Treatment of Complex Regional Pain Syndrome (CRPS) Using Low Dose Naltrexone (LDN)

Abstract

Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms.

Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome

“…Experimental therapy of unregulated inflammation and microglia activation using LDN has been reported in pain disorders including 2 cases of CRPS. 11,20 Systemic pain disorders have been reported in association with SIBO, and thus, this inflammatory state may also play an additional role in CRPS in a patient who has the appropriate phenotypic risk and/or had one of the classic initial inciting triggering events (as was seen in this patient). Pain disorders associated with SIBO include IBS with diarrhea predominance (IBS-d), fibromyalgia, restless legs syndrome, interstitial cystitis, and chronic prostatitis.…”

“…Thus, published reports of concomitant CRPS and Ehlers-Danlos syndrome are far rare. 20,34 The authors of a case series with 4 patients proposed that Ehlers-Danlos syndrome contributed to CRPS via stretch injury to the nerves traversing hypermobile joints, increased fragility of nerve connective tissue, and/or nerve trauma from more frequent surgery. 34 Subsequently, both syndromes have been subsequently concurrently diagnosed in approximately 25% of 1 of the author's pain management practice.…”

“…Rifaximin was given for SIBO (1650 mg/d/2 week), and long-term low-dose naltrexone (LDN; 4.5 mg/d) was prescribed based on the success in a previous publication. 20 At the 1-month gastroenterology clinic visit, she reported a marked improvement in her leg and bowel symptoms. LDN was continued long term.…”

“…2). LDN was continued, and 3 therapies were added: (1) rifaximin (1650 mg/d for 1 month) to retreat SIBO; (2) erythromycin (50 mg/night long term, which acts as motilin-like hormone to stimulate the small intestinal migrating motor complex, which reduces SIBO relapse) 20 ; and (3) clonazepam (1 mg/night) to reduce nightmares and reduce the urge to remove the BiPAP device. At the 6-month sleep medicine clinic visit, interrogation of the BiPAP device over 30 days documented improvement to 100% use >4 hours with >7 hours average use per night.…”

Neues aus der Forschung zum Komplexen Regionalen Schmerzsyndrom (CRPS)

“…In einer Fallserie von 2 Patienten mit CRPS (einer davon mit fi xierter Fehlstellung), welche mit niedrig dosiertem Naltrexon behandelt wurden, wird über einen positiven Verlauf nach 2 Monaten berichtet. Als Hintergrund wurde eine mögliche Antagonisierung des Toll-like-Rezeptors 4 und der entsprechenden interzellulären Signalkaskaden diskutiert [ 59 ] . Eine ausgeprägte Symptomverschlechterung wurde nach einmaliger Applikation eines hochdosierten Capsaicinpfl asters 8 % bei einer Patientin mit CRPS Typ II beobachtet [ 60 ] .…”