Low dose naltrexone (LDN) was originally introduced as a treatment for HIV/AIDS back in the 1980s. It has also been used in the treatment of autoimmune diseases (especially multiple sclerosis), neurodegenerative illnesses and even many cancers.
The first study of LDN for fibromyalgia was published in 2009. The small trial found LDN helpful for pain and other symptoms. Interestingly, it was actually better tolerated than a placebo. The researchers have announced a upcoming clinical trial of LDN in children with fibromyalgia (juvenile fibromyalgia).
Obviously more research is needed to demonstrate the efficacy of LDN in fibromyalgia, but because of its safety and almost complete lack of side effects, many patients are already making use of this inexpensive medication.
How Low Dose Naltrexone Works
Naltrexone is an opioid antagonist, meaning it blocks the opioid receptors that both opioid drugs (like morphine and fentanyl) and our endogenous opioids (like beta endorphin) act on. But when used in very small doses, the blockage is short-lived and actually stimulates the release of these endogenous opioids.
This alone seems like a sensible way to treat fibromyalgia instead of narcotic painkillers inducing the secretion of the body's own opioids to relieve pain. But there is likely even more to it, considering that LDN also helps most neurological and immune system illnesses, even if they do not cause pain.
Endorphins help regulate the immune system and have neuroprotective properties. Based on the mode of action of LDN in other diseases and the way it reduces many different symptoms it seems plausible that it not only reduces pain, but may actually affect the source of pain - the disease process behind fibromyalgia.
Using LDN for Fibromyalgia
Besides fibromyalgia, LDN also works well for autoimmune diseases and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). It would be a particularly good treatment for those who also suffer from other autoimmune diseases, such as rheumatoid arthritis, lupus (SLE) or autoimmune thyroiditis.
Besides pain, LDN can help fatigue, cognitive problems ("fibro fog"), depression and sleep - the most important symptoms of fibromyalgia. Patients have also reported improvement in IBS, migraines and allergic symptoms.
Some people notice improvement right away, but for others it can take several weeks. LDN does not work for everyone, but it appears to help at least half of the people with fibromyalgia. One should take it for at least a few months before judging its efficacy
More and more fibromyalgia experts are prescribing LDN for their patients, but most doctors are not yet familiar with LDN. One good scientific textbook people can take to their doctors is The Promise of Low Dose Naltrexone Therapy. While this book only has a few paragraphs about fibromyalgia, the book thoroughly examines the science behind the treatment as a whole.
LDN Side Effects and Drug Interactions
Because of its mode of action, LDN cannot be taken with any narcotic painkillers, such as morphine, fentanyl or oxycodone. This also includes tramadol, which usually isn't counted as a narcotic but does act on opioid receptors.
LDN should also not be combined with immunosuppressant drugs (which are not used in the treatment of fibromyalgia, but many people with FM may be taking them for an autoimmune disease).
Low dose naltrexone is, however, compatible with all other medications, including Lyrica, Savella, Cymbalta and other antidepressants and anticonvulsants. It may work particularly well with the supplement DL-phenylalanine or DLPA, which increases dopamine levels and slows down the breakdown of endorphins.
LDN can cause transient sleeping problems when initiating use and occasionally short-lived nausea, but other than that side effects are very rare. This goes in stark contrast with the official FDA-approved treatments for fibromyalgia, which often cause quite bothersome adverse effects.
References:
Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. 2009 May-Jun;10(4):663-72.
Low Dose Naltrexone for the Treatment of Juvenile Primary Fibromyalgia Syndrome
Haavisto Maija. Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia. 2008.
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