Utilizing Low Dose Naltrexone for Pain Relief After Failed First Line Interventions: A Case Report

Case Diagnosis: Neuropathic pain likely secondary to thalamic stroke

Case Description or Program Description: 68-year-old male with neuropathic pain likely secondary to thalamic stroke. He was initially started on Gabapentin and Cymbalta without significant pain relief. After discussion, he was started on low-dose naltrexone at 3 mg daily. He continued all three medication and referred to physical therapy for desensitization. Other than a minor diarrhea briefly, he tolerated this regiment well. He reported that this was the first time he had significant decrease in pain since onset. Physical therapist gave him a compression wrist splint and was then prescribed full compression sleeve and stocking for his left leg which helped as well.

Setting: Musculoskeletal and Spine Clinic

Assessment/Results: Reported continued pain relief at follow up visits over the last 18 months. He has been able to return to hobbies and activities that were previously hindered by pain. Pain was assessed using VAS pain scale and patient subjective reporting. It is also noted, that while no objective data was collected, the patient was satisfied with the level of pain relief achieved and ability to improve quality of life.

Discussion (relevance): Chronic pain is a challenging medical condition affecting millions worldwide, with a substantial impact on quality of life, physical function, and mental health. Despite advances in pharmacological and interventional therapies, management of chronic pain remains a significant clinical burden. Low-dose naltrexone (LDN), an opioid receptor antagonist has emerged as a novel and promising option for pain relief exhibiting unique immunomodulatory and anti-inflammatory properties. Emerging evidence suggests it may be effective in a range of chronic pain conditions, including fibromyalgia, complex regional pain syndrome (CRPS), and neuropathic pain, offering a favorable safety profile with minimal side effects.

Conclusions: Despite its potential, LDN remains underutilized in clinical practice, partly due to limited large-scale studies and a lack of standardization in dosing and administration protocols.