Sahar Swidan, Pharm.D.

Sahar Swidan, Pharm.D.

BCPS, ABAAHP, FAARFM, FACA

Have you heard of Low Dose Naltrexone?

Has it been a struggle finding unique and innovative ways to treat your difficult patients? There’s new and exciting information on the variety of ways Low Dose Naltrexone (LDN) could offer help. LDN has shown to be helpful in a variety of disease states. For example, patients with autoimmune illnesses, chronic pain and fibromyalgia could benefit from LDN therapy.

Treatment Options with Low Dose Naltrexone (LDN)

Dr. Sahar Swidan recently interviewed with LDN Research Trust about her journey into the world of pharmacy, compounding, and low dose naltrexone (LDN). Dr. Swidan has a special interest in LDN and the ways it can impact patient care. This interview gives you a view into her experience with this novel treatment option and some of her successes.
Listen to the full interview here.

 

LDN in the Management of Chronic Pain and Inflammation of Multiple Sclerosis, Firbromyalgia, Crohn’s Disease, and other Chronic Pain Disorders

Chronic inflammatory diseases are complex to treat and have an impact on a large number ofpatients. Since the 1990s, opioid prescriptions have been increasing in prevalence in chronic inflammatory and neuropathic conditions. However, most opioids are considered less effective or have unproven efficacy in chronic conditions such as multiple sclerosis, fibromyalgia, and Crohn’s disease. Due to the difficulty of treating these diseases and their great impact on quality of life, patients often seek complementary or functional medicine options to obtain relief from symptoms. Naltrexone is a mu-opioid receptor antagonist indicated by the U.S. FDA for opioid and alcohol dependence. It is hypothesized that lower than standard doses of naltrexone inhibit cellular proliferation of T and B cells and block Toll-like receptor 4, resulting in an analgesic and anti-inflammatory effect. Low-dose naltrexone (LDN) has been used off-label for treatment of pain and inflammation and evidence supports the safety and tolerability of LDN in multiple sclerosis, Crohn’s disease, fibromyalgia, and other diseases.

Fibromyalgia is not considered a classic inflammatory disease, but rather a disorder of the central nervous system that has a neuroimmune component. The effect of LDN as an immune-modulator may be beneficial for treating fibromyalgia, and pilot studies have started to evaluate its impact. One single-blind crossover study looked at the serum cytokine levels of eight women over the course of 10 weeks. After 8 weeks of LDN therapy, a variety of proinflammatory markers were reduced, especially those associated with nociception and allodynia. The participants reported significantly less pain and symptoms associated with their fibromyalgia, and no moderate or major adverse effects were reported.

A recent pilot study found LDN produced a significant improvement in daily pain, stress, and fatigue associated with fibromyalgia. The study only included 12 participants, who all followed the same treatment schedule. Severity of symptoms was tracked using a visual analog scale, and the patients also underwent mechanical, thermal, and cold pain assessments every 2 weeks.

A notable effect of LDN in fibromyalgia has been increased pain tolerance. One case report involved a patient with fibromyalgia on a daily LDN dose of 6 mg undergoing a cold pressor test (CPT) to determine pain tolerance every few weeks along with self-reporting the patient’s quality of life and general pain. After 18 weeks of LDN therapy, the patient’s CPT time increased 10-fold. An additional small double-blinded crossover study of 31 participants showed a significant reduction in daily pain as compared to placebo and baseline pain. The participants reported not only reduction in daily pain but also significantly increased quality of life and mood.

The use of LDN as a potential anticancer agent has been researched for some time. The mechanism is presumed to be due to inhibition of cellular proliferation that occurs with intermittent blockade of OGFr.

The full study is available via Pharmacotherapy, 2018 Jan 27. [Epub ahead of print]