Low Dose Naltrexone for Chronic Pain?

Medical Q&A [Moderated]
1

Hey BBM Crew,

Do you know if low dose naltrexone has shown any efficacy in treating chronic pain in conditions such as fibromyalgia? I’ve done some very limited internet research on this topic and what I found seems pretty positive. I recently found out about the INNOVA Study, which is a study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost–utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia.

This is what the abstract introduction says, “There is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost–utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up.”

I’ve heard Austin and Jordan say on the podcast that there is a lot that you can’t really tell by simply reading an abstract. This is why I’d like to get the BBM perspective on the topic of low dose naltrexone. Do you think that low dose naltrexone could be a useful tool in treating chronic pain in conditions like fibromyalgia? Or would it be better to focus on other avenues of treatment? In other words, is LDN even worth discussing?

Thanks!
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2

As you noted,

However, no randomised controlled trials with long-term follow-ups have been carried out.

This is what we would prefer to see in order to justify confident recommendations here. Short of that, it is difficult to be confident in clinically significant efficacy here.

I would also not lump “chronic pain” and “fibromyalgia” together as the same thing. In other words, even if this trial were carried out and showed positive findings among patients with FM, it would not generalize to all other chronic pain conditions.

3

That makes sense, thanks Austin!