MEpedia - User contributions [en]

GETSET trial

2024-06-25T06:55:51Z

Pookey:/* Documents */ Added therapists manual

The '''GETSET''' trial (short for ''Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome'') was a trial investigating the effectiveness of "guided graded exercise self-help" in patients with [[CFS/ME]]. The protocol was published in June 2016.<ref name="getsetprotocol" /> The results were published in June 2017.<ref name="getset" />

==Researchers==
Lead Author [[Lucy Clark]], [[Peter White]], Francesca Pesola, Janice M Thomas, Mario Vergara-Williamson and Michelle Beynon

==Funding==
The trial was funded in full by the [[National Institute for Health Research]]'s Research for Patient Benefit programme.<ref name="getsetisrctn" />

==Protocol==
The protocol of the trial was published in ''JMIR Research Protocols'' in June 2016.<ref name="getsetprotocol" />

==Publications==
The results were published on 22 June 2017 in the [[The Lancet|Lancet]]: ''[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2932589-2/fulltext Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial]<ref>{{Cite journal | last = Clark | first = Lucy V. | last2 = Pesola | first2 = Francesca | last3 = Thomas | first3 = Janice M. | last4 = Vergara-Williamson | first4 = Mario | last5 = Beynon | first5 = Michelle | last6 = White | first6 = PeterD. | date = 2017-07-22 | title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial| url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32589-2/abstract|journal=The Lancet|language=English|volume=390|issue=10092 | pages = 363–373|doi=10.1016/S0140-6736(16)32589-2|issn=0140-6736|pmid=28648402}}</ref>''

Commentary was provided by [[Daniel Clauw]] in the Lancet: [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30577-9/fulltext ''Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome''].<ref>{{Cite journal | last = Clauw | first = Daniel J | author-link = Daniel Clauw | date = Jul 2017 | title = Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome | url =https://linkinghub.elsevier.com/retrieve/pii/S0140673617305779|journal=The Lancet|language=en|volume=390|issue=10092 | pages = 335–336|doi=10.1016/S0140-6736(17)30577-9|pmc=|pmid=|access-date=|quote=|via=}}</ref>

The [[Science Media Centre]] provided: [http://www.sciencemediacentre.org/expert-reaction-to-study-on-guided-self-help-graded-exercise-therapy-as-a-treatment-for-chronic-fatigue-syndrome-cfs/ ''Expert reaction to study on guided self-help graded exercise therapy as a treatment for chronic fatigue syndrome (CFS)''].<ref>{{Cite web | url = https://www.sciencemediacentre.org/expert-reaction-to-study-on-guided-self-help-graded-exercise-therapy-as-a-treatment-for-chronic-fatigue-syndrome-cfs/ | title = expert reaction to study on guided self-help graded exercise therapy as a treatment for chronic fatigue syndrome (CFS) {{!}} Science Media Centre|language=en-US|access-date=2020-05-08}}</ref>

It was reported in the Telegraph as [http://www.telegraph.co.uk/science/2017/06/22/exercise-can-help-chronic-fatigue-syndrome-study-shows/ Exercise can help chronic fatigue syndrome, study shows] and other media outlets: ''[http://www.emergency-live.com/en/news/defeating-chronic-fatigue-thanks-to-guided-self-help-approach-to-exercise/ Defeating chronic fatigue thanks to guided self-help approach to exercise].''<ref>{{Cite web | url = https://www.emergency-live.com/health-and-safety/defeating-chronic-fatigue-thanks-to-guided-self-help-approach-to-exercise/ | title = Defeating chronic fatigue thanks to guided self-help approach to exercise|website=Emergency Live|language=en-US|access-date=2020-05-08}}</ref>

The long term follow-up results were published July 2021 in the Journal of Psychosomatic Research: ''[https://doi.org/10.1016/j.jpsychores.2021.110484 Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial]''.<ref>{{Cite journal | title = Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial| date = 2021-07-01| url = https://www.sciencedirect.com/science/article/pii/S002239992100129X|journal=Journal of Psychosomatic Research|volume=146|pages=110484 | last = Clark | first = Lucy V. | last2 = McCrone | first2 = Paul | last3 = Pesola | first3 = Francesca | last4 = =Vergara-Williamson | first4 = Mario | last5 = White | first5 = Peter D.|language=en|doi=10.1016/j.jpsychores.2021.110484|issn=0022-3999}}</ref>

==Criticism==
Dr [[David Tuller]] criticized the trial in the blog post [http://www.virology.ws/2017/06/28/trial-by-error-continued-more-on-graded-exercise-from-peter-white-and-the-lancet/ Trial by Error, Continued: More on Graded Exercise from Peter White and The Lancet]. Tuller later also criticized misleading presentation of the long term follow-up results, which presented the results as demonstrating sustained improvement, despite them finding a lack of significant difference between the treated and untreated groups.<ref>{{Cite web | url = https://www.virology.ws/2021/04/06/trial-by-error-getset-study-reports-null-results-for-self-help-graded-exercise-but-declares-success-anyway/ | title = Trial By Error: GETSET Study Reports Null Results for Self-Help Graded Exercise–but Declares Success Anyway|website=www.virology.ws|access-date=2022-11-08}}</ref> The paper was subsequently revised in response to this criticism.<ref>{{Cite journal | title = Corrigendum to “Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial” [Journal of Psychosomatic Research 146 (2021) 110484]| date = 2021-09-01| url = https://www.sciencedirect.com/science/article/pii/S0022399921001872|journal=Journal of Psychosomatic Research|volume=148|pages=110542 | last = Clark | first = Lucy V. | last2 = McCrone | first2 = Paul | last3 = Pesola | first3 = Francesca | last4 = =Vergara-Williamson | first4 = Mario | last5 = White | first5 = Peter D.|language=en|doi=10.1016/j.jpsychores.2021.110542|issn=0022-3999}}</ref>

[[Spoonseekerdotcom]] has criticised the GETSET trial.<ref>{{Cite web | url = https://spoonseeker.com/2016/05/23/a-few-notes-on-getset/ | title = A Few Notes on GETSET | last = Spoonseeker | first = Author | date = 2016-05-23 | website = spoonseekerdotcom|language=en|access-date=2020-01-26}}</ref><ref>{{Cite web | url = https://spoonseeker.com/2017/06/29/do-get-yourself/ | title = Do GET Yourself | last = Spoonseeker | first = Author | date = 2017-06-29 | website = spoonseekerdotcom|language=en|access-date=2020-01-26}}</ref><ref>{{Cite web | url = https://spoonseeker.com/2017/07/03/spotlight-on-getset-julie/ | title = Spotlight on GETSET Julie | last = Spoonseeker | first = Author | date = 2017-07-03 | website = spoonseekerdotcom|language=en|access-date=2020-01-26}}</ref>

Professor [[Jonathan Edwards]] criticised the study for its "incompetent level of science".<ref>{{Cite web | url = https://forums.phoenixrising.me/threads/trial-by-error-continued-more-on-graded-exercise-from-peter-white-and-the-lancet.52541/ | title = Trial by Error, Continued: More on Graded Exercise from Peter White and The Lancet | website = Phoenix Rising ME / CFS Forums|language=en-US|access-date=2020-01-26}}</ref>

The [[ME Association]] also criticised the trial in [http://www.meassociation.org.uk/2017/06/me-association-review-getset-fails-to-demonstrate-get-can-significantly-improve-physical-function-28-june-2017/ ME Association Review: GETSET fails to demonstrate GET can significantly improve physical function].

Additional criticism has been published by other patients such as Lou Corsius and [[Cort Johnson]].<ref>{{Cite web | url = https://corsius.wordpress.com/2017/06/23/yet-another-publication-with-misleading-conclusions-from-pace-land/ | title = Yet another publication with misleading conclusions from PACE-land | last = Corsius | first = Lou | date = 2017-06-23 | website = it's about ME|language=nl|access-date=2020-01-26}} </ref><ref>{{Cite web | url = https://www.healthrising.org/blog/2017/06/25/graded-exercise-get-chronic-fatigue-syndrome-underwhelms/ | title = On Your Marks GETSET: Don't Go - Major Graded Exercise ME/CFS Trial Underwhelms (Again) | last = Johnson | first = Cort | date = 2017-06-26 | website = Health Rising|language=en-US|access-date=2020-01-26}} </ref>

==Documents==
* Lead author Lucy Clark had previously published a booklet called [[:File:GET booklet web July 2009 2 .pdf | Graded Exercise Therapy - A self-help guide for those with chronic fatigue syndrome/myalgic encephalomyelitis]]. This booklet was apparently distributed to patients in the GETSET trial.
* [https://huisartsvink.wordpress.com/wp-content/uploads/2022/11/getset-therapists-manual-with-appendices.pdf GUIDED GRADED EXERCISE SELF- HELP (GES) FOR CFS/ME Therapist Manual]

==Learn more ==
*[https://spoonseeker.com/2016/05/23/a-few-notes-on-getset/ A few notes on GETSET] - Spoonseekerdotcom
*[[Graded exercise therapy]]
*[[Biopsychosocial model]]

==See also==
*[[PACE trial]]

==References==
<references>
<ref name="getsetisrctn">{{Cite web | url = http://www.isrctn.com/ISRCTN22975026 | title = ISRCTN - ISRCTN22975026: Graded Exercise Therapy guided SElf-help Treatment for CFS/ME | website = isrctn.com|language=en|access-date=2020-01-26}}</ref>
<ref name="getsetprotocol">{{Citation | doi = 10.2196/resprot.5395 | volume = 5 | issue = 2 | pages = 70 | last1 = Clark | first1 = Lucy V. | authorlink1 = Lucy Clark | last2 = McCrone | first2 = Paul | authorlink2 = Paul McCrone | last3 = Ridge | first3 = Damien | authorlink3 = Damien Ridge | last4 = Cheshire | first4 = Anna | authorlink4 = Anna Cheshire | last5 = Vergara-Williamson | first5 = Mario | authorlink5 = Mario Vergara-Williamson | last6 = Pesola | first6 = Francesca | authorlink6 = Francesco Pesola | last7 = White | first7 = PeterD. | author-link8 = Peter White | title = Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study | journal = JMIR research protocols | date = 2016-06-08 | pmid = 27278762 | pmc = 4917732 }}</ref>
<ref name="getset">{{Citation | doi = 10.1016/S0140-6736(16)32589-2 | volume = | issue = | pages = | last1 = Clark | first1 = Lucy V. | authorlink1 = Lucy Clark | last2 = Pesola | first2 = Francesca | authorlink2 = Francesca Pesola | last3 = Thomas | first3 = Janice | authorlink3 = Janice Thomas | last4 = Vergara-Williamson | first4 = Mario | authorlink4 = Mario Vergara-Williamson | last5 = Beynon | first5 = Michelle | authorlink5 = Michelle Beynon | last6 = White | first6 = PeterD. | authorlink6 = Peter White | title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial | journal = The Lancet | date = 2017-06-22 | pmid = | pmc = }}</ref>
</references>

[[Category:Psychological paradigm]]
[[Category:Notable studies]]

GETSET trial

2024-06-25T06:54:13Z

Pookey:/* Documents */

The '''GETSET''' trial (short for ''Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome'') was a trial investigating the effectiveness of "guided graded exercise self-help" in patients with [[CFS/ME]]. The protocol was published in June 2016.<ref name="getsetprotocol" /> The results were published in June 2017.<ref name="getset" />

==Researchers==
Lead Author [[Lucy Clark]], [[Peter White]], Francesca Pesola, Janice M Thomas, Mario Vergara-Williamson and Michelle Beynon

==Funding==
The trial was funded in full by the [[National Institute for Health Research]]'s Research for Patient Benefit programme.<ref name="getsetisrctn" />

==Protocol==
The protocol of the trial was published in ''JMIR Research Protocols'' in June 2016.<ref name="getsetprotocol" />

==Publications==
The results were published on 22 June 2017 in the [[The Lancet|Lancet]]: ''[http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2932589-2/fulltext Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial]<ref>{{Cite journal | last = Clark | first = Lucy V. | last2 = Pesola | first2 = Francesca | last3 = Thomas | first3 = Janice M. | last4 = Vergara-Williamson | first4 = Mario | last5 = Beynon | first5 = Michelle | last6 = White | first6 = PeterD. | date = 2017-07-22 | title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial| url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32589-2/abstract|journal=The Lancet|language=English|volume=390|issue=10092 | pages = 363–373|doi=10.1016/S0140-6736(16)32589-2|issn=0140-6736|pmid=28648402}}</ref>''

Commentary was provided by [[Daniel Clauw]] in the Lancet: [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30577-9/fulltext ''Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome''].<ref>{{Cite journal | last = Clauw | first = Daniel J | author-link = Daniel Clauw | date = Jul 2017 | title = Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome | url =https://linkinghub.elsevier.com/retrieve/pii/S0140673617305779|journal=The Lancet|language=en|volume=390|issue=10092 | pages = 335–336|doi=10.1016/S0140-6736(17)30577-9|pmc=|pmid=|access-date=|quote=|via=}}</ref>

The [[Science Media Centre]] provided: [http://www.sciencemediacentre.org/expert-reaction-to-study-on-guided-self-help-graded-exercise-therapy-as-a-treatment-for-chronic-fatigue-syndrome-cfs/ ''Expert reaction to study on guided self-help graded exercise therapy as a treatment for chronic fatigue syndrome (CFS)''].<ref>{{Cite web | url = https://www.sciencemediacentre.org/expert-reaction-to-study-on-guided-self-help-graded-exercise-therapy-as-a-treatment-for-chronic-fatigue-syndrome-cfs/ | title = expert reaction to study on guided self-help graded exercise therapy as a treatment for chronic fatigue syndrome (CFS) {{!}} Science Media Centre|language=en-US|access-date=2020-05-08}}</ref>

It was reported in the Telegraph as [http://www.telegraph.co.uk/science/2017/06/22/exercise-can-help-chronic-fatigue-syndrome-study-shows/ Exercise can help chronic fatigue syndrome, study shows] and other media outlets: ''[http://www.emergency-live.com/en/news/defeating-chronic-fatigue-thanks-to-guided-self-help-approach-to-exercise/ Defeating chronic fatigue thanks to guided self-help approach to exercise].''<ref>{{Cite web | url = https://www.emergency-live.com/health-and-safety/defeating-chronic-fatigue-thanks-to-guided-self-help-approach-to-exercise/ | title = Defeating chronic fatigue thanks to guided self-help approach to exercise|website=Emergency Live|language=en-US|access-date=2020-05-08}}</ref>

The long term follow-up results were published July 2021 in the Journal of Psychosomatic Research: ''[https://doi.org/10.1016/j.jpsychores.2021.110484 Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial]''.<ref>{{Cite journal | title = Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial| date = 2021-07-01| url = https://www.sciencedirect.com/science/article/pii/S002239992100129X|journal=Journal of Psychosomatic Research|volume=146|pages=110484 | last = Clark | first = Lucy V. | last2 = McCrone | first2 = Paul | last3 = Pesola | first3 = Francesca | last4 = =Vergara-Williamson | first4 = Mario | last5 = White | first5 = Peter D.|language=en|doi=10.1016/j.jpsychores.2021.110484|issn=0022-3999}}</ref>

==Criticism==
Dr [[David Tuller]] criticized the trial in the blog post [http://www.virology.ws/2017/06/28/trial-by-error-continued-more-on-graded-exercise-from-peter-white-and-the-lancet/ Trial by Error, Continued: More on Graded Exercise from Peter White and The Lancet]. Tuller later also criticized misleading presentation of the long term follow-up results, which presented the results as demonstrating sustained improvement, despite them finding a lack of significant difference between the treated and untreated groups.<ref>{{Cite web | url = https://www.virology.ws/2021/04/06/trial-by-error-getset-study-reports-null-results-for-self-help-graded-exercise-but-declares-success-anyway/ | title = Trial By Error: GETSET Study Reports Null Results for Self-Help Graded Exercise–but Declares Success Anyway|website=www.virology.ws|access-date=2022-11-08}}</ref> The paper was subsequently revised in response to this criticism.<ref>{{Cite journal | title = Corrigendum to “Guided graded exercise self-help for chronic fatigue syndrome: Long term follow up and cost-effectiveness following the GETSET trial” [Journal of Psychosomatic Research 146 (2021) 110484]| date = 2021-09-01| url = https://www.sciencedirect.com/science/article/pii/S0022399921001872|journal=Journal of Psychosomatic Research|volume=148|pages=110542 | last = Clark | first = Lucy V. | last2 = McCrone | first2 = Paul | last3 = Pesola | first3 = Francesca | last4 = =Vergara-Williamson | first4 = Mario | last5 = White | first5 = Peter D.|language=en|doi=10.1016/j.jpsychores.2021.110542|issn=0022-3999}}</ref>

[[Spoonseekerdotcom]] has criticised the GETSET trial.<ref>{{Cite web | url = https://spoonseeker.com/2016/05/23/a-few-notes-on-getset/ | title = A Few Notes on GETSET | last = Spoonseeker | first = Author | date = 2016-05-23 | website = spoonseekerdotcom|language=en|access-date=2020-01-26}}</ref><ref>{{Cite web | url = https://spoonseeker.com/2017/06/29/do-get-yourself/ | title = Do GET Yourself | last = Spoonseeker | first = Author | date = 2017-06-29 | website = spoonseekerdotcom|language=en|access-date=2020-01-26}}</ref><ref>{{Cite web | url = https://spoonseeker.com/2017/07/03/spotlight-on-getset-julie/ | title = Spotlight on GETSET Julie | last = Spoonseeker | first = Author | date = 2017-07-03 | website = spoonseekerdotcom|language=en|access-date=2020-01-26}}</ref>

Professor [[Jonathan Edwards]] criticised the study for its "incompetent level of science".<ref>{{Cite web | url = https://forums.phoenixrising.me/threads/trial-by-error-continued-more-on-graded-exercise-from-peter-white-and-the-lancet.52541/ | title = Trial by Error, Continued: More on Graded Exercise from Peter White and The Lancet | website = Phoenix Rising ME / CFS Forums|language=en-US|access-date=2020-01-26}}</ref>

The [[ME Association]] also criticised the trial in [http://www.meassociation.org.uk/2017/06/me-association-review-getset-fails-to-demonstrate-get-can-significantly-improve-physical-function-28-june-2017/ ME Association Review: GETSET fails to demonstrate GET can significantly improve physical function].

Additional criticism has been published by other patients such as Lou Corsius and [[Cort Johnson]].<ref>{{Cite web | url = https://corsius.wordpress.com/2017/06/23/yet-another-publication-with-misleading-conclusions-from-pace-land/ | title = Yet another publication with misleading conclusions from PACE-land | last = Corsius | first = Lou | date = 2017-06-23 | website = it's about ME|language=nl|access-date=2020-01-26}} </ref><ref>{{Cite web | url = https://www.healthrising.org/blog/2017/06/25/graded-exercise-get-chronic-fatigue-syndrome-underwhelms/ | title = On Your Marks GETSET: Don't Go - Major Graded Exercise ME/CFS Trial Underwhelms (Again) | last = Johnson | first = Cort | date = 2017-06-26 | website = Health Rising|language=en-US|access-date=2020-01-26}} </ref>

==Documents==
* Lead author Lucy Clark had previously published a booklet called [[:File:GET booklet web July 2009 2 .pdf | Graded Exercise Therapy - A self-help guide for those with chronic fatigue syndrome/myalgic encephalomyelitis]]. This booklet was apparently distributed to patients in the GETSET trial.
* GUIDED GRADED EXERCISE SELF- HELP (GES) FOR CFS/ME Therapist Manual - https://huisartsvink.wordpress.com/wp-content/uploads/2022/11/getset-therapists-manual-with-appendices.pdf

==Learn more ==
*[https://spoonseeker.com/2016/05/23/a-few-notes-on-getset/ A few notes on GETSET] - Spoonseekerdotcom
*[[Graded exercise therapy]]
*[[Biopsychosocial model]]

==See also==
*[[PACE trial]]

==References==
<references>
<ref name="getsetisrctn">{{Cite web | url = http://www.isrctn.com/ISRCTN22975026 | title = ISRCTN - ISRCTN22975026: Graded Exercise Therapy guided SElf-help Treatment for CFS/ME | website = isrctn.com|language=en|access-date=2020-01-26}}</ref>
<ref name="getsetprotocol">{{Citation | doi = 10.2196/resprot.5395 | volume = 5 | issue = 2 | pages = 70 | last1 = Clark | first1 = Lucy V. | authorlink1 = Lucy Clark | last2 = McCrone | first2 = Paul | authorlink2 = Paul McCrone | last3 = Ridge | first3 = Damien | authorlink3 = Damien Ridge | last4 = Cheshire | first4 = Anna | authorlink4 = Anna Cheshire | last5 = Vergara-Williamson | first5 = Mario | authorlink5 = Mario Vergara-Williamson | last6 = Pesola | first6 = Francesca | authorlink6 = Francesco Pesola | last7 = White | first7 = PeterD. | author-link8 = Peter White | title = Graded Exercise Therapy Guided Self-Help Trial for Patients with Chronic Fatigue Syndrome (GETSET): Protocol for a Randomized Controlled Trial and Interview Study | journal = JMIR research protocols | date = 2016-06-08 | pmid = 27278762 | pmc = 4917732 }}</ref>
<ref name="getset">{{Citation | doi = 10.1016/S0140-6736(16)32589-2 | volume = | issue = | pages = | last1 = Clark | first1 = Lucy V. | authorlink1 = Lucy Clark | last2 = Pesola | first2 = Francesca | authorlink2 = Francesca Pesola | last3 = Thomas | first3 = Janice | authorlink3 = Janice Thomas | last4 = Vergara-Williamson | first4 = Mario | authorlink4 = Mario Vergara-Williamson | last5 = Beynon | first5 = Michelle | authorlink5 = Michelle Beynon | last6 = White | first6 = PeterD. | authorlink6 = Peter White | title = Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial | journal = The Lancet | date = 2017-06-22 | pmid = | pmc = }}</ref>
</references>

[[Category:Psychological paradigm]]
[[Category:Notable studies]]

Classic Pacing for a Better Life with ME

2023-08-08T15:18:26Z

Pookey:/* Pacing tips Videos */

{{Infobox book
| name = Classic Pacing for a Better Life with ME
| image = File:ClassicPacing-MECFS-bookcover.jpg
| caption =
| author = Ingebjørg Midsem Dahl
| illustrator =
| cover_artist =
| country =
| language = English, Norwegian, Icelandic
| subject = [[Myalgic encephalomyelitis|Myalgic Encephalomyelitis]]/[[Chronic fatigue syndrome|Chronic Fatigue Syndrome]], [[pacing]]
| genre = Self-help, non-fiction
| publisher = Lyngsmyr AS
| pub_date =
| media_type = Hardcover, spiral-bound, kindle eBook
| pages =
| isbn = 1999641817, 978-1999641818, 1999641809, 978-1999641801 (English)
1999641809, 9781999641801 (Norwegian)
| website = http://www.pacinginfo.eu/
}}

===Translations===
*[http://aktivitetsavpassing.no/ Aktivitetsavpassing: For en bedre hverdag med ME] (Norwegian book page)
* Virkniaðlögun bók um betra líf með ME (Icelandic)

==Background (from the author)==
Classic Pacing for a Better Life with ME is a self-help book which explains [[pacing]] and how it can be applied to daily life. Although aimed at patients, the book can also be of interest to professionals. Pacing is a coping strategy used in illnesses that cause low energy levels. It consists of splitting activities into small chunks so that symptoms are not worsened, as well as alternating activity and rest to maintain energy levels throughout the day.

==Synopsis==
'''Part 1''' - basic pacing<br>
'''Part 2''' - advanced pacing, for people who have been ill a long time and tried many ways to improve<br>
'''Part 3''' - Covers different themes, including pacing social activities and major events.<br>

*Chapter 1 - Be Gentle with Yourself
*Chapter 2 - Listen to Your Body
*Chapter 3 - Pace Yourself
*Chapter 4 - Grieve What You’ve Lost
*Chapter 5 - Deal with Anxiety and Depression
*Chapter 6 - Deal with Isolation
*Chapter 7 - Learn to Accept Help
*Chapter 8 - Let Go of False Guilt
*Chapter 9 - Deal with Emotions
*Chapter 10 - Write in a Journal
*Chapter 11 - Guard Your Heart
*Chapter 12 - Practice Forgiveness
*Chapter 13 - Deal with Jealousy
*Chapter 14 - Use Your Personality Traits to Your Advantage
*Chapter 15 - Stay Informed and Take Action

== Pacing tips Videos ==
https://www.facebook.com/pacinginfo/videos/?ref=page_internal

==Reception==

==Online presence==
*[http://www.pacinginfo.eu/ Website (English)]
*[http://aktivitetsavpassing.no/ Website (Norwegian)]
*[https://www.mefelag.is/virkniadloegun-bok Book description - Icelandic]
*Twitter
*https://www.facebook.com/pacinginfo/
*YouTube
*Facebook https://www.facebook.com/pacinginfo

==See also==
* [[Pacing]]

==Learn more==

==References==
{{reflist}}

[[Category:Books]]
[[Category:English books]]
[[Category:Norsk books]]
[[Category:Íslenskar books]]
[[Category:Self-help books]]
[[Category:Non-fiction books]]

Low dose naltrexone

2022-09-12T08:30:00Z

Pookey:External link

'''Low Dose Naltrexone''' (LDN) refers to very small doses of the drug '''naltrexone hydrochloride''', which is normally used to treat drug or [[alcohol]] dependence. When taken at much smaller doses naltrexone may reduce [[pain]], or potentially [[Nervous system|neurological]] symptoms. Brand names of naltrexone include '''ReViva''', '''Depade''', and '''Vivitrol'''.<ref name="brands">{{Cite web|url=https://www.drugs.com/ingredient/naltrexone.html|title=Naltrexone - brand name list from Drugs.com|website=Drugs.com|language=en|access-date=2022-01-17}}</ref>
LDN use other for treating drug dependence is considered off-label. Some patients report that LDN helps reduce their symptoms of [[ME/CFS]], [[multiple sclerosis]] (MS), [[fibromyalgia]] (FMS), or [[autoimmune disease]]. Although its mechanism of action is unclear, some have speculated that it may act as an anti-inflammatory.<ref name="Younger2014" />

==Prescription forms ==
LDN is typically prescribed using generic naltrexone hydrochloride or branded naltrexone, divided into much smaller doses. LDN may be taken in the form of liquid solution/syrup, sublingual doses or 1.5mg capsules, or a compounding pharmacy can create smaller sized capsules or tablets. LDN in the form of naltrexone cream, subcutaneous injections, IV naltrexone and eye drops (for [[Sjögren's syndrome|dry eyes]]) are also available.<ref name="forms">{{Cite web|url=https://ldnresearchtrust.org/types-of-ldn|title=Types of LDN|last=|first=|authorlink=|date=|website=LDN Research Trust|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-17}}</ref>

== VLDN and ULDN ==
'''Very Low Dose Naltrexone''' (VLDN) and '''Ultra-Low Dose Naltrexone''' (ULDN) have recently been used in limited trials, both VLDN and ULDN involve doses of naltrexone significantly below 1mg.<ref>{{Cite journal|last=Toljan|first=Karlo|author-link=Karlo Toljan|last2=Vrooman|first2=Bruce|author-link2=Bruce Vrooman|date=Sep 21, 2018|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/|journal=Medical Sciences|volume=6|issue=4|pages=|doi=10.3390/medsci6040082|issn=2076-3271|pmc=|pmid=30248938|quote=|via=}}</ref>

==Evidence==
[[File:LDN-Fibro2014.jpg|alt=Data shows a graph with 10% worse after treatment, 57% improved or much improved, and 12% very much improved. Darker colors are the most improved sections.|thumb|350x350px|Low Dose Naltrexone results for 29 patients with [[Fibromyalgia]]. Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment.
Source: Clin Rheumatol 2014; 33(4):452-459. Fig 1.<ref name="Younger2014" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/figure/Fig1/ PMC3962576] ]]

[[Jarred Younger]] published a small study that concluded "...low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".<ref name="Younger2009" /><ref name="Mackey2009" />

A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".<ref name="Younger2013" /><ref>{{Cite web|url=https://med.stanford.edu/pain/snapl/completed-research/naltrexone2.html|title=Low Dose Naltrexone for Fibromyalgia|website=Systems Neuroscience and Pain Lab {{!}} Stanford Medicine|language=en|access-date=2018-10-04|date=|last=|first=|authorlink=|archive-url=|archive-date=|url-status=}}</ref>

A 2014 review by Stanford researchers suggests that "LDN may operate as a novel anti-inflammatory agent in the [[central nervous system]], via action on [[microglia]]l cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on [[opioid]] receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated."<ref name="Younger2014" />
[[File:LDN-Fibro-ESR.jpg|thumb|420x420px|Relationship between ESR, a marker inflammation, and LDN treatment in 29 patients with [[Fibromyalgia]]. ]]
The [[FDA]] approved naltrexone HCL in 1984 to treat opioid addiction. Low-dose naltrexone is typically given at about 1/10th the typical dose of naltrexone. By blocking opioid receptors, naltrexone can increase pain, but at very low doses naltrexone has both pain-reducing ([[analgesic]]) and anti-inflammatory properties.

In 2012 [[Solve ME/CFS Initiative]] contracted [[Biovista]] to use drug models to identify existing drugs that may be worth investigating for treatment. The results suggested Naltrexone was worth considering.<ref>{{Cite web|url=http://solvecfs.org/biovista-work-released|title=Biovista work released|last=Solve ME/CFS Initiative|first=|authorlink=Solve ME/CFS Initiative|date=|website=|archive-url=|archive-date=|access-date=|url-status=live}}</ref>

Jarred Younger's research suggests that people with an [[Erythrocyte sedimentation rate|Erythrocyte Sedimentation Rate]] (ESR) over 40 millimeters an hour, tend to be strong responders to LDN, and that there may be other predictive factors for success.<ref name="Younger20160329sh" />

==News articles==
* 2019, [https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain] - NPR, All Things Considered
* September 9, 2021<nowiki/>https://www.empr.com/home/news/drugs-in-the-pipeline/low-dose-naltrexone-designated-orphan-drug-for-complex-regional-pain-syndrome/

==Clinical use==

Naltrexone is a prescription drug in many countries including the [[United States]].<ref name="naltrexonecompliance">{{Cite journal|last=Feeney|first=G. F. X.|last2=Connor|first2=J. P.|last3=Young|first3=R. McD|last4=Tucker|first4=J.|last5=Czajkowski|first5=F.|date=2001|title=Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2710.2001.00326.x|journal=Journal of Clinical Pharmacy and Therapeutics|language=en|volume=26|issue=1|pages=73–79|doi=10.1111/j.1365-2710.2001.00326.x|issn=1365-2710}}</ref>Compounding chemists or compounding pharmacists can mix naltrexone with a powder filler or dilute in into a liquid to create the lower dose.

=== Fast-release fillers only ===
The LDN Research Trust advises that:
"Pharmacies should be instructed NOT to provide LDN in an "SR" or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt "spike" in the blood stream, its therapeutic effects may be inhibited."<ref name="leaflet2014" /> and states that calcium carbonate filler should NOT be used because they reduce absorption, instead Avicel, lactose, or sucrose fillers as alternative fast-release fillers."<ref name="leaflet2014">{{Cite web|url=https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf|title=Low-dose Naltrexone (LDN) Fact Sheet 2014|website=LDN Research Trust|date=2014}}</ref>

===Do not take with===
In general, Low Dose Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs (opioid receptors in brain are blocked by LDN), alcohol, immunosuppressive drugs, or immunomodulator drugs.{{citation needed|date=2021}} LDN blocks the effect of opioid drugs.<ref name="chronicpain">{{Cite web|url=https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md|title=Low Dose Naltrexone and chronic pain|first = Pradeep |last =Chopra|website=LDN Research Trust|access-date=2019-01-31}}</ref> Some opioid drugs are [[codeine]], [[tramadol]], [[oxycodone]], [[vicodin]], [[hydrocodone]], [[fentanyl]] and [[morphine]].
==Pharmacies ==

=== Australia ===
''Compounding Pharmacies'' are able to fill these prescriptions, and post if needed.

=== UK ===
LDN suppliers in the UK include '''Dickson Chemist''' in Glasgow, Roseway Labs, and Specialist Pharmacy (The London Specialist Pharmacy Ltd). All these are compounding pharmacies and require a perscription, they are usually able to put patients in contact with private doctors who will consider writing a prescription, and can post medications to you.<ref name="RosewayLabs">{{Cite web |url =https://rosewaylabs.com/compounding-processes-regulations|title=Compounding processes regulations/|website =Roseway Labs}}</ref> Compounding pharmacies are regulated by the UK's General Pharmaceutical Council.<ref name="RosewayLabs" />

===United States===
Neighborhood ''Compounding Pharmacies'' are able to fill these prescriptions and mail if needed. Your prescribing doctor can help you locate a compounding pharmacy in your area/state or you can look online.<ref>[http://www.wikihow.com/Find-a-Compounding-Pharmacy Finding a Compounding Pharmacy - WIKI How]</ref>

===Other countries ===
The LDN Research Trust lists pharmacies in multiple countries.<ref name="sources">{{Cite web |url =https://ldnresearchtrust.org/ldn-pharmacists|website=LDN Research Trust|title =LDN Pharmacists |access-date =}}</ref>

== Clinical trials ==
A large number of clinical trials have been completed for LDN recently, although none have looked at the effect of LDN on symptoms of [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]]. Research has been carried out on patients with MS, [[Chronic Regional Pain Syndrome]], FMS, [[Irritable bowel syndrome|Irritable Bowel Syndrome]] (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.<ref name="trials">{{Cite web|url=https://www.ldnresearchtrust.org/ldn-clinical-trials|title=Clinical Trials|website=LDN Research Trust|access-date=2019-01-21}}</ref>

==When, How To Take ==
Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg.<ref name="LDN-now">{{Cite web|url=http://www.ldnnow.com/48591/90512.html|title=LDN Dosing|last=LDN Now|first=|authorlink=|date=|website=|access-date=2018-02-01}}</ref> Common dosages are 1.5mg, 3mg, 4.5mg.<ref>{{Cite web|url=https://www.amymyersmd.com/2017/05/low-dose-naltrexone/|title=Low-Dose Naltrexone for Autoimmunity?|last=Myers|date=2017-05-02|website=Amy Myers MD|language=en-US|access-date=2019-02-02|first=Amy|authorlink=|archive-url=|archive-date=|url-status=}}</ref><ref name=":1">{{Cite web|url=https://www.drwhitaker.com/what-is-low-dose-naltrexone|title=What is Low-Dose Naltrexone?|last=Dr Whitaker|first=|authorlink=|date=|website=www.drwhitaker.com|language=en|archive-url=|archive-date=|access-date=2019-01-21}}</ref><ref name="chronicpain" /> When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake; discuss how best to do this with your doctor and pharmacist.<ref name=":1" /><ref>{{Cite web|url=https://collierdrug.com/low-dose-naltrexone-ldn/|title=Low Dose Naltrexone (LDN) – Collier Drug Store|last=|first=|authorlink=|date=|website=collierdrug.com|at=What dose of Low Dose Naltrexone (LDN) is best?|archive-url=|archive-date=|access-date=2019-02-02}}</ref><ref name="chronicpain" />

LDN is usually taken at bedtime. Some people take LDN in the morning to minimize [[Sleep dysfunction|sleep disturbance]], [[insomnia]], and vivid dreams.<ref name="chronicpain" />

== Talks and webinars==
*2012, [https://www.youtube.com/watch?v=z0p0ykSzy9o LDNscience® Presents - How LDN (Low Dose Naltrexone) Works]<ref>{{Cite web|url=https://www.youtube.com/watch?v=z0p0ykSzy9o|title=LDNscience® Presents - How LDN (Low Dose Naltrexone) Works|last=|first=|authorlink=|date=Dec 20, 2012|website=YouTube|publisher=LDNscience|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''LDNscience® Presents - How LDN (Low Dose Naltrexone) Works'' By LDNscience">https://www.youtube.com/watch?v=z0p0ykSzy9o</embedvideo>

*2015, [https://www.youtube.com/watch?v=8a-ULCaarCQ Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez]<ref>{{Cite web|url=https://www.youtube.com/watch?v=8a-ULCaarCQ|title=Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez|last=Carnahan|first=Jill|authorlink=|last2=Vasquez|first2=Alex|authorlink2=|date=Nov 30, 2015|website=YouTube|publisher=Alex Vasquez|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez '' By Alex Vasquez">https://www.youtube.com/watch?v=8a-ULCaarCQ</embedvideo>

*2015, [https://www.youtube.com/watch?v=Qnr51yU9ih8 Is Low Dose Naltrexone (LDN) for you?]<ref>{{Cite web|url=https://www.youtube.com/watch?v=Qnr51yU9ih8|title=1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?|last=|first=|authorlink=|date=Oct 11, 2015|website=YouTube|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Is Low Dose Naltrexone (LDN) for you?'' By Integrative Health Solutions">https://www.youtube.com/watch?v=Qnr51yU9ih8</embedvideo>

==Notable studies==
* 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study<ref>{{Cite journal|last=Younger|first=Jarred|author-link=Jarred Younger|last2=Mackey|first2=Sean|author-link2=|date=May 2009|title=Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study|url=https://academic.oup.com/painmedicine/article-lookup/doi/10.1111/j.1526-4637.2009.00613.x|journal=Pain Medicine|language=en|volume=10|issue=4|pages=663–672|doi=10.1111/j.1526-4637.2009.00613.x|issn=1526-2375|pmc=2891387|pmid=19453963|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ (Full text)]
* 2013, Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels<ref name="Younger2013" /> - [https://onlinelibrary.wiley.com/doi/full/10.1002/art.37734 (Full text)]
* 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain<ref name="Younger2014" /> - [http://link.springer.com/article/10.1007%2Fs10067-014-2517-2 (Full text)]
*2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat [[Gulf War Illness]]<ref name="Brewer, 2018" /> - [https://www.tandfonline.com/doi/full/10.1080/21641846.2018.1477034 (Abstract)]

* 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization<ref>{{Cite journal|last=Toljan|first=Karlo|last2=Vrooman|first2=Bruce|date=2018-09-21|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=http://www.mdpi.com/2076-3271/6/4/82|journal=Medical Sciences|language=en|volume=6|issue=4|pages=82|doi=10.3390/medsci6040082|issn=2076-3271|pmc=6313374|pmid=30248938}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/#!po=19.1057 (Full text)]

* 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)<ref name="Polo2019">{{Cite journal|last=Polo|first=Olli|author-link=Olli Polo|last2=Pesonen|first2=Pia|author-link2=|last3=Tuominen|first3=Essi|author-link3=|date=2019-11-19|title=Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=207-217|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2019.1692770?journalCode=rftg20 (Abstract)]
* 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome<ref>{{Cite journal|last=Bolton|first=Monica Jane|author-link=|last2=Chapman|first2=Bryan Paul|author-link2=|last3=Van Marwijk|first3=Harm|author-link3=|date=Jan 2020|title=Low-dose naltrexone as a treatment for chronic fatigue syndrome|url=http://casereports.bmj.com/lookup/doi/10.1136/bcr-2019-232502|journal=BMJ Case Reports|language=en|volume=13|issue=1|pages=e232502|doi=10.1136/bcr-2019-232502|issn=1757-790X|pmc=6954765|pmid=31911410|access-date=|quote=|via=}}</ref> - [https://casereports.bmj.com/content/bmjcr/13/1/e232502.full.pdf (Full text)]
*2021, Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment<ref name="Cabanas2021">{{Cite journal|title=Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment|date=2021|url=https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806|journal=Frontiers in Immunology|volume=12|issue=|pages=687806|last=Cabanas|first=Helene|author-link=Hélène Cabanas|last2=Muraki|first2=Katsuhiko|author-link2=|last3=Eaton-Fitch|first3=Natalie|author-link3=Natalie Eaton-Fitch|last4=Staines|first4=Donald Ross|author-link4=Donald Staines|last5=Marshall-Gradisnik|first5=Sonya|author-link5=Sonya Marshall-Gradisnik|doi=10.3389/fimmu.2021.687806|pmc=PMC8313851|pmid=34326841|access-date=|issn=1664-3224|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806/full (Full text)]

==See also==
*[[Endorphin]]
*[[Brain#Microglia|Microglia]]
*[[Oxymatrine]]
*[[The LDN Book]]

==Learn more==
*[https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf Low-dose Naltrexone (LDN) Doctor's Fact Sheet 2014] - LDN Research Trust
*[https://www.ldnresearchtrust.org LDN Research Trust]<ref>{{Cite web|url=https://www.ldnresearchtrust.org/|title=Low Dose Naltrexone {{!}}|website=LDN Research Trust|access-date=2019-02-02}}</ref>
*[https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md Low Dose Naltrexone and chronic pain]<ref name="chronicpain" />
*[https://en.wikipedia.org/wiki/Naltrexone Wikipedia - Naltrexone]
*[http://www.ldnnow.com/ LDN Now]
*[https://www.ldnscience.org/ LDN Science - MedInsight Research Institute]
*2015, [https://www.ncbi.nlm.nih.gov/books/NBK390569/ The Use of Naltrexone in Low Doses Beyond the Approved Indication]<ref name="NBK390569">{{Citation|url=https://www.ncbi.nlm.nih.gov/books/NBK390569/|title=The Use of Naltrexone in Low Doses Beyond the Approved Indication|last=Ringerike|first=Tove|last2=Pike|first2=Eva|last3=Nevjar|first3=Janicke|last4=Klemp|first4=Marianne|publisher=NIPH|year=2015|isbn=|location=}}</ref>
* [https://selfhacked.com/2016/06/20/top-22-scientific-health-benefits-low-dose-naltrexone/ Top 15 Scientific Health Benefits of Low Dose Naltrexone] (2016)
*[https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/low-dose-naltrexone-ldn-fibromyalgia-chronic-fatigue-syndrom/ Low Dose Naltrexone Resource Center for Fibromylgia and ME/CFS] (2019)
*2016, [http://www.rheumatologyadvisor.com/fibromyalgia/using-low-dose-naltrexone-in-fibromyalgia/article/478182/ Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia]
*[[The LDN Book]] - Lisa Elsegood (2016)
*[http://www.cortjohnson.org/blog/2016/02/04/low-dose-naltrexone-combo-chronic-fatigue/ 2016, Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome] - Health Rising, by [[Cort Johnson]] (2016)
*[https://cfsremission.wordpress.com/2016/03/19/review-of-low-dose-naltrexone/ Low dose naltrexone: side effects and efficacy in gastrointestinal disorders] by [[CFS Remission]] (2016)
*Opioid blocking and alcohol - [http://www.well.com/user/woa/revia/reviafaq.htm FAQ About Naltrexone Treatment for Alcoholism - 10.]
*[https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-for-fibromyalgia Low Dose Naltrexone for Fibromyalgia] (2018)
* [https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-therapy-for-crohn-s-disease Low Dose Naltrexone Therapy for Crohn's Disease] (2018)
* [https://www.facebook.com/groups/200010163370187 LDN LOW DOSE NALTREXONE FOR ME/CFS MYALGIC ENCEPHALOMYELITIS & FIBROMYALGIA]

==References==
<references>
<ref name="Brewer, 2018">{{Cite journal
| last1 = Brewer | first1 = Kori L. | authorlink1 =
| last2 = Mainhart | first2 = Allison | authorlink2 =
| last3 = Meggs | first3 = William J. | authorlink3 =
| title = Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness
| journal = Fatigue: Biomedicine, Health & Behavior | volume = 6 | issue = 3 | pages = 132-140
| date = 2018
| pmid = | url = https://ldnresearchtrust.org/double-blinded-placebo-controlled-cross-over-pilot-trial-naltrexone-treat-gulf-war-illness-abstract
| doi = 10.1080/21641846.2018.1477034}}</ref>
<ref name="Younger2009">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Mackey | first2 = Sean | authorlink2 = Sean Mackey
| title = Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study
| journal = Pain Med | volume = 10 | issue = 4 | pages = 663–672
| date = Apr 22, 2009
| pmid = 2891387 | doi = 10.1111/j.1526-4637.2009.00613.x
| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ }}</ref>
<ref name="Younger2013">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Noor | first2 = Noorulain | authorlink2 = Noorulain Noor
| last3 = McCue | first3 = Rebecca | authorlink3 = Rebecca McCue
| last4 = Mackey | first4 = Sean | authorlink4 = Sean Mackey
| title = Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels
| journal = Arthritis Rheum | volume = 65 | issue = 2 | pages = 529-38
| date = Jan 28, 2013
| pmid = 23359310 | doi = 10.1002/art.37734
| url = http://onlinelibrary.wiley.com/enhanced/doi/10.1002/art.37734/}}</ref>
<ref name="Mackey2009">{{Cite web
| last1 = Mackey | first1 = Sean | authorlink1 = Sean Mackey
| title = An Update on Fibromyalgia
| publisher = Research Channel (USA)
| date = May 1, 2009
| url = https://www.youtube.com/watch?v=jtc2JARVpPw}}</ref>
<ref name="Younger2014">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Parkitny | first2 = Luke | authorlink2 = Luke Parkitny
| last3 = McLain | first3 = David | authorlink3 = David McLain
| title = The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain
| journal = Clin Rheumatol | volume = 33 | issue = 4 | pages = 451-459
| date = Feb 15, 2014
| pmid = 24526250 | doi = 10.1007/s10067-014-2517-2
| url = http://link.springer.com/article/10.1007%2Fs10067-014-2517-2}}</ref>
<ref name="Younger20160329sh">{{Cite web | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Cohen | first2 = Joseph M | authorlink2 = Joseph Cohen
| title = Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue
| type = video interview with transcript
| publisher = Self Hacked Blog
| date = Mar 29, 2016
| url = http://selfhacked.com/2016/03/29/dr-jared-younger-cutting-edge-research-on-cfs-neuroinflammation-pain-and-fatigue/#Leptin_and_Chronic_Fatigue_Syndrome}}</ref>
</references>

[[Category:Potential treatments]]
[[Category:Anti-inflammatories]]
[[Category:Analgesics]]

Low dose naltrexone

2022-09-12T08:27:37Z

Pookey:/* Learn more */

'''Low Dose Naltrexone''' (LDN) refers to very small doses of the drug '''naltrexone hydrochloride''', which is normally used to treat drug or [[alcohol]] dependence. When taken at much smaller doses naltrexone may reduce [[pain]], or potentially [[Nervous system|neurological]] symptoms. Brand names of naltrexone include '''ReViva''', '''Depade''', and '''Vivitrol'''.<ref name="brands">{{Cite web|url=https://www.drugs.com/ingredient/naltrexone.html|title=Naltrexone - brand name list from Drugs.com|website=Drugs.com|language=en|access-date=2022-01-17}}</ref>
LDN use other for treating drug dependence is considered off-label. Some patients report that LDN helps reduce their symptoms of [[ME/CFS]], [[multiple sclerosis]] (MS), [[fibromyalgia]] (FMS), or [[autoimmune disease]]. Although its mechanism of action is unclear, some have speculated that it may act as an anti-inflammatory.<ref name="Younger2014" />

==Prescription forms ==
LDN is typically prescribed using generic naltrexone hydrochloride or branded naltrexone, divided into much smaller doses. LDN may be taken in the form of liquid solution/syrup, sublingual doses or 1.5mg capsules, or a compounding pharmacy can create smaller sized capsules or tablets. LDN in the form of naltrexone cream, subcutaneous injections, IV naltrexone and eye drops (for [[Sjögren's syndrome|dry eyes]]) are also available.<ref name="forms">{{Cite web|url=https://ldnresearchtrust.org/types-of-ldn|title=Types of LDN|last=|first=|authorlink=|date=|website=LDN Research Trust|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-17}}</ref>

== VLDN and ULDN ==
'''Very Low Dose Naltrexone''' (VLDN) and '''Ultra-Low Dose Naltrexone''' (ULDN) have recently been used in limited trials, both VLDN and ULDN involve doses of naltrexone significantly below 1mg.<ref>{{Cite journal|last=Toljan|first=Karlo|author-link=Karlo Toljan|last2=Vrooman|first2=Bruce|author-link2=Bruce Vrooman|date=Sep 21, 2018|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/|journal=Medical Sciences|volume=6|issue=4|pages=|doi=10.3390/medsci6040082|issn=2076-3271|pmc=|pmid=30248938|quote=|via=}}</ref>

==Evidence==
[[File:LDN-Fibro2014.jpg|alt=Data shows a graph with 10% worse after treatment, 57% improved or much improved, and 12% very much improved. Darker colors are the most improved sections.|thumb|350x350px|Low Dose Naltrexone results for 29 patients with [[Fibromyalgia]]. Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment.
Source: Clin Rheumatol 2014; 33(4):452-459. Fig 1.<ref name="Younger2014" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/figure/Fig1/ PMC3962576] ]]

[[Jarred Younger]] published a small study that concluded "...low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".<ref name="Younger2009" /><ref name="Mackey2009" />

A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".<ref name="Younger2013" /><ref>{{Cite web|url=https://med.stanford.edu/pain/snapl/completed-research/naltrexone2.html|title=Low Dose Naltrexone for Fibromyalgia|website=Systems Neuroscience and Pain Lab {{!}} Stanford Medicine|language=en|access-date=2018-10-04|date=|last=|first=|authorlink=|archive-url=|archive-date=|url-status=}}</ref>

A 2014 review by Stanford researchers suggests that "LDN may operate as a novel anti-inflammatory agent in the [[central nervous system]], via action on [[microglia]]l cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on [[opioid]] receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated."<ref name="Younger2014" />
[[File:LDN-Fibro-ESR.jpg|thumb|420x420px|Relationship between ESR, a marker inflammation, and LDN treatment in 29 patients with [[Fibromyalgia]]. ]]
The [[FDA]] approved naltrexone HCL in 1984 to treat opioid addiction. Low-dose naltrexone is typically given at about 1/10th the typical dose of naltrexone. By blocking opioid receptors, naltrexone can increase pain, but at very low doses naltrexone has both pain-reducing ([[analgesic]]) and anti-inflammatory properties.

In 2012 [[Solve ME/CFS Initiative]] contracted [[Biovista]] to use drug models to identify existing drugs that may be worth investigating for treatment. The results suggested Naltrexone was worth considering.<ref>{{Cite web|url=http://solvecfs.org/biovista-work-released|title=Biovista work released|last=Solve ME/CFS Initiative|first=|authorlink=Solve ME/CFS Initiative|date=|website=|archive-url=|archive-date=|access-date=|url-status=live}}</ref>

Jarred Younger's research suggests that people with an [[Erythrocyte sedimentation rate|Erythrocyte Sedimentation Rate]] (ESR) over 40 millimeters an hour, tend to be strong responders to LDN, and that there may be other predictive factors for success.<ref name="Younger20160329sh" />

==News articles==
* 2019, [https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain] - NPR, All Things Considered
* September 9, 2021[[Low Dose Naltrexone Designated Orphan Drug for Complex Regional Pain Syndrome]]

==Clinical use==

Naltrexone is a prescription drug in many countries including the [[United States]].<ref name="naltrexonecompliance">{{Cite journal|last=Feeney|first=G. F. X.|last2=Connor|first2=J. P.|last3=Young|first3=R. McD|last4=Tucker|first4=J.|last5=Czajkowski|first5=F.|date=2001|title=Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2710.2001.00326.x|journal=Journal of Clinical Pharmacy and Therapeutics|language=en|volume=26|issue=1|pages=73–79|doi=10.1111/j.1365-2710.2001.00326.x|issn=1365-2710}}</ref>Compounding chemists or compounding pharmacists can mix naltrexone with a powder filler or dilute in into a liquid to create the lower dose.

=== Fast-release fillers only ===
The LDN Research Trust advises that:
"Pharmacies should be instructed NOT to provide LDN in an "SR" or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt "spike" in the blood stream, its therapeutic effects may be inhibited."<ref name="leaflet2014" /> and states that calcium carbonate filler should NOT be used because they reduce absorption, instead Avicel, lactose, or sucrose fillers as alternative fast-release fillers."<ref name="leaflet2014">{{Cite web|url=https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf|title=Low-dose Naltrexone (LDN) Fact Sheet 2014|website=LDN Research Trust|date=2014}}</ref>

===Do not take with===
In general, Low Dose Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs (opioid receptors in brain are blocked by LDN), alcohol, immunosuppressive drugs, or immunomodulator drugs.{{citation needed|date=2021}} LDN blocks the effect of opioid drugs.<ref name="chronicpain">{{Cite web|url=https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md|title=Low Dose Naltrexone and chronic pain|first = Pradeep |last =Chopra|website=LDN Research Trust|access-date=2019-01-31}}</ref> Some opioid drugs are [[codeine]], [[tramadol]], [[oxycodone]], [[vicodin]], [[hydrocodone]], [[fentanyl]] and [[morphine]].
==Pharmacies ==

=== Australia ===
''Compounding Pharmacies'' are able to fill these prescriptions, and post if needed.

=== UK ===
LDN suppliers in the UK include '''Dickson Chemist''' in Glasgow, Roseway Labs, and Specialist Pharmacy (The London Specialist Pharmacy Ltd). All these are compounding pharmacies and require a perscription, they are usually able to put patients in contact with private doctors who will consider writing a prescription, and can post medications to you.<ref name="RosewayLabs">{{Cite web |url =https://rosewaylabs.com/compounding-processes-regulations|title=Compounding processes regulations/|website =Roseway Labs}}</ref> Compounding pharmacies are regulated by the UK's General Pharmaceutical Council.<ref name="RosewayLabs" />

===United States===
Neighborhood ''Compounding Pharmacies'' are able to fill these prescriptions and mail if needed. Your prescribing doctor can help you locate a compounding pharmacy in your area/state or you can look online.<ref>[http://www.wikihow.com/Find-a-Compounding-Pharmacy Finding a Compounding Pharmacy - WIKI How]</ref>

===Other countries ===
The LDN Research Trust lists pharmacies in multiple countries.<ref name="sources">{{Cite web |url =https://ldnresearchtrust.org/ldn-pharmacists|website=LDN Research Trust|title =LDN Pharmacists |access-date =}}</ref>

== Clinical trials ==
A large number of clinical trials have been completed for LDN recently, although none have looked at the effect of LDN on symptoms of [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]]. Research has been carried out on patients with MS, [[Chronic Regional Pain Syndrome]], FMS, [[Irritable bowel syndrome|Irritable Bowel Syndrome]] (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.<ref name="trials">{{Cite web|url=https://www.ldnresearchtrust.org/ldn-clinical-trials|title=Clinical Trials|website=LDN Research Trust|access-date=2019-01-21}}</ref>

==When, How To Take ==
Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg.<ref name="LDN-now">{{Cite web|url=http://www.ldnnow.com/48591/90512.html|title=LDN Dosing|last=LDN Now|first=|authorlink=|date=|website=|access-date=2018-02-01}}</ref> Common dosages are 1.5mg, 3mg, 4.5mg.<ref>{{Cite web|url=https://www.amymyersmd.com/2017/05/low-dose-naltrexone/|title=Low-Dose Naltrexone for Autoimmunity?|last=Myers|date=2017-05-02|website=Amy Myers MD|language=en-US|access-date=2019-02-02|first=Amy|authorlink=|archive-url=|archive-date=|url-status=}}</ref><ref name=":1">{{Cite web|url=https://www.drwhitaker.com/what-is-low-dose-naltrexone|title=What is Low-Dose Naltrexone?|last=Dr Whitaker|first=|authorlink=|date=|website=www.drwhitaker.com|language=en|archive-url=|archive-date=|access-date=2019-01-21}}</ref><ref name="chronicpain" /> When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake; discuss how best to do this with your doctor and pharmacist.<ref name=":1" /><ref>{{Cite web|url=https://collierdrug.com/low-dose-naltrexone-ldn/|title=Low Dose Naltrexone (LDN) – Collier Drug Store|last=|first=|authorlink=|date=|website=collierdrug.com|at=What dose of Low Dose Naltrexone (LDN) is best?|archive-url=|archive-date=|access-date=2019-02-02}}</ref><ref name="chronicpain" />

LDN is usually taken at bedtime. Some people take LDN in the morning to minimize [[Sleep dysfunction|sleep disturbance]], [[insomnia]], and vivid dreams.<ref name="chronicpain" />

== Talks and webinars==
*2012, [https://www.youtube.com/watch?v=z0p0ykSzy9o LDNscience® Presents - How LDN (Low Dose Naltrexone) Works]<ref>{{Cite web|url=https://www.youtube.com/watch?v=z0p0ykSzy9o|title=LDNscience® Presents - How LDN (Low Dose Naltrexone) Works|last=|first=|authorlink=|date=Dec 20, 2012|website=YouTube|publisher=LDNscience|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''LDNscience® Presents - How LDN (Low Dose Naltrexone) Works'' By LDNscience">https://www.youtube.com/watch?v=z0p0ykSzy9o</embedvideo>

*2015, [https://www.youtube.com/watch?v=8a-ULCaarCQ Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez]<ref>{{Cite web|url=https://www.youtube.com/watch?v=8a-ULCaarCQ|title=Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez|last=Carnahan|first=Jill|authorlink=|last2=Vasquez|first2=Alex|authorlink2=|date=Nov 30, 2015|website=YouTube|publisher=Alex Vasquez|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez '' By Alex Vasquez">https://www.youtube.com/watch?v=8a-ULCaarCQ</embedvideo>

*2015, [https://www.youtube.com/watch?v=Qnr51yU9ih8 Is Low Dose Naltrexone (LDN) for you?]<ref>{{Cite web|url=https://www.youtube.com/watch?v=Qnr51yU9ih8|title=1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?|last=|first=|authorlink=|date=Oct 11, 2015|website=YouTube|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Is Low Dose Naltrexone (LDN) for you?'' By Integrative Health Solutions">https://www.youtube.com/watch?v=Qnr51yU9ih8</embedvideo>

==Notable studies==
* 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study<ref>{{Cite journal|last=Younger|first=Jarred|author-link=Jarred Younger|last2=Mackey|first2=Sean|author-link2=|date=May 2009|title=Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study|url=https://academic.oup.com/painmedicine/article-lookup/doi/10.1111/j.1526-4637.2009.00613.x|journal=Pain Medicine|language=en|volume=10|issue=4|pages=663–672|doi=10.1111/j.1526-4637.2009.00613.x|issn=1526-2375|pmc=2891387|pmid=19453963|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ (Full text)]
* 2013, Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels<ref name="Younger2013" /> - [https://onlinelibrary.wiley.com/doi/full/10.1002/art.37734 (Full text)]
* 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain<ref name="Younger2014" /> - [http://link.springer.com/article/10.1007%2Fs10067-014-2517-2 (Full text)]
*2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat [[Gulf War Illness]]<ref name="Brewer, 2018" /> - [https://www.tandfonline.com/doi/full/10.1080/21641846.2018.1477034 (Abstract)]

* 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization<ref>{{Cite journal|last=Toljan|first=Karlo|last2=Vrooman|first2=Bruce|date=2018-09-21|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=http://www.mdpi.com/2076-3271/6/4/82|journal=Medical Sciences|language=en|volume=6|issue=4|pages=82|doi=10.3390/medsci6040082|issn=2076-3271|pmc=6313374|pmid=30248938}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/#!po=19.1057 (Full text)]

* 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)<ref name="Polo2019">{{Cite journal|last=Polo|first=Olli|author-link=Olli Polo|last2=Pesonen|first2=Pia|author-link2=|last3=Tuominen|first3=Essi|author-link3=|date=2019-11-19|title=Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=207-217|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2019.1692770?journalCode=rftg20 (Abstract)]
* 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome<ref>{{Cite journal|last=Bolton|first=Monica Jane|author-link=|last2=Chapman|first2=Bryan Paul|author-link2=|last3=Van Marwijk|first3=Harm|author-link3=|date=Jan 2020|title=Low-dose naltrexone as a treatment for chronic fatigue syndrome|url=http://casereports.bmj.com/lookup/doi/10.1136/bcr-2019-232502|journal=BMJ Case Reports|language=en|volume=13|issue=1|pages=e232502|doi=10.1136/bcr-2019-232502|issn=1757-790X|pmc=6954765|pmid=31911410|access-date=|quote=|via=}}</ref> - [https://casereports.bmj.com/content/bmjcr/13/1/e232502.full.pdf (Full text)]
*2021, Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment<ref name="Cabanas2021">{{Cite journal|title=Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment|date=2021|url=https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806|journal=Frontiers in Immunology|volume=12|issue=|pages=687806|last=Cabanas|first=Helene|author-link=Hélène Cabanas|last2=Muraki|first2=Katsuhiko|author-link2=|last3=Eaton-Fitch|first3=Natalie|author-link3=Natalie Eaton-Fitch|last4=Staines|first4=Donald Ross|author-link4=Donald Staines|last5=Marshall-Gradisnik|first5=Sonya|author-link5=Sonya Marshall-Gradisnik|doi=10.3389/fimmu.2021.687806|pmc=PMC8313851|pmid=34326841|access-date=|issn=1664-3224|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806/full (Full text)]

==See also==
*[[Endorphin]]
*[[Brain#Microglia|Microglia]]
*[[Oxymatrine]]
*[[The LDN Book]]

==Learn more==
*[https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf Low-dose Naltrexone (LDN) Doctor's Fact Sheet 2014] - LDN Research Trust
*[https://www.ldnresearchtrust.org LDN Research Trust]<ref>{{Cite web|url=https://www.ldnresearchtrust.org/|title=Low Dose Naltrexone {{!}}|website=LDN Research Trust|access-date=2019-02-02}}</ref>
*[https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md Low Dose Naltrexone and chronic pain]<ref name="chronicpain" />
*[https://en.wikipedia.org/wiki/Naltrexone Wikipedia - Naltrexone]
*[http://www.ldnnow.com/ LDN Now]
*[https://www.ldnscience.org/ LDN Science - MedInsight Research Institute]
*2015, [https://www.ncbi.nlm.nih.gov/books/NBK390569/ The Use of Naltrexone in Low Doses Beyond the Approved Indication]<ref name="NBK390569">{{Citation|url=https://www.ncbi.nlm.nih.gov/books/NBK390569/|title=The Use of Naltrexone in Low Doses Beyond the Approved Indication|last=Ringerike|first=Tove|last2=Pike|first2=Eva|last3=Nevjar|first3=Janicke|last4=Klemp|first4=Marianne|publisher=NIPH|year=2015|isbn=|location=}}</ref>
* [https://selfhacked.com/2016/06/20/top-22-scientific-health-benefits-low-dose-naltrexone/ Top 15 Scientific Health Benefits of Low Dose Naltrexone] (2016)
*[https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/low-dose-naltrexone-ldn-fibromyalgia-chronic-fatigue-syndrom/ Low Dose Naltrexone Resource Center for Fibromylgia and ME/CFS] (2019)
*2016, [http://www.rheumatologyadvisor.com/fibromyalgia/using-low-dose-naltrexone-in-fibromyalgia/article/478182/ Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia]
*[[The LDN Book]] - Lisa Elsegood (2016)
*[http://www.cortjohnson.org/blog/2016/02/04/low-dose-naltrexone-combo-chronic-fatigue/ 2016, Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome] - Health Rising, by [[Cort Johnson]] (2016)
*[https://cfsremission.wordpress.com/2016/03/19/review-of-low-dose-naltrexone/ Low dose naltrexone: side effects and efficacy in gastrointestinal disorders] by [[CFS Remission]] (2016)
*Opioid blocking and alcohol - [http://www.well.com/user/woa/revia/reviafaq.htm FAQ About Naltrexone Treatment for Alcoholism - 10.]
*[https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-for-fibromyalgia Low Dose Naltrexone for Fibromyalgia] (2018)
* [https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-therapy-for-crohn-s-disease Low Dose Naltrexone Therapy for Crohn's Disease] (2018)
* [https://www.facebook.com/groups/200010163370187 LDN LOW DOSE NALTREXONE FOR ME/CFS MYALGIC ENCEPHALOMYELITIS & FIBROMYALGIA]

==References==
<references>
<ref name="Brewer, 2018">{{Cite journal
| last1 = Brewer | first1 = Kori L. | authorlink1 =
| last2 = Mainhart | first2 = Allison | authorlink2 =
| last3 = Meggs | first3 = William J. | authorlink3 =
| title = Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness
| journal = Fatigue: Biomedicine, Health & Behavior | volume = 6 | issue = 3 | pages = 132-140
| date = 2018
| pmid = | url = https://ldnresearchtrust.org/double-blinded-placebo-controlled-cross-over-pilot-trial-naltrexone-treat-gulf-war-illness-abstract
| doi = 10.1080/21641846.2018.1477034}}</ref>
<ref name="Younger2009">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Mackey | first2 = Sean | authorlink2 = Sean Mackey
| title = Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study
| journal = Pain Med | volume = 10 | issue = 4 | pages = 663–672
| date = Apr 22, 2009
| pmid = 2891387 | doi = 10.1111/j.1526-4637.2009.00613.x
| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ }}</ref>
<ref name="Younger2013">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Noor | first2 = Noorulain | authorlink2 = Noorulain Noor
| last3 = McCue | first3 = Rebecca | authorlink3 = Rebecca McCue
| last4 = Mackey | first4 = Sean | authorlink4 = Sean Mackey
| title = Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels
| journal = Arthritis Rheum | volume = 65 | issue = 2 | pages = 529-38
| date = Jan 28, 2013
| pmid = 23359310 | doi = 10.1002/art.37734
| url = http://onlinelibrary.wiley.com/enhanced/doi/10.1002/art.37734/}}</ref>
<ref name="Mackey2009">{{Cite web
| last1 = Mackey | first1 = Sean | authorlink1 = Sean Mackey
| title = An Update on Fibromyalgia
| publisher = Research Channel (USA)
| date = May 1, 2009
| url = https://www.youtube.com/watch?v=jtc2JARVpPw}}</ref>
<ref name="Younger2014">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Parkitny | first2 = Luke | authorlink2 = Luke Parkitny
| last3 = McLain | first3 = David | authorlink3 = David McLain
| title = The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain
| journal = Clin Rheumatol | volume = 33 | issue = 4 | pages = 451-459
| date = Feb 15, 2014
| pmid = 24526250 | doi = 10.1007/s10067-014-2517-2
| url = http://link.springer.com/article/10.1007%2Fs10067-014-2517-2}}</ref>
<ref name="Younger20160329sh">{{Cite web | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Cohen | first2 = Joseph M | authorlink2 = Joseph Cohen
| title = Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue
| type = video interview with transcript
| publisher = Self Hacked Blog
| date = Mar 29, 2016
| url = http://selfhacked.com/2016/03/29/dr-jared-younger-cutting-edge-research-on-cfs-neuroinflammation-pain-and-fatigue/#Leptin_and_Chronic_Fatigue_Syndrome}}</ref>
</references>

[[Category:Potential treatments]]
[[Category:Anti-inflammatories]]
[[Category:Analgesics]]

Low dose naltrexone

2022-09-12T08:18:17Z

Pookey:/* Learn more */

'''Low Dose Naltrexone''' (LDN) refers to very small doses of the drug '''naltrexone hydrochloride''', which is normally used to treat drug or [[alcohol]] dependence. When taken at much smaller doses naltrexone may reduce [[pain]], or potentially [[Nervous system|neurological]] symptoms. Brand names of naltrexone include '''ReViva''', '''Depade''', and '''Vivitrol'''.<ref name="brands">{{Cite web|url=https://www.drugs.com/ingredient/naltrexone.html|title=Naltrexone - brand name list from Drugs.com|website=Drugs.com|language=en|access-date=2022-01-17}}</ref>
LDN use other for treating drug dependence is considered off-label. Some patients report that LDN helps reduce their symptoms of [[ME/CFS]], [[multiple sclerosis]] (MS), [[fibromyalgia]] (FMS), or [[autoimmune disease]]. Although its mechanism of action is unclear, some have speculated that it may act as an anti-inflammatory.<ref name="Younger2014" />

==Prescription forms ==
LDN is typically prescribed using generic naltrexone hydrochloride or branded naltrexone, divided into much smaller doses. LDN may be taken in the form of liquid solution/syrup, sublingual doses or 1.5mg capsules, or a compounding pharmacy can create smaller sized capsules or tablets. LDN in the form of naltrexone cream, subcutaneous injections, IV naltrexone and eye drops (for [[Sjögren's syndrome|dry eyes]]) are also available.<ref name="forms">{{Cite web|url=https://ldnresearchtrust.org/types-of-ldn|title=Types of LDN|last=|first=|authorlink=|date=|website=LDN Research Trust|language=en|archive-url=|archive-date=|url-status=|access-date=2022-01-17}}</ref>

== VLDN and ULDN ==
'''Very Low Dose Naltrexone''' (VLDN) and '''Ultra-Low Dose Naltrexone''' (ULDN) have recently been used in limited trials, both VLDN and ULDN involve doses of naltrexone significantly below 1mg.<ref>{{Cite journal|last=Toljan|first=Karlo|author-link=Karlo Toljan|last2=Vrooman|first2=Bruce|author-link2=Bruce Vrooman|date=Sep 21, 2018|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/|journal=Medical Sciences|volume=6|issue=4|pages=|doi=10.3390/medsci6040082|issn=2076-3271|pmc=|pmid=30248938|quote=|via=}}</ref>

==Evidence==
[[File:LDN-Fibro2014.jpg|alt=Data shows a graph with 10% worse after treatment, 57% improved or much improved, and 12% very much improved. Darker colors are the most improved sections.|thumb|350x350px|Low Dose Naltrexone results for 29 patients with [[Fibromyalgia]]. Fibromyalgia participants’ (N = 29) self-reported improvement in symptoms after daily LDN treatment.
Source: Clin Rheumatol 2014; 33(4):452-459. Fig 1.<ref name="Younger2014" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/figure/Fig1/ PMC3962576] ]]

[[Jarred Younger]] published a small study that concluded "...low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia".<ref name="Younger2009" /><ref name="Mackey2009" />

A second study concluded that "specific and clinically beneficial impact on fibromyalgia pain".<ref name="Younger2013" /><ref>{{Cite web|url=https://med.stanford.edu/pain/snapl/completed-research/naltrexone2.html|title=Low Dose Naltrexone for Fibromyalgia|website=Systems Neuroscience and Pain Lab {{!}} Stanford Medicine|language=en|access-date=2018-10-04|date=|last=|first=|authorlink=|archive-url=|archive-date=|url-status=}}</ref>

A 2014 review by Stanford researchers suggests that "LDN may operate as a novel anti-inflammatory agent in the [[central nervous system]], via action on [[microglia]]l cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on [[opioid]] receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated."<ref name="Younger2014" />
[[File:LDN-Fibro-ESR.jpg|thumb|420x420px|Relationship between ESR, a marker inflammation, and LDN treatment in 29 patients with [[Fibromyalgia]]. ]]
The [[FDA]] approved naltrexone HCL in 1984 to treat opioid addiction. Low-dose naltrexone is typically given at about 1/10th the typical dose of naltrexone. By blocking opioid receptors, naltrexone can increase pain, but at very low doses naltrexone has both pain-reducing ([[analgesic]]) and anti-inflammatory properties.

In 2012 [[Solve ME/CFS Initiative]] contracted [[Biovista]] to use drug models to identify existing drugs that may be worth investigating for treatment. The results suggested Naltrexone was worth considering.<ref>{{Cite web|url=http://solvecfs.org/biovista-work-released|title=Biovista work released|last=Solve ME/CFS Initiative|first=|authorlink=Solve ME/CFS Initiative|date=|website=|archive-url=|archive-date=|access-date=|url-status=live}}</ref>

Jarred Younger's research suggests that people with an [[Erythrocyte sedimentation rate|Erythrocyte Sedimentation Rate]] (ESR) over 40 millimeters an hour, tend to be strong responders to LDN, and that there may be other predictive factors for success.<ref name="Younger20160329sh" />

==News articles==
* 2019, [https://www.npr.org/sections/health-shots/2019/09/23/741783834/in-tiny-doses-an-addiction-medication-moonlights-as-a-treatment-for-chronic-pain In Tiny Doses, An Addiction Medication Moonlights As A Treatment For Chronic Pain] - NPR, All Things Considered

==Clinical use==

Naltrexone is a prescription drug in many countries including the [[United States]].<ref name="naltrexonecompliance">{{Cite journal|last=Feeney|first=G. F. X.|last2=Connor|first2=J. P.|last3=Young|first3=R. McD|last4=Tucker|first4=J.|last5=Czajkowski|first5=F.|date=2001|title=Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2710.2001.00326.x|journal=Journal of Clinical Pharmacy and Therapeutics|language=en|volume=26|issue=1|pages=73–79|doi=10.1111/j.1365-2710.2001.00326.x|issn=1365-2710}}</ref>Compounding chemists or compounding pharmacists can mix naltrexone with a powder filler or dilute in into a liquid to create the lower dose.

=== Fast-release fillers only ===
The LDN Research Trust advises that:
"Pharmacies should be instructed NOT to provide LDN in an "SR" or slow-release or timed-release form. Unless the low dose of naltrexone is in an unaltered form, which permits it to reach a prompt "spike" in the blood stream, its therapeutic effects may be inhibited."<ref name="leaflet2014" /> and states that calcium carbonate filler should NOT be used because they reduce absorption, instead Avicel, lactose, or sucrose fillers as alternative fast-release fillers."<ref name="leaflet2014">{{Cite web|url=https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf|title=Low-dose Naltrexone (LDN) Fact Sheet 2014|website=LDN Research Trust|date=2014}}</ref>

===Do not take with===
In general, Low Dose Naltrexone (LDN) should not be taken concurrently with opioid-containing drugs (opioid receptors in brain are blocked by LDN), alcohol, immunosuppressive drugs, or immunomodulator drugs.{{citation needed|date=2021}} LDN blocks the effect of opioid drugs.<ref name="chronicpain">{{Cite web|url=https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md|title=Low Dose Naltrexone and chronic pain|first = Pradeep |last =Chopra|website=LDN Research Trust|access-date=2019-01-31}}</ref> Some opioid drugs are [[codeine]], [[tramadol]], [[oxycodone]], [[vicodin]], [[hydrocodone]], [[fentanyl]] and [[morphine]].
==Pharmacies ==

=== Australia ===
''Compounding Pharmacies'' are able to fill these prescriptions, and post if needed.

=== UK ===
LDN suppliers in the UK include '''Dickson Chemist''' in Glasgow, Roseway Labs, and Specialist Pharmacy (The London Specialist Pharmacy Ltd). All these are compounding pharmacies and require a perscription, they are usually able to put patients in contact with private doctors who will consider writing a prescription, and can post medications to you.<ref name="RosewayLabs">{{Cite web |url =https://rosewaylabs.com/compounding-processes-regulations|title=Compounding processes regulations/|website =Roseway Labs}}</ref> Compounding pharmacies are regulated by the UK's General Pharmaceutical Council.<ref name="RosewayLabs" />

===United States===
Neighborhood ''Compounding Pharmacies'' are able to fill these prescriptions and mail if needed. Your prescribing doctor can help you locate a compounding pharmacy in your area/state or you can look online.<ref>[http://www.wikihow.com/Find-a-Compounding-Pharmacy Finding a Compounding Pharmacy - WIKI How]</ref>

===Other countries ===
The LDN Research Trust lists pharmacies in multiple countries.<ref name="sources">{{Cite web |url =https://ldnresearchtrust.org/ldn-pharmacists|website=LDN Research Trust|title =LDN Pharmacists |access-date =}}</ref>

== Clinical trials ==
A large number of clinical trials have been completed for LDN recently, although none have looked at the effect of LDN on symptoms of [[myalgic encephalomyelitis]]/[[chronic fatigue syndrome]]. Research has been carried out on patients with MS, [[Chronic Regional Pain Syndrome]], FMS, [[Irritable bowel syndrome|Irritable Bowel Syndrome]] (IBS), Ulcerative Colitis, Skin Disorders and a range of other illnesses.<ref name="trials">{{Cite web|url=https://www.ldnresearchtrust.org/ldn-clinical-trials|title=Clinical Trials|website=LDN Research Trust|access-date=2019-01-21}}</ref>

==When, How To Take ==
Dr Whitaker states that the ideal dose is different for each person. Some doctors recommend starting at 1mg.<ref name="LDN-now">{{Cite web|url=http://www.ldnnow.com/48591/90512.html|title=LDN Dosing|last=LDN Now|first=|authorlink=|date=|website=|access-date=2018-02-01}}</ref> Common dosages are 1.5mg, 3mg, 4.5mg.<ref>{{Cite web|url=https://www.amymyersmd.com/2017/05/low-dose-naltrexone/|title=Low-Dose Naltrexone for Autoimmunity?|last=Myers|date=2017-05-02|website=Amy Myers MD|language=en-US|access-date=2019-02-02|first=Amy|authorlink=|archive-url=|archive-date=|url-status=}}</ref><ref name=":1">{{Cite web|url=https://www.drwhitaker.com/what-is-low-dose-naltrexone|title=What is Low-Dose Naltrexone?|last=Dr Whitaker|first=|authorlink=|date=|website=www.drwhitaker.com|language=en|archive-url=|archive-date=|access-date=2019-01-21}}</ref><ref name="chronicpain" /> When beginning use of LDN, the drug must be stepped up over 6-8+ weeks as it may keep you awake; discuss how best to do this with your doctor and pharmacist.<ref name=":1" /><ref>{{Cite web|url=https://collierdrug.com/low-dose-naltrexone-ldn/|title=Low Dose Naltrexone (LDN) – Collier Drug Store|last=|first=|authorlink=|date=|website=collierdrug.com|at=What dose of Low Dose Naltrexone (LDN) is best?|archive-url=|archive-date=|access-date=2019-02-02}}</ref><ref name="chronicpain" />

LDN is usually taken at bedtime. Some people take LDN in the morning to minimize [[Sleep dysfunction|sleep disturbance]], [[insomnia]], and vivid dreams.<ref name="chronicpain" />

== Talks and webinars==
*2012, [https://www.youtube.com/watch?v=z0p0ykSzy9o LDNscience® Presents - How LDN (Low Dose Naltrexone) Works]<ref>{{Cite web|url=https://www.youtube.com/watch?v=z0p0ykSzy9o|title=LDNscience® Presents - How LDN (Low Dose Naltrexone) Works|last=|first=|authorlink=|date=Dec 20, 2012|website=YouTube|publisher=LDNscience|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''LDNscience® Presents - How LDN (Low Dose Naltrexone) Works'' By LDNscience">https://www.youtube.com/watch?v=z0p0ykSzy9o</embedvideo>

*2015, [https://www.youtube.com/watch?v=8a-ULCaarCQ Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez]<ref>{{Cite web|url=https://www.youtube.com/watch?v=8a-ULCaarCQ|title=Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez|last=Carnahan|first=Jill|authorlink=|last2=Vasquez|first2=Alex|authorlink2=|date=Nov 30, 2015|website=YouTube|publisher=Alex Vasquez|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Functional Medicine & LDN (low-dose naltrexone) with Drs Carnahan and Vasquez '' By Alex Vasquez">https://www.youtube.com/watch?v=8a-ULCaarCQ</embedvideo>

*2015, [https://www.youtube.com/watch?v=Qnr51yU9ih8 Is Low Dose Naltrexone (LDN) for you?]<ref>{{Cite web|url=https://www.youtube.com/watch?v=Qnr51yU9ih8|title=1:05 / 7:05 Is Low Dose Naltrexone (LDN) for you?|last=|first=|authorlink=|date=Oct 11, 2015|website=YouTube|archive-url=|archive-date=|access-date=}}</ref>
<embedvideo service="youtube" dimensions="400" alignment="center" container="frame" description="''Is Low Dose Naltrexone (LDN) for you?'' By Integrative Health Solutions">https://www.youtube.com/watch?v=Qnr51yU9ih8</embedvideo>

==Notable studies==
* 2009, Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study<ref>{{Cite journal|last=Younger|first=Jarred|author-link=Jarred Younger|last2=Mackey|first2=Sean|author-link2=|date=May 2009|title=Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study|url=https://academic.oup.com/painmedicine/article-lookup/doi/10.1111/j.1526-4637.2009.00613.x|journal=Pain Medicine|language=en|volume=10|issue=4|pages=663–672|doi=10.1111/j.1526-4637.2009.00613.x|issn=1526-2375|pmc=2891387|pmid=19453963|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ (Full text)]
* 2013, Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels<ref name="Younger2013" /> - [https://onlinelibrary.wiley.com/doi/full/10.1002/art.37734 (Full text)]
* 2014, The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain<ref name="Younger2014" /> - [http://link.springer.com/article/10.1007%2Fs10067-014-2517-2 (Full text)]
*2018, Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat [[Gulf War Illness]]<ref name="Brewer, 2018" /> - [https://www.tandfonline.com/doi/full/10.1080/21641846.2018.1477034 (Abstract)]

* 2018, Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization<ref>{{Cite journal|last=Toljan|first=Karlo|last2=Vrooman|first2=Bruce|date=2018-09-21|title=Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization|url=http://www.mdpi.com/2076-3271/6/4/82|journal=Medical Sciences|language=en|volume=6|issue=4|pages=82|doi=10.3390/medsci6040082|issn=2076-3271|pmc=6313374|pmid=30248938}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/#!po=19.1057 (Full text)]

* 2019, Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)<ref name="Polo2019">{{Cite journal|last=Polo|first=Olli|author-link=Olli Polo|last2=Pesonen|first2=Pia|author-link2=|last3=Tuominen|first3=Essi|author-link3=|date=2019-11-19|title=Low-dose naltrexone in the treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)|url=https://www.tandfonline.com/doi/full/10.1080/21641846.2019.1692770|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=7|issue=4|pages=207-217|doi=10.1080/21641846.2019.1692770|issn=2164-1846|pmc=|pmid=|access-date=|quote=|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/21641846.2019.1692770?journalCode=rftg20 (Abstract)]
* 2020, Low-dose naltrexone as a treatment for chronic fatigue syndrome<ref>{{Cite journal|last=Bolton|first=Monica Jane|author-link=|last2=Chapman|first2=Bryan Paul|author-link2=|last3=Van Marwijk|first3=Harm|author-link3=|date=Jan 2020|title=Low-dose naltrexone as a treatment for chronic fatigue syndrome|url=http://casereports.bmj.com/lookup/doi/10.1136/bcr-2019-232502|journal=BMJ Case Reports|language=en|volume=13|issue=1|pages=e232502|doi=10.1136/bcr-2019-232502|issn=1757-790X|pmc=6954765|pmid=31911410|access-date=|quote=|via=}}</ref> - [https://casereports.bmj.com/content/bmjcr/13/1/e232502.full.pdf (Full text)]
*2021, Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment<ref name="Cabanas2021">{{Cite journal|title=Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment|date=2021|url=https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806|journal=Frontiers in Immunology|volume=12|issue=|pages=687806|last=Cabanas|first=Helene|author-link=Hélène Cabanas|last2=Muraki|first2=Katsuhiko|author-link2=|last3=Eaton-Fitch|first3=Natalie|author-link3=Natalie Eaton-Fitch|last4=Staines|first4=Donald Ross|author-link4=Donald Staines|last5=Marshall-Gradisnik|first5=Sonya|author-link5=Sonya Marshall-Gradisnik|doi=10.3389/fimmu.2021.687806|pmc=PMC8313851|pmid=34326841|access-date=|issn=1664-3224|quote=|via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fimmu.2021.687806/full (Full text)]

==See also==
*[[Endorphin]]
*[[Brain#Microglia|Microglia]]
*[[Oxymatrine]]
*[[The LDN Book]]

==Learn more==
*[https://ldnresearchtrust.org/sites/default/files/Doctors-info-pack-US.pdf Low-dose Naltrexone (LDN) Doctor's Fact Sheet 2014] - LDN Research Trust
*[https://www.ldnresearchtrust.org LDN Research Trust]<ref>{{Cite web|url=https://www.ldnresearchtrust.org/|title=Low Dose Naltrexone {{!}}|website=LDN Research Trust|access-date=2019-02-02}}</ref>
*[https://www.ldnresearchtrust.org/content/low-dose-naltrexone-and-chronic-pain-pradeep-chopra-md Low Dose Naltrexone and chronic pain]<ref name="chronicpain" />
*[https://en.wikipedia.org/wiki/Naltrexone Wikipedia - Naltrexone]
*[http://www.ldnnow.com/ LDN Now]
*[https://www.ldnscience.org/ LDN Science - MedInsight Research Institute]
*2015, [https://www.ncbi.nlm.nih.gov/books/NBK390569/ The Use of Naltrexone in Low Doses Beyond the Approved Indication]<ref name="NBK390569">{{Citation|url=https://www.ncbi.nlm.nih.gov/books/NBK390569/|title=The Use of Naltrexone in Low Doses Beyond the Approved Indication|last=Ringerike|first=Tove|last2=Pike|first2=Eva|last3=Nevjar|first3=Janicke|last4=Klemp|first4=Marianne|publisher=NIPH|year=2015|isbn=|location=}}</ref>
* [https://selfhacked.com/2016/06/20/top-22-scientific-health-benefits-low-dose-naltrexone/ Top 15 Scientific Health Benefits of Low Dose Naltrexone] (2016)
*[https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/low-dose-naltrexone-ldn-fibromyalgia-chronic-fatigue-syndrom/ Low Dose Naltrexone Resource Center for Fibromylgia and ME/CFS] (2019)
*2016, [http://www.rheumatologyadvisor.com/fibromyalgia/using-low-dose-naltrexone-in-fibromyalgia/article/478182/ Low-Dose Naltrexone as Adjunctive Pharmacotherapy for Fibromyalgia]
*[[The LDN Book]] - Lisa Elsegood (2016)
*[http://www.cortjohnson.org/blog/2016/02/04/low-dose-naltrexone-combo-chronic-fatigue/ 2016, Low Dose Naltrexone Drug Combination Proposed for Chronic Fatigue Syndrome] - Health Rising, by [[Cort Johnson]] (2016)
*[https://cfsremission.wordpress.com/2016/03/19/review-of-low-dose-naltrexone/ Low dose naltrexone: side effects and efficacy in gastrointestinal disorders] by [[CFS Remission]] (2016)
*Opioid blocking and alcohol - [http://www.well.com/user/woa/revia/reviafaq.htm FAQ About Naltrexone Treatment for Alcoholism - 10.]
*[https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-for-fibromyalgia Low Dose Naltrexone for Fibromyalgia] (2018)
* [https://www.cfspharmacy.pharmacy/blog/post/low-dose-naltrexone-therapy-for-crohn-s-disease Low Dose Naltrexone Therapy for Crohn's Disease] (2018)
* [https://www.facebook.com/groups/200010163370187 LDN LOW DOSE NALTREXONE FOR ME/CFS MYALGIC ENCEPHALOMYELITIS & FIBROMYALGIA]

==References==
<references>
<ref name="Brewer, 2018">{{Cite journal
| last1 = Brewer | first1 = Kori L. | authorlink1 =
| last2 = Mainhart | first2 = Allison | authorlink2 =
| last3 = Meggs | first3 = William J. | authorlink3 =
| title = Double-blinded placebo-controlled cross-over pilot trial of naltrexone to treat Gulf War Illness
| journal = Fatigue: Biomedicine, Health & Behavior | volume = 6 | issue = 3 | pages = 132-140
| date = 2018
| pmid = | url = https://ldnresearchtrust.org/double-blinded-placebo-controlled-cross-over-pilot-trial-naltrexone-treat-gulf-war-illness-abstract
| doi = 10.1080/21641846.2018.1477034}}</ref>
<ref name="Younger2009">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Mackey | first2 = Sean | authorlink2 = Sean Mackey
| title = Fibromyalgia Symptoms Are Reduced by Low-Dose Naltrexone: A Pilot Study
| journal = Pain Med | volume = 10 | issue = 4 | pages = 663–672
| date = Apr 22, 2009
| pmid = 2891387 | doi = 10.1111/j.1526-4637.2009.00613.x
| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891387/ }}</ref>
<ref name="Younger2013">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Noor | first2 = Noorulain | authorlink2 = Noorulain Noor
| last3 = McCue | first3 = Rebecca | authorlink3 = Rebecca McCue
| last4 = Mackey | first4 = Sean | authorlink4 = Sean Mackey
| title = Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels
| journal = Arthritis Rheum | volume = 65 | issue = 2 | pages = 529-38
| date = Jan 28, 2013
| pmid = 23359310 | doi = 10.1002/art.37734
| url = http://onlinelibrary.wiley.com/enhanced/doi/10.1002/art.37734/}}</ref>
<ref name="Mackey2009">{{Cite web
| last1 = Mackey | first1 = Sean | authorlink1 = Sean Mackey
| title = An Update on Fibromyalgia
| publisher = Research Channel (USA)
| date = May 1, 2009
| url = https://www.youtube.com/watch?v=jtc2JARVpPw}}</ref>
<ref name="Younger2014">{{Cite journal
| last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Parkitny | first2 = Luke | authorlink2 = Luke Parkitny
| last3 = McLain | first3 = David | authorlink3 = David McLain
| title = The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain
| journal = Clin Rheumatol | volume = 33 | issue = 4 | pages = 451-459
| date = Feb 15, 2014
| pmid = 24526250 | doi = 10.1007/s10067-014-2517-2
| url = http://link.springer.com/article/10.1007%2Fs10067-014-2517-2}}</ref>
<ref name="Younger20160329sh">{{Cite web | last1 = Younger | first1 = Jarred | authorlink1 = Jarred Younger
| last2 = Cohen | first2 = Joseph M | authorlink2 = Joseph Cohen
| title = Dr. Jarred Younger: Cutting Edge Research on CFS, Neuroinflammation, Pain, and Fatigue
| type = video interview with transcript
| publisher = Self Hacked Blog
| date = Mar 29, 2016
| url = http://selfhacked.com/2016/03/29/dr-jared-younger-cutting-edge-research-on-cfs-neuroinflammation-pain-and-fatigue/#Leptin_and_Chronic_Fatigue_Syndrome}}</ref>
</references>

[[Category:Potential treatments]]
[[Category:Anti-inflammatories]]
[[Category:Analgesics]]

Leptin

2021-05-17T06:23:46Z

Pookey:/* Learn more */

[[File:Leptin.png|alt=A computer graphic drawing of leptin.|thumb|Leptin]]
'''Leptin''' is a hormone involved in energy expenditure. Blood leptin levels vary exponentially with body fat mass (not linearly). Higher leptin levels are correlated with higher levels of inflammation.

==Purpose==
Leptin is primarily produced in the adipocytes of white adipose (fat) tissue. It helps to regulate energy balance by inhibiting feelings of hunger.

==In M.E.==
Two studies found correlation between leptin levels and symptom severity.<ref name="Younger2013" /><ref name="MDavis2017" /> Another study found raised leptin levels in patients.<ref>{{Cite journal|last1=Hornig|first1=M|authorlink1=Mady Hornig|last2= Montoya|first2=JG|authorlink2=Jose Montoya|last3=Klimas|first3=NG|authorlink3=Nancy Klimas|last4=Levine|first4=SM|authorlink4=Susan Levine|last5=Felsenstein|first5=D|authorlink5=Donna Felsenstein|last6=Bateman|first6=L| authorlink6=Lucinda Bateman|last7=Peterson|first7=DL|authorlink7=Daniel Peterson|last8=Gottschalk|first8=CG|authorlink8=Gunnar Gottschalk|last9=Schultz|first9 = AF|authorlink9=Andrew Schultz|last10=Che|first10=X|authorlink10=Xiaoyu Che|last11=Eddy| first11=ML|authorlink11=Meredith Eddy|last12=Komaroff|first12=AL|authorlink12=Anthony Komaroff|last13=Lipkin|first13=WI|authorlink13=Ian Lipkin|title=Distinct plasma immune signatures in ME/CFS are present early in the course of illness|journal=Science Advances|volume=1|issue=1|page=|date=2015|pmid = |doi =10.1126/sciadv.1400121|url = http://advances.sciencemag.org/content/1/1/e1400121.full}}</ref> Several other studies have been published on leptin in [[ME]] and [[CFS]].<ref name="Cleare2001" /><ref name="Cleare2003" /><ref name="Covelli2005" />

Australian researcher [[Michael Musker]] is undertaking a study entitled "Chronic fatigue syndrome: Leptin, interleukin 6 and clinical symptoms".<ref>[http://sacfs.asn.au/news/2016/02/02_13_sahmri_calling_for_research_participants.htm South Australian Health And Medical Research Institute (SAHMRI) Calling For Research Participants]</ref><ref>{{Cite journal|last=Musker|first=Michael|last2=McArthur|first2=Alexa|last3=Munn|first3=Zachary|last4=Wong|first4=Ma-Li|date=2020-11-02|title=Circulating leptin levels in patients with myalgic encephalomyelitis, chronic fatigue syndrome or fibromyalgia: a systematic review protocol|url=https://journals.lww.com/10.11124/JBIES-20-00125|journal=JBI Evidence Synthesis|language=en|volume= 19| issue =
3 | pages = 695-701|doi=10.11124/JBIES-20-00125|issn=2689-8381}}</ref>

==Learn more==
*2014, [http://phoenixrising.me/archives/24695 Phoenix Rising - Leptin]
*2015, [https://www.healthrising.org/blog/2015/01/26/getting-younger-leptin-chronic-fatigue-fibromyalgia/ Getting “Younger”: Leptin, Chronic Fatigue Syndrome and Fibromyalgia]
*2015, [https://www.youtube.com/watch?v=bFwAyrb5p34 Pandora Research Report: Jarred Younger - Leptin in the Role of Neuroinflammation, Pain and Fatigue] ([[Jarred Younger]])
*2015, [http://www.drcourtneycraig.com/blog/2015/1/27/leveraging-leptin Leveraging Leptin] - Dr [[Courtney Craig]]
*2016 [https://selfhack.com/blog/dr-jared-younger-cutting-edge-research-on-cfs-neuroinflammation-pain-and-fatigue/ Self Hacked Interview]
*2016, [http://www.healthrising.org/blog/2016/07/22/fatigue-pain-hormone-leptin-shows-time-fibromyalgia/ The Fatigue and Pain Hormone? Leptin Shows Up Again – in Fibromyalgia]
*2016, [http://selfhacked.com/2016/03/22/all-about-leptin-its-role-in-chronic-inflammation-cfs-and-weight/ All About Leptin: Its Role in Chronic Inflammation, CFS and Weight]
*2017, [https://med.stanford.edu/news/all-news/2017/07/researchers-id-biomarkers-associated-with-chronic-fatigue-syndrome.html Researchers identify biomarkers associated with chronic fatigue syndrome severity]

==See also==
*[[:Category:Diets|Diets]]
*[[Jarred Younger]]
*[[Ghrelin]]

==References==
<references>
<ref name="MDavis2017">{{Citation
| last1 = Montoya | first1 = JG | authorlink1 = Jose Montoya
| last2 = Holmes | first2 = TH | authorlink2 =
| last3 = Anderson | first3 = JN | authorlink3 =
| last4 = Maecker | first4 = HT | authorlink4 =
| last5 = Rosenberg-Hasson | first5 = Y | authorlink5 =
| last6 = Valencia | first6 = IJ | authorlink6 = Ian Valencia
| last7 = Chu | first7 = L | authorlink7 = Lily Chu
| last8 = Younger | first8 = JW | authorlink8 = Jarred Younger
| last9 = Tato | first9 = CM | authorlink9 =
| last10 = Davis | first10 = MM | authorlink10 = Mark Davis
| title = Cytokine signature associated with disease severity in chronic fatigue syndrome patients
| journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 34 | pages = E7150-E7158
| date = 2017
| pmid = 28760971
| doi = 10.1073/pnas.1710519114
}}
</ref>
<ref name="Younger2013">{{Citation
| last1 = Stringer | first1 = EA | authorlink1 = EA Stringer
| last2 = Baker | first2 = KS | authorlink2 = KS Baker
| last3 = Carroll | first3 = IR | authorlink3 =
| last4 = Montoya | first4 = JG | authorlink4 = Jose Montoya
| last5 = Chu | first5 = L | authorlink5 = Lily Chu
| last6 = Maecker | first6 = HT | authorlink6 = HT Maecker
| last7 = Younger | first7 = JW | authorlink7 = Jarred Younger
| title = Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology
| journal = Journal of Translational Medicine |volume = 11 |issue = 1|page= 93
| date = 2013
| pmid = 23570606
| doi = 10.1186/1479-5876-11-93
}}
</ref>
<ref name="Covelli2005">{{Citation
| last1 = Covelli | first1 = V | authorlink1 = V Covelli
| last2 = Passeri | first2 = ME | authorlink2 = ME Passeri
| last3 = Leogrande | first3 = D | authorlink3 = D Leogrande
| last4 = Jirillo | first4 = E | authorlink4 = E Jirillo
| last5 = Amati | first5 = L | authorlink5 = L Amati
| title = Drug targets in stress-related disorders
| journal = Current Medicinal Chemistry | volume = 12 | issue = 15 | page = 1801 - 1809
| date = 2005
| pmid = 16029148
| doi =
}}
</ref>
<ref name="Cleare2003">{{Citation
| last1 = Cleare | first1 = Anthony J | authorlink1 = Anthony Cleare
| title = The neuroendocrinology of chronic fatigue syndrome
| journal = Endocrine Reviews | volume = 24 | issue = 2 | page = 236-252
| date = 2003
| pmid = 12700181
| doi = 10.1210/er.2002-0014
}}
</ref>
<ref name="Cleare2001">{{Citation
| last1 = Cleare | first1 = Anthony J | authorlink1 = Anthony Cleare
| last2 = O'Keane | first2 = V | authorlink2 = V O'Keane
| last3 = Miell | first3 = J | authorlink3 = J Miell
| title = Plasma leptin in chronic fatigue syndrome and a placebo-controlled study of the effects of low-dose hydrocortisone on leptin secretion
| journal = Clinical Endocrinology | volume = 55 | issue = 1 | page = 113-119
| date = 2001
| pmid = 11453960
| doi =
}}
</ref>
</references>

[[Category:Neurotransmitters and hormones]]
[[Category:Hormones]]