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Naltrexone May Ease Fibromyalgia SymptomsPreliminary Study Shows That Low-Dose Naltrexone May Be an Effective, Low-Cost Treatment for Fibromyalgia
By Miranda Hitti April 17, 2009 -- An inexpensive drug called Naltrexone may make a good treatment for fibromyalgia, report researchers at Stanford University. Naltrexone isn't a new drug; it's been around for more than 30 years and is used to treat opioid addiction. Stanford's Jarred Younger, PhD, and Sean Mackey, MD, PhD, tested a low dose of naltrexone as a fibromyalgia treatment in 10 women who had had fibromyalgia for about 10 years, on average. First, the women spent two weeks recording the severity of their fibromyalgia symptoms every day using a handheld computer. And they took lab tests to gauge their fibromyalgia pain and sensitivity to heat and cold. After that, the women took a placebo pill every day for two weeks, but they didn't know it was a placebo pill. At the end of the placebo period, the women took a Naltrexone pill once a day for eight weeks. Finally, they spent the last two weeks of the study not taking Naltrexone or the placebo. All along, the women continued to rate their fibromyalgia symptoms every day, and they repeated their lab tests every two weeks. While taking the placebo, the women reported a 2.3% drop in the severity of their fibromyalgia symptoms, compared to their symptom ratings at the start of the study. When they switched from the placebo to Naltrexone, they reported an additional 30% drop in their fibromyalgia symptom severity. The women also showed greater tolerance for pain and for hot (but not cold) temperatures while taking Naltrexone. Most of the women -- six out of 10 -- responded to Naltrexone. Side effects were mild and brief. Two women reported having more vivid dreams during the study, and one woman reported transient nausea and insomnia during the first few nights of taking the pills, note Younger and Mackey. The study, which appears online in Pain Medicine, was a small, preliminary project to see if low-dose Naltrexone showed promise. It did, so Younger and Mackey are already working on a new study that will test low-dose Naltrexone in 30 fibromyalgia patients for 16 weeks. Antidepressants Don't Work for All continued...Since antidepressants can have significant side effects, even when given in small doses, patients taking them for fibromyalgia should be followed closely, he adds. Right now, it is not clear which fibromyalgia patients will benefit from treatment with antidepressants and which ones will not, but National Fibromyalgia Association President Lynne Matallana tells us that this may soon change. "These drugs are useful in a certain population of people with fibromyalgia," she says. "I would say that within three years we will be better able to tell who these patients are and target treatments to them." University of North Carolina rheumatologist and professor of medicine Nortin Hadler, MD, remains unconvinced that fibromyalgia is a distinct medical condition and he says it is far from clear whether the benefits of giving antidepressants for this indication outweigh the risks. Just over 75% of the patients taking antidepressants in the analysis reported side effects, compared to just over 62% of patients taking placebo. "I have a problem with telling people to take antidepressants if they are not suffering from depression," he says. "In the studies included in the analysis, the patients who responded to treatment did not get that much better. There is nothing dramatic going on with these drugs except their side effects and their price." Other Fibromyalgia TreatmentsMatallana points out that while drug treatments have been shown to help some fibromyalgia patients, so have other approaches to treatment including:
"One of the most important and most challenging things is to find a health care provider who knows about fibromyalgia," she says. "That can be really difficult, because so many physicians still don't understand it."
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