Before on this site numerous posts have discussed how many feel dentists and oral surgeons prescribe (or in the past have prescribed) too many opioids for their patients to help manage pain of dental procedures like wisdom teeth removal, see for example the post Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal?. In recent years there have been investigations into alternatives to opioids for dental procedures and also for chronic pain management when opioids in the past were more regularly prescribed for as well. One such approach is to prescribe a combination of ibuprofen and acetaminophen as discussed in the articles New Research Being Conducted at Rutgers for Opioid Alternatives Could Lead to Less Potential Drug Abuse for those Having Wisdom Teeth Surgery and Reducing Opioids in Oral and Maxillofacial Surgery. Recently, there have been articles and studies exploring the use of low-dose naltrexone for chronic pain management and for potential use in orofacial pain management.
A low dose of the drug naltrexone is a potential alternative to addictive opioids and does not carry the risk of addiction. Low doses of naltrexone, ranging from 0.1 to 4.5 mg work by acting on a unique cellular pathway in the nervous system to deliver chronic pain relief. Low doses of naltrexone are currently off label and more on the fringes of medicine, as it it not approved by the FDA. Currently, high doses of naltrexone prescribed at 50 milligrams are used to treat addiction to opioids and alcohol. If patients are working with a physician to treat pain, they can potentially bring up low-dose naltrexone as a possible alternative to opioids for chronic pain or for pain management. At low doses, naltrexone restore some balance to the opioid system. Unfortunately, low doses of naltrexone may not be covered by insurance in the U.S. Low doses of naltrexone are also not an option for people who use alcohol or opioids regularly.
In recent years, studies like [1] and [2] have appeared strengthening claims of low doses of naltrexone as effective option for a treatment of chronic pain. In [1] the authors found a found a reduction in pain intensity, an improvement in quality of life, and a reduction in opioid use for patients with chronic pain. In studies like these, the authors mention the way low dose naltrexone works. They say that chronic pain causes the body to go through a sensitization process where the nervous system becomes more sensitive. Low-dose naltrexone targets the cells that cause the nervous system to be sensitized and as a result cause a reduction in the pain threshold and the nervous system sensitivity. Specifically the mechanism of low-dose naltrexone seems to be the modulation of the glial cells and release of inflammatory chemicals in the central nervous system. Therefore, low-dose naltrexone targets the overactive nervous system and actually addresses the cause of the pain to begin with instead of just masking symptoms.
So far low dose naltrexone seems to be more used and studied for chronic pain management instead of for temporary pain management that might happen after wisdom teeth surgery. Studies like [2] have found for example low dose naltrexone to reduce reduce symptoms related to chronic pain conditions such as multiple sclerosis, fibromyalgia, and inflammatory bowel conditions. A randomized control trial of low dose naltrexone would be needed to explore its potential for temporary pain management for procedures like wisdom teeth surgery. Even if such studies were to show strong evidence of low-dose naltrexone as an alternative to opioids that have been prescribed for wisdom teeth surgery, getting the drug companies and insurance companies around to actually using it may be a challenge. As mentioned in [3] naltrexone is a generic drug. Drug companies don’t have much interest in a new drug unless they can be the only maker of it which would involving getting a patent and being able to advertise it on television. Therefore, wide spread adoption of low-dose naltrexone as an alternative to opioids to manage pain after wisdom teeth removal may never occur.
- E. Hatfield and et al., “Use of low-dose naltrexone in the management of chronic pain conditions,” The Journal of the American Dental Association, 2020, vol. 151, no. 12, pp. 891-902.
- P. S. Kim and M. A. Fishman, “Low-Dose Naltrexone for Chronic Pain: Update and Systemic Review.“ Current Pain and Headache Reports, vol. 24, article no. 64, 2020.
- Alex Smith, “In Tiny Doses, An Addiction Medication Moonlights As Treatment For Chronic Pain,” KHN (Kaiser Health News), Sept. 26, 2019.