Low Dose Naltrexone (LDN) for Chronic Pain, Vulvodynia & Interstitial Cystitis?

LDN Specialist Pharmacist Michelle Moser
Pharmacist Michelle Moser

Low Dose Naltrexone (LDN) for Chronic Pain, Vulvodynia & Interstitial Cystitis?

I started LDN three and a half months ago for chronic pain, vulvodynia, and interstitial cystitis.  I started at two milligram, jumped to four.  I began getting headaches at four and a half so went back down to one and a half. How long does LDN take to work because I have seen where it can take weeks, months and even up to a year.  Can you give clarification?  Also, can you give me a dosing regimen?   You are dealing with chronic pain, which chronic pain is usually addressed with a different dosing routine than vulvodynia and or interstitial cystitis.  

Usually with vulvodynia and interstitial cystitis we dose once a day.  I personally think your doses are too high. If your provider is allowable you may want to jump down to anywhere from a 0.1 to a 0.5 milligram.  Maybe even do a liquid and try the very low dose 0.1 milligram and slowly increase and see if that's helpful with the vulvodynia.  Again, that's usually inflammation around nerves and that nerve bundle in the pelvic floor can trigger interstitial cystitis. 

Sometimes there is a hormone deficiency as well that can be associated with that.  All of this can be associated with and leads back to chronic pain. When people have chronic pain, let's say they were in an accident of some sort and they just have this chronic pain that just they just never seems to go away that can actually lower your sex steroid hormones just from the chronic pain, but even the medications that are are used to help treat chronic pain like opiates and tramadol can actually lower your sex steroid hormones which can then make vulvodynia and interstitial cystitis worse.  If you started getting headaches at four and a half milligram and then you went down to 1.5 I think maybe even try much lower and then increase from that.  Try seven days.  

At three and a half months you are probably right on the cusp dealing with issues that could be autoimmune in nature.  With chronic pain we're now seeing 0.1 milligram increasing by 0.1 milligram every three, five or seven days.  We don't use that same dosing routine for autoimmune issues. You don't get the same response from the endorphins and from the modulation of the immune system.  So two different routines.  My suggestion is to deal with the autoimmune issues first, the vulvodynia and the interstitial cystitis,  perhaps the chronic pain will go away simultaneously. The dosing routine I would start with is once a day and whether that's in the morning or at night really has to do with how you are doing with that and what fits best with your schedule, side effects, etc.  Talk to your provider or have your compounding pharmacist ask about a liquid so that you can very slowly, very in little teeny increments increase that dose to hone in on your happy dose.