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Fibromyalgia and Low Dose Naltrexone (LDN)

Fibromyalgia is characterized by widespread musculoskeletal pain typically accompanied by sleep disturbances, chronic fatigue, memory issues, headaches, as well as depression and anxiety.  The specific casual factors are still being defined but are thought to involve dysfunction in CNS processing of pain signals.  Initiating events can include trauma, infection, surgery, and acute psychological stress, however many cases have no definitive triggering event having symptom severity gradually grow over time.  Women appear to be more likely to develop fibromyalgia,as do those with existing osteo and rheumatoid arthritis, and lupus.  Given it's tendency to run in families, a genetic mutation is suspected as making certain individuals more susceptible to developing the disorder.

The widespread pain that comes with fibroymyalgia is often described as a constant dull ache, lasting more than 3 months.  The fatigue reported is unrelieved by sleep, with poor sleep being commonly reported along with accompanying sleep disorders such as restless leg syndrome and sleep apnea.   Cognitive impairments involve difficulties in the ability to focus as well as memory issues, collectively known as "fibro fog". Co-morbidites include irritable bowl syndrome, migraine headaches, as well as temporomandibular joint disorders.

A pressure point test may be used to help diagnose the disease.  Blood tests are typically utilized to rule out other causes of the pain and inflammation. 

There exist only mediocre treatment options for the typical fibromyalgia patient, with only a minority of patients achieving significant, sustained relief.  Because there is no cure,  treatment options are aimed at minimizing symptoms.  Medications include over the counter pain relievers such as Tylenol, ibuprofen and naproxen.  Prescription medication can include pain relievers such as Tramadol and traditional opioids, as well as antidepressants and anti-seizure medications such as gabapentin.  Physical therapy, massage and acupuncture as typically recommended, as is stress reduction and exercise.

This study by Dr. Jared Younger was the first ever to evaluate LDN as an adjunct therapy in the treatment of fibromyalgia.  Designed as a single-blind placebo controlled-crossover pilot study, ten women were given 4.5mg LDN and followed over a 12 week time period.   The results were promising , showing six patients who were considered responsive achieving a greater than 30% reduction in symptoms.  Overall cohort symptom reduction was 2.3% on placebo and 32.5% on LDN as compared to baseline. Secondary benefits reaching significance included reductions in daily pain, highest pain, fatigue, and stress.  

Interestingly initial erythrocyte sedimentation rate (ESR) was shown to be a predictor for response point to LDN as a tool to address the inflammatory component of fibroymyalgia.

The authors concluded that low-dose naltrexone may be "an effective, highly tolerable, and inexpensive treatment for fibromyalgia".  

This article describes a well-designed pilot study demonstrating LDN's safety, efficacy and low-side effect profile int he treatment of fibroymyalgia, a clinical indication very difficult to successfully treat by traditional treatment protocols.  Given these clinical factors, and the successful results of this study,  LDN represents a possible effective primary or adjunct therapy option in the treatment of fibromyalgia.

Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone:
A Pilot Study Jarred Younger, PhD and Sean Mackey, MD, PhD School of Medicine, Department of Anesthesia, Division of Pain Management, Stanford University, Palo Alto, California, USA 

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