The People's Perspective on Medicine

Low Dose Naltrexone Worked for Pain

People with chronic pain from fibromyalgia, MS or complex regional pain syndrome have few options. Low dose naltrexone is a novel approach gaining converts.
Young female touching her left side in pain. Kidney inflammation and therapy. Medicine and health care concept.

Have you ever heard of low dose naltrexone (LDN)? Most people have never heard about this interesting drug. It was created in 1963 and approved by the FDA in 1984. Many physicians are also unaware of the potential of low dose naltrexone. They are familiar with regular dose naltrexone. It is prescribed for people who are trying to overcome an alcohol problem. Nalrexone is technically an opioid antagonist. That means it blocks the effects of opioid narcotics. Surprisingly, low dose naltrexone seems to have a positive impact on some kinds of pain, as this reader relates.

Staying Active with Low Dose Naltrexone:

Q. I have had pain in many parts of my body for years. Like the proverbial frog in boiling water, as my pain increased I just dealt with it because I seem to have so many side-effects from medications.

My doctor put me on low dose naltrexone (LDN). It is not an opioid, and it has definitely helped me with my pain so I can think and stay active.

Some people have switched from opioids to LDN, but medical oversight is essential. Not all doctors know how to do this correctly. I wish more of them would educate themselves in its use.

A. Naltrexone is an opioid blocker that is prescribed to help people overcome addictions like alcoholism and a dependence on narcotics. When used for such purposes the dose is 50 mg.

There is growing interest in low dose naltrexone (1.5 to 5 mg) for conditions such as Crohn’s disease, fibromyalgia and multiple sclerosis (Pharmacotherapy, March, 2018).  At such low doses naltrexone appears to help regulate the immune system and reduce inflammation.

Lest you assume this is some wacky alternative medicine approach, we would like to share observations from mainstream medical publications.

Pain experts writing in the journal Clinical Rheumatology (Feb. 15, 2014) call low dose naltrexone a “novel anti-inflammatory treatment.” They conclude:

“The totality of the basic and clinical research to date suggests that LDN is a promising treatment approach for chronic pain conditions thought to involve inflammatory processes.”

Those conditions include:

  • Fibromyalgia
  • Crohn’s disease
  • Multiple Sclerosis
  • Complex regional pain syndrome

It is possible that LDN will be found to be helpful for other painful conditions or autoimmune problems. Despite the long experience with naltrexone there remains surprisingly little research about it novel benefits against pain.

Low Dose Naltrexone Side Effects

The doses that are employed with LDN start around 1.5 mg at bedtime for a few weeks. That is gradually increased to 3.0 mg and then to 4.5 or 5.0 mg. The most common complication is reported to be vivid dreams. A small number of people experience nightmares. Fortunately, the dreams and nightmares usually fade away pretty quickly.

Headaches are another possible side effect, though this adverse reaction is just a little higher than with placebo. Some people may experience anxiety, though this too is uncommon. People with liver problems should be monitored.

This drug requires a prescription and is only available in low doses from compounding pharmacies. If your doctor is unfamiliar with LDN, you can show him this article from Medical Sciences (Sept. 21, 2018). Be sure to download the free pdf file for your doctor. This review is also informative: Clinical Rheumatology (Feb. 15, 2014).

If you have had any experience with low dose naltrexone please share your story below in the comment section.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I have been taking Naltrexone for less than a year, but find it helpful with the pain from non-diabetic periphal Neuropathy. I have been upped from 1.4 mg to 4.5 over several months. I too have been plagued by insomnia, but I have had insomnia for years, so I don’t see any difference with my sleep problems. I also have frequent headaches, but they seem to be easing off a bit, no dreams or nightmare!

My doctor was willing to write me the prescription, so I tried it at 1.5 mg for three weeks. All I got was the vivid dreams, shading into nightmare and nighttime anxiety, which didn’t go away until three days after I stopped.

The pills were $100.00 for a two-month supply at a compounding pharmacy. I now consider this yet another failed experiment in the search for pain relief and money down the drain.

Ah, well. I tried. Hope springs eternal, I suppose. 🙄

I have been on LDN for Fibro for 5 yrs. It has helped me immensely. Do your research, go armed with print-outs and talk to your DR. It’s an off-label use for an old, off-patent drug. No harm in trying it.

Will LDN help w pain from non diabetic peripheral nerve pain?

I’ve taken 4.5 mg of LDN for 5 yrs for Fibro. Recently had a hip replacement that caused severe femoral nerve damage. Due to the very restricted positioning of my body during surgery. It has improved but is still a problem affecting my walking. I’m not sure if the improvement is due to the LDN or just the natural progression I was told would occur. But it’s worth a try. LDN is safe. But you may need to educate your DR. They know little about this off-label use. So do your research and go armed with print-outs. I did and my Dr was not only receptive he was grateful.

I have advanced prostate cancer and have been exploring using LDN as an adjuvant treatment to potentially enhance the effects of primary chemo or radiation therapy (off label, of course). One caveat I read was that care should be taken in patients who are also taking opoid pain killers when adding and dose regulating LDN. Joe G, are pharmacists familiar with these potential interactions and able to advise patients accordingly? I also read that a pulsed schedule may be more efficacious than continuous use. Any thoughts on this? There are a number of physicians (on YouTube) who have incorporated LDN to enhance conventional therapy. Any chance you might know any who would come on your podcast?

I was on high dose opiopds after a severe back injury and subsequent back surgery. I was switched to Suboxone after the “opiod crisis” was brought to the forefront in America. It was my only option as all the Pain Specialists in my area are scared to death to prescribe ANY opiates even for people like me with serious injuries and pain. Suboxone has a low dose of Naltrexone and it really worked wonders for my pain. I was pleasantly surprised! But I have read you must use caution if you need any type of anesthesia for any surgical procedure…the LDN works against the anesthetic and may prove hard to keep you under during surgery. I have read about this in detail online, so I am just quoting info second hand and have no personal evidence of this. Do your own due diligence to keep yourself safe!!!

I have Rheumatoid arthritis and other autoimmune diseases; I also have pain from a spinal fusion and scoliosis. I started on LDN a few weeks ago. I was at 1.5mg. I didn’t sleep, and being on medication for sleep, I felt terrible! However, I didn’t have pain the next day! This would be a life saver for me if I could get passed the insomnia side effects!
Has anyone else experienced this, and how long before you could sleep?

Does it work best taken daily?

I, too, have autoimmune and chronic pain issues. LDN has helped significantly with my pain. I had insomnia initially, but this side effect has gone away. It probably took a couple of weeks I’d say. It’s worth it though! Hang in there!

I’ve been taking LDN, 4.5 mg daily, for two years. I have an autoimmune disease called discoid lupus that affects my skin. It was aggravated by the chemotherapy I had for breast cancer and would not clear up. Then, when I began taking Tamoxifen for the cancer, I experienced a lot of muscle and joint pain. At this point my naturopath suggested trying LDN. Within weeks the rash on my face greatly improved and the muscle and joint pain decreased significantly. I believe it is the naltrexone that has made the difference. The only side effect I have is vivid, but not unpleasant dreams, and a tendency to be groggy in the morning upon awakening.

Would this work for post nerve pain following shingles outbreak?

I have moderate to severe osteoarthritis in my hips and lumbar spine. Due to a-fib, I cannot take NSAIDS. I am in constant pain of varying degrees, and do not want to take opioids. Would LDN work for me?

I am in my fourth month of taking LDN, and I find it helpful. We started my dose at 1.5 mg, then went to 2.5mg, and for one and-a-half months, it’s been 3.5mg. I have MS, and I have had three back surgeries involving fusions; all of this has caused me to have problems walking, and LDN seems to be improving my ability to move. I’m hoping to increase to 4.5mg at some point. I am 75 years old, and I’ve not suffered any side effects.

I was just wondering if Naltrexone would help people who have Post Herpetic Neuralgia. My wife has had it for over a year after a case of Shingles. She has been in constant pain since around September 2017. She has seen 2 different pain management providers and they have done several nerve blocks and she has been on Gabapentin and Norco but all that has had little effect in calming her pain. She is now undergoing accupuncture, which seems to help. After a recent treatment, her pain was reduced significantly, but returned after a couple of days. Has Naltrexone been tried for Post Herpetic Neuralgia. I would appreciate knowing if anyone has tried Naltrexone for this painful disease.

I have found LIN extremely helpful. I love waking jup without joint pain. I’ve had fibromyalgia for 40 years. This and Effexor have proved their value.

Since low dose Naltrexone helps regulate the immune system, could it help psoriasis? Side effects of psoriasis meds are scarey.

Wow! This is great news! As soon as some drug company figures out a way to jack the price on this old drug by a few hundred percent it may become readily available. Surely they can come up with some snow job about the cost of R+D (already done) or perhaps how it costs them more to use far less active ingredient … yadda yadda. I don’t expect any less of the “biz”. We’ll see.

My doctor prescribed LDN for fibromyalgia. She increased my dose slowly, but I still had migraines most of the time that I used LDN. After 2 weeks I quit taking it, and the headaches disappeared. I’m glad it works for some fibro patients, but not for me!

I have been on LDN for about 13 years. Started after learning about it from a Brewer Science Library newsletter. Diagnosed with MS in 2000. Mild case, but didn’t want to take the MS drugs. My regression in this period of time has been minimal. I’m also 76 so some issues may be more age-related than MS related.

Brewer Science Library was still in existence a short time ago, they have great information on MS. Also check out http://www.ldn.org. Lots of information.

LDN is also used as a prokinetic to help the migrating motor complex clear the small intestine after treatment for SIBO. It is taken at bedtime and recommended by both Dr Pimentel and naturopaths.

My Dr. has me on a 3mg dose for Fibromyalgia, and it does help some of the pain.

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