Prosthetic Categories

Low-Dose Naltrexone May Offer Phantom Pain Relief

    The treatments for chronic pain are as diverse as the causes, and phantom limb pain is no exception. Physicians have long depended on big-name opioid drugs to relieve pain, but there is another promising treatment that can alleviate phantom pain without unwanted side effects: small doses of naltrexone.

     Low-dose naltrexone may relieve phantom limb pain.

    Low-dose naltrexone is a mild opioid typically used to treat Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD). Naltrexone attaches to opioid receptors, intercepting the sedative effects of opioid medications while quelling the cravings associated with substance dependence. When used for substance abuse treatment, naltrexone is prescribed at around 50 mg.

    A growing body of research shows that less than a tenth of the amount used to treat substance abuse (from 1 to 4.5 mg) can offer relief for phantom limb pain and other forms of chronic pain minus the side effects. Numerous recent studies have confirmed that low-dose naltrexone can alleviate other forms of chronic pain, including orofacial pain, complex regional pain syndrome, fibromyalgia, and various musculoskeletal and inflammatory conditions. And the best thing about these findings is, unlike other opioids, low-dose naltrexone doesn’t have unwanted side effects.

    Bruce Vrooman, an associate professor at Dartmouth’s Geisel School of Medicine, noted in a 2018 paper on low-dose naltrexone that the medication can be a game-changer for many chronic pain sufferers. One part of low-dose naltrexone’s game-changing characteristics is that it’s well-tolerated by patients than the well-known opioids used for pain management for decades.

    The findings of Vrooman’s study are consistent with the results of a 2021 case study published in BMJ Case Reports. The research team examined the effects of prescribing a combination of low-dose naltrexone and another mild opioid called buprenorphine. They found that the combination gave the study participant extended relief after battling severe phantom limb pain for two years.

    A negligibly larger 2013 study confirms the findings of the 2021 study, showing that both low-dose naltrexone and buprenorphine provided significant relief to four amputee veterans. The study participants have already tried numerous treatments, including acupuncture, gabapentin, nortriptyline, pregabalin, transcutaneous electrical nerve stimulation (TENS), Toradol, and various opioids.

    Cornell Weill Medicine Center pain specialist Dr. Neel Mehta said on a radio show that he had gotten a good success rate from using low-dose naltrexone for phantom limb pain. He also recommended making low-dose naltrexone one of the mainstays in phantom limb pain treatment.

    How it works  

    Experts believe phantom limb pain appears when the central nervous system gets overworked, with pain signals firing in an out-of-control feedback loop that silences the body’s natural pain-relieving systems. Low-dose naltrexone works by dampening the inflammation and kickstarting the body’s production of pain-killing endorphins—minus the unwanted side effects.  

    Unlike traditional pain management, which focuses on the site of injury, low-dose naltrexone works by targeting the overactive nervous system. University of Michigan’s Elizabeth Hatfield said that low-dose naltrexone targets the glial cells that keep the nervous system sensitized. This reduces the nervous system’s sensitivity and the pain threshold over time.

    Although opiates have mainly been successful in dampening pain receptors’ sensitivity, they also come with significant overdose risks, as well as increased tolerance. Low-dose naltrexone is much safer, plus it’s not addictive. 

    The bottom line  

    While low-dose naltrexone shows great potential, it still hasn’t been studied enough to confirm it as a clinically proven cure for phantom limb pain and other types of chronic pain. Furthermore, phantom limb pain management requires a holistic, individualized approach. The best results come from honest communication between physicians and well-informed patients.

    Low-dose naltrexone may be essential in your phantom limb pain treatment plan. We suggest discussing the pros and cons of including this mild opioid in your treatment plan with your doctor.