Low dose of drug may help fibromyalgia patients
Years ago, I began to treat some therapy-resistant fibromyalgia patients with a medication used primarily for drug withdrawal, naltrexone. Case studies and personal experience suggested that naltrexone, at a low dose, could reduce pain and increase function in fibromyalgia patients. Today, there are a number of studies showing benefit and elucidating possible mechanisms of action.
Fibromyalgia is characterized by chronic, widespread pain, fatigue, brain fog and difficulty sleeping. These symptoms can be mild to debilitating. Fibromyalgia is diagnosed in 6 to 12 million Americans. Ninety percent of those affected are women. Some estimates of fibromyalgia make it as common as Type 2 diabetes and that 70% of people with fibromyalgia have not yet been diagnosed.
The cause of fibromyalgia has not been uncovered. However, stress and trauma, repetitive injuries, viral infections, family history and obesity increase the risk of fibromyalgia as well as autoimmune illnesses like rheumatoid arthritis. It is believed central nervous system defects in pain perception may play an important role in the perception and processing of pain signals.
Naltrexone is classified as a morphine antagonist because it binds to the same receptors as morphine, thus blocking other opioids from binding. At low doses, naltrexone still binds to the morphine receptors but for a shorter period of time and this stimulates the production of endorphins. Endorphins are made by the body. They reduce pain and inflammation. In the treatment of fibromyalgia, it is believed that low dose naltrexone reduces inflammation and "soothes" the hyper-reactivity of the nervous system associated with pain perception.
One small study published in the medical journal Biomedicines evaluated the serum levels of inflammatory markers (cytokines) and pain levels in eight women taking low dose naltrexone over a 10-week course. At eight weeks, cytokine levels were reduced, especially those associated with pain. In addition, all of the participants reported significantly less pain and associated fibromyalgia symptoms.
In another study in the medical journal Psychosomatics, in patients with severe fibromyalgia, there was a significant improvement in pain, stress and fatigue. Interestingly, these participants also were evaluated as to their ability to withstand pain associated with heat, cold and pressure on the skin. After 18 weeks of low-dose naltrexone, fibromyalgia pain decreased notably and the ability to handle pain increased up to tenfold.
Low-dose naltrexone is a prescription medication and has to be made at a pharmacy specializing in compounding medications. There are few contraindications with one being that you cannot use it if also taking opioid medications. It also, in some people, may result in vivid dreams -- not scary but vivid. Other than that, low-dose naltrexone is quite safe even if taken for long periods of time.
At this time there are no large, double-blinded placebo studies with low-dose naltrexone and fibromyalgia. However, there seems to be tangible benefits and the side effects few and mild.
• Dr. Patrick Massey is president of ALT-MED Medical and Physical Therapy, 1544 Nerge Road, Elk Grove Village.