Will LDN therapy improve the quality of life of patients with fibromyalgia?

In the treatment of fibromyalgia, pharmacological therapy, physiotherapy and psychotherapy are used. It is extremely important that people with a diagnosis of fibromyalgia receive appropriate support from doctors and loved ones, to whom it is necessary to explain exactly what the disease is and what it can do. show symptoms, as well as warn about the ineffectiveness of treatment and its chronic nature. People suffering from fibromyagia should have easy access to appropriate forms of therapy to help them cope with the disease. Unfortunately, a common problem is misdiagnosis, which translates into the lack or improper treatment of this disease that hinders everyday functioning.Fibromyalgia is a disease that can be and is quite often misdiagnosed as other conditions due to the similarity of symptoms. Often, women complaining of pain in places typical of fibromyalgia are considered as hypochondriacs for whom the recommended treatment are sedatives. Most often hydroxyzine or benzodiazepines that can be addictive. It is worth remembering, that the diseases that are often misdiagnosed as fibromyalgia include diseases that rheumatologists treat i.e. rheumatoid arthritis (RA), lupus and ankylosing spondylitis. It happens that fibromyalgia is confused with stiff man syndrome - a severe neurological disease characterized by, among others, strong and painful muscle contractions. In the case of symptoms such as generalized musculoskeletal pain and increased sensitivity to tactile stimuli, it is worth consulting an experienced specialist in order to exclude other diseases and make a correct diagnosis. It is also worth remembering that fibromyalgia can accompany other diseases such as irritable bowel syndrome or Hashimoto's disease. Thus, patients with fibromyalgia may also be patients of endocrinologists or gastroenterologists, who very often also specialize in internal medicine, which increases the chance that they will be able to make the correct diagnosis when treating diseases typical of their specific specialization. In April this year, the Australian Journal of General Practice published a scientific publication entitled: "Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis”. The authors of the article reviewed the literature published so far to assess the effectiveness of low-dose naltrexone therapy (LDN therapy) in the treatment of fibromyalgia and to highlight potential challenges and future directions in this field. Fibromyalgia, as the researchers write, is a multifaceted disorder that poses a serious challenge to healthcare professionals. Unfortunately, current treatment options for fibromyalgia are mainly aimed at relieving the symptoms of the disease and mainly include medications such as antidepressants, anticonvulsants and painkillers. However, as is well known, these drugs may not be effective in all people, and in some people they may even cause side effects that limit their use. Complementary therapies such as tai chi, qigong and yoga have also been suggested as potential treatment options in various publications. Despite the availability of various treatment options, many people with fibromyalgia, including our patients in Poland, still experience persistent and unpleasant pain symptoms. This phenomenon indicates the need to search for other effective alternative methods of treatment. Low-dose naltrexone (LDN) is a type of therapy that has been gaining more and more interest among many doctors in recent years as a potential treatment option for various diseases, including long-COVID, supportive treatment of fertility disorders, and fibromyalgia. LDN works, among others in the mechanism of blocking opioid receptors in the brain, which leads to increased production of endorphins, which are natural painkillers. Naltrexone in LDN therapy also has a systemic anti-inflammatory effect.The results of several recently published scientific papers have shown that LDN may be effective in reducing the symptoms of fibromyalgia, including pain, fatigue and sleep disturbances. However, more research is needed to confirm these findings, and the optimal dose and duration of LDN treatment remain unclear. Despite these doubts, many people also among patients with fibromyalgia in Poland treated off-label by some rheumatologists report a significant improvement in symptoms after LDN treatment. While LDN seems promising as a potential treatment option for fibromyalgia, there are several challenges ahead that need to be considered. One of them is the lack of solid clinical evidence supporting the use of LDN in the treatment of fibromyalgia, so it is worth starting well-constructed clinical trials now. In addition, it should be noted that LDN is not officially licensed for the treatment of fibromyalgia and is still an off-label treatment. Future research should focus on addressing these issues. They should also take into account the optimal duration of drug use, because LDN therapy, due to the need to systematically increase doses and reach the target dose of usually 4.5 mg naltrexone/day, is spread over several weeks, and the positive effects reported by patients often appear only after after at least 12 weeks of treatment. Some of the studies, the results of which are later published, last shorter, which, due to the too short observation period, often makes them of little use. It is also worth paying attention to the potential conflict of interest of the authors and taking it into account when interpreting the final results. LDN therapy is undoubtedly a cheap therapy and appears to be very safe, even with long-term use. It is therefore worth asking the question why some of the studies, including pilot studies, despite promising results, are not or have not been continued? To sum up - in the light of the results of studies to date, taking into account the appropriate time of observation of patients and the correct methodology, LDN therapy seems to be promising, and at the same time safe and showing significantly fewer side effects than other therapies - an option, among others, in the treatment of fibromyalgia, which justifies further research on the evaluation its effectiveness. Perhaps in the near future, it will become a standard complementary treatment to the previous, often ineffective treatment of patients with medications frequently used in monotherapy. Marek Derkacz, MD, PhD, MBA

The main treatments for fibriomyalgia are drug therapy, physiotherapy and psychotherapy. It is extremely important that people with a diagnosis of fibromyalgia receive adequate support from doctors and loved ones, who should be explained in detail what the disease is and what it can

give symptoms, and warn of the ineffectiveness of treatment and its chronic nature. People suffering from fibriomygia should have easy access to appropriate forms of therapy to help them cope with the disease. Unfortunately, a common problem is misdiagnosis, which translates into a lack of or inadequate treatment for this disease that impedes daily functioning.

Fibromyalgia is a disease that can be and is quite often confused with other conditions due to the similarity of symptoms. Often, women who complain of pain in the typical fibromyalgia locations are considered hypochondriacs for whom the recommended treatment is sedative therapy. Most often hydroxyzine or benzodiazepines, which can be addictive.

It is worth remembering that the diseases that are often confused with fibromyalgia include, in particular, diseases that rheumatologists treat on a daily basis, namely rheumatoid arthritis (RA), lupus and ankylosing spondylitis. Sometimes fibromyalgia is sometimes confused with stiff man syndrome - a severe neurological disease characterized by, among other things, strong and painful muscle spasms. For symptoms such as generalized musculo-articular pain and increased sensitivity to tactile stimuli, it is worth consulting an experienced specialist to rule out other diseases and make the correct diagnosis.

It is also worth remembering that fibromyalgia can accompany other diseases such as irritable bowel syndrome or Hashimoto's disease. Patients with fibromyalgia can therefore also be concomitant patients of endocrinologists or gastrointestinal specialists, who very often also have a specialty in internal medicine, which increases the chance that they will be able to make the right diagnosis when treating diseases typical of their specific specialty.

In April of this year, the Australian Journal of General Practice published a scientific paper titled: "Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis," which translates to: "Low-dose naltrexone in the treatment of fibromyalgia: A systematic review and narrative synthesis." The authors of the article reviewed the literature published to date to assess the efficacy of low-dose naltrexone therapy (LDN therapy) in the treatment of fibromyalgia and to highlight potential challenges and future directions in the field.

Fibromyalgia, the researchers write, is a multifaceted disorder that poses a serious challenge for health care professionals. Unfortunately, current treatment options for fibromyalgia are mainly aimed at relieving the symptoms of the condition and mainly include medications such as antidepressants, anticonvulsants and painkillers. However, as is well known, these medications may not be effective in all people, and in some may even cause side effects that limit their use.

Various publications have also suggested complementary therapies such as tai chi, qigong and yoga as potential treatment options. Despite the availability of various treatment options, many people with fibromyalgia, including among our patients in Poland, continue to experience persistent and unpleasant pain symptoms. This phenomenon indicates the need to seek other effective alternative treatments as well.

Low-dose naltrexone (LDN) is a type of therapy that has been gaining interest among many physicians in recent years as a potential treatment option for a variety of conditions, including long-COVID, adjunctive treatment of fertility disorders, as well as fibromyalgia. Among other mechanisms, LDN works by blocking opioid receptors in the brain, leading to increased production of endorphins, which are natural painkillers. Naltrexone in LDN therapy also exhibits systemic anti-inflammatory effects.

The results of several recently published scientific papers have shown that LDN can effectively reduce fibromyalgia symptoms, including pain, fatigue and sleep disturbances. However, further studies are needed to confirm these findings, and the optimal dose and duration of LDN treatment remain unclear. Despite these doubts, many people also among fibromyalgia patients in Poland treated off-label by some rheumatologists report significant improvement in symptoms after LDN treatment.

While LDN appears promising as a potential treatment option for fibromyalgia, there are several challenges to consider. One is the lack of solid clinical evidence supporting the use of LDN for the treatment of fibromyalgia, so it makes sense to start well-constructed clinical trials now. In addition, it should be noted that LDN is not officially registered for the treatment of fibromyalgia and is still an off-label treatment. Future studies should focus on addressing these issues. They should also take into account the optimal duration of the drug's use, as LDN therapy, due to the need for systematic dose escalation and the target to reach a dose of usually 4.5 mg of naltrexone/day, is spread over several weeks, and positive effects reported by patients often appear only after at least 12 weeks of treatment.

Some of the studies whose results are later published last for a shorter period of time, which, already due to too short a follow-up period, often makes them of little use. It is also worth paying attention to the authors' potential conflict of interest and taking it into account when interpreting the final results. LDN therapy is undoubtedly an inexpensive therapy and appears to be very safe, even with long-term use. It is therefore worth asking why some studies, including pilot studies despite promising results, are not or have not been continued? In conclusion - in light of the results of studies to date that take into account adequate follow-up time for patients and proper methodology, LDN therapy appears to be a promising - and safe, with significantly fewer side effects than other therapies - option for the treatment of fibromyalgia, among others, which justifies further research to evaluate its efficacy. Perhaps in the near future it will become a standard of treatment supplementing patients' existing, often not very effective treatment with drugs quite often used in monotherapy.

Dr. Marek Derkacz, MBA