People’s Pharmacy: Can low-dose naltrexone relieve pain?
Q. I suffer from arthritis pain in my joints and muscle pain due to old injuries as an athlete. This limits my ability to exercise. I have hypothyroidism, so I have difficulty losing weight and managing my blood pressure as a result of the ongoing pain as well as the NSAIDs I take for it.
I have read about low-dose naltrexone and have discussed it with my primary care provider. He insists I should stick to aspirin and NSAIDs. Given the reported safety and effectiveness of LDN, why don’t doctors prescribe it? This is particularly irksome since there is so much concern about opiates.
A. The Food and Drug Administration approved naltrexone (Trexan) in 1984 to treat people with opioid use disorder. The drug is considered an opioid antagonist and is now also prescribed to treat alcohol dependence. The dose for such indications is 50 to 100 mg daily.
At low doses (1 to 4.5 mg), it is prescribed to ease the pain and inflammation associated with conditions such as fibromyalgia, chronic pain syndrome, multiple sclerosis and Crohn’s disease (Current Pain and Headache Reports, Aug. 26, 2020).
Because this is an old, inexpensive generic medication, pharmaceutical companies have no incentive to conduct research on it. Consequently, large, well-controlled clinical trials of low-dose naltrexone (LDN) are scarce. That may be why your doctor is reluctant to prescribe it.
Researchers reviewing Norwegian prescription records concluded that when people start taking LDN, they seem to need less of other pain-relieving medicines such as NSAIDs (PLoS One, Feb. 14, 2019).
Most people tolerate LDN well, although some report nausea, nightmares or vivid dreams. Taking it in the morning may minimize sleep disturbances.
Q. As many others have testified on your website, I, too, tried Vicks VapoRub on the soles of my feet. I was certainly skeptical of this weird remedy for nighttime coughing and congestion from a cold, but I was desperate. I had already determined what I had was not COVID-19.
To my surprise, I awoke in the morning refreshed, baffled and yet delighted to realize that I had slept through the night without so much as a sniffle, a tickle or a cough. Thank you.
A. We are delighted to hear that putting Vicks on the soles of your feet was so helpful against your cough. As you note, many others have tried this remedy for nighttime cough, donning thick socks to protect the bedsheets.
If you are interested in a scientific explanation for how Vicks works to quell a cough, you may want to read our eGuide to Colds, Coughs & the Flu. This online resource may be found under the Health eGuides tab at peoplespharmacy.com. It also contains information on many other approaches for easing symptoms of upper respiratory tract infections.
Q. In a recent article, you referred to docusate sodium as a common laxative. I’m writing to remind you that this product is not a laxative at all. It is a surfactant that only helps prevent stool from hardening as bowel content progresses to the point of evacuation.
By referring to it as a laxative, you may lead readers to mistakenly expect results that docusate sodium cannot produce. It does not increase bowel movements.
A. You are correct that the docusate sodium that can unexpectedly help with earwax removal is a stool softener rather than a laxative. When people look for it in the drugstore, however, they’ll find it near the laxatives rather than anywhere close to products related to ears.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website peoplespharmacy.com.