Naltrexone for Fibromyalgia
Naltrexone is a medication used for the treatment of drug and alcohol addiction. It is a member of the drug class known as opiate antagonists, and works by decreasing the cravings for alcohol and blocking the effects of opioid medications and opioid street drugs (such as heroin). It does not prevent or relieve withdrawal symptoms. Naltrexone is marketed under the brand names ReVia and Depade. It is generally taken in tablet form once per day, and common side effects include the following: nausea, vomiting, stomach pain, stomach cramps, diarrhea, constipation, decreased appetite, headache, dizziness, anxiety, nervousness, irritability, tearfulness, insomnia, changes in energy level, drowsiness, muscle or joint pain, and rash. Serious side effects include confusion, hallucinations, blurred vision, and severe vomiting or diarrhea.
Naltrexone and Fibromyalgia
In the hunt for an ever-elusive cause of fibromyalgia, some researchers have hypothesized that certain endorphins within the body may somehow be associated with the distorted pain perception that afflicts most Fibromyalgia sufferers. Endorphins are a group of hormones that act as the body’s natural painkillers. Opiate pain medications mimic the actions of endorphins in the body, thereby relieving pain. Based on these assumptions, emerging research has investigated the use of naltrexone as a treatment for fibromyalgia-related pain in recent years.
The first such study was published in 2009 by Younger et al. This randomized controlled study (considered the “gold standard” for research study design) treated 10 women with fibromyalgia and 10 control subjects (matched to the age and gender of the fibromyalgia patients) with 50mg naltrexone or placebo (one at each of two sessions). All participants were evaluated to determine any changes in their sensitivity to heat, cold, and pain. At the outset of the study, those patients in the fibromyalgia group had more symptoms, greater sensitivity to sensory stimuli, more symptoms associated with opioid withdrawal, and lower pain and cold tolerances than the controls. Following administration of naltrexone, neither group experienced changes in cold or pain sensitivity, nor did anyone in either group experience positive changes in self-reported withdrawal symptoms or mood. The authors concluded that the findings of their study did not support a role for endorphin activity in the symptoms of women with fibromyalgia (Younger et al., 2009).
A subsequent study, also led by Younger, evaluated the effectiveness of low-dose (4.5 mg) naltrexone in the treatment of fibromyalgia symptoms among 10 women who met the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia and who were not taking any opioid pain medications. In this study, each participant was followed for an initial 2 week baseline period, then received treatment with a placebo for 2 weeks, then received naltrexone for 8 weeks. After treatment was finished, each participant was also followed for a 2 week “wash-out” period during which they received no drug or placebo. Using a handheld computer, each participant recorded the severity of their symptoms on a daily basis, and also visited the laboratory every 2 weeks to be tested for mechanical, heat, and cold pain sensitivity. At the conclusion of the study, the researchers found that all participants experienced a reduction in their fibromyalgia symptoms, including improvements in mechanical and heat pain thresholds. Side effects were rare in this study, and included insomnia and vivid dreams. Based on their findings, the authors concluded that naltrexone might be an effective, tolerable, and inexpensive option for the treatment of fibromyalgia (Younger & Mackey, 2009).
Most recently, Ramanathan et al., (2012) presented a case report of a 37 year old male who presented with a two-year history of widespread pain, eye pain, sleep difficulties, concentration problems, and anxiety. This individual also reported a family history of adult-onset chronic pain (in particular his mother and brother). The patient had previously received diagnoses of carpal tunnel syndrome, hypoparathyroidism, and fibromyalgia. Following unsuccessful treatment with naproxen, amitriptyline (Elavil), and milnacipran (Savella) due to unwanted side effects, the authors placed this patient on the following regimen of naltrexone: 1mg for 2 nights, 2mg for 2 nights, and then 4.5mg for a 2 week period. After a 2 week rest period, treatment with naltrexone resumed at the 4.5mg dose for a 14 week period. Within one week of treatment, the patient reported a significant improvement intender point pain, and after one month, dull pain previously reported in his neck and back had improved considerably. Self-reported measures of pain severity steadily declined throughout his course of treatment, while his self-reported mood and quality of life improved. The authors conclude that low-dose naltrexone may be a safe, effective, and affordable option for treating fibromyalgia-related symptoms(Ramanathan et al., 2012).
Take a deep breath. Hold it for a moment, and then exhale. Feel more relaxed? Breathing exercises are one way to relax. Here you will learn about different ways to relax your mind and body. Being relaxed can help ease stress. It can also relieve anxiety, depression, and sleep problems.
- To relax means to calm the mind, the body, or both.
- Relaxing can quiet your mind and make you feel peaceful and calm. Your body also reacts when you relax. For example, your muscles may be less tense and more flexible.
- There are different ways to relax. You may find one or more ways help to you calm down and feel at peace.
Many methods of relaxation work on both the mind and the body at the same time. Other ways to relax focus on just one or the other.
- Relaxing the mind means to quiet your thoughts so that you feel calm and peaceful. This can help you feel better and think more clearly than when you are stressed or anxious.
- Relaxing the body depends on where you are holding your tension. When people are stressed, their muscles often become tight. Learning how to relax your muscles, such as through progressive muscle relaxation, is one way to relax your body. Breathing deeply is another way.
Relaxing your mind and body can make you feel calm and peaceful. It can help relieve stress as well as anxiety, depression, and sleep problems.
Stress is a physical or emotional response to life?s changes and challenges. When you are under stress or feel anxious, your body reacts as if it is under attack. This is called the fight-or-flight stress response. Your body releases hormones that speed up your heart rate and breathing and make your muscles tense. Stress also affects your emotions, making you feel moody, tense, upset, or depressed. Over time, stress can affect your health in other ways too. For example, stress has been linked to high blood pressure.
When you are able to relax your mind and body, your body stops producing the hormones that create stress. The feelings of stress ease, and you return to a state of calm, both physically and mentally.
February 19, 2013 — John Cannell, MD
Oxidative stress is thought to underlie cardiovascular and many other diseases. Oxidative stress reflects an imbalance between the byproducts of humans being on fire (oxidizing), and human’s ability to readily repair that damage with our antioxidant systems. Malondialdehyde (MDA) is a complex molecule that serves as a marker for oxidative stress, the higher the MDA, the worse the oxidative stress.
Inflammation (Latin root “to set alight or burn”) is a complex biological response to harmful stimuli, such as pathogens, damaged cells, toxins, or antigens. Inflammation is an attempt by the organism to remove the injurious stimuli and begin the healing process. C-reactive protein (CRP) is a protein found in the blood, the levels of which rise in response to inflammation: the higher the CRP, the worse the inflammation.
Both statins and vitamin D have pleiotropic effects, meaning they have many different effects on the body and appear to work in different ways. Pleiotropic comes from the Greek, meaning “more,” and “convert.” While the mechanism of action of vitamin D’s pleiotropy is easy to explain (vitamin D has as many mechanisms of action as genes it regulates), the same cannot be said of statins. How do they work other than reducing cholesterol?
Dr Thozhukat Sathyapalan and colleagues of the Hull York Medical School in England recently conducted a remarkable study of two statins.
Sathyapalan T, Shepherd J, Atkin SL, Kilpatrick ES. The effect of atorvastatin and simvastatin on vitamin D, oxidative stress and inflammatory marker concentrations in patients with type 2 diabetes: a crossover study. Diabetes Obes Metab. 2013 Jan 28.
The two statin drugs studied were atorvastatin (Lipitor) and simvastatin (Zocor). Both lower cholesterol equally well and both are used to prevent cardiovascular disease. However, at least one study shows that cardiovascular events are lower with atorvastatin than simvastatin.
Super Immunity by Joel Fuhrman
He’s scared for me and my health. First time ever that I actually feel like he cares and is starting to understand my pain.
A small study has linked the pain of fibromyalgia to small nerve fiber neuropathy, which is painful damage to a certain part of a certain nerve. This could be a ground-breaking study, as fibromyalgia has previously been linked to nerve dysfunction, but not to actual nerve damage.
Researchers examined the small fibers in different areas of the body using three different methods: sensory testing, pain response, and skin biopsy. They compared them between people with fibromyalgia, those with depression, and healthy control subjects.
They determined that people with fibromyalgia had:
- Impaired small fiber function that lead to increased temperature sensitivity;
- Sensory irregularities in the feet, face, and hands;
- Lower total nerve fibers and fewer regenerating nerve fibers in the skin;
- Fewer unmyelinated nerve fiber bundles in the skin, but normal levels of myelinated nerve fibers.
Researchers concluded that all three testing methods support the idea of impaired small fiber function, and therefore a high likelihood of neuropathic pain, in fibromyalgia.
Understanding the Science
A quick lesson in neurology now, so that these findings make sense to you.
First, look at the picture above. The pink spots are neurons, the cells that make up nerves. The stringy things connecting them are called axons or fibers.
The fibers in the skin, organs, and peripheral nerves are called C fibers or small fibers. Their job is to provide sensation for your skin and to control autonomic function - all the automatic jobs your body does, like regulating heart rate, breathing, and body temperature. Damage to these nerves is called peripheral neuropathy.
Now let’s look at the final finding listed above: Fewer unmyelinated nerve fiber bundles in the skin, but normal levels of myelinated nerve fibers.
Picture a large electronic cable cut in half. Inside, it contains a bunch of smaller cables that are bundled together and put inside a casing. Small fibers in your body are bundled in a similar way as they travel together away from nerve cells and toward the areas they serve.
Some of those bundles are in a protective casing called myelin, or a myelin sheath. The medical term for a sheathed bundle is myelinated.
Other bundles are “naked” - they don’t get a myelin sheath. It’s these naked, unmyelinated bundles that, according to this study, appear to be damaged in fibromyalgia. That could be an important clue to researchers as they try to uncover the reasons for the damage.
This could be an extremely important avenue of research. Doctors understand neuropathic pain. It’s common in diabetes and as a result of nerve damage. It’s a concrete explanation for our pain, which is currently classified as “poorly understood” or “idiopathic” (meaning without cause.)
Neuropathy in us makes sense. It explains why medications known to improve neuropathy, such as Lyrica (pregabalin), work for some of us. It also explains the nature of our pain and the way it moves around.
It also raises a new question - what is damaging our small fibers? Is it our immune systems, which would mean fibromyalgia is autoimmune? Do we lack an enzyme that aides in axon growth and repair? Is it a problem with cellular metabolism (mitochondrial dysfunction)?
Let’s hope that researchers start asking those questions and looking for answers, because if it truly is nerve damage - and not just dysfunction - it brings us better credibility along with more concrete targets for treatment.