Efficacy of Low Dose Naltrexone on Pain Reduction in Chronic Pain Syndromes: A Meta Analysis

Chronic pain is a multifaceted debilitating experience often associated with significant physical and emotional burden. Low dose naltrexone (LDN) has gained attention in recent years for its potential utility in the management of fibromyalgia, irritable bowel syndrome, multiple sclerosis, and painful diabetic neuropathy. LDN’s analgesic effects have been associated with its ability to increase the production of endorphins while reducing the production of tumor necrosis factor-alpha, interleukin-6, reactive oxygen species and nitric oxide. This meta-analysis aims to systematically review and synthesize the available evidence on efficacy of LDN as an analgesic in pain syndromes, with a focus on chronic (neuro) inflammatory diseases. The goal is to provide clinicians with a more comprehensive estimate of the effectiveness of LDN as a non-opioid option for managing chronic pain and guide future research in the area. Thirteen randomized control trials, published from 1990 to 2022, were selected for the analysis that satisfied inclusion criteria. The overall effects in these studies were calculated using the standardized mean difference (SMD) between the LDN and placebo groups. We found an overall SMD of -10.77 (95% CI: -13.96 to -7.58) with a p-value of 0.002. This indicated that the LDN group experienced a statistically significant reduction in pain compared to placebo. This meta-analysis provides evidence for the potential efficacy of low dose naltrexone in reducing pain and enhancing analgesia in various pain syndromes. LDN may be a useful treatment option for patients suffering from chronic pain, particularly with fibromyalgia, multiple sclerosis, or diabetic neuropathy. However, further research is needed to confirm the efficacy and safety of low dose naltrexone for chronic pain conditions, especially with larger sample sizes, standardized dosing regimens and treatment durations.

Effects of long-term sustained naltrexone release on the optic center in opioid-dependent patients Case-control study in four provinces of China

Very little is known about visual functional recovery following long-term naltrexone administration in opioid-dependent patients. In the present study, a portable event-related potential （ERP） working system was utilized to collect and record ERP in opioid-dependent patients and normal controls in visual half-field testing. In addition, the influence of long-term sustained naltrexone release on the visual nervous system was observed in opioid-dependent patients. Results revealed a significant main group effect in reaction time to visual signal stimulations. The reaction time of normal controls was shortest, but longest in opioid-dependent patients. The reaction time of long-term sustained naltrexone release group and compulsory detoxification group was similar to normal controls. A significant main group effect was also observed in P100 latency, and P100 latency in normal controls and the compulsory detoxification group was significantly decreased compared with the opioid-dependent patients. P100 amplitude at the Oz-electrode resulted in a significant main group effect. In particular, normal controls exhibited significant differences compared with long-term sustained release naltrexone and compulsory detoxification groups. These findings demonstrated that long-term sustained naltrexone release effectively ameliorated optic center function and improved visual sensitivity and reactions in opioid-dependent patients.

Effect of oral naltrexone on pruritus in cholestatic patients

AIM： To determine the efficacy and potential complications of oral naltrexone used in the treatment of pruritus in cholestatic patients and to compare them with other studies.METHODS： Thirty-four enrolled cholestatic patients complaining of pruritus were studied. In the initial phase, pruritus scores during day and night were evaluated. Subsequently, patients were given a placebo for one week followed by naltrexone for one week. In each therapeutic course （placebo or naltrexone） day and night pruritus scores were distinguished by a visual analogue scale （VAS） system and recorded in patients＇ questionnaires.RESULTS： Both naltrexone and placebo decreased VAS scores significantly. Naltrexone was more effective than placebo in decreasing VAS scores. Both day and night scores of pruritus decreased by half of the value prior to therapy in thirteen patients （38%）. Daytime pruritus improved completely in two patients （5.9%）, but no improvement in the nighttime values was observed in any patient. Sixteen patients （47%） suffered from naltrexone complications, eleven （32%） of them were related to its withdrawal. Complications were often mild. In the case of withdrawal, the complication was transient （within the first 24-28 h of therapy） and self-limited. We had to cease the drug in two cases （5.9%） because of severe withdrawal symptoms. CONCLUSION： Naltrexone can be used in the treatment of pruritus in cholestatic patients and is a safe drug showing few, mild and self-limited complications.

Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials

Substance use disorders(SUDs)are a growing problem among older adults.Acamprosate,disulfiram,and naltrexone are United States Food and Drug Administration(referred to as FDA)approved for the treatment of alcohol use disorder,and buprenorphine is approved for the treatment of opiate use disorder among adults.However,the data on the use of these medications for the treatment of SUDs among older adults are unclear from randomized controlled trials(referred to as RCTs).A review of the literature indicates that there are only two RCTs that evaluated the use of pharmacologic agents for SUDs among older adults(≥50 years).One trial evaluated the use of naltrexone when compared to placebo for the treatment of alcohol use disorder among individuals,50-70 years in age.The other trial evaluated the use of naltrexone or placebo as adjuncts with sertraline in the treatment of alcohol use disorder among individuals older than 55 years in age.Both trials indicated that the use of naltrexone reduced the rates of relapse among older adults with alcohol use disorder.However,we did not identify any RCTs that studied the use of buprenorphine,acamprosate,or disulfiram for SUDs among older adults.Based on available evidence,it would be safe to conclude that limited data indicate some efficacy for naltrexone in the treatment of alcohol use disorder among older adults.However,data from controlled trials on the use of other medications that are FDA approved for the treatment of SUDs among younger adults are nonexistent among older adults with SUDs.

毒瘾治疗药物纳曲酮可能对癌症也有效

研究人员最近发现将用于成瘾治疗的药物纳曲酮（ naltrexone ）以低剂量治疗癌症病人能带来一些有益治疗效果。研究人员发现纳曲酮不仅可以阻止癌细胞生长，还能够使癌细胞发生“自杀”。研究还发现纳曲酮在小剂量下能够激活促进癌细胞自杀的基因表达，同时还会影响免疫系统增加对癌细胞的监视和杀伤。

Addiction Treatment Aftercare Outcome Study

Aftercare is crucial once an individual has completed drug or alcohol treatment and is in recovery. There is a continuity of care that should be followed once initial treatment is completed. This usually involves a lower level of treatment such as outpatient care and a sober living environment. In order to assess the efficacy and benefit of our addiction treatment program, we investigate a set of patients in which addiction treatment outcome and rehabilitation is determined for patients who have completed treatment and followed up. We determine abstinence rates and identify predictors of treatment outcome.

SUPPRESSIVE EFFECT OF STRESS ON THE RELEASE OF HYDROGEN PEROXIDE FROM RAT MACROPHAGES

It is known that exposure to stress reduces the activity of T lymphocytes and natural killer cells. The effect of stress on B lymphocyte is more complicated. It may reduce or enhance the activity, depending on the nature and intensity of the stimulus, as well as the biological characteristics of the anima. Macrophages are versatile cells which play a central role in the stimulation and expression of immune system. Hydrogen peroxide （H2O2）, superoxide anion and hydroxyl radicals produced by macrophages are involved in the killing of microorganisms and tumor cells.

FDA批准Vivitrol用于预防阿片依赖复发

FDA批准Alkermes公司的Vivitrol（naltrexone hydrochloride，注射用缓释悬浮液）用于预防阿片脱毒后的阿片依赖复发。获批后，naltrexone成为首个治疗阿片依赖的非麻醉剂、非成瘾性药物，每月用药1次。此项批准是基于1项为期6个月、多中心、随机、Ⅲ期临床研究的数据。该研究达到其有效性终点。