Low-dose naltrexone at the pain consultation

Low-dose Naltrexone (LDN) is gaining acceptance in a wide range of medical fields. Its reduced side effects, alongside its high potential for improving the quality of life of patients with chronic diseases, make LDN a critical supplement in curing these diseases.

In a comprehensive review of the scientific literature published in the Journal of the American Dental Association, the authors concluded that:

  • In low doses, naltrexone is an alternative for the medical treatment of chronic pain disorders, acting as a new anti-inflammatory and immunomodulator.
  • LDN can be used in cases of orofacial pain, given that orofacial pain conditions have characteristics that are similar to other chronic pain disorders.
  • One of the biggest risks of prescribing an opioid medication for chronic pain is addiction. Given that LDN is not an opioid, and is not addictive, it has no opioid-like effects and is therefore considered a promising treatment for millions of chronic pain patients.

What is LDN?

Naltrexone is an orally active competitive antagonist opioid receptor. It was first approved in 1984 for the treatment of opioid addiction. For this indication, naltrexone is taken in doses of 50 mg to 100 mg per day. Low dose naltrexone refers to a dose that is about 1/10 of the current dosage. The maximum daily dose of LDN is 4.5 mg for most patients taking low doses of naltrexone. The dose can start from 0.5 mg to 1.5 mg and be increased to the maintenance dosage. The analgesic and anti-inflammatory actions that naltrexone has at this low dose do not occur with higher doses. With lower doses, naltrexone can increase the production of endogenous opioids, a beneficial factor in controlling chronic inflammatory diseases such as cancer. Although LDN has been clinically used since the 1980s, it was only during the last decade that publications on the effectiveness of this therapy have increased.

LDN for chronic disease

One of the first chronic pain conditions studied with LDN was fibromyalgia. This chronic pain condition involves musculoskeletal pain throughout the body, accompanied by fatigue and cognitive difficulties. Typical anti-inflammatory medications usually don’t work for fibromyalgia pain. Small-scale studies have shown that LDN can effectively reduce fibromyalgia pain in women – up to 57%, with a number of studies presenting a significant reduction in pain. Half of the participants reported feeling great improvements with LDN after treatment.

LDN has been prescribed for a variety of other pain conditions, including different types of neuropathic pain and orofacial pain. In general, LDN is prescribed as part of a broader pain relief strategy that involves lifestyle changes, physical therapy, and complementary therapies.

Orafacial pain

Orofacial pain disorders can involve the head, face, and neck. Pain conditions that affect these areas can be complex and require specialised knowledge in order to be diagnosed. The most common types of orofacial pain that dentist’s encounter fall under the category of temporomandibular disorders, which involve the facial muscles and are sometimes called musculoskeletal disorders. Many patients are familiar with a specific temporomandibular disorder called temporomandibular joint disorder (TMJ). Symptoms can include pain when chewing, headaches and facial pain. Certain types of orofacial pain can be cyclical – these symptoms may disappear or return later on.

There are a variety of physical therapy and home remedies for treating certain types of orofacial pain. Physiotherapy, with the help of a professional, can be effective. Pharmacotherapy for conditions such as TMJ usually involve NSAIDs, local anesthetics and corticosteroids, although various other treatments such as botox injections and antidepressants can sometimes also be applied. LDN has been considered a low-cost drug with few side effects for patients with chronic orofacial pain disorders.

The biggest controversy in the field of pain pharmacotherapy in recent years has been the widespread prescription of opioid medications. One reason why LDN is promising is that it offers a possible alternative to opioids that have a high addiction potential. For chronic conditions, such as orofacial pain, which may require ongoing treatment over months and years, LDN can be a low-cost, non-addictive alternative that helps with pain relief.

How is LDN administered for orafacial pain?

Low-dose naltrexone is most often prescribed to be taken once a day before bed. Given that the required dose is not commercially available, it must be made by a compounding drug pharmacy. At White Clinic, we use LDN not only in cases of orofacial pain, but also in patients with chronic diseases and as a complementary therapy for patients with teeth grinding issues. According to several studies carried out in the USA, there is relevant evidence that demonstrates that this drug should be part of any dentist’s “arsenal” of drugs.

*Dr. Ana Paz, Science, Research and Daily Practice at White Clinic
  • Use of low-dose naltrexone in the management of chronic pain conditions – Journal of the American Dental Association
  • The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain – Clinical Rheumatology
  • Orofacial pain management: current perspectives – Journal of Pain Management

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