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Complex Regional Pain Syndrome (CRPS) is a condition involving chronic, severe pain of a an arm or leg, usually occurring after an injury to that limb. The symptoms can involve the area of the injury, but can also spread to the entire limb and even the opposite side. The pain is described as tightness, burning and pins and needles and can also include increased sensitivity of the skin with changes in skin temperature, skin color and/or swelling.

The symptoms result from damage to the nerves controlling blood flow and temperature. CRPS occurs more often in women and in people around 40 years old, but can develop at any age.

The diagnosis is based on the person’s medical history and signs and symptoms. There is no definitive test for CRPS. It is important, however, to rule out other conditions that have similar symptoms but require different treatment.

Treatment may include physical therapy, non-steroidal anti-inflammatories, steroids, antiseizure drugs that help with neuropathic pain, topical anesthetic creams, nerve block and neural stimulation. Some newer treatments include intravenous immune globulin and intravenous ketamine. Some people find that acupuncture, behavior modification, biofeedback and relaxation techniques also help.

Research with Low-dose Naltrexone (LDN) in CRPS

While there have been no clinical trials yet using LDN in CRPS, there has been scientific literature published—in the form of a large literature review, a retrospective chart review, and several case reports.

In July 2021, a large cross-institutional research collaboration published an article "Low-Dose Naltrexone Use for Patients with Complex Regional Pain Syndrome: A Systematic Literature Review" which summarized and assessed the quality of the available evidence for the use of LDN in treating chronic pain syndromes, including complex regional pain syndrome. They reported finding that low-dose naltrexone treatment was positively associated with symptom relief in patients experiencing chronic pain, dystonia, and sleep disturbances.

Previously, in April 2016, a retrospective chart review was published in the Journal of Pain. Twenty-seven patients with chronic pain, including some with CRPS, were treated with LDN 4.5 mg daily. They were asked to complete symptom surveys between 31 to 60 days after starting treatment and then again between 61 and 90 days. Patients taking LDN reported “significantly lower average pain scores, lower “lowest” pain scores, and improved physical function”. Depression scores were also significantly reduced and physical function improved. LDN was reported as being well-tolerated.

In addition to those studies, case reports have also been published by doctors describing what happened when they used LDN to treat patients with CRPS. Also in July 2021, Dr. Amol Soin reported success using LDN to treat one patient with pediatric CPRS. In another report published in the International Journal of Pharmaceutical Compounding in February 2016, LDN “dramatically improved the patient’s pain symptoms”.

Two other case reports were described in the Journal of Neuroimmune Pharmacology in January 2013:

  1. Regarding one patient, a 48 year old male who developed CRPS with severe skin changes, the clinicians reported that, after two months of taking LDN, “he recovered from his flares more quickly, felt more energetic, and tolerated pain better. He became physically more active and his sleep improved significantly. His spasms stopped and he was able to walk without a cane”.
  2. Regarding the other patient, a 12 year old girl, she had repeated dislocations of her right shoulder and ankle and subsequently developed CRPS. After being on 4.5 mg daily for one month, her pain scores dropped to 3 to 5 out of 10. She had less sensitivity to pain, touch and temperature change. At the time of publication of the report, she had been on LDN for 18 months with no side effects.

Read more about the scientific articles on the use of LDN for CRPS here.

For a personal perspective on using LDN for CRPS, see LDNscience's interview with 21 year old Tia Khan.

Learn more about LDN’s mechanism of action here.

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