I have been meaning to write this article for some time but could not figure out how to approach a subject that passionately motivates me, and at the same time informs, but not overwhelms, readers. I have been prescribing Low Dose Naltrexone (LDN) for about a year and a half. It has helped me treat patients with some of the most difficult-to-treat disease states. Prior to my learning and use of this medication, certain patients (and I) were frustrated by how difficult it was to advance their pain management treatment.
Naltrexone was developed in the 1960s. It was first used in the 1970s, and it achieved mainstream use in the early 1980s. At the typical dose of 150 mg, it was effective in treating heroin addiction by completely blocking the opiate receptors in the body and thereby blocking the effects of heroin, which is an opioid. In 1984 Dr. Bernard Bihari deduced that Naltrexone was blocking all opiates, including the natural ones that our bodies produce. These natural opiates, called endorphins, have a positive impact on many processes in our body including mood, inflammation and disease immunity.
Endorphin levels decrease in many chronic disease states, which can wreak havoc on mood, inflammation and disease immunity. Dr. Bihari experimented with dosage levels of Naltrexone to see if there was a dose that could block artificial opiates, like heroin, but allow the effects of our natural opiates, such as endorphins, to remain effective. He found that in people with low endorphin levels, such as those with certain chronic diseases, much lower doses of Naltrexone, 0.5-4.5mg per day, caused endorphin levels to increase, bringing it closer to a normal baseline level.
Many chronic diseases that impact people have a persistently lowered level of endorphins. Their optimal care with certain medications may be limited because of side effects, lack of efficacy, cost, coexisting medical conditions or the nature of their disease. Some common threads that link these various chronic disease states are immune system malfunction and inflammation. Examples of these conditions are fibromyalgia, irritable bowel disease, Crohn’s, lupus, Lyme disease, rheumatoid arthritis, multiple sclerosis, polycystic ovary syndrome and reflex sympathetic dystrophy. There is a growing foundation of medical literature that supports the benefit of LDN in more than 30 disease states.
My own personal experience in using LDN to treat my patients has confirmed the findings noted in the medical literature. I use LDN to fight the effects of a malfunctioning immune system and chronic inflammation, especially those with nervous system inflammation. One of my patients is a 50-year-old woman who has had back surgeries and three knee surgeries and who also has fibromyalgia. She required high levels of opiate pain medication just to function throughout her day. Unfortunately she still experienced a high degree of pain. Procedures for her back and knee pain provided temporary relief only, as her fibromyalgia would flare and negate the relief. After seven years of no significant progress, I convinced her to wean off of the opiate medication through a treatment that was done in my office, and she started LDN. Once the correct dose was identified, she reported significant improvement in her fibromyalgia, back and body pain, saying that this was the best she had felt in more than two decades. The primary pain disease was not the sequela of her multiple surgeries, but that of her fibromyalgia. She is able to ignore her reduced pain nowadays, weather cooperating. She is now able to do chores around the house, go for long walks, play with her grandchildren and sit through an entire movie. She no longer shrinks away from a hug because of the anticipated pain. This is only one example of many patients that I have successfully treated with LDN where other therapies and medications have failed. I must also note the benefit of its low cost and minimal side effect profile.
I have been prescribing LDN for 18 months and continue to learn and be excited about it. I encourage you to learn about it as well. Even if LDN is not something you need, perhaps there is someone in your life that can benefit.
In my opinion, a very good resource is LDNresearchtrust.org. If you do your own research online please make sure to use ‘low dose naltrexone’ in the search engine, and not ‘naltrexone’, as they are not the same. I welcome questions in person, by phone (201-645-4336) or via email at [email protected].
Asher Goldstein has been a practicing pain management physician for 15 years. He is now the Chair of Pain Medicine, in the Pain Medicine and Palliative Medicine department at Holy Name Medical Center. He has his own private practice in Hackensack New Jersey.
