Saturday, February 12, 2011
Low Dose Naltrexone
Naltrexone is an opioid antagonist used for treating addiction to alcohol and opiates. The doses used for this type of treatment are around 50 mg once daily. Reason would tell you that something that counteracts opiate pain medication would also be something that does not help pain.
There are some doctors now prescribing this in a very low dose to treat a variety of disorders (off label - meaning it is not the reason this drug has FDA approval). The dose recommended is between 1.5 mg and 4.5 mg per day. The website that touts this drug states that this must be compounded at a compounding pharmacy (where they build the pill from other components in the strength desired) and must be prescribed by a physician. It seems to be fairly inexpensive and at that very low dose hopefully side effects would be minimal.
I learned of it through a discussion group I belong to. One of the ladies who has a very destructive autoimmune disorder is giving low dose naltrexone (LDN) a try. I don't know her success yet with it as I am not sure even how long she has been taking it - maybe just a few months. I looked it up and read about it and am intrigued, though skeptical.
There are anecdotal claims and a few scientific studies that LDN can stop the progression of certain cancers, help with multiple sclerosis mood disorders and pain, help with fibromyalgia pain, stops the inflammation in Crohn's disease, and works to stop the immune response of autoimmune disorders. Instead of working by suppressing the immune system (as prednisone, dexamethasone, prednisolone and cyclosporine do) it seems to work by boosting the immune system.
How does this work to decrease pain? According to the authors of the website low dose naltrexone taken before bedtime produces "a prolonged up-regulation of vital elements of the immune system by causing an increase in endorphin and enkephalin production." Endorphins are the body's natural opiates - pain killers manufactured by your body. Enkephalin is a specific type of endorphin that is sensitive to certain types of stimuli that might damage your body. Enkephalin is also thought to be part of the cascade that creates an autoimmune response.
Since I rarely am asleep in the middle of the night, I can see how my body might be missing some nature endorphins and enkephalins. Maybe this is what my PCP means when he says lack of sleep creates a build up that increases pain?
In treating cancer some think that in addition to increasing endorphin and enkephalin LDN targets the opioid receptors on certain types of cancers and thus somehow inhibits reproduction. My interest in this is because the type of cancer I had (endometrial cancer) is hard to treat with a recurrence. I am keeping LDN as a treatment possibility in case my cancer ever decides to return. I believe in using conventional treatments, but this would be an option you could take with the conventional treatment.
Do I believe all the hype? Not really. The studies done are just for small cohorts under controlled conditions. Most of the evidence is from patient stories and physician use which of course are not a controlled scientific blind study. The studies seem to all agree there is no harm from taking LDN and that if LDN is taken concurrently with opioids it seems to boost the opioid effect instead of suppressing it. The one study on fibromyalgia said a significant gain of 30% reduction in pain was found. I guess that is another disease where people are not able to have restful sleep! I do find it hard to believe that one drug treats all these disparate diseases with the same mechanism, but that's the logical me talking!
Will I ever try it? Definitely if my cancer returns (knock on wood!) because I won't have anything to lose. If my neuropathic pain and The Legs get worse or The Headache or The Belly pain are not controlled I might give it a whirl. I've tried a bunch of other stuff that didn't work so why not this? Just more money down the drain! After all, I bought HeadOn and applied it directly to my forehead - directly to my forehead - directly to my forehead - in a desperate attempt to quell The Headache!
Below find a link to a blog entry skeptical of most of the claims at the low dose naltrexone website. Some points made agree with my conclusion that there are not enough real scientific studies to sort it out yet.
LDN - Medical Revolution or Psuedoscience?
Articles from peer reviewed journals concerning low dose naltrexone - most of these are for very small studies or a single case.
LDN and Pancreatic Cancer - a case study
DN and IL2 in Metastic Cancer Treatment
LDN and Crohn's Disease
LDN and Multiple Sclerosis 2010 (fairly lukewarm review)
LDN and untreatable solid tumors -2002- a study
LDN and fibromyalgia 2009 study (favorable)