Low-Dose Naltrexone for Chronic Pain: Update and Systemic Review
- PDF / 470,260 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 38 Downloads / 247 Views
ANESTHETIC TECHNIQUES IN PAIN MANAGEMENT (D WANG, SECTION EDITOR)
Low-Dose Naltrexone for Chronic Pain: Update and Systemic Review Phillip S. Kim 1
&
Michael A. Fishman 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to evaluate and explain our current understanding of the clinical use of low-dose naltrexone in the treatment of chronic pain. Recent Findings Recent pre-clinical uses and clinical studies further elucidate the use of low-dose naltrexone in the treatment of chronic pain. Summary Low-dose naltrexone (LDN) has shown promise to reduce symptoms related to chronic pain conditions such as fibromyalgia, inflammatory bowel conditions, and multiple sclerosis. The mechanism of LDN appears to be modulation of neuro-inflammation, specifically, the modulation of the glial cells and release of inflammatory chemicals in the central nervous system. These effects appear to unique at low dosage compared to dosage for food and drug administration approved use for alcohol and opioid dependence. We review the evidence that LDN has shown more than promise and should be further investigated in clinical practice. Keywords Naltrexone . Chronic pain . Fibromyalgia . Neuroinflammation
Introduction Chronic pain is one of the most important public health issues we face in USA, with direct and indirect consequences. The prevalence and financial costs of chronic pain eclipse any other health problem, affecting 100 million US adults at a cost of at least $600 billion annually [1]. Chronic pain affects more Americans than heart disease, diabetes, and cancer combined [1]. Chronic pain is a complex disease that is typically described in terms of biological, psychological, and social inputs that affect the pathogenesis, chronicity, severity, and impact on an individual. Multimodal treatments for pain attempt to address each of these domains to synergistically reduce suffering and restore function in those affected by this disease. Although this paper will focus on the role of LDN in the This article is part of the Topical Collection on Anesthetic Techniques in Pain Management * Phillip S. Kim [email protected] Michael A. Fishman [email protected] 1
Center for Interventional Pain & Spine, Wilmington, DE, USA
treatment of chronic pain, it is critical to remember that pharmacotherapy should be part of a broader pain care strategy that employs multiple modalities, including psychological (e.g., mindfulness meditation, cognitive behavioral therapy), rehabilitative, interventional, and complementary/alternative therapies. Naltrexone was developed in 1963 as an orally active opioid receptor antagonist to be used in the treatment of opioid and alcohol addiction. It is FDA-approved for the indication of medical-assisted treatment of alcoholism or opioid use disorder, and is prescribed in doses of 50–100 mg daily. Low-dose naltrexone (LDN) in the 1–5 mg per day range seems to work beyond the opioid receptor antagonism and modulate neuro-inflammatory proces
Data Loading...
