Low-Dose Naltrexone for Invisible Pain
Apr 06, 2023What we are talking about applies to “invisible” pain, the pain of fibromyalgia, Alzheimer's, Guillain Barre, myofascial pain, headache management, and others that are often treated conventionally with reluctance, with either opioids or analgesics of another variety.
Opioids have to be used appropriately, and medical providers must have a lot of training with opioids. Just to write a prescription is ill-advised. A healthcare provider should know what the risk-reward benefit is.
What Kinds of Pain are Resistant to Opioids?
It is often the tough “invisible” pains like neuropathic pains, central pain (from the central nervous system), and of course fibromyalgia that are resistant to opioids. In other words, those pains that are “inside out” as opposed to “outside in”.
There are 3 types of opioid-related medications we should understand:
1. Agonist or Pure Opioid Type Drugs
They work to help pain, for a while, and then you start getting side effects. And the side effects just keep going. These medicines are:
- morphines
- oxycodones
- hydrocodones
These are pure, or what we call “mu” opioid agonists.
Mu is the receptor where opioids work.
2. Opioid Agonists/Antagonists
These both work with and work against the opioid. Buprenorphine is the classic. There are others, but buprenorphine is well-known as a recovery drug in the medication assisted treatment of opioid addiction or dependency.
Keep in mind, not every person that takes opioids is an addict! Please don't mix that up.
3. Opioid Antagonist
These medications work completely against opioids:
- Naloxone, Narcan (reverses opioids)
- Naltrexone
Naltrexone binds tightly to the mu opioid receptor and blocks opioids.
Buprenorphine is pretty tight too, but less so.
We give naltrexone to folks when we want to really block opioids.
You can take it in oral or IM form (intramuscular form), about 50 milligrams, usually. For a period of time, it can really work. The intramuscular form can work quite a while. There's a formulation that can last up to a month and it's really a good drug.
Naltrexone can also be taken daily, and it can block the opioid as well, and it can do it really well. But you don't want to take that drug under any circumstances until you're absolutely sure that the opioids are out of your system, period. A drug like naltrexone given with methadone, which has a long half-life (especially if you take other medicines that make it even longer such as Ranitidine, simple drugs you get over the counter) you could give that drug naltrexone and throw somebody into withdrawal!
Naltrexone in very low doses seems to decrease the irritability in those glial cells, those little tiny things in the nervous system that may have something to do with neural inflammation.
Low-dose naltrexone has shown in my practice to help quite a few disease state/pain states that are very resistant. Some examples are interstitial cystitis, fibromyalgia, and neuropathies. It can help “inside out” problems as opposed to those that are “outside in”.
