How Non-opioid Medication Can Help Manage Chronic Pain
“It’s a Game Changer”
A 50 year old female woman who has had chronic pain since the age of 15 was featured in an article by NPR, In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain. She reports that she can now be up and moving around, functioning, within a half-hour of taking this medication.
After two decades of “disastrous” prescribing of opioids, researchers and physicians are searching for alternatives for pain management. Is LDN the answer? It seems that more and more reports are showing the benefits of this hidden gem.
The article discusses how naltrexone is available in 50mg tablets, but that dosage is not what is used to treat chronic pain. “Low dose” naltrexone is what is used for chronic pain and can be prescribed from micrograms up to 4.5 milligrams in strength.
The microgram dosing is called “ultra-low dose naltrexone” or “ULDN”. There is research on this and it does take working with an experienced physician and an experienced pharmacy for finding the right dose for the patient.
At the high dose naltrexone (50mg) , it will block the opioid receptors and prevent the high that is felt from taking a drug. At the low dose, it does not work in that way.
Researchers hypothesize that in chronic pain, the central nervous system (CNS) gets overexcited and the body’s natural pain-relieving systems do not work properly. LDN briefly comes in contact with opioid receptors and increases the body’s natural pain-relieving substances. With this also comes reduced inflammation and improved healing.
Read full article here: https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain
At Town & Country Compounding we do the best to work with the patient and the practitioner to offer other options for the patients.
*Northern New Jersey & NYC Area
LDN and Chronic Pain
Naltrexone is an opioid receptor antagonist with FDA approval for treating opioid addiction since 1984. While typical dose for treating opioid addiction with naltrexone is between 50 mg to 150 mg, the use of low dose naltrexone (LDN) with doses ranging from 1.5 mg to 4.5 mg per day has been growing in popularity. The most common use of LDN has been treating autoimmune disorders; consequently, there have been clinical trials investigating the effectiveness of LDN for clinical conditions such as multiple sclerosis, systemic sclerosis, and Crohn’s disease.
More recently, exploring the role low dose naltrexone and ultra-low dose naltrexone (microgram dosing of naltrexone) for chronic pain have been described in the literature.
It has been proposed that LDN halts inflammatory cascades via glial cell inactivation. In addition, the role of microgram dosing of naltrexone has shown promise as a means to increase analgesia and decrease tolerance to opioid medications. This review evaluates the existing evidence for using LDN for treating pain and its microgram dosing in the potentiation of opioid medication while reducing side effects.
Why have we not heard about this before, if it’s not a new drug?
Patricia Danzon, from the Wharton School at the University of Pennsylvania, discussed why money is involved in a drug company’s decision to bring a drug to market. This would involve clinical trials which involves a huge investment. If patent rights are not available (they would not be for an older drug like this), then there is not a financial incentive to go forward. Without large companies backing it financially, there is little chance you will see big media advertising about it.
Therefore, the general public and even the medical community is often not aware of the potential. Once something becomes generic you won’t see much promotion of it because the companies can’t be sure they will get their return on investment.
Dr. Bruce Vrooman, who is an associate professor at Dartmouth’s Geisel School of Medicine, authored a recent review of low-dose naltrexone research. His opinion is that LDN appears to be more effective in treating complex pain patients than the now opioids that have ruled for decades.
Read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/
Low-Dose Naltrexone – Review of Therapeutic Utilization
Naltrexone and naloxone are classical opioid antagonists. In substantially lower than standard doses, they exert different pharmacodynamics. Low-dose naltrexone (LDN), considered in a daily dose of 1 to 5 mg, has been shown to reduce glial inflammatory response by modulating Toll-like receptor 4 signaling in addition to systemically upregulating endogenous opioid signaling by transient opioid-receptor blockade.
Clinical reports of LDN have demonstrated possible benefits in diseases such as fibromyalgia, Crohn’s disease, multiple sclerosis, complex-regional pain syndrome, Hailey-Hailey disease, and cancer. In a dosing range at less than 1 μg per day, oral naltrexone or intravenous naloxone potentiate opioid analgesia by acting on filamin A, a scaffolding protein involved in μ-opioid receptor signaling. This dose is termed ultra low-dose naltrexone/naloxone (ULDN). It has been of use in postoperative control of analgesia by reducing the need for the total amount of opioids following surgery, as well as ameliorating certain side-effects of opioid-related treatment. A dosing range between 1 μg and 1 mg comprises very low-dose naltrexone (VLDN), which has primarily been used as an experimental adjunct treatment for boosting tolerability of opioid-weaning methadone taper. In general, all of the low-dose features regarding naltrexone and naloxone have been only recently and still scarcely scientifically evaluated. This review aims to present an overview of the current knowledge on these topics and summarize the key findings published in peer-review sources. The existing potential of LDN, VLDN, and ULDN for various areas of biomedicine has still not been thoroughly and comprehensively addressed.
Read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/
Low Dose Naltrexone (LDN) Titration Kit Using Oral Capsules
The titration kit enables a patient to start their low dose naltrexone therapy and slowly ease into the dose that is appropriate for them.
The kit contains a combination of 0.5mg (Green Vial) and 1.5mg (Amber Vial) capsules allowing the patient to start at a dose of 1.5mg and increase their dosage weekly by 0.5mg until they reach their personal effective dose typically somewhere between 3mg to 4.5mg. We can communicate during the titration period with the patient and physician as needed to help determine the maintenance dose that is right for the patient.
When smaller doses such as microgram dosing is necessary, sometimes a liquid dosage form is desirable for easier titration for the doctor and patient. However, customized microgram strength capsules are also available.
Get the Help You Need to Improve Your Quality of Life
If you have a condition that involves pain, or opioid dependence, depression or something else listed in our previous blogs about LDN, please call us and we’ll work with you and your doctor to find the appropriate solution.
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Town & Country Compounding offers several hormone saliva testing kits and helps analyze results through a scheduled private consultation with the patient. The pharmacy can then get in contact with your physician and help find a treatment plan that fits your needs. We can ship out to you just email or call the pharmacy.
- Sources:
- Sjogren’s syndrome https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/symptoms-causes/syc-20353216
- Sjogren’s Syndrome: Clinical Benefits of Low-dose Naltrexone Therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510571/
- Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. https://www.ncbi.nlm.nih.gov/pubmed/19453963
- Venus Williams Opens Up About Rare Autoimmune Disease As She Prepares for the U.S. Open https://www.prevention.com/health/a28446557/venus-williams-sjogren-syndrome/
- MUCOLOX™ (30-4782) https://www.pccarx.com/products/PCCA-MUCOLOX%E2%84%A2/30-4782/PROPRIETARYBASES
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