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Does the word ‘Naltrexone’ sound familiar? It’s a medication often prescribed for people who are trying to get off alcohol or opioids. Now that researchers have had plenty of time to analyze naltrexone, they’ve noticed how well it can also help people with chronic pain. 

5 things low-dose naltrexone does for chronic pain 

Conventionally, naltrexone makes opioids and alcohol less appealing, since it blocks many of the body’s pleasure receptors (specifically, its mu receptors). When this happens, the body detects an overall lack of endorphins and releases a homemade one, called met-enkephalin. This gives the patient a break from artificially triggered endorphins and reduces the urge to take alcohol or opioids. It’s proven a boon for people seeking support with tapering off a variety of substances, including heroin, morphine, codeine, oxycodone and other opioids and painkillers. 

Naltrexone also helps relieve pain, it turns out. We didn’t realize this at first because the doses needed for pain relief are typically much lower than traditional doses. But when given in low amounts, naltrexone decreases the amount of cytokines circulating throughout the body. Cytokines irritate body tissues during inflammatory responses meant to suppress infections. If inflammatory responses go on too long though, they “get stuck” in the mind and body, becoming a self-driving cycle that increases chronic pain. So when low-dose naltrexone springs into action, it reduces cytokine bursts and summons pain relief.

Here’s five quick facts about low-dose naltrexone:

1. It works against many kinds of chronic pain

Low-dose naltrexone seems to work particularly well against fibromyalgia, migraines and neuropathy (nerve pain). It’s also proving promising for Crohn’s, diabetic neuropathy and more. The common key could be low-dose naltrexone’s ability to soothe inflammation, which is often the culprit behind chronic pain. In some cases, low-dose naltrexone is even appropriate to take for certain mental conditions.

2. It’s not addictive and doesn’t have many side effects

Unlike opioids, low-dose naltrexone does not get people addicted. Rather, it blocks opioid receptors for up to six hours, encouraging your body to produce natural pain-relieving endorphins. It also soothes your central nervous system, turning down alarm systems throughout the body and making it easier to handle stress. Its side effects are generally minimal, and can include vivid dreams, nausea or diarrhea, headaches and joint pain. Some people report losing a little weight while taking low-dose naltrexone, although it’s not a diet drug. It does not typically cause weight gain.

3. It’s a generic drug

The FDA approved naltrexone for use against opioids in 1984. Since then, the medication has gone off patent and is now classified as a generic drug. This means it can be produced by multiple manufacturers and is typically less expensive to purchase. This could be considered positive for patients, but supporters of naltrexone worry that manufacturers won’t be as interested in producing low-dose versions of it for chronic pain, since there may not be as much profit in it for them. 

4. You get it from a compounding pharmacist

In the current pharmaceutical landscape, naltrexone comes in doses of 25mg and up. That’s usually much more than you need for chronic pain treatment, when doses can be a tenth or even less of the dose given for naltrexone’s usual purposes. A common dose of low-dose naltrexone is 4.5mg, though the exact amount can vary by person. While some patients prepare their own doses, many get low dose naltrexone from a compounding pharmacist who can prepare it according to your doctor’s specifications. It might be prescribed for you in oral or liquid form.

5. It can start working in two months and cut pain by 30%

Low-dose naltrexone may take a little while to kick in. Experts recommend taking it for at least eight to ten weeks, as some people don’t experience results until then. As shown by initial research, low-dose naltrexone has reduced fibromyalgia patients’ pain by around 30%. As with many medications, it may work best for pain relief in combination with non-pharmaceutical treatment approaches that address the whole body. 

That’s a lot of potential benefits, making low-dose naltrexone an intriguing candidate for many people with chronic pain.

How to take low-dose naltrexone

According to the FDA, low-dose naltrexone being given for chronic pain is still under investigation. That doesn’t mean it’s inappropriate, it only means naltrexone is still being analyzed and is currently prescribed “off label.” Naltrexone is not a controlled substance.

Your pain doctor may already have mentioned low-dose naltrexone to you, but if not, it could be worth bringing up to see if it could be part of a solid overall pain treatment plan. Off-label usage may not be covered by insurance, but since naltrexone is a generic medication, it may still be affordable. 

Many people prefer to take low-dose naltrexone with food. It can interact with other drugs, so if you plan on taking it, you’ll want to avoid any pain meds that contain opioids, starting at least a week before you begin low-dose naltrexone. Also avoid taking alcohol, tramadol and methadone with naltrexone. After you start taking low-dose naltrexone, keep an eye out for nausea or any signs of an allergic reaction. 

You might also wonder how naltrexone differs from naloxone or similar medications. A few key differences of naloxone vs naltrexone include:

  • Naloxone is a fast-acting medication to be given during an overdose emergency. Naltrexone doesn’t act with the same immediacy and is designed for interrupting opioid effects over a longer period of time.
  • Naloxone is not a prescription medication, but naltrexone, even low-dose naltrexone, is.
  • Naloxone lasts for a shorter period of time in the body and is meant to be taken once or twice during an overdose, whereas naltrexone lasts for several hours and can be taken for a longer duration.

How Bliss teams up with you to address chronic pain

If you notice your symptoms getting any worse, don’t hesitate to consult an understanding professional. If you’re looking for reliable help from pain specialists who really listen, please get in touch. Our care plans are customized to you and can include pain creams, exercises, nutritional supplements, support from health coaches, 24/7 access to pain doctors and more.


Does naltrexone keep working or does its effect taper off?

Naltrexone keeps working without showing a steep drop-off in efficacy. Like most medications, however, you don’t necessarily want to keep taking it long-term. With professional medical support, you can slowly taper off naltrexone and retrain your body. Think of low-dose naltrexone, perhaps, as a stepping stone to long-term, sustainable pain management.

Why haven’t I heard about naltrexone before?

Since naltrexone is most commonly used for helping break addictive habits, it may not have come up in conversations you’ve been having about pain relief. If you’re interested in it, try bringing it up with your medical team. You could bring some articles with you about it to show your doctor in case they would like to know more. You could also access patient communities to read how it works for others and to reach out to them if you would like to know more.

Will normal dose naltrexone work for me?

If you’re seeking solutions for chronic pain, more isn’t necessarily better when it comes to naltrexone. If you take a “normal” dose of 50 - 100 mg, you may not feel pain relief, due to the medication’s pharmacokinetics. We know it’s not easy to obtain naltrexone in a proper dosing for chronic pain, but your medical team should be able to help you find a compounding pharmacist to dispense low-dose naltrexone that’s right for you.

Dr. Jacob, MD