Marcus Norman J, Robbins Lexi, Araki Aya, Gracely Edward J, Theoharides Theoharis C
Norman Marcus Pain Institute, New York, NY, USA.
Department of Anesthesiology and Neurological Surgery, Weill Cornell Medicine, New York, NY, USA.
J Pain Res. 2024 Mar 21;17:1273-1284. doi: 10.2147/JPR.S451183. eCollection 2024.
Despite the availability of a wide variety of analgesics, many patients with chronic pain often experience suboptimal pain relief in part related to the absence of any medication to address the nociplastic component of common pain syndromes. Low-dose naltrexone has been used for the treatment of chronic pain, typically at 4.5 mg per day, even though it is also noted that effective doses of naltrexone for chronic pain presentations range from 0.1 to 4.5 mg per day. We performed an observational analysis to determine the range of effective naltrexone daily dosing in 41 patients with chronic musculoskeletal pain.
Charts of 385 patients, 115 males, 270 females, ages 18-92, were reviewed. Two hundred and sixty patients with chronic diffuse, symmetrical pain were prescribed a titrating dose of naltrexone to determine a maximally effective dose established by self-report of 1) reduction of diffuse/generalized and/or severity level of pain and/or 2) positive effects on mood, energy, and mental clarity. Brief Pain Inventory and PROMIS scales were given pre- and post-determining a maximally effective naltrexone dose.
Forty-one patients met all criteria for inclusion, successfully attained a maximally effective dose, and completed a pre- and post-outcome questionnaire. Hormesis was demonstrated during the determination of the maximally effective dosing, which varied over a wide range, with statistically significant improvement in BPI.
The maximally effective dose of low-dose naltrexone for the treatment of chronic pain is idiosyncratic, suggesting the need for 1) dosage titration to establish a maximally effective dose and 2) the possibility of re-introduction of low-dose naltrexone to patients who had failed initial trials on a fixed dose of naltrexone.
尽管有各种各样的镇痛药可供使用，但许多慢性疼痛患者的疼痛缓解效果往往不尽人意，部分原因是缺乏针对常见疼痛综合征的神经可塑性成分的药物。低剂量纳曲酮已被用于治疗慢性疼痛，通常剂量为每天4.5毫克，尽管也有人指出，用于慢性疼痛的纳曲酮有效剂量范围为每天0.1至4.5毫克。我们进行了一项观察性分析，以确定41例慢性肌肉骨骼疼痛患者的纳曲酮每日有效剂量范围。
回顾了385例患者的病历，其中男性115例，女性270例，年龄在18至92岁之间。对260例患有慢性弥漫性、对称性疼痛的患者给予滴定剂量的纳曲酮，以确定通过自我报告确定的最大有效剂量，即1）弥漫性/全身性疼痛和/或疼痛严重程度降低，和/或2）对情绪、精力和思维清晰度有积极影响。在确定纳曲酮最大有效剂量之前和之后，使用简短疼痛量表和患者报告结果测量信息系统（PROMIS）量表。
41例患者符合所有纳入标准，成功达到最大有效剂量，并完成了结果前后问卷。在确定最大有效剂量期间显示出剂量效应，其变化范围很广，简短疼痛量表有统计学显著改善。
低剂量纳曲酮治疗慢性疼痛的最大有效剂量因人而异，这表明需要1）进行剂量滴定以确定最大有效剂量，以及2）对初始固定剂量纳曲酮试验失败的患者重新引入低剂量纳曲酮的可能性。
