By: Christina Le-Short, MD
If you live with chronic pain, you may have heard about low-dose naltrexone, or LDN. It has been getting more attention because it is a non-opioid medication that may help some people with chronic pain, especially when the nervous system has become overly sensitive. LDN is usually prescribed in very small doses, often around 1 to 5 mg daily, and is used off-label for pain.¹
What makes LDN interesting is that it may work differently from many traditional pain medications. Rather than simply dulling pain signals, it may help calm some of the inflammatory and sensitization processes involved in chronic pain. That is why it is often discussed for conditions like fibromyalgia and other pain states where the body’s alarm system seems stuck in the “on” position.
The evidence for LDN is most encouraging in fibromyalgia. Reviews and meta-analyses suggest that some patients experience improvement in pain and related symptoms, and that LDN is generally well tolerated. At the same time, the studies have been small, so more research is still needed.
For patients, one of the biggest appeals of LDN is that it is not an opioid and is usually not sedating. Some people who respond to it report improvement not just in pain, but also in fatigue, sleep, brain fog, and flares. It is not a cure, and it does not work for everyone, but it can be a reasonable option to discuss as part of a broader pain treatment plan.²
LDN is generally considered well tolerated, but side effects can happen. The most commonly reported ones include vivid dreams, trouble sleeping, headache, nausea, and stomach upset.
One important caution: because naltrexone blocks opioid receptors, LDN is usually not a good fit for people who are taking regular opioid pain medication unless there is a very specific clinician-guided plan. It can also complicate pain control around surgery or acute injuries if opioid medication is needed.³
The bottom line is that LDN is a promising non-opioid option for some people with chronic pain, especially those with fibromyalgia, widespread pain, or pain sensitization, but it works best when it is part of a larger plan that may also include movement, pacing, sleep support, rehabilitation, and behavioral strategies.
Interested in whether LDN could be right for you?
At Override, we take a whole-person approach to chronic pain. We look at the full picture, including your symptoms, goals, medical history, nervous system sensitivity, sleep, stress, movement, and what you have already tried. If you are interested in whether LDN may be a fit for you, our team can help you think through the potential benefits, risks, and how it fits into a broader plan to help you feel and function better.
¹ Aitcheson, N., Lin, Z., & Tynan, K. (2023). Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis. Australian Journal of General Practice.
² Vatvani, A. D., Patel, P., Hariyanto, T. I., & Yanto, T. A. (2024). Efficacy and safety of low-dose naltrexone for the management of fibromyalgia: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Korean Journal of Pain, 37(4), 367–378. https://doi.org/10.3344/kjp.24202
³ U.S. Food and Drug Administration. REVIA (naltrexone hydrochloride tablets USP) 50 mg, Opioid Antagonist. FDA label, 2013.
