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Low Dose Naltrexone for Neuropathic Pain Related to an Electrical Burn Injury: A Case Study
J Pain
April 2019
https://www.sciencedirect.com/science/article/pii/S1526590019306595
A 36- year old male with a past history significant for bipolar disorder, depression, and PTSD presented to UW Pain Clinic for management of ongoing pain related to an electrical burn injury (4.5%) to the left hand and flank sustained in August 2016. He underwent a skin graft for the burn six months later and has experienced difficulties with his pain since. During the consult, the patient described his pain as a burning, tingling sensation over the left flank and hand. He also experiences sharp muscle cramps in that area which are made significantly worse in cold temperatures. His described pain upon initial presentation was an 8-9/10. Prior to the consult, the patient was prescribed several medications for muscle spasms and neuropathic pain including baclofen, Lyrica, Topamax, Cymbalta, and topical pain creams without significant benefit. Patient then underwent a trial of IV lidocaine infusion however this treatment likewise did not provide any significant pain relief. Considering the lack of success with the previous attempted treatment regimens, patient was prescribed Low Dose Naltrexone (LDN). Within 8 weeks, the patient reported meaningful pain relief compared to the previous unsuccessful treatments with continued progress reported during subsequent visits. In this case, LDN provided effective relief for neuropathic burn related pain where previous conventional modalities failed. Potential explanations include direct pharmacological effects of LDN and/or its synergistic effects with the patient's other medications that continued to be prescribed. This case provides the opportunity to further explore the use and benefits of LDN for neuropathic pain in patients, particularly those with burn related injuries who do not favorably respond to conventional medication therapies.