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December JADA looks at use of low-dose naltrexone in chronic pain management

November 20, 2020

By Mary Beth Versaci

December JADA cover image

Low-dose naltrexone, a semisynthetic opioid, can serve as an alternative to nonsteroidal anti-inflammatory drugs and other opioids in the medical management of chronic pain disorders, according to a study published in the December issue of The Journal of the American Dental Association.

The cover story, "Use of Low-Dose Naltrexone in the Management of Chronic Pain Conditions: A Systematic Review," looked at eight studies that evaluated the efficacy of low-dose naltrexone in reducing the pain intensity of patients with chronic pain disorders, finding the medication helps to reduce pain and improve the quality of life in patients with conditions associated with nociplastic changes and chronic widespread pain, such as fibromyalgia, chronic regional pain syndrome, chronic pelvic pain and interstitial cystitis.

Past research has found that naltrexone possesses novel anti-inflammatory, immunomodulatory and antinociceptive capabilities at doses of 0.1 through 4.5 milligrams. These characteristics provide a unique pathway through which low-dose naltrexone can provide pain relief for patients managing chronic pain, according to the study. Due to the low cost and relatively low adverse effect profile, it has been used as an off-label medication for patients seeking alternative treatments for their pain.

Like other chronic pain disorders, orofacial pain disorders, such as persistent temporomandibular joint disorder and myofascial pain, also involve nociplastic changes. The study found the role of low-dose naltrexone on other chronic pain diagnoses can be applied to orofacial pain, and it has use as a management tool for dentists to offer patients with chronic facial pain. However, to further determine potential applications, more large-scale studies are needed to investigate the efficacy of low-dose naltrexone in reducing pain and improving the quality of life in patients with chronic orofacial pain conditions.

"The unique antinociceptive properties mediated via glial cell modulation, as opposed to previously identified pathways of opioids and anti-inflammatories such as NSAIDs, is attractive as it bypasses certain side effects and concerns with long-term NSAID and opioid use," said Elizabeth Hatfield, D.D.S., corresponding author and clinical lecturer at the University of Michigan School of Dentistry. "Further benefits include reduction in reported pain levels and measurable increases in quality of life for patients with chronic pain disorders. Additionally, it offers an option for prescribers managing temporomandibular joint disorders with a centralized pain component. Currently, low-dose naltrexone is prescribed on an off-label basis. With the results of this systematic review, future studies of low-dose naltrexone will help further elucidate prescribing practices."

Other articles in the December issue of JADA discuss the impact of electronic cigarette use on young adults, children's dental service use and peri-implantitis associated with residual cysts.

Every month, JADA articles are published online at JADA.ADA.org in advance of the print publication.