugs used to treat neuropathic pain. However, its concurrent use with opioids is not recommended due to severe side effects or interaction risk.

Among chronic pains, nothing is more challenging to treat than intractable pain. As the name suggests, it is not just pain but a condition that is challenging to treat with traditional painkillers. People living with intractable pain continue to experience pain, even when the condition that caused pain initially has been cured. Doctors do not fully understand why some people continue to experience intractable pain. However, they think such pain occurs due to neuroinflammation, spinal inflammation, and changes in certain brain centers.

Hence, intractable pain requires quite a different treatment approach compared to pains that occur due to other reasons like low back pain, arthritis, or rheumatological conditions. However, very few options currently exist to provide satisfactory relief for intractable pain. That is why regulatory agencies in some US states have identified intractable pain as a distinct kind of health problem that is different from chronic pain and a condition that justifies prolonged opioid therapy.

However, issues related to prolonged opioid use are not a secret. First, people become addicted to these drugs. Not only that, these drugs cause hyperalgesia, and thus people need to increase their dose over time, further increasing the risk of side effects. However, it appears that researchers have now identified a novel way to manage intractable pain. Using low-dose Naltrexone (LDN) is one of the emerging therapies for intractable and chronic pain treatment.

Naltrexone is an old and well-known medication used to treat substance abuse, and it is also good for treating opioid abuse and even reversing some of the side effects of opioids. However, now researchers have found that when used at lower dosages, it can be an excellent painkiller that also helps lower inflammation of spinal and brain tissues and even boost immunity.

This use of LDN to manage intractable pain is still an off-label use. It means the US FDA has still not approved it for such use. Nonetheless, its use is justified due to its excellent safety profile. Moreover, the clinical safety of the drug is well established. The only limitation of this drug is that it should not be used along with opioids since it would reduce the impact of opioids and may have certain unpleasant interactions with these drugs.

Doctors generally use 0.5 to 1 milligrams of Naltrexone medication twice daily to manage intractable pain. Using LDN may help intractable pain without the need for opioids. It seems that LDN is good to use along with other medications like gabapentin used for neuropathic pains, Adderall, Mucuna, and other medications. Doctors may also recommend Naltrexone (LDN) for pain relief along with standard anti-inflammatory medications like ketorolac.

LDN can have significant results in case of complex regional pain syndrome (CRPS) treatment and sciatica nerve pain relief. It appears that LDN is quite beneficial when used consistently for a long period, along with other less toxic painkillers. In addition, unlike other drugs, LDN has the ability to modulate intractable pain by altering immune responses and reducing neuro-inflammation. Thus, in the long run, it may help achieve complete remission of intractable pain.

As already mentioned, it is not good to use opioids, as it can interact with these medications in an unpleasant way. However, doctors may use synthetic opioids in a low dose during pain flares. Though, its long-term use, along with high-dose opioids, is not recommended due to the risk of some severe side effects. Those taking opioids can also be switched to LDN therapy. However, such patients would first need to discontinue opioid use. Studies show that some patients may become severely ill if they take LDN while using opioids.

Since LDN is still an experimental therapy, researchers say that if a person is experiencing satisfactory pain relief from opioids, then there is no reason to switch to LDN.

By Gurpreet Singh Padda, MD, MBA