by Heath McAnally: For Complete Post, Click Here…
Recent study highlights benefits and builds on previous research.
Most of the long-term pharmacotherapeutic options for treating chronic pain have failed us over the years in one way or another. The tragic results of opioid overprescribing need no further review. Adverse effects from nonsteroidal anti-inflammatory (NSAID) overuse are more insidious but may in fact confer (or at least contribute to) even greater morbidity and mortality given their far greater prevalence. (While gastric and renal toxicity get the most airplay, vascular injury including coronary and cerebrovascular issues may comprise the most serious harms from these ubiquitous medications.) Many of the potential long-term individual and community implications of marijuana use for pain remain unknown, but some evidence suggests potential harms involved with chronic use.
When confronted with serious chronic pain, then, what’s a caring physician to do?
This month I’d like to highlight a (non-funded) study carried out by our practice over the past few years on low-dose naltrexone (LDN), which builds on previous research in this area. For those in a hurry, I’ll start with the highlights and circle back to basic science a little later, but for starters, I want to point out that our most intriguing and encouraging finding is that so-called neuropathic pain may benefit even more from LDN than the so-called nociceptive or inflammatory pain states that it has been directed at over the past 20 years.
The Main Points
First off, we saw no harms from LDN over the 6-year study, which relied on a retrospective cohort design using data from 2014 to 2020. In fact, no one has really ever seen (nor would we expect, based on the drug’s known safety profile especially at very low doses) any adverse effects with LDN treatment.
We saw a statistically significant (P<0.001) 38% pain reduction reported by people who consistently used LDN for at least 2 months, with a number needed to treat (NNT) of 3.2 to achieve an outcome of at least 50% pain reduction. Age, gender, and disease-matched controls reported 4% improvement in pain over the study period, without significant differences in interventional procedures performed.
One statistically significant confounder was chronic opioid use; LDN patients discontinued the use of chronic opioids, or simply were not on them to begin with, whereas controls had a 65.3% prevalence of use during the study.