Although there are a variety of treatment options for multiple sclerosis (MS), many people still struggle with managing their symptoms. Pain is one symptom that can be especially hard to live with on a daily basis. Low-dose naltrexone (LDN) has shown real potential for use as a pain medication due to its anti-inflammatory effect.
In particular, LDN has been shown to improve pain symptoms and quality of life in some individuals with multiple sclerosis, an autoimmune disorder of the brain and spinal cord (central nervous system) that impairs nerve communication. This disease strips away the coating of cells of the brain and nerves, called myelin, leading to problems with pain, movement, speech, and cognition.
At higher doses, naltrexone is better known for its use in the treatment of alcohol use disorder and opioid use disorder. When used at doses prescribed for substance use disorders, naltrexone is what’s known as a competitive antagonist at opioid receptors. In other words, it blocks the effects of opioids and other drugs, like alcohol, that work on opioid receptors. Naltrexone is not an opioid. It is not addictive, and it can be used safely and without the risk of addiction.
For MS, naltrexone is used at lower doses than it is for substance use disorders. At low doses, naltrexone shows anti-inflammatory properties and pain-relieving effects.
Low-dose naltrexone is not used for the treatment of multiple sclerosis directly — that is, it’s not a disease-modifying therapy. But LDN can help manage difficult symptoms, such as chronic pain. Naltrexone is not approved by the U.S. Food and Drug Administration (FDA) for this use, but your doctors may still prescribe it for MS pain relief in what’s called off-label use.
Science supports the use of LDN for multiple sclerosis and other chronic pain disorders. For example, LDN has been scientifically shown to help complex regional pain syndrome and refractory chronic lower back pain. In another study involving people with fibromyalgia, LDN reduced inflammation-causing substances known as cytokines and decreased fibromyalgia-associated pain and symptoms.
In a clinical trial of multiple sclerosis and LDN, participants took 4.5 milligrams of naltrexone nightly for eight weeks. These researchers found that LDN treatment resulted in significant improvement on quality-of-life measures related to mental health and pain.
Research suggests that MS is associated with lower levels of a substance that plays a role in maintaining cell health, called opioid growth factor, or enkephalin. In one study, enkephalin levels in individuals with multiple sclerosis were improved by taking LDN, which may help relieve MS symptoms.
Other research has shown that naltrexone has protective effects in the brain. LDN may also prevent inflammatory processes from beginning in the first place. Specifically, levels of IL-6 and TNF alpha — both of which are pro-inflammatory (or inflammation-causing) markers in MS — are reduced following LDN treatment. This effect may reduce neuropathic pain.
Keep in mind that if you or a loved one is considering taking naltrexone, it cannot be taken with opioid pain medications. Naltrexone prevents opioid drugs from working by competing against them inside the brain.
Although LDN appears to be a promising off-label drug treatment for pain symptoms associated with multiple sclerosis, it is not a cure. Also remember that LDN is not approved by the FDA for the treatment of MS. Finally, never start taking any drug without first consulting your doctor or physician.
MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 167,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Have you been prescribed low-dose naltrexone for MS? Did it help? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.