The “typical” patient Neel Mehta, MD sees at his practice has been experiencing chronic pain for at least 90 days. Some have been suffering for a lifetime.
Now Dr. Mehta and the Weill Cornell Medicine pain management team have begun using a safe, old drug in new ways—and in low doses—to treat certain patients.
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Their work with the drug, Naltrexone, is an outgrowth of an international partnership with the UK-based LDN Research Trust Charity. According to The Trust, Naltrexone is safe, non-toxic, and inexpensive, and has been used in the United States since the FDA first approved it in 1984.
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Though physicians previously prescribed Naltrexone to treat opioid addictions, they now are employing the drug in off-label uses to aid patients with conditions ranging from pain and a dysfunctional immune system, to inflammation, cancer, and mental health issues.
Here’s what else is new: the WCM team is not prescribing the old, high dose that had originally been considered standard, 50 mg to 100 mg per day. Their patients are using “low” or “ultra-low” doses of Naltrexone.
“We’ve discovered that, if you give patients doses far less than 50 mg, we may be able to achieve pain relief,” says Dr. Mehta says. “In fact, some of the doses we give in tablet or liquid form range from as low as 0.01 mg to six to eight milligrams. We usually start patients with a 1.5 mg dose on an empty stomach at night, and then look for a response after a few weeks.”
Keeping a close watch on patient’s symptoms and use, a WCM physician may increase the Naltrexone dose to 3 mg, and then perhaps 6 mg.
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Naltrexone works by temporarily binding and blocking a mechanism called the MU receptor, which is linked to pain. Blocking the receptor tells our bodies that we aren’t producing enough endorphins (our natural pain relievers), and then releases them.
“Generally, my patients report pain relief greater than 50 percent, that they’re sleeping better, or can return to work,” Dr. Mehta reports. “And some patients end up responding well to doses as low as 0.1 for reasons we don’t yet completely understand. Patients are experiencing good results with low harm in these early studies.”
If a patient is a good candidate for low-dose Naltrexone, they can fill their prescriptions from compounding pharmacies that grind up the higher dose tablet into the ultra-low doses.
“Patients should know that there are additional opportunities and innovations in pain relief,” Dr. Mehta adds. “I advise patients to ask their physicians about it and learn more about the LDN Research Trust online.”
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