Low-dose naltrexone safe, effective for neuropathic corneal pain
SAN FRANCISCO — Treatment with low-dose naltrexone resulted in improvements in pain and quality of life scores without serious side effects among patients with neuropathic corneal pain, according to a presenter at the American Academy of Ophthalmology annual meeting.
“Neuropathic corneal pain is a disease that causes nerve damage and results in pain or discomfort,” Gabriela Dieckmann, MD, from the department of ophthalmology at Tufts Medical Center, said. “Low-dose naltrexone has been used as an off-label treatment for many neuropathic pain diseases, such as fibromyalgia and multiple sclerosis.”
Dieckmann and colleagues conducted a study to determine the efficacy and tolerability of low-dose naltrexone among patients with neuropathic corneal pain (n = 30). All participants were treated with low-dose naltrexone for at least 4 weeks and answered a questionnaire that evaluated ocular pain and quality of life. Patients with any pathology that may cause pain or discomfort were excluded from the study.
The researchers analyzed demographics, changes in pain scores, mean duration of treatment and side effects.
The most common comorbidities prior to treatment were dry eye disease and neuropsychiatric disease. All participants were taking previous systemic medications, mainly nortriptyline and followed by SSRIs.
Treatment with low-dose naltrexone over 14.03 ± 9.8 months reduced mean pain scores by 36.4% (from 4.8 ± 2.18 to 3.08 ± 2). Nearly half of participants (45.8%) showed improvements in pain by at least 50%. Additionally, 12.5% of patients had a positive percentage change in pain scores between 30% and 49.9% and 37.5% of patients improved by less than 30%. Quality of life scores also improved.
Only one patient demonstrated symptoms of a headache related to treatment, but did not discontinue therapy.
“Low-dose naltrexone can be effective as an adjunct treatment for neuropathic corneal pain,” Dieckmann said. “We need to have placebo-controlled studies. We are trying to find the best treatment, best solution for our patients and with low dose naltrexone we saw an improvement in our patients.” – by Alaina Tedesco
Reference: Dieckmann G. Low-dose naltrexone is effective and well tolerated in patients with neuropathic corneal pain. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: Dieckmann reports no relevant financial disclosures.