Patients with cardiac failure, chronic lung disease, diabetes, and other terminal illnesses account for two-thirds of those who need of palliative care to relieve symptoms near the end of life. These patients can experience comparable pain to that of patients with cancer. Management is crucial because pain can have a devastating impact on the quality of life. Opioid-based medications can cause gastrointestinal (GI) side effects such as nausea and constipation, mental status changes, hemodynamic disturbance, and respiratory depression. There is concern about the long-term use of opioids, and the potential for subsequent diversion or abuse by others.

Non-opioid analgesics (like ibuprofen) have limitations due to GI and renal adverse effects; therefore, an alternative approach to pain management is needed that would adequately alleviate pain and enhance quality of life without significant risks. Low Dose Naltrexone (LDN) is increasingly used as an off-label treatment for several autoimmune diseases including multiple sclerosis and inflammatory bowel disease, as well as chronic pain disorders including fibromyalgia, complex regional pain syndrome (CRPS), and diabetic neuropathy. LDN also has the potential to improve mood disorders and enhance the quality of life.

LDN may also be helpful in treating cancer-related pain and may improve quality of life in patients unable to tolerate chemotherapy. LDN may support the immune system. Research indicates that LDN may promote resilience and emotional well-being, as well as help with anxiety. However, larger studies need to confirm these potential benefits.

LDN is inexpensive and has a low side effect profile, with some reported incidences of vivid dreams, nightmares, headaches, and anecdotal reports of anxiety and rapid heart rate. There has not been any observed toxicity or withdrawal symptoms with chronic use.

 

LDN is not commercially available but can be prescribed for preparation by our compounding pharmacy.

 

Am J Hosp Palliat Care. 2019 Oct;36(10):907-912. (link reference to https://pubmed.ncbi.nlm.nih.gov/30917675/)

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