Real-Life Case Studies & Research
LDN: A Non-Opioid Alternative for Pain, Autoimmune & More
A compounding pharmacy is necessary to fill prescriptions for LDN.
Prescribers often turn to Town & Country Compounding to provide in-depth LDN education, patient follow-up and to create the highest quality of compounded medication producing the best patient outcomes.
Town & Country Compounds Quality.
Recently, John Herr, RPh from Town & Country Compounding Pharmacy in Ramsey, NJ, along with NJ Pain Management Specialist, Dr. Asher Goldstein, collaborated with several pharmacies and practitioners from across the country to provide information for health care practitioners and their patients about the benefits of LDN.
This blog contains highlights from Dr. Asher Goldstein’s presentation. The information is available to help assist various types of providers who have patients with pain symptoms that arise from immune dysfunction diseases (autoimmune disorders). Click for access to the full presentation»
Now, with LDN in his practice, he has ~ 85% success rate for meaningful improvement. This doesn’t mean that the patient will not have pain, but this improvement in pain management, it makes a difference in their lives.
“Imagine such a big jump in success- it’s very meaningful work.”
Asher Goldstein, MD
Why Low Dose Naltrexone (LDN)?
Many patients have been living with pain for years and have had many failures with pain medications, including opioids. They are looking for any improvement in pain and quality of life.
Often, with such painful disease states, the patients will never be completely pain free; the goal is to see some significant improvement. We also want those people to be able to minimize their level of pain without using opioids.
People with painful disorders of the immune system (autoimmune diseases) are commonly on some type of opiate and often complain it is not as effective as they think it should be.
“Patients do not want to hear that they will just have to live with pain. One day, hopefully LDN will be at the forefront and there are many patients who can benefit from this. The studies have been picking up steam, but they are not as strong as they could be. There is little money to be made in Pharma for manufacturing this medication, which has to do with funding studies.”
Asher Goldstein, MD
What to Expect with LDN
LDN, when started, may take 2 months to see results when titrated properly. How can you tell your patients that something may take a couple of months to work?
Education of patients is key. Patience is also key.
These patients have had these diseases for years, and been in pain for years. They know that typical medications do not work for them. Now, you have an atypical medication, and Dr Goldstein’s patients’ willingness to try has been over 90%.
Even patients who have been on high levels of opioids have often been able to decrease and even eliminate opioids with LDN.
LDN Dosing and Dosing with Titration
Titrating the LDN dose is very important for success
LDN is dosed most commonly once/day. A common range is 0.5 mg-12 mg, and 4.5 mg is often a sweet spot. The 4.5 is not a hard stop; it is an aiming point. This is a lot of art with science .
Important: There is a variable response dose and time to relief onset. Dr. Goldstein explains that this medication allows your body to start functioning better. The practitioner must provide realistic expectations for the patient; 2-3 months for results is very realistic.
Slow titration in dose is necessary: You need to prescribe a titration, starting very low and going up slow. The patient may respond to a low dose, such as 0.5mg and if you started at 4.5 you would have missed it. You want the patient to feel good at the dose they are at. It will take up to 2 months of titration to find the correct dose for the patient. (see T&C titration)
Dr. Goldstein recommends to start very low with dosing so they can slowly start making endorphins and he slowly titrates up. He starts with 0.5 mg and goes up slowly by 0.5 each week.
You create a small increase in the amount of endorphin levels and the body starts responding. Small endorphin boosts will eventually match the deficit the patient has, and the body will start responding.
We don’t want to just turn on endorphins full force because the patient will burn out.
Titration Scenario Example: The patient starts the titration at 0.5 mg, then 1 mg, and then 1.5 mg feeling no improvement with any of those doses. Then, when they hit 2 mg they “may” feel something, not sure. Next, at 2.5 mg they suddenly feel great. (Hint- this may be the best dose, but we are not yet sure) The the next week when they increase up to 3 mg they suddenly feel awful! This means to back down to the previous dose of 2.5 and that is the maintenance dose.
Mechanism of Action
LDN is not like ANY other medication that you have given to your patients, or that your patients have ever taken.
It allows the body to start functioning again.
It blocks the mu opioid receptor, and because of that, the body is blinded (from the homeostasis perspective) to the level of endorphins that are available within the system, and therefore, starts producing more.
This is important because in patients with chronic disease states, especially those with immune dysfunction disease states, their endorphins levels have already started to go down.
Their mood is low, and it is hard to feel happy and easy to feel sad; many are on antidepressants. The patients often say they do not feel “too sad” once they are on antidepressants but, they also do not feel “happy”. It is because they do not have enough endorphins.
The endorphins will help to relieve pain, stabilize mood and may also help them get off antidepressants over time if they are low strength.
Downstream, the endorphin molecule interacts with the TLR4 receptor. It is shaped like an X and has 2 arms. One arm upregulates the body’s own immune system, and the other arm upregulates the ability for the body to suppress inflammation.
Wrap Up: Dr Goldstein’s Message to Prescribers
When someone comes to you and says they have been in pain for many years (8+ years), you know it has been difficult. Don’t rush this, give the body time to work.
Would you like to collaborate with T&C regarding LDN? We are available for zoom or local in-person presentations.
- Speaking events
- Office education
- Team up for patient education
Remember, education is key. If your staff understands, the success will be higher. Reach out to Town & Country Compounding for all your staff and education needs!
Set up an appointment to talk with owner John Herr, RPh., about how we can work together to get the best patient outcomes.
Stay up to date with the latest news on Health and Compounding Solutions
Town & Country Compounding provides the most advanced formulations based on the most recent research and peer-reviewed guidelines.
We work with patients and their medical providers to customize solutions that are right for their individual needs when commercially-made medications are not showing results. Medication is not one-size-fits-all.
Please contact our experts to learn more.