scholarly journals The Effects of Low Dose Naltrexone on Opioid Induced Hyperalgesia and Fibromyalgia

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Jackson ◽  
Sunita Singh ◽  
Yanli Zhang-James ◽  
Stephen Faraone ◽  
Brian Johnson
Keyword(s):  
Low Dose ◽  
Clinical Care ◽  
Cold Pressor Test ◽  
Case Series ◽  
Pain Tolerance ◽  
Control Group ◽  
Addiction Medicine ◽  
Endogenous Opioid ◽  
Opioid Induced Hyperalgesia ◽  
Low Dose Naltrexone

Objectives:While opioids temporarily alleviate pain, the overshoot of balancing pain drivers may increase pain, leading to opioid induced hyperalgesia (OIH). Our goal was to find out what chronic opioid treatment does to pain tolerance as measured by the cold pressor test (CPT), an objective measure of pain tolerance, and to find an alternative effective treatment for chronic pain and FM.Materials and Methods:The setting was an academic addiction medicine service that has an embedded pain service. Patients had routine clinical care starting with an evaluation that included assessment of medical and psychiatric conditions. Participants were 55 patients with OIH and 21 patients with fibromyalgia; all had at least two CPTs. Treatment included a single dose of buprenorphine for detoxification. In this open-label case series, patients were treated with low dose naltrexone (LDN), a pure opioid receptor antagonist that, we hypothesize, treats OIH and FM by restoring endogenous opioid tone.Results:Comparing initial and last CPT times, those with OIH more than quadrupled their pain tolerance, and those with FM doubled theirs. This improved pain tolerance for OIH and FM was statistically significant (p< 0.0001 andp= 0.003, respectively) and had a large effect size (r= 0.82 andr= 0.63, respectively).Discussion:Results suggest that patients on chronic opioid therapy should have pain tolerance measured by CPT with detoxification and LDN provided to correct opioid induced hyperalgesia if found. FM may also be treated with LDN. The main limitation of the findings was lack of a randomized control group treated with placebo.

scholarly journals Low-Dose Naltrexone for Pruritus in Systemic Sclerosis

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Tracy Frech ◽  
Kirsten Novak ◽  
Monica P. Revelo ◽  
Maureen Murtaugh ◽  
Boaz Markewitz ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Gastrointestinal Tract ◽  
Los Angeles ◽  
Low Dose ◽  
Treatment Options ◽  
Case Series ◽  
Common Symptom ◽  
Naltrexone Hydrochloride ◽  
The University ◽  
Low Dose Naltrexone

Pruritus is a common symptom in systemic sclerosis (SSc), an autoimmune disease which causes fibrosis and vasculopathy in skin, lung, and gastrointestinal tract (GIT). Unfortunately, pruritus has limited treatment options in this disease. Pilot trials of low-dose naltrexone hydrochloride (LDN) for pruritus, pain, and quality of life (QOL) in other GIT diseases have been successful. In this case series we report three patients that had significant improvement in pruritus and total GIT symptoms as measured by the 10-point faces scale and the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0) questionnaire. This small case series suggests LDN may be an effective, highly tolerable, and inexpensive treatment for pruritus and GIT symptoms in SSc.

scholarly journals Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost–utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e055351
Author(s):  
Ariadna Colomer-Carbonell ◽  
Juan P Sanabria-Mazo ◽  
Halbert Hernández-Negrín ◽  
Xavier Borràs ◽  
Carlos Suso-Ribera ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Low Dose ◽  
Cost Utility ◽  
Phase Iii ◽  
Control Group ◽  
Phase Iii Trial ◽  
Life Years ◽  
Double Blinded ◽  
Ecological Momentary ◽  
Low Dose Naltrexone

IntroductionThere is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost–utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up.Methods and analysisA single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured.Ethics and disseminationThis study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities.Trial registration numberNCT04739995.

Personality traits and sensitivity to pain in male chronic opioid addicts

2007 ◽  
Vol 3 (4) ◽  
pp. 225 ◽  
Author(s):  
Elon Eisenberg, MD ◽  
Doron Cohen, MA ◽  
Eli Lawental, PhD ◽  
Dorit Pud, PhD
Keyword(s):  
Personality Traits ◽  
Pain Perception ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Significant Negative Correlation ◽  
Pain Tolerance ◽  
Control Group ◽  
Healthy Population ◽  
Novelty Seeking ◽  
Pain Mechanisms

Objective: Previous evidences concerning pain mechanisms, long-term opioids use, and personality traits evolve the possibility that pain perception and opioid abuse are two related phenomena and there is a need to take into account the specific personality traits as well, in examining the relationships among them. Opioid addicts (OAs) have been shown to exhibit different personality traits and pain perception as compared with healthy subjects. The aim of the present study was to examine the relations between personality traits and pain perception among in-treatment OAs in comparison with controls.Design: Participants (54 OAs, 59 controls), all males, were exposed to the cold pressor test and were evaluated for latency of pain onset (seconds); pain intensity (0-100 visual analogue scale [VAS)]); and pain tolerance (time for hand withdrawal). Personality traits were evaluated using Cloninger’s Tridimensional Personality Questionnaire, TPQ; harm avoidance, HA; reward dependence, RD; novelty seeking, NS.Results: In comparison with controls, OAs exhibited longer latencies, lower VAS scores, and shorter tolerance, and significantly higher NS, higher HA, and lower RD. Control group, but not OAs, showed a significant positive correlation between HA and VAS (r = 0.31, p = 0.02) and significant negative correlation between HA and tolerance (r = −0.29, p = 0.03).Conclusions: It is concluded that in contrast to healthy population, personality traits, as measured by the TPQ, do not predict pain perception in OAs.

P418 Low dose naltrexone in therapy resistant IBD, a case series

2014 ◽  
Vol 8 ◽  
pp. S240 ◽  
Author(s):  
M. Lie ◽  
G. Fuhler ◽  
A. de Lima ◽  
C. van der Ent ◽  
C.J. van der Woude
Keyword(s):  
Low Dose ◽  
Case Series ◽  
Low Dose Naltrexone

Su1417 Low Dose Naltrexone in Therapy Resistant IBD, a Case Series

2014 ◽  
Vol 146 (5) ◽  
pp. S-464
Author(s):  
Mitchell R. Lie ◽  
Gwenny Fuhler ◽  
Alison de Lima ◽  
Cokkie van der Ent ◽  
Christien J. van der Woude
Keyword(s):  
Low Dose ◽  
Case Series ◽  
Low Dose Naltrexone

scholarly journals Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

2021 ◽  
Vol 12 ◽  
Author(s):  
Hisham Salahuddin ◽  
Giana Dawod ◽  
Syed F. Zaidi ◽  
Julie Shawver ◽  
Richard Burgess ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Low Dose ◽  
Case Series ◽  
Control Group ◽  
Anterior Circulation ◽  
Study Objective ◽  
Safety And Efficacy ◽  
Stroke Treatment

Background: Neurointerventional procedures in acute ischemic stroke often require immediate antiplatelet therapy in the cases of acute stenting and occasionally re-occluding vessels. Intravenous cangrelor is a P2Y12 receptor antagonist with short onset and quick offset. The study objective was to evaluate the safety and efficacy of intravenous cangrelor in patients with acute ischemic stroke requiring urgent antiplatelet effect.Methods: Patients who received intravenous cangrelor intra-procedurally during acute ischemic stroke treatment were identified from a prospectively collected database. Cangrelor was administered as a bolus of 15 mcg/kg, followed by an infusion rate of 2 mcg/kg/min. A historical control group consisting of anterior circulation tandem occlusions was used to compare to patients with similar lesions who received intravenous cangrelor. Outcomes of interest included in-stent thrombosis, thromboembolic complications, intracranial hemorrhage, and functional outcomes at 90 days.Results: Twelve patients received intravenous cangrelor for acute ischemic stroke between October 2018 and April 2020 at a comprehensive stroke center. Eleven patients had intra or extracranial stenting performed, which included two posterior circulation lesions. No cases of symptomatic intracranial hemorrhage were reported. At 90 day follow-up, two patients had died and 10 had a good functional outcome. Patients with anterior circulation tandem occlusions who received cangrelor and those who received dual antiplatelets orally had similar radiographic and clinical outcomes.Conclusion: Low dose intravenous cangrelor is similar in safety and efficacy to oral antiplatelets in acute ischemic stroke in a small case series. Larger prospective studies on the efficacy, safety, and effect on procedure times of intravenous cangrelor in neurointervention are warranted.

Variable response to low‐dose naltrexone in patients with Darier disease: a case series

2019 ◽  
Vol 33 (5) ◽  
pp. 950-953 ◽  
Author(s):  
D. Boehmer ◽  
K. Eyerich ◽  
U. Darsow ◽  
T. Biedermann ◽  
A. Zink
Keyword(s):  
Low Dose ◽  
Case Series ◽  
Variable Response ◽  
Darier Disease ◽  
Low Dose Naltrexone

scholarly journals Improvement in Hailey–Hailey disease with a combination of low-dose naltrexone and oral magnesium chloride: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2098412
Author(s):  
Darosa Lim ◽  
Annie Belisle ◽  
Sandra Davar
Keyword(s):  
Magnesium Chloride ◽  
Low Dose ◽  
Autosomal Dominant ◽  
Case Series ◽  
Sustained Improvement ◽  
The Third ◽  
Emerging Treatments ◽  
Low Dose Naltrexone ◽  
Oral Magnesium

Hailey–Hailey disease is a rare autosomal dominant acantholytic disorder due to mutation in the ATP2C1 gene and presents with flaccid blisters in intertriginous regions. Its chronic and relapsing course may negatively impact patients’ quality of life. Multiple medical and interventional treatments have been described with various efficacy. Low-dose naltrexone and oral magnesium chloride represent emerging treatments. Sustained improvement in Hailey–Hailey disease has been reported with the former in case series, while others have shown variable results. Oral magnesium chloride has been reported in four patients with possible results after 2–4 weeks. Two recent cases suggest that the combination of both treatments may have a synergistic effect. Herein, we present a 63-year-old woman with long-standing and recurrent bilateral inguinal Hailey–Hailey disease who significantly improved with low-dose naltrexone and oral magnesium chloride, representing the third case described with this combination.

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