Ginevra Liptan, MD Talks about Fibromyalgia on the LDN Radio Show 2017 (LDN, low dose naltrexone)

Ginevra Liptan, MD Talks about Fibromyalgia (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.

Summary from Dr. Ginevra Liptan LDN Radio Show August 2020

I am Dr. Ginevra Liptan and have worked hard and tirelessly with people with Fibromyalgia, and I have written a book.

Fibromyalgia is becoming more accepted as a diagnosis. Many more physicians and healthcare providers feel comfortable making the diagnosis and starting the initial treatment.

There's a lot less stigma around it. Now people are really getting much more quickly into the treatment regimen. So that's hugely positive.

I've actually seen Low Dose Naltrexone (LDN) being used more frequently. It used to be only specialists or naturalpath, but I've actually seen at our Academic Pain Centre in Portland, the Oregon Health and Sciences University Pain Clinic, they're starting people on LDN now.

There's more of a sense of there are things out there that can help. There are people that are understanding more about Fibromyalgia.

There are celebrities now with Fibromyalgia. Lady Gaga coming out of saying that she has Fibromyalgia has been huge. I hope, what patients are feeling like that they're not feeling as alone in their struggle. I'm hereby declaring my intent to bring lady Gaga to the LDN conference.

The negatives I see now are using opiates for any reason whether it's acute pain, whether it's chronic pain, opiates are sort of the scapegoat.

I feel like, for the average Fibromyalgia patients, there are so little options in our toolbox that are really accessible to people. For example, cannabis and marijuana-based medicines have great potential but they're not accessible to everybody.

I hope that we can get back to more of that middle ground where opiates have a lot of problems, and we're learning that they really aren't good for longterm daily use, but do have some benefit for short term do use for flares only. That's how I prescribed them because Fibromyalgia is not a steady-state.

There are times where people have huge spikes of pain, and during those times opiates can be hugely effective as a short term kind of rescue option to help bring things back down, and then you go off of them again.

So maybe taking them five days out of the month, five of your worst most intense pain days.

I've anecdotally experimented, and I've found that for some of my patients a little bit of Low Dose Naltrexone (LDN), like 0.05 milligrams seems to limit less than some of the negative side effects from opiates.

I've also found it helps to limit some of the dependence or tolerance issues. If you've been on high doses of opiates over time, sometimes within a few months they become less effective.

Some found Ultra dose Naltrexone helps them titrating it down opiods whilst titrating the LDN up. It eliminated all side effects and withdrawals.

But alongside the opioids,  I use things like Gabapentin, Lyrica to kind of calm down that angry, overactive nerve signalling. I use muscle relaxants for some people, muscle relaxation, and it's like Baclofen can be really helpful for both reducing pain and improving sleep quality. And in Fibromyalgia, sleep is the area that I really work on the most.

If we can get people getting better quality, more deep sleep, their pain levels will automatically reduce because sleep deprivation itself is part of what generates a lot of the fatigue and pain and inflammation of Fibromyalgia. So I use a lot of alternative pain treatments, but I'm usually using ones that also have the added benefit of improving sleep and Gabapentin and Lyrica and Baclofen all have that capacity.

If I'm usually trying to get kind of a two for one benefit, some of the muscle relaxing, like Cyclobenzaprine and also can relax the muscle tension and helps the brain get into a deep sleep and also that gives some pain relief. ...

So I'm trying to reduce the painful nerve signalling, let's say with Gabapentin, but I'm also trying to help people soften their muscle tightness with maybe something like a muscle relaxants. ...

Some people said they benefit from anti-inflammatories like Celecoxib,  Antifa moratorium. That's something that we add into their toolbox.

Wiith Fibromyalgia, we have to have as big a toolbox. That was my motivation for writing the "Fibro Manual" book.

I wanted people to kind of know every possible option out there that they could consider, talk with their doctor about some things they could try on their own to find that right combination that really helped ease their symptoms because there is not, unfortunately, that one magic bullet that works.

I have people that use Low Dose Naltrexone plus maybe a different type of anti-inflammatory or Low Dose Naltrexone (LDN) plus Gabapentin. It seems like we have to approach the brain from multiple different pathways, multiple angles and push it down into a  more conducive to kind of less pain, less inflammation. ...

This patient population tends to be more sensitive to drugs. Now we starting with one milligram, and I'll have people do that for a month, and then two milligrams for a month and then three milligrams for a month.

I don't always need to get somebody up to that 4.5 milligrams, and I saw that a lot of my folks don't tolerate the 4.5-milligram dose.

It seems to maybe generate more sleep disturbance or more anxiety.

That's the biggest issue I've had with particularly I think in the fibromyalgia population. I know that anxiety is a side effects that can occur with LDN, but I've seen it much more frequently in my patient group then than kind of what the literature reports as far as the frequency.

And I think that maybe has something to do with kind of the underlying fight or flight response over activation that's going on in Fibromyalgia.

I've had a few people that I started at 0.5, and I have some folks that even with 0.5, they get some side effects.

Pain reduction, fatigue reduction, sleep improvement. So what I found is that it really can be helpful to have people, either keep a diary, track their symptoms.

I have one patient that she's at 0.25 milligrams, and when we go up to like 0.3 she notices worsening of symptoms. If she's at 0.2, she doesn't get a benefit. Literally, she is that sensitive to 0.25 that is we've, but we've only been able to fine-tune it to that level because she's so good at tracking her symptoms.

Watch the video for the entire show.