Effective Doses of Low-Dose Naltrexone for Chronic Pain – An Observational Study

Effective Doses of Low-Dose Naltrexone for Chronic Pain – An Observational Study

Norman Marcus et al.

21st March 2024

https://doi.org/10.2147/JPR.S451183

Purpose: Despite the availability of a wide variety of analgesics, many patients with chronic pain often experience suboptimal pain relief in part related to the absence of any medication to address the nociplastic component of common pain syndromes. Low-dose naltrexone has been used for the treatment of chronic pain, typically at 4.5 mg per day, even though it is also noted that effective doses of naltrexone for chronic pain presentations range from 0.1 to 4.5 mg per day. We performed an observational analysis to determine the range of effective naltrexone daily dosing in 41 patients with chronic musculoskeletal pain.

Conclusion: LDN with idiosyncratic dosing appears to effectively suppress chronic pain. LDN may be a useful medication for patients with pain related to hEDS. The findings of this small study suggest that the current standard of care of utilizing a fixed dose, often 4.5 mg/day as the LDN dose, may be ill-advised. We present patients who achieved an effective dose utilizing our titration schedule but had prior multiple unsuccessful trials of LDN at fixed or variable doses using large dose adjustments. All patients who have failed LDN trials at standard fixed doses could be retreated with a titration schedule to find an MED. A lengthy titration schedule may result in frequent non-compliance, perhaps justifying an arbitrary fixed dose which, if successful, could be followed by micro adjustments above or below the effective dose to establish a MED. Selecting the right subgroup of patients may enhance the possibility of success.