Chronic Pain
Everyone experiences occasional aches and pains. In fact, sudden pain is an important reaction of the nervous system that helps alert you to possible injury. When an injury occurs, pain signals travel from the injured area up your spinal cord and to your brain. Pain will usually become less severe as the injury heals. However, chronic pain is different from typical pain. With chronic pain, your body continues to send pain signals to your brain, even after an injury heals. This can last several weeks to years. Chronic pain can limit your mobility and reduce your flexibility, strength, and endurance. This may make it challenging to get through daily tasks and
activities.
Chronic pain is defined as pain that lasts at least 12 weeks. The pain may feel sharp or dull, causing a burning or aching sensation in the affected areas. It may be steady or intermittent, coming and going without any apparent reason. Chronic pain can occur in nearly any part of your body. The pain can feel different in the various affected areas. Some of the most common types of chronic pain include:
• Headache
• Post-surgical pain
• Post-trauma pain
• Lower back pain
• Cancer pain
• Arthritis pain
• Neurogenic pain (pain caused by nerve damage)
• Psychogenic pain (pain that isn't caused by disease, injury, or nerve damage)
According to the American Academy of Pain Medicine, more than 1.5 billion people around the world have chronic pain. It's the most common cause of long-term disability in the United States, affecting about 100 million Americans.
What causes chronic pain?
Chronic pain is usually caused by an initial injury, such as a back sprain or
pulled muscle. It's believed that chronic pain develops after nerves
become damaged. The nerve damage makes pain more intense and long
lasting. In these cases, treating the underlying injury may not
resolve the chronic pain. In some cases, however, people experience chronic pain without any prior injury. The exact causes of chronic pain without injury aren't well understood. The pain may sometimes result from an underlying health condition, such as:
• Chronic fatigue syndrome: characterized by extreme, prolonged weariness
that's often accompanied by pain
• Endometriosis: a painful disorder that occurs when the uterine lining grows outside of the uterus
• Fibromyalgia: widespread pain in the bones and muscles
• Inflammatory bowel disease: a group of conditions that causes painful, chronic inflammation in the digestive tract
• Interstitial cystitis: a chronic disorder marked by bladder pressure and pain
• Temporomandibular joint dysfunction (TMJ): a condition that causes painful clicking, popping, or locking of the jaw
• Vulvodynia: chronic vulva pain that occurs with no obvious cause
Who is at risk for chronic pain?
Chronic pain can affect people of all ages, but it's most common in older adults. Besides age, other factors that can increase your risk of developing chronic pain include:
• having an injury
• having surgery
• being female
• being overweight or obese
How is chronic pain treated?
The main goal of treatment is to reduce pain and boost mobility. This helps you return to your daily activities without discomfort. The severity and frequency of chronic pain can differ among individuals. So doctors create pain management plans that are specific to each person. Your pain management plan will depend on your symptoms and any underlying health conditions. Medical treatments, lifestyle remedies, or a combination of these methods may be used to treat your chronic pain.
Medications
Several types of medications are available that can help treat chronic pain.
Here are a few examples:
• Over-the-counter pain relievers, including acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil).
• Opioid pain relievers, including morphine, codeine, and hydrocodone
• Adjuvant analgesics, such as antidepressants and anticonvulsants
Medical Procedures
Certain medical procedures can also provide relief from chronic pain. An
example of a few are:
• Electrical stimulation, which reduces pain by sending mild electric shocks into your muscles
• Nerve block, which is an injection that prevents nerves from sending pain signals to your brain
• Acupuncture, which involves lightly pricking your skin with needles to alleviate pain
• Surgery, which corrects injuries that may have healed improperly and that may be contributing to the pain
Lifestyle Remedies
Additionally, various lifestyle remedies are available to help ease chronic pain. Examples include:
• Physical therapy
• Tai chi
• Yoga
• Art and music therapy
• Pet therapy
• Psychotherapy
• Massage
• Meditation
There isn't a cure for chronic pain, but the condition can be managed successfully. It's important to stick to your pain management plan to help relieve symptoms.
Physical pain is related to emotional pain, so chronic pain can increase your stress levels. Building emotional skills can help you cope with any stress related to your condition. Here are some steps you can take to reduce stress:
• Take good care of your body: Eating well, getting enough sleep, and exercising regularly can keep your body healthy and reduce feelings of stress.
• Continue taking part in your daily activities: You can boost your mood and decrease stress by participating in activities you enjoy and socializing with friends. Chronic pain may make it challenging to perform certain tasks. But isolating yourself can give you a more negative outlook on your condition and increase your sensitivity to pain.
• Seek support: Friends, family, and support groups can lend you a helping hand and offer comfort during difficult times. Whether you're having trouble with daily tasks or you're simply in need of an emotional boost, a close friend or loved one can provide the support you need.
What is Low Dose Naltrexone?
LDN is a prescription drug that helps to regulate a dysfunctional immune
system. It reduces pain and fights inflammation. It is not a narcotic or a
controlled substance. It is an opioid receptor antagonist that is taken orally to block opioid receptors. An antagonist is a chemical that acts within the body to reduce the physiological activity of another chemical substance.
Naltrexone was approved by the FDA in 1984 for the treatment of opioid addiction, usually at a dose of 50-100mg a day. It blocks the receptors that opioids like oxycodone bind to negating the euphoric effect. However, at much lower doses, naltrexone has been used for autoimmune disorders like
Hashimoto’s disease as well as chronic pain.
For more information on how LDN works, please click here.
Image Credit: https://pubchem.ncbi.nlm.nih.gov/compound/Naltrexone
How does LDN provide pain relief?
Before we discuss how LDN works, we need to go over the role of endorphins in the body. Endorphins are opiate-like molecules in the body. They are produced in most cells in the body and are important regulators of cell growth and the immune system. The particular endorphin that has been found to influence cell growth is called Opioid Growth Factor (OGF). For an endorphin such as OGF to exert its beneficial effects, it must interact with the body’s cells. It does this by binding to a receptor on the surface of the cells.
Naltrexone is an orally administered drug that binds to opioid receptors. In doing so, it displaces the endorphins which were previously bound to the receptors. Specifically, by binding to the OGF receptors, it displaces the body’s naturally produced OGF. As a consequence of this displacement, the affected cells become deficient in OGF and three things happen:
1) Receptor production is increased, in order to try to capture more OGF.
2) Receptor sensitivity is increased, also to try to capture more OGF.
3) Production of OGF is increased, in order to compensate for the perceived shortage of OGF.
Since LDN blocks the OGF receptors only for a few hours before it is naturally excreted, what results is a rebound effect; in which both the production and utilization of OGF is greatly increased. Once the LDN has been metabolized, the elevated endorphins produced as a result of the rebound effect can now interact with the more-sensitive and more-plentiful receptors and assist in regulating cell growth and immunity. The elevated level of endorphins can result in an enhanced feeling of well-being as well as a reduction in pain and inflammation. The duration of the rebound effect varies from person to person but generally lasts about one day. This effect can only be utilized by taking a low dose of naltrexone and not a high dose or extended-release naltrexone.
What does the research show?
Research has been done over the years evaluating how LDN and its use in chronic pain patients. Some of the studies that have been published are smaller studies but show promise for the treatment of chronic pain using LDN. Studies include:
• Clinical Rheumatology - showed that LDN was effective at reducing symptom severity in patients.
• Journal of the Neurological Sciences - showed improvement in quality of life as well as reduced pain for patients on LDN.
• Senior Care Pharmacist - suggests that LDN is a viable option for patients in reducing pain and improving quality of life measures.
For a list of more studies, please click here.
What dosage forms are available?
LDN is available by prescription only from compounding pharmacies. It is available as an immediate-release oral capsule or a liquid. LDN is typically prescribed at doses from 0.001mg-16mg with the most common dose of 4.5 mg.
Ask your doctor or one of our compounding pharmacists if LDN is right for you.
Sources:
https://www.healthline.com/health/chronic-pain
https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain
https://ldnresearchtrust.org/how-naltrexone-works
https://www.psychologytoday.com/us/blog/holistic-psychiatry/201910/my-exploration-low-dose-naltrexones-benefits
https://pubmed.ncbi.nlm.nih.gov/30821677/
https://ldnresearchtrust.org/content/ldn-and-pain
https://www.jns-journal.com/article/S0022-510X(15)01775-X/fulltext