Sahar Swidan, Pharm.D.

Sahar Swidan, Pharm.D.

BCPS, ABAAHP, FAARFM, FACA

Low Dose Naltrexone in Fibromyalgia

“Fibromyalgia is a multi-factorial disorder and many co-morbid illnesses are also present in these patients.  Studies have shown elevated levels of inflammation and more importantly higher levels of Substance P in the CSF of fibromyalgia patients as compared to normal controls.  We know that immune dysregulation and inflammation is common in these patients and using something like low dose naltrexone (LDN) that may modulate the immune system may be helpful.  These studies highlight the immunomodulatory effect of LDN on many pro-inflammatory cytokines and decrease in pain scores.

Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. (Apr 2017)

Objective: To study the immune effects of low-dose naltrexone (LDN) on patients with fibromyalgia.

Design: This was a single-blind crossover trial that included eight women with fibromyalgia. Participants blindly received placebo for two weeks to establish a baseline, then received LDN for eight weeks. Pain and overall fibromyalgia symptoms were recorded twice daily, and blood samples were collected twice weekly throughout the trial duration.

Treatment: Patients took naltrexone 4.5 mg every day at least one hour before going to bed.

Results: LDN was associated with significantly reduced plasma concentrations of the inflammatory cytokines interleukin (IL)-1β, IL-1Ra, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p40, IL-12p70, IL-15, IL-17A, IL-27, interferon (IFN)-α, transforming growth factor (TGF)-α, TGF-β, tumor necrosis factor (TNF)-α, and granulocyte-colony stimulating factor (G-CSF). Additionally, LDN treatment resulted in 15% lower pain scores from baseline as well as 18% lower overall fibromyalgia scores.

Conclusion: This study suggests that fibromyalgia pathophysiology may have a significant immune component, which can be effectively treated with low-dose naltrexone.

Study: Reduced Pro-Inflammatory Cytokines after Eight Weeks of Low-Dose Naltrexone for Fibromyalgia. (Apr 2017)

Low Dose Naltrexone is great to modulate the immune system at doses of 4.5mg. The recommended starting dose in Opioid Naïve patients is 1.5mg at bedtime for one week, then 3mg at bedtime for one week, then 4.5mg at bedtime thereafter.

 

Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. (Feb 2013)

Objective: To determine the effects of low dose naltrexone on fibromyalgia symptoms compared to placebo.

Design: 31 women with fibromyalgia were enrolled in this randomized, double-blind, placebo-controlled crossover study. After a 2-week baseline period, participants were randomized to receive either 4 weeks of placebo followed by 12 weeks of naltrexone, or 12 weeks of naltrexone followed by 4 weeks of placebo. Overall pain severity was self-reported daily before bedtime, on a 0-100 visual analogue scale.

Treatment: The active drug was naltrexone 4.5 capsule taken once daily.

Results: Pain was reduced from baseline by 28.8% on average when patients took naltrexone. This reduction was significantly greater than the reduction from placebo, which was 18.0% (p=0.016).

Conclusion: Low dose naltrexone appears to be effective in treating pain associated with fibromyalgia.

Study: Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. (Feb 2013)

CBD oil has anti-inflammatory properties so check out our Slyngshot SmartCBD oil and recommend starting dose at 2.5mg once daily and titrate slowly to 10mg if needed.

Always check with your health care provider before starting any new supplement such as CBD, as it may interact with your current medication regimen.