I have been meaning to write this article for some time but could not figure out how to approach a subject that passionately motivates me, and at the same time inform, but not overwhelm readers. I have been prescribing Low Dose Naltrexone (LDN) for about two years. It has helped me treat patients with some of the most difficult to treat disease states. Patients, that prior to my learning of this medication, would cause great frustration in my inability to advance their pain management treatment. Holding the fort shouldn’t be the option, conquering the enemy is better.
First though, a brief history. Naltrexone was created in the 1960’s, first used in the 1970’s, and hit mainstream use in the early 1980’s. At full dose, 150mg, the medication was effective in treating heroin addiction in that it completely blocked the opiate receptors in the body, thereby blocking the effects of heroin, an opioid. In 1984 Dr. Bihari deduced that Naltrexone was blocking all opiates, even the natural ones that we produce. These natural opiates, called endorphins, have impact on many processes in our body including mood, inflammation, and disease immunity. Additionally, in many chronic disease states endorphin levels decrease additionally wreaking havoc on mood, inflammation, and the immune system. Dr. Bihari experimented with lowering the the dose of Naltrexone to see if there was a dose that could block artificial opiates, like Heroin, but allow natural opiates, like endorphins, to slip through. He found that in people with low endorphin levels, much lower doses of Naltrexone, 0.5-4.5mg, caused the level of endorphins to increase, bringing it closer in line with a normal baseline level.
So, I have given you a bit of the history of Naltrexone, and that at low levels of Naltrexone, the levels of endorphins increase. Ok, so how does this help anyone? Well it turns out that there are many chronic diseases, which have a chronically lowered level of endorphins, and which are very difficult to treat with conventional medicine, or that medicine is expensive\has side effects. The common thread that link these various disease states is immune system malfunction and inflammation. A short list of these diseases are Fibromyalgia, IBS, Chrons, Lupus, Lyme, Multiple Sclerosis, and RSD/CRPS. This is by no means an exhaustive list. There are now over 30 disease states in which LDN has had a positive effect. I use LDN to cause the body to raise endorphin levels, from their lowered state, thereby combatting the effects of a malfunctioning immune system and chronic inflammation, especially nervous system inflammation. I personally treated a middle aged female patient who had back surgery twice and 3 knee surgeries, who also had Fibromyalgia. She took high levels of opiate pain medication in order to function, but she still had significant pain daily. I performed multiple injections for her back and knee pain, which always helped, until her Fibromyalgia would flare and all of the relief would be wiped away. After 7 years of no significant progress, I convinced her to come off her opiate medication with an out-patient based Suboxone treatment, which was done in my office. Once she was off her opiates, (LDN and opiate medication do not interact well. It is actually one of 2 types of medication that do not work together with LDN, the other being the drugs that are given to transplant recipients) she started LDN. Once the correct dose was found she reported feeling better then she felt since she was in her 30’s when her Fibromyalgia was diagnosed. You see, her main pain disease was not the sequelae of her multiple surgeries, but that of her Fibromyalgia. Once she was on LDN her body pain went from an 8/10 to a 3/10, and her back pain decreased to 6/10. She usually ignores her back pain nowadays, as long as the weather co-operates, since her entire body was no longer in pain. She is now able to do chores around the house, go for long walks, and sit through an entire movie. She no longer shrinks away from a hug because of the anticipated pain. Another patient that added this regimen to her stable Rheumatoid Arthritis regimen. She reports that her usual aches and pains dropped away. I have given this to patients with RSD/CRPS, a very painful and difficult to treat (sometimes) outcome of minor injuries or surgeries, and have been amazed at LDNs success.
I have been prescribing LDN for 18 months and continue to learn and be excited about it. I encourage you to learn about it as well. Even if LDN is not something you need, perhaps there is some in your life that can benefit. A very good resource put together by someone with MS who’s life was becoming more and more constricted before starting LDN is LDNresearchtrust.org . If you want to spend a fascinating hour then look up the video interview of Dr. Bihari about LDN on YouTube. I welcome questions either in person or via email at firstname.lastname@example.org.
Thank you for your time.
Asher Goldstein has been a practicing pain management physician for 15 years. He is now the Chair of Pain Medicine, in the Pain Medicine and Palliative Medicine department at Holy Name Medical Center. He has his own private practice in Hackensack NJ.