Low-dose Naltrexone for lower back pain

Have you gone to a pain management specialist?

No and don’t wish to…LDN and Aleve seem to work for me. ..at least for now.

Hi Lorie,

I hope you can help me. What was the nature of your lumbar surgery? How satisfied have you been with the results?

I'm 70 and have been told since 2007 I need to fuse at least 3 vertebra - S1/L5/L4 - and possibly more. So far I've avoided fusion. My surgeon told me my strong core is the only thing holding my lumbar spine together - I have stenosis, scoliosis, listhesis, degenerative arthritis, and very little disc remaining. I did have laminotomies done 10 years ago to remove ruptured disc material from S1/L5 and to smooth some arthritis spurs in my spinal canal.

So far so good but my surgeon said if sciatica returns, he'll have to fuse. This is the only orthopedic surgery that worries me, so I'm very interested in what you had done and if it worked.

Thanks Lorie. I do hope you are doing well! Joe

I did have this same situation. I love having my tramadol on bad days. So I was apprehensive to not being able to take with low dose naltrexone..
I took LDN for months I was on the highest dose my pain continued to worsen. So for me it didn’t work. I had to stop it to go back to the tramadol.
I had a laminectomy in 2021 with cyst removal to relieve right leg sciatica now I’m scheduled for MIS TLIF of L4L5 on 11-18-24.
I have a 12 mm disc slippage and Leviscoliosis and facet joint arthropathy as well as neurogenic clarification numbing tingling down right leg to foot. If I push it thru standing past 10 min burning pain down to feel b/l. . I run into a store and make it 6-7 min standing before I must sit down from excruciating pain in lower lumbar.. Years And years of living like this.. enough is enough I was always afraid of fusion now I’m afraid of living like this. Good luck to everyone on here I’m praying for positive outcome relief and positive vibes for us all.

Good morning joe!
I had everything you can have at L3 L4 L5. I also had cervical spine surgery last summer that was failed so I immediately had to have another surgery. It wasn’t the surgeons fault. It was my body, my bones, not being hard enough to hold the screws in the front. So I needed bigger hardware in the back when I had my lumbar surgery in 2018 my surgeon wanted to do more but it would’ve interfered with my mobility to work. I was 62 at the time I worked doing shock in the street , with all the things he did I never missed a beat. Meaning I never felt restricted in my lumbar spine whatsoever. He told me he may not be able to get rid of all my pain. Indeed he did not. We were both OK with that because I got my life back ! My lady friend who is 97 had a complete fusion at 80 years old! She was the happiest person on earth! Got rid of all her pain. Lost a little mobility because of the fusion, but she got her life back. Here’s the deal have the best orthopedic spine surgeon money can buy or that you have access to. If you are not sure that you have the best surgeon( I clearly knew I did when I landed on the fourth opinion, after I investigated all the surgeons reviews/histories) then you should keep on searching until you are confident. It was a 20 year search for me. The surgeries were very bad so in hindsight it was all OK. You learn a lot in the process. I had one surgeon who was going to reconstruct my whole back to make it straight, and he got angry with me and wouldn’t do the surgery after everything was all approved. It was a horrible experience for me to endure, but three years later I found out that his spine surgeries are not successful and that the surgeon who did my surgery does all of the other guys revisions ! I wouldn’t concerned yourself so much with all the various details. I would concern yourself entirely with having a good surgical team and had surgeon. Things show up that are unexpected when they open up. They sometimes have to work in the moment and you better damn well be sure you have the best surgeon available to you . I had a pulmonary embolism and I was grateful I was at UCSD for surgery and they could take me down to the heart area to do all the work needed and have all the doctors available to deal with the blood clot that was on its way to my heart. About sciatica: I have had a perform issue for 25 years and the sciatica is part of that. Sciatica is a really complicated thing and MFR myofascial release therapy and not sitting, and keeping your buttocks area. Toned and stretched really helps. Sciatica is not necessarily something, that emanates from your spine, it could be from the nerves being pinched under tight buttocks, muscles, and that’s a whole different ball of wax and a whole different subject. Mine came and went over the years and it always gets really bad if I sit too much during tax season. it has to be dealt with separately I believe. As I am now six years out from lumbar surgery my spine is continuing to collapse around the areas where I had surgery and we are just waiting until it gets squished enough. We’re all I will have to go back and have more surgery. However, I believe it’s going to be lighter than the major one done in 2018. The point is not to be afraid at all and to get your life back . I used to be afraid but now I’ve had so many surgeries. I just know that I’m going to always be a better person and have more of my life returned back to me after the surgeons. I told my surgeon he can’t retire before I stop needing surgeries . I’m getting on a plane right now so I have to go and I hope this roundabout answer helps some. Please read past the dictation errors and let me know if I can help further. Take care, Lori.

Thank you for detailing and providing information about LDN. I've been prescribed for chronic fatigue/fibro/Autonomic dysfunction. I've already titrated to 4.5 mg. and am wondering if you ever experienced heart palpitations when starting a new dosage? My heart feels like it's flipping over in the middle of my chest. I've reached out to my cardiologist and autonomic dr (waiting to hear back) but thought I'd see if anyone else experienced this as a side effect that eventually went away?

Hi, no I've not experienced any symptoms but I increased very very slowly. Is there a reason you are on the highest dose? The way it works is the lower the dose that os helpful, the better. Ot can take months at 3mg, like 6, to see if that will help. Then increase by .5 every several months. It should take almost a year to need to go as high as 4.5. That may be too high for you. The quicker the highlife is reached and endorphins kick in, the better. Like 2 or 3 hours of halflife is best. Achieved by lower dose. Best of luck. Have ypu added other meds at the same time. You can't take any opioids on it. Be

I started at 1.5 for one week, then 3 for one week, then 4.5. They told me yesterday to go back down to 3mg for another week. I haven't added any new medicines but am on quite a few already. No opioids for sure.
How did you know it was working? I'm not sure what I'm looking for. I just feel nauseous and have heart palpitations.
Thanks for your reply. It's nice to hear what other real patients have been through and experience with these medicines rather than reading about it.

Id say slow it way way down. Not all drs know how to prescribe this. A friends dr gave her 4.5mg pills from day one.

It takes months or more to feel anything, and you might not. BUT, if ypu stay on for a year (id say minimum. If you don't plan at least a year, don't go on it? This is a very very slow lifelong commitment - except coming off for surgery. I'm off right now as I'm on tramedol for preop pain and then ill be postop. Pain meds don't work on it.

But here's the thing you may not feel any difference being on it but then when you come off after 6 or 8 months you're paying may go through the roof. It's that kind of thing we don't feel a difference because it happens very very slowly and then all of a sudden you come off and you're like oh wow I guess it was helping.

I hipe this helps. I investigated LDN for over a year before I went on it. Then I specifically hunted for a doctor in town who prescribed it and knew how to prescribe it. It seems like now everybody just wants to put you on it but hasn't really done any research about how to do it correctly.

And what ends up happening is people like you end up with serious side effects and then stop taking it when if done right it very well could have helped you.

What I would do personally, just my thoughts. No scientific background to this just 8 years experience.

One week is not enough to start increasing your dose more like two months, by 0.5. If I were you and I was having those kinds of side effects I would go off of it totally for about 6 months and make sure symptoms are gone or that this caused them.

Then I would start at .5 for 2 weeks, 1mg for 2 weeks, up by .5 every week or two after that and stop for many months at 3.

Many doctors don't understand the shortest amount of time it's in your system is best. Therefore a lower dose gets out of your system faster.

You also want short acting not long acting! Not even all pharmacies know how to do this. And also a lot of pharmacies are getting powder/medication to capsulize from places in India that have bad powder.

Like with all generic meds, there are different levels of Naltrexone powder some of which is not medication at all and some of which is allowed to legally be 120% or more of your dosage?

I'm afraid right now you're set up for failure. It's too bad when medications not started correctly cuz I still give up on medications that could have been helpful.

And even for regular generic medication to just try a different manufacturer instead of saying the entire medication doesn't work. I've experienced this myself. Some Tramadol Works some doesn't work at all. And I have to find a pharmacy that gives out the manufacture that I need.

Good luck. Slow it way way down. Read much online.

Thank you so much, this is very helpful. I agree, many Drs just prescribe it now without knowing all the ins and outs from experienced patients. I'm willing to keep trying as I've heard great results can happen over time, as you said. I will dial it back and go slowly though. I have to be patient but hopefully, it's worth it. Plaquenil had the same effect on me, I didn't know it was working until I stopped taking it and after 3 months went by I realized I was back to a higher pain level without it. It's subtle so I do know how that goes and will now think about that with LDN. Thanks for this advice, it's more valuable than anything I've heard from Drs so far.
Do you have any specific research articles or sites that have been the most helpful? I've read a lot but clearly there's more out there. Again, many thanks. I hope you are well.