Fibromyalgia is a common condition of widespread pain reflecting central nervous system sensitization. To understand how to direct treatment of this complex illness one needs to understand the pathophysiology leading to abnormal spinal cord amplification of pain signals, so will start with a brief tour of our scientific understanding of fibromyalgia. With this data it will be clear why fibromyalgia pain has been notoriously resistant to standard treatments.
Fortunately there are some newer alternative pain relief treatments that specifically target the central nervous system sensitization. One of the best studied is low-dose naltrexone (LDN) which calms activated glial cells and lowers the volume of pain transmitted to the brain.
Several case studies of fibromyalgia patients using LDN in a specialty practice will be reviewed, each highlighting one important aspect of prescribing LDN for this specific population. One challenge to prescribing LDN to patients with fibromyalgia is that many utilize opiate-based medications to manage their symptoms. There are ways to overcome this, including using ultra low-dose naltrexone along with separating dosage times adequately to lessen any interactions.
Session Learning Objective
1) Describe the central nervous system sensitization that occurs in fibromyalgia
2) Review how low dose naltrexone can lessen fibromyalgia pain
3) Identify ways to avoid interactions between opiate-based pain medications and LDN
4) Understand common LDN dosing adjustments that may be required for fibromyalgia