How to treat central pain with low-dose naltrexone (LDN)

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In patients with central sensitization, pain signal is generated directly from within the spinal cord & brain. This means treatments targeting the tissue & peripheral nerves are less effective. To treat central sensitization directly, we use medications that work directly the cells involved in this pathologic process, the glial cells.

Low-Dose Naltrexone (LDN) is a glial-cell modulator

LDN is naltrexone at very low doses, typically 4.5 mg once a day. Taken this way, LDN “modulates” the function of glial cells and helps reduce central sensitization.

This is a very low dose compared to the usual dose of naltrexone of 50 mg, which is given for the treatment of addiction. So small is this dose that it is not available as a pill. It needs to be specially made by compounding pharmacies.


  1. Patients already on opioid medications should not take naltrexone due to the opioid withdrawal that may be triggered. Patients on low dose opioids can try to space out the opioids vs the naltrexone.
  2. Some patients experience vivid dreams. Taking the medication in the morning can reduce this occurrence.
  3. The medication is compounded by pharmacies, and some pharmacies put lactose in the medication as a filler. Patients with sensitivity may experience abdominal upset due to lactose intolerance.


  1. Patients with central pain who respond to this therapy, a response that requires at least 6 weeks, report better sleep, more energy during the day, and less pain.
  2. Naltrexone is easy to administer at one time a day, typically 2 hours before bedtime
  3. Side effects are minimal.