McKenzie-Brown Anne Marie, Boorman David W, Ibanez Kristen R, Agwu Ezihe, Singh Vinita
Department of Anesthesiology, School of Medicine, Emory University, Atlanta, GA, USA.
School of Medicine, University of Central Florida, Orlando, FL, USA.
J Pain Res. 2023 Jun 14;16:1993-1998. doi: 10.2147/JPR.S389957. eCollection 2023.
Low-dose naltrexone (LDN) has increased in popularity as a non-opioid medication that may decrease chronic pain symptoms. LDN is most commonly used to treat fibromyalgia, complex regional pain syndrome (CRPS), and painful diabetic neuropathy. Other studies suggest that LDN provides general symptom reduction in inflammatory conditions such as Crohn's disease and multiple sclerosis. We reviewed our experience with patients to whom we have prescribed LDN to see what types of painful conditions were most responsive to LDN in our patient population.
Charts from patients who came to the Pain Center between 2014 and 2021 were reviewed.
Of the n = 137 patients who were prescribed LDN, 44% had no evidence of ever filling the prescription, and 4.4% of the responses were not charted. Of the remaining who took LDN (n = 70), 64% had some relief and were designated as 'Responders'. The most common pain diagnosis was neuropathic pain which, when added to the diagnosis of complex regional pain syndrome, accounted for 51% of responders to LDN. Patients who experienced greater than 50% pain relief from LDN were more likely to have the diagnosis of neuropathic pain or complex regional pain syndrome (p = 0.038, Fisher's Exact Test). There was a significant difference in the diagnosis of patients who responded to LDN. Patients with spondylosis were much less likely to respond to LDN when compared with other diagnoses (p = 0.00435, Chi-Square Test).
Patients with all types of neuropathic pain, including CRPS, were significantly more likely to have pain relief from LDN than patients with spondylosis (p=0.018). The diagnosis of spondylosis was more often associated with a lack of response to LDN than any other diagnosis. Patients may need to have a trial of several weeks before analgesic effects are seen with LDN.
低剂量纳曲酮（LDN）作为一种非阿片类药物，越来越受欢迎，它可能减轻慢性疼痛症状。LDN最常用于治疗纤维肌痛、复杂性区域疼痛综合征（CRPS）和疼痛性糖尿病神经病变。其他研究表明，LDN能减轻诸如克罗恩病和多发性硬化症等炎症性疾病的一般症状。我们回顾了给患者开LDN的经验，以了解在我们的患者群体中，哪些类型的疼痛状况对LDN反应最为敏感。
回顾了2014年至2021年期间前来疼痛中心就诊患者的病历。
在137例被开具LDN的患者中，44%没有证据表明曾取药，4.4%的反馈未记录在案。在其余服用LDN的患者（n = 70）中，64%有一定程度的缓解，被指定为“有反应者”。最常见的疼痛诊断是神经性疼痛，若加上复杂性区域疼痛综合征的诊断，则占LDN有反应者的51%。从LDN获得超过50%疼痛缓解的患者更有可能被诊断为神经性疼痛或复杂性区域疼痛综合征（p = 0.038，Fisher精确检验）。对LDN有反应的患者诊断存在显著差异。与其他诊断相比，患有脊椎病的患者对LDN有反应的可能性要小得多（p = 0.00435，卡方检验）。
包括CRPS在内的所有类型神经性疼痛患者从LDN获得疼痛缓解的可能性显著高于脊椎病患者（p = 0.018）。与其他任何诊断相比，脊椎病的诊断更常与对LDN无反应相关。患者可能需要试用数周才能看到LDN的镇痛效果。
