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Low dose naltrexone markedly reduces pain in fibromyalgia, but shows no overall superiority to active treatments or in broader chronic pain conditions.
A meta-analysis has highlighted the potential role of low dose naltrexone (LDN) in managing chronic pain syndromes, especially fibromyalgia. Investigators conducted a comprehensive review and analysis of 7 randomized controlled trials (RCTs) identified through databases such as PubMed, Embase, Scopus, Cochrane, and clinical trial registries. Pain outcomes were assessed using standardized mean difference (SMD; Cohen’s d) between LDN and control treatments, applying a random-effects model. Subgroup analyses were also executed based on condition type and comparator drug.
In addition, the study evaluated safety through incidence rate ratios (IRR) for adverse events, assessed publication bias using funnel plots, risk of bias with the Cochrane Risk of Bias tool (version 2.0), and graded the certainty of evidence using GRADE criteria. The results showed that LDN was not substantially better than control treatments for overall chronic pain [d = -0.11]. However, in people with fibromyalgia, LDN was linked with a statistically significant reduction in pain when compared to placebo [d = -0.34].
When compared to active treatments, such as conventional analgesics, LDN exhibited no meaningful difference in efficacy [d = 0.67]. On the safety front, LDN was linked to a higher incidence of adverse events compared to placebo [IRR = 1.4], though it was comparable in safety to active treatments [IRR = 0.55]. In summary, while LDN does not show broad benefits across all chronic pain conditions, it demonstrates considerable promise in fibromyalgia and appears to be as safe and effective as other commonly used interventions for chronic pain.
Current Pain and Headache Reports
Low Dose Naltrexone In The Management Of Chronic Pain Syndrome: A Meta-Analysis Of Randomized Controlled Clinical Trials
Naveen Chandrashekar Hegde et al.
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