The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain

Abstract

Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn's disease, multiple sclerosis, and complex regional pain syndrome. We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated. Despite initial promise of efficacy, the use of LDN for chronic disorders is still highly experimental. Published trials have low sample sizes, and few replications have been performed. We cover the typical usage of LDN in clinical trials, caveats to using the medication, and recommendations for future research and clinical work. LDN may represent one of the first glial cell modulators to be used for the management of chronic pain disorders.

Fig. 1

Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment. The figure uses data from an earlier clinical trial [9] and has not been previously published

Fig. 2

Relationship between baseline erythrocyte sedimentation rate (ESR) and change in pain during administration of LDN (left pane) and placebo (right pane). The figure uses data from earlier clinical trials [9, 15] and has not been previously published