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Low-dose naltrexone is effective and well-tolerated for modulating symptoms in patients with Neuropathic Corneal Pain

Low-dose naltrexone is effective and well-tolerated for modulating symptoms in patients with Neuropathic Corneal Pain
Publication Type
Journal Article
Research Type
Reported as
Case Report/Series/Restrospective Study
January 12, 2021
G. Dieckmann, MC Ozmen, SM Cox, RC Engert, P. Hamrah
Tufts University School of Medicine

PURPOSE: Neuropathic corneal pain (NCP) is caused, by damage or disease of the somatosensory nervous system that innervates the cornea and presents with symptoms of pain or persistent unpleasant sensations, such as burning, dryness, or light sensitivity. This retrospective study aims to assess the efficacy and tolerability of low-dose naltrexone (LDN) in refractory NCP patients.

METHODS: Fifty-nine NCP patients with a centralized component treated with oral LDN 4.5  mg at bedtime for at least four weeks were identified. Thirty out of 59 patients who had a baseline pain score ≥4 on the visual analogue scale had completed the ocular pain assessment survey and presented persistent pain despite instillation of topical anesthetic, were included. Changes in pain scores, comorbidities, side effects, among others, were analyzed. Change in ocular pain scores (scale 0-10) and quality of life (QoL) scores (scale 0-100%) were the main endpoints.

RESULTS: Mean age (years ± SD) was 45.60 ± 19.30 with a white (80.00%) female (73.33%) predominance. Duration of LDN use was 14.87 ± 11.25 months, and the duration of NCP before treatment was 17.53 ± 17.29 months. Eight patients used LDN as monotherapy, whereas the remaining used it as an adjunct therapy. LDN resulted in a 49.22% decrease in mean pain score from 6.13 ± 1.93 to 3.23 ± 2.60 (p < 0.001. Mean QoL scores by the ocular pain assessment survey were 5.84 ± 2.57 at the first visit and improved to 3.77 ± 2.91 at the last visit (p = 0.023). Common side effects were vivid dreams, headache, and stomachache.

CONCLUSION: LDN was effective and well tolerated either as an adjunct therapy for NCP treatment.

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