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Fibromyalgia and chronic pain go together. An old drug, used in low dosages, called low-dose naltrexone (LDN) has been found to be effective in treating fibromyalgia. The unusual thing is that this drug actually is used to treat opiate and alcohol addiction.
Naltrexone is prescribed in higher doses (50-300 mg) to treat opiate and alcohol addiction. When LDN is taken at very low doses (1.5-4.5 mg) it can reduce pain via two methods. Low dose naltrexone can increase the release of endorphins, which is why runners get a runner’s high. The other thing LDN does is lowers inflammation in the central nervous system.
What Causes Chronic Pain of Fibromyalgia
Inflammation around the nerves in the brain and spinal cord is what causes the transition from acute pain to chronic pain. This type of inflammation is very difficult to reduce. The fact that LDN is safe and inexpensive and works for chronic pain is just amazing. Expect to spend around forty dollars a month for this medication.
Why Does LDN Work for Pain
Low dose naltrexone binds with specific receptors on glial cells in the nervous system. Glial cells are immune and support cells around nerve cells that are dormant until triggered for action. Glial cells used to be thought of structural material. We are now learning that glial cells play a large role in chronic pain.
Our bodies are well adapted to handling short periods of stress. Once the stress becomes chronic this activates the glial cells to start releasing inflammatory chemicals. The nerve cells then become hypersensitized to pain. It is like adding gasoline to a fire. Activated glial cells are causing a controlled situation to get out of control and triggering the nerve cells to be hypersensitive to pain.
Current medications for Fibromyalgia
Pregabalin and gabapentin are two common fibromyalgia medications. They work by quieting the pain nerve signals themselves. They are only partly or temporarily effective because the nerves are still getting gasoline poured on them by the glial cells. The best way to reduce the pain is to calm the glial cells back into going dormant. That is how LDN works. LDN binds to receptors on the glial cells and tells them to go dormant and stop releasing inflammatory chemicals. This allows the nerve cells to normalize the volume on pain signals again. Low dose naltrexone ability to calm down nervous system inflammation means it has huge potential for treating autoimmune diseases, including multiple sclerosis and lupus.
Loveland Medical Clinic has had quite a few fibromyalgia patients get impressive pain reduction with LDN. Stanford University conducted two small studies on LDN and fibromyalgia pain. They found that LDN reduced fibromyalgia pain, with 57% of the participants reporting a significant (1/3) reduction of pain. The study found that LDN was well tolerated. Side effects of LDN included headaches, vivid dreams, insomnia, and anxiety, but these occurred infrequently.
Problems with Low Dose Naltrexone
LDN has to be specially made by a compounding pharmacy. Many doctors are not used to writing compounded prescriptions so you will have to find a doctor willing to do this. Low dose naltrexone does not mix with opiate pain medications because it might induce withdrawal symptoms. If you are on long-acting opiates you won’t be able to use LDN. If you take short-acting pain meds then you need to space them at least six hours apart from LDN to avoid any possible negative interactions.
More research is really needed on low dose naltrexone. Unfortunately, since naltrexone is a generic medication there is no pharmaceutical company interested in funding studies. Because of this, LDN will continue to be used in an off label method because no one can afford to go through the FDA approval process. If you are interested in trying Loveland Medical Clinic fibromyalgia treatment protocol give us a call and we will do a consultation.
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Siegfried Emme, FNP
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