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Off-Label, Low-Dose Naltrexone for Treatment of Systemic Polyneuropathy of Unknown Origin

Title
Off-Label, Low-Dose Naltrexone for Treatment of Systemic Polyneuropathy of Unknown Origin
Publication Type
Abstract/Poster/Letter
Research Type
Human
Reported as
Case Report/Series/Restrospective Study
Date
April 19, 2018
Authors
J. Mintz, P. Pham
Institution
University of Miami, Jackson Health System
Link
Abstract

The patient is a 40-year-old male who complained of pain and paresthesias which began approximately ten years ago without an inciting event. He described the sensation as intermitent "pins and needles," 10/10 at times, and associated with fatigue and weakness. His past medical history includes migraines, nephrolithiasis, psoriasis, and rosacea. His clinical examination was nonfocal. Skin biopsies by dermatology were non-diagnostic. He was seen by neurology who performed an EMG which was negative. Allergy testing was also negative. He tried gabapentin, pregabalin, amitriptyline, doxepin, tramadol, ibuprofen, acetaminophen, antihistamines, and various topicals all without significant relief. We restarted amitriptyline 25mg QHS and gradually titrated gabapentin up to 1100mg TID. The patient reported only minimal relief of symptoms, so the decision was made to start a trial of off-label LDN. After initiation of naltrexone 2.5mg daily, the patient reported a decrease in his pain to 2/10 over the next month. After seven months at this dose, the patient reported that his symptoms had resolved completely (0/10 pain). Amitriptyline was discontinued, and the patient has continued to report 0/10 pain at his three subsequent 3-month visits on the regimen of gabapentin 1100mg TID and naltrexone 2.5mg daily.