Managing multiple sclerosis (MS) can be challenging, even with a variety of treatment options available. Chronic pain is one of the most difficult MS symptoms to cope with, affecting many individuals on a daily basis. Low-dose naltrexone (LDN) has garnered attention for its potential role in managing pain due to its unique combination of anti-inflammatory properties and ability to regulate immune system activity.

LDN has been shown to improve pain and quality of life in some individuals with multiple sclerosis, an autoimmune disease that damages the central nervous system (CNS), which includes the brain and spinal cord. This damage occurs when the immune system mistakenly attacks myelin, the protective layer around nerve fibers. As a result, individuals with MS may experience pain, mobility issues, and difficulties with speech and cognition.

What Is Naltrexone?

At higher doses, naltrexone is commonly used to treat alcohol dependence or opioid addiction. High-dose naltrexone works by blocking the effects of opioids and alcohol, which reduces the rewarding sensations these substances typically provide. This can help people with alcohol or opioid use disorders manage cravings and maintain sobriety.

Naltrexone itself is not an opioid and is not addictive, meaning it can be used safely without the risk of dependence. For multiple sclerosis, however, naltrexone is prescribed at a much lower dose compared to its use in treating substance use disorders.

How Does Low-Dose Naltrexone Help Symptoms of MS?

At low doses, naltrexone shows anti-inflammatory properties and pain-relieving properties. Although low-dose naltrexone is not a direct treatment for multiple sclerosis, it is often used to help manage challenging MS symptoms, such as chronic pain.

Naltrexone is not approved by the U.S. Food and Drug Administration (FDA) for this purpose, but your health care provider may still prescribe it for MS pain relief in what’s called “off-label use.”

Doctors may turn to off-label prescriptions when standard, FDA-approved treatment options have been tried without success or when no approved treatments exist for specific symptoms. Since pain management options for MS are limited, low-dose naltrexone is sometimes prescribed despite its lack of FDA approval for treating MS.

Is LDN Beneficial for Other Chronic Conditions?

Research supports the use of LDN not only for multiple sclerosis but also other chronic inflammatory disorders. LDN has been shown to benefit individuals with conditions such as fibromyalgia, irritable bowel syndrome (IBS), and diabetic neuropathy.

All of these conditions can lead to symptoms of chronic pain, which can be difficult to manage due to the limited availability of effective treatment options. Like MS, managing chronic pain in these conditions is challenging due to limited effective treatments.

In one study, LDN was found to improve both overall mood and pain severity in people with fibromyalgia, a condition characterized by widespread pain, fatigue, and tenderness in the muscles and soft tissues. Notably, more than 4,900 members of MyMSTeam report having fibromyalgia in addition to MS. Other research has shown that naltrexone has protective effects in the brain, which may help reduce neuropathic pain.

Although the research is promising, further research is needed in order to fully understand the effectiveness and safety of LDN for these conditions, including MS.

Potential Side Effects of Low-Dose Naltrexone

Generally, people who take LDN experience few serious side effects. One MyMSTeam member said, “I have taken LDN since 2012 with no side effects! They start you on a lower dose and titrate you up for the first week to reduce any nightmares/side effects.”

Like with any medication, there is always a possibility of side effects. Common side effects of low-dose naltrexone may include:

• Headaches
• Stomach pain
• Difficulty sleeping
• Vivid dreams

Drug Interactions for LDN

If you or a loved one is considering taking naltrexone, it’s important to know that it should not be taken alongside opioid pain medications. Naltrexone blocks opioids by competing for the same receptors in the brain. Taking both at the same time can lead to severe withdrawal symptoms.

Additionally, people with liver failure or acute hepatitis (inflammation of the liver) should avoid taking LDN, as it may worsen these conditions.

Is LDN Right for You?

Although low-dose naltrexone shows promise as an off-label treatment for managing pain in multiple sclerosis, it may not be right for everyone. Individuals taking opioid medications or those with liver conditions like acute hepatitis or liver failure should avoid LDN. Additionally, its use in MS is not FDA-approved, and while some people may benefit from its pain-relieving and anti-inflammatory properties, others may experience side effects or find it less effective.

Fortunately, there are other pain management options for MS, including disease-modifying therapies, physical therapy, and medications such as muscle relaxants and anticonvulsants. Speak with your doctor to explore all available treatments and determine if LDN is the right choice for your MS symptom management.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 216,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

If you were prescribed low-dose naltrexone for MS, did it help with pain management? What other treatments have you tried for pain? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.