Low Dose Naltrexone – LDN Part Four
by Jeffrey Dach MD
Reflex Sympathetic Dystrophy RSD – and Fibromyalgia
Left Image: Bone Scan showing increased uptake left hand, positive for reflex sympathetic dystrophy, courtesy of medscape.com.
My previous articles on LDN discuss its use in Multiple Sclerosis (1,2) and Crohn’s Disease (3,4). This article deals with the use of LDN for Chronic Pain Syndromes of Fibromyalgia and Reflex Sympathetic Dystrophy, RSD.
Reflex Sympathetic Dystrophy, RSD, is a neurological disorder in which a minor injury to an extremity leads to a chronic and debilitating pain syndrome called Allodynia, a form of hypersensitivity to touch. Any minor brushing or touching the skin triggers a severely painful sensation which may in turn trigger muscle spasms. The sensory-motor feedback loop in the spinal cord is magnified. Typically, there is also disturbance of the sympathetic nervous system with increased vascular flow, discoloration and swelling of the extremity.
RSD Case Report
I recall one young female who had RSD of the leg. Many years ago, her leg had been struck by a car while she was a pedestrian. The injury was minor and she recovered quickly. However, there was residual neurologic damage. She had “allodynia”, severe pain would result from a light touch to the skin, and the leg immediately went into muscle spasms. Any minimal sensory input was magnified in a feedback loop to the motor neurons system which caused excessive uncontrollable muscle movements and spasms. She had been to numerous doctors, clinics, rehabilitation facilities, and nothing they did could halt the progression of the symptoms. The doctors had given her various psychoactive drugs and increasing doses of narcotic pain killers, providing some temporary relief, yet none was effective long term. She was now confined to a wheel chair and addicted to narcotics. Her future appeared bleak. However she had not yet been treated with LDN, and this was worth a try.
Low Dose Naltrexone is a capsule taken at night before sleep. Except for the fact that it is a narcotics blocker, there are no known adverse effects. Habitual users of narcotic pain pills (oxycodone, morphine, tramadol) will be thrown into drug withdrawal if they take LDN, so it is not advised for this group.
Radionuclide Bones Scans
Decades
ago when I was a nuclear medicine resident in training, we did
radionuclide bone scans on the RSD patients. The diagnosis was made by
increased uptake in the affected extremity (left image).(16-18)
As was usual in those days, diagnosis was way ahead of treatment for these disorders. Medical science had little to offer the RSD patient. If you can’t cure it, then the next best thing is to rename it. RSD has now been renamed “Complex Regional Pain Syndrome”.
Above left image: Bone scan showing increased activity in the left foot, indicating positive study for RSD, reflex sympathetic dystrophy, courtesy of medscape.com.
Successful Outcomes Using LDN
This is exactly why I found reports of successful outcomes using LDN for RDS so intriguing. RSD patients drag themselves from clinic to clinic having no effective treatment for the relentless progression of disease. They have little to offer except chronic narcotic addiction which is actually worse than the underlying disease.
Fibromyalgia Related to RSD
A number of studies and anecdotal reports show that LDN is useful for the fibromyalgia patient. (8-15) Perhaps Fibromyalgia and Chronic Regional Pain Syndrome are related in some way, since LDN seems to be effective for fibromyalgia as well. Perhaps the common thread is microglia activation in the central nervous system. LDN is an anti-inflammatory agent in the central nervous system, via action on microglial cells. (5)
According to Pradeep Chopra, MD ” In painful conditions such as Complex regional pain) and neuropathic pain, damage to the peripheral nerves shifts the glia to an activated state within the spinal cord….Glia are activated by trauma, injury, infection, opioids. When activated, glia release pro-inflammatory and neurotoxic factors (cytokines)….Drugs that block the effect of opioids (morphine) may help prevent activation of glia. Such drugs are naltrexone and naloxone. Low dose naltrexone (hence, LDN) may inhibit the activation of glia.”(6)
Nancy Sajben MD comments: ” New science shows naltrexone to be a potent anti-inflammatory — much stronger and with a much different mechanism than the weaker cox inhibitors such as ibuprofen, Vioxx, Celebrex, Naproxen with none of those adverse side effects. Dr. Hong reports that in animal studies, dextromethorphan is even stronger than naltrexone.”(20)
Chronic Major Depression - LDN Effective
Nancy Sajben MD suggests the anti-inflammatory activity of LDN explains its effectiveness in Major Depression refractory to the usual medications such as SSRI drugs. (19-20)
Medicinal Marijuana, Cannabis Sativa – Cannabinoids – Complex Regional Pain Syndrome
Another treatment modality showing success against RSD chronic refractory pain is medicinal marijuana.(21) “An oral cannabinoid was associated with up to 60% reductions in pain in 10 patients with refractory complex regional pain syndrome (CRPS), according to research presented at the 2010 annual World Congress on Pain in Montreal. The study investigators also reported that most of the patients were able to discontinue long-term opioid therapy and reported signi ficant improvements in quality of life.” (21) from Pharmacy Practice News. (More on this report)
Here is a review article on use of medicinal cannabis for allodynia, neuropathic pain and other chronic pain syndromes: Cannabinergic Pain Medicine Aggarwal_2013 Clinical Journal of Pain.
Cannabis for Fibromyalgia Pain – works better than prescription medications. “Medical marijuana is far more effective at treating symptoms of fibromyalgia than any of the three prescription drugs Cymbalta, Lyrica and Savella” (22)
Cannabis for Chronic Pain (23-25)
Current treatment of chronic pain leaved much to be desired. Chronic opiate use is not a good long term solution, yet is commonly employed. Studies show that in chronic patients on long term opiates, they report an augmented reduction in pain when vaporized cannabis is inhaled (25) Cannabis has been suggested as an adjunct or substitute for opiates in the treatment of chronic pain. This is our goal, to wean patients off addictive and dangerous opiates to safer alternatives. Any day a chronic pain patient can be weaned off opiates, that a good day.
A review of the literature showed 15 of 18 studies report analgesic effects of medical cannabis exceeding placebo, with improved sleep, and reporting no serious adverse effects.(23-25)
Medical cannabis is effective for chronic pain because it reduces perception of pain, is anti-inflammatory and affects voltage-gated sodium channels in nerves similar to action of neve blocking such such as lidocaine
Anecdotal Reports
Elaine’s Story – 20 years of opiate refractory RSD, finally better with when Elaine tries medicinal cannabis for pain.
Also See the next article: Neuropathic Pain, Part Two
Articles with Related Interest:
Remission from Crohns Disease with Low Dose Naltrexone
Low Dose Naltrexone LDN Part One
Low Dose Naltrexone LDN Part Two
Low Dose Naltrexone LDN Part Three
Suppression of Research on Medical Cannabis
Jeffrey Dach MD
7450 Griffin Road, Suite 180/190
Davie, Fl 33314
954-792-4663
www.jeffreydach.com
www.drdach.com
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www.bioidenticalhormones101.com
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Link to this article:http://wp.me/p3gFbV-1hZ
Links and references:
1) http://www.ncbi.nlm.nih.gov/
Am J Gastroenterol. 2007 Apr;102(4):820-8. Epub 2007 Jan 11.
Low-dose naltrexone therapy improves active Crohn’s disease.
Smith JP1, Stock H, Bingaman S, MauRger D, Rogosnitzky M, Zagon IS.
2) Dig Dis Sci. 2011 Jul;56(7):2088-97. doi:
10.1007/s10620-011-1653-7. Epub 2011 Mar 8. Therapy with the opioid
antagonist naltrexone promotes mucosal healing in active Crohn’s
disease: a randomized placebo-controlled trial.
Smith JP1, Bingaman SI, Ruggiero F, Mauger DT, Mukherjee A, McGovern CO, Zagon IS.
3) http://www.ncbi.nlm.nih.gov/
Exp Biol Med (Maywood). 2009 Nov;234(11):1383-92. doi:
10.3181/0906-RM-189. Endogenous opioids regulate expression of
experimental autoimmune encephalomyelitis: a new paradigm for the
treatment of multiple sclerosis.
Zagon IS1, Rahn KA, Turel AP, McLaughlin PJ.
4) http://www.ncbi.nlm.nih.gov/
Ann Neurol. 2010 Aug;68(2):145-50. doi: 10.1002/ana.22006.
Pilot trial of low-dose naltrexone and quality of life in multiple sclerosis.
Cree BA1, Kornyeyeva E, Goodin DS.
———————————————
5) http://www.ncbi.nlm.nih.gov/pubmed/24526250
Clin Rheumatol. 2014 Feb 15. [Epub ahead of print]
The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain. Younger J1, Parkitny L, McLain D.
Low-dose naltrexone (LDN) has been demonstrated to reduce symptom
severity in conditions such as fibromyalgia, Crohn’s disease, multiple
sclerosis, and complex regional pain syndrome. We review the evidence
that LDN may operate as a novel anti-inflammatory agent in the central
nervous system, via action on microglial 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. Despite
initial promise of efficacy, the use of LDN for chronic disorders is
still highly experimental. Published trials have low sample sizes, and
few replications have been performed. We cover the typical usage of LDN
in clinical trials, caveats to using the medication, and recommendations
for future research and clinical work. LDN may represent one of the
first glial cell modulators to be used for the management of chronic
pain disorders.
—–
6) http://www.ldnresearchtrust.
Low Dose Naltrexone and chronic pain – Pradeep Chopra, MD
In painful conditions such as Complex regional pain) and neuropathic
pain, damage to the peripheral nerves shifts the glia to an activated
state within the spinal cord. Glia are activated by trauma, injury,
infection, opioids. When activated, glia release pro-inflammatory and
neurotoxic factors (cytokines).
Drugs that block the effect of opioids (morphine) may help prevent
activation of glia. Such drugs are naltrexone and naloxone. Low dose
naltrexone (hence, LDN) may inhibit the activation of glia.
It should not be taken by patients who are on opioids or tramadol.
7) http://www.ncbi.nlm.nih.gov/
J Neuroimmune Pharmacol. 2013 Jun;8(3):470-6. doi: 10.1007/s11481-013-9451-y. Epub 2013 Apr 2.
Treatment of Complex Regional Pain Syndrome (CRPS) using low dose naltrexone (LDN). Chopra P1, Cooper MS.
Fibromyalgia
8) http://www.ncbi.nlm.nih.gov/
Arthritis Rheum. 2013 Feb;65(2):529-38. doi: 10.1002/art.37734.
Low-dose naltrexone for the treatment of fibromyalgia: findings of a
small, randomized, double-blind, placebo-controlled, counterbalanced,
crossover trial assessing daily pain levels. Younger J1, Noor N, McCue
R, Mackey S.
To determine whether low dosages (4.5 mg/day) of naltrexone reduce
fibromyalgia severity as compared with the nonspecific effects of
placebo. In this replication and extension study of a previous clinical
trial, we tested the impact of low-dose naltrexone on daily
self-reported pain. Secondary outcomes included general satisfaction
with life, positive mood, sleep quality, and fatigue.
METHODS:Thirty-one women with fibromyalgia participated in the
randomized, double-blind, placebo-controlled, counterbalanced, crossover
study. During the active drug phase, participants received 4.5 mg of
oral naltrexone daily. An intensive longitudinal design was used to
measure daily levels of pain.
RESULTS:When contrasting the condition end points, we observed a
significantly greater reduction of baseline pain in those taking
low-dose naltrexone than in those taking placebo (28.8% reduction versus
18.0% reduction; P = 0.016). Low-dose naltrexone was also associated
with improved general satisfaction with life (P = 0.045) and with
improved mood (P = 0.039), but not improved fatigue or sleep. Thirty-two
percent of participants met the criteria for response (defined as a
significant reduction in pain plus a significant reduction in either
fatigue or sleep problems) during low-dose naltrexone therapy, as
contrasted with an 11% response rate during placebo therapy (P = 0.05).
Low-dose naltrexone was rated equally tolerable as placebo, and no
serious side effects were reported.
CONCLUSION:The preliminary evidence continues to show that low-dose
naltrexone has a specific and clinically beneficial impact on
fibromyalgia pain. The medication is widely available, inexpensive,
safe, and well-tolerated. Parallel-group randomized controlled trials
are needed to fully determine the efficacy of the medication.
9)http://www.ncbi.nlm.nih.gov/
Pain Med. 2009 May-Jun;10(4):663-72. doi: 10.1111/j.1526-4637.2009.
Fibromyalgia is a chronic pain disorder that is characterized by
diffuse musculoskeletal pain and sensitivity to mechanical stimulation.
In this pilot clinical trial, we tested the effectiveness of low-dose
naltrexone in treating the symptoms of fibromyalgia. Participants
completed a single-blind, crossover trial with the following time line:
baseline (2 weeks), placebo (2 weeks), drug (8 weeks), and washout (2
weeks).
PATIENTS:Ten women meeting criteria for fibromyalgia and not taking an opioid medication.
INTERVENTIONS:Naltrexone, in addition to antagonizing opioid receptors
on neurons, also inhibits microglia activity in the central nervous
system. At low doses (4.5 mg), naltrexone may inhibit the activity of
microglia and reverse central and peripheral inflammation.
OUTCOME MEASURES:Participants completed reports of symptom severity
everyday, using a handheld computer. In addition, participants visited
the lab every 2 weeks for tests of mechanical, heat, and cold pain
sensitivity.
RESULTS:Low-dose naltrexone reduced fibromyalgia symptoms in the entire
cohort, with a greater than 30% reduction of symptoms over placebo. In
addition, laboratory visits showed that mechanical and heat pain
thresholds were improved by the drug. Side effects (including insomnia
and vivid dreams) were rare, and described as minor and transient.
Baseline erythrocyte sedimentation rate predicted over 80% of the
variance in drug response. Individuals with higher sedimentation rates
(indicating general inflammatory processes) had the greatest reduction
of symptoms in response to low-dose naltrexone.
CONCLUSIONS:We conclude that low-dose naltrexone may be an effective,
highly tolerable, and inexpensive treatment for fibromyalgia.
10)http://www.ncbi.nlm.nih.gov/
Psychosomatics. 2012 Nov-Dec;53(6):591-4. doi:
10.1016/j.psym.2011.11.006. Epub 2012 Apr 4. Is fibromyalgia an
endocrine/endorphin deficit disorder? Is low dose naltrexone a new
treatment option? Ramanathan S1, Panksepp J, Johnson B.
http://www.cortjohnson.org/
Low Dose Naltrexone (LDN) for Fibromyalgia and Chronic Fatigue Syndrome
12) http://med.stanford.edu/snapl/
Low-Dose Naltrexone Reduces the Symptoms of Fibromyalgia
Fibromyalgia Symptoms are reduced by low-dose naltrexone: A pilot study.
Pain Medicine (2009) Jarred W. Younger and Sean C. Mackey
13)http://chronicfatigue.about.
More Positive Results: Low-Dose Naltrexone for Fibromyalgia
By Adrienne DellwoFebruary 8, 201314)
14)http://www.amazon.com/forum/
Ms. Linda G. Zambanini says: I am an RN and Information Scientist who
researches novel adjuvant cancer therapies and i had fibromyalgia. I say
HAD because i no longer have fibromyalgia pain. I was in horrible pain
for 8 years prior to that. I initially learned about LDN as a novel
adjuvant for cancer – but soon learned it was also being used for
fibromyalgia. I have been on Low Dose Naltrexone (also called LDN) for
over a year now and the results have been nothing short of miraculous.
It is an old, off-patent drug that is compounded and used in dosages
less than a 1/10th of the original dosage. As such it functions as an
immunomodulator. That is, if one’s immune system is hyperactive as with
autoimmune diseases like SLE and MS it brings it down to normal; and if
one’s immune system is hypoactive as with cancer and HIV it brings it up
to normal. LDN is currently being being studied for fibromyalgia at
Stanford; but only after getting funding from the Fibromyalgia Society
since drug companies were not interested (in fact they are not
interested in it for cancer or MS or any other indication) – it is an
old off patent drug which one can buy for almost nothing. (I get 3
months worth from a compounding pharmacy in Colorado -Belmar Pharmacy –
for about $40). From the research i had done prior to taking it most
reported it took several months for it to work in the case of
fibromyalgia (much faster results with MS). Sure enough it did not work
for me initially, but knowing what to expect i continued it and after 2
months i became painfree! It had been so long since i had been pain free
i had almost forgotten what that was like. I hope everyone with
fibromyalgia looks into LDN. In fact if you know anyone with Cancer,
SLE, Crohns disease, MS, HIV etc… please let them know about LDN. There
are many videos on Youtube about LDN also. Just type LDN or low dose
naltrexone in the search box.www.lowdosenaltrexone.org http://snapl.stanford.edu/ldn/
15) http://snapl.stanford.edu/
The Use of Low Dose Naltrexone in Fibromyalgia
Interview with Dr. Jarred Younger, Instructor in the Department of
Anesthesia at Stanford University School of Medicine Topic: The Use of
Low Dose Naltrexone in Fibromyalgia-
16)http://emedicine.medscape.com/
Reflex Sympathetic Dystrophy Imaging Lawrence E Holder, MD; Chief Editor: Felix S Chew, MD
17)http://www.ncbi.nlm.nih.gov/
Arch Phys Med Rehabil. 1989 Feb;70(2):135-7.
Predictive value of the three-phase technetium bone scan in diagnosis of
reflex sympathetic dystrophy syndrome. Davidoff G1, Werner R, Cremer
S, Jackson MD, Ventocilla C, Wolf L.
http://www.ncbi.nlm.nih.gov/
Indian J Nucl Med. 2013 Jan;28(1):11-6. doi: 10.4103/0972-3919.116798.
Usefulness of asymmetry score on quantitative three-phase bone scintigraphy in the evaluation of complex regional pain syndrome.
Sampath S1, Mittal BR, Arun S, Sood A, Bhattacharya A, Sharma A.
18)http://www.ncbi.nlm.nih.gov/
Clin J Pain. 2010 Mar-Apr;26(3):182-9. doi: 10.1097/AJP.0b013e3181c20207.
Sensitivity and specificity of 3-phase bone scintigraphy in the
diagnosis of complex regional pain syndrome of the upper extremity.
Wüppenhorst N1, Maier C, Frettlöh J, Pennekamp W, Nicolas V.
Joint and bone alterations are seldom mentioned in the diagnostic
criteria for complex regional pain syndrome (CRPS) even though they are
important for long-term outcome. Altered periarticular bone metabolism
can be detected by 3-phase bone scintigraphy (TPBS). Although frequently
examining the diagnostic efficacy of TPBS is debatable.
METHODS:In all, 78 TPBS (45 CRPS/33 control group) were evaluated
qualitatively and quantitatively. Sensitivity and specificity of the
qualitative blinded reviewer analysis (n=57) compared with quantitative
region of interest (ROI)-based analysis over the metacarpophalangeal,
proximal, and distal interphalangeal joints (n=74) were evaluated.
Patients’ sex, age, duration of CRPS, inciting event, extent of joint
alteration, and handedness were included as covariables.
RESULTS:Qualitative blinded reviewer TPBS analysis had a high
specificity (83%-100%). However, sensitivity was 31% to 50%. Interrater
reliability was moderate (kappa score 0.56). Using the ROI-based
evaluation, the highest sensitivity (69%) and specificity (75%) (ROI
score > or =1.32) was shown for phase 3, whereas sensitivity of
phases 1 and 2 rapidly declined to 50%. Duration of CRPS until TPBS was
the only variable with significant impact on ROI scores of phase 3
(F=23.7; P=0.000; R=0.42). ROI scores declined with increasing duration
of CRPS.
DISCUSSION:In conclusion, TPBS is a highly specific tool for diagnosing
CRPS of the upper limb. ROI evaluation of phase 3 within the first 5
months after onset of CRPS is an appropriate additional diagnostic tool
to confirm or exclude CRPS of the upper extremity.
Nancy Sajben MD
19)http://painsandiego.com/2014/
Low dose naltrexone (LDN), novel anti-inflammatory treatment for chronic pain
02/15/2014 — Nancy Sajben MD
20) http://painsandiego.com/2009/
Nancy Sajben MD Low Dose Naltrexone “LDN” and Dextromethorphan off
label for Pain, RSD, Chronic Fatigue, Fibromyalgia, MS, Crohn’s Disease
05/26/2009 — Nancy Sajben MD
New science shows naltrexone to be a potent anti-inflammatory — much stronger and with a much different mechanism than the weaker cox inhibitors such as ibuprofen, Vioxx, Celebrex, Naproxen with none of those adverse side effects. Dr. Hong reports that in animal studies, dextromethorphan is even stronger than naltrexone.
(21) http://www.braatah.com/
Refractory CRPS Patients Discontinue Opiates With Cannabinoid Treatment by David Wild, Pharmacy Practice News
Montreal—An oral cannabinoid was associated with up to 60% reductions in
pain in 10 patients with refractory complex regional pain syndrome
(CRPS), according to research presented at the 2010 annual World
Congress on Pain in Montreal. The study investigators also reported that
most of the patients were able to discontinue long-term opioid therapy
and reported significant improvements in quality of life.
Marijuana Rated Most Effective for Treating Fibromyalgia
April 21st, 2014 by Pat Anson, Editor
Medical marijuana is far more effective at treating symptoms of fibromyalgia than any of the three prescription drugs approved by the Food and Drug Administration to treat the disorder.
That is one of the surprise findings in an online survey of over 1,300 fibromyalgia patients conducted by the National Pain Foundation and National Pain Report.
Cymbalta graphThe FDA has approved only three drugs – Cymbalta, Lyrica and Savella — for the treatment of fibromyalgia. Although they generate billions of dollars in annual sales for Pfizer, Eli Lilly, Forest Laboratories and other drug makers, most who have tried the medications say they don’t work.
——————————————————
23) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3939704/
Front Pharmacol. 2014 Mar 3;5:28. full text free
Targeting the endogenous cannabinoid system to treat neuropathic pain.
Lau BK, Vaughan CW. Pain Management Research Institute, Kolling
Institute of Medical Research, Northern Clinical School, University of
Sydney Sydney, NSW, Australia.
the currently recommended pharmacological treatments for neuropathic
pain display poor efficacy and illicit undesirable side effects
free full text
24) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243008/
Lynch M. E., Campbell F. (2011). Cannabinoids for treatment of chronic
non-cancer pain; a systematic review of randomized trials.
Br J Clin Pharmacol. Nov 2011; 72(5): 735–744.
Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials
Mary E Lynch1 and Fiona Campbell2 1Department Anesthesia, Psychiatry, Dalhousie University, Halifax, Canada
2Department of Anaesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
Dr Mary E. Lynch, MD, FRCPC, Pain Management Unit, Queen Elizabeth II
Health Sciences Centre, 4thFloor Dickson Centre, Room 4086, Halifax,
Nova Scotia,
Fifteen of the eighteen trials that met the inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared with placebo and several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis.
25) http://www.ncbi.nlm.nih.gov/pubmed/22048225
Clin Pharmacol Ther. 2011 Dec;90(6):844-51. doi: 10.1038/clpt.2011.188. Epub 2011 Nov 2.
Cannabinoid-opioid interaction in chronic pain.
Abrams DI1, Couey P, Shade SB, Kelly ME, Benowitz NL.
Cannabinoids and opioids share several pharmacologic properties and may
act synergistically. The potential pharmacokinetics and the safety of
the combination in humans are unknown. We therefore undertook a study to
answer these questions. Twenty-one individuals with chronic pain, on a
regimen of twice-daily doses of sustained-release morphine or oxycodone
were enrolled in the study and admitted for a 5-day inpatient stay.
Participants were asked to inhale vaporized cannabis in the evening of
day 1, three times a day on days 2-4, and in the morning of day 5. Blood
sampling was performed at 12-h intervals on days 1 and 5. The extent of
chronic pain was also assessed daily. Pharmacokinetic investigations
revealed no significant change in the area under the plasma
concentration-time curves for either morphine or oxycodone after
exposure to cannabis. Pain was significantly decreased (average 27%, 95%
confidence interval (CI) 9, 46) after the addition of vaporized
cannabis. We therefore concluded that vaporized cannabis augments the
analgesic effects of opioids without significantly altering plasma
opioid levels. The combination may allow for opioid treatment at lower
doses with fewer side effects.
http://www.lowdosenaltrexone.
Jeffrey Dach MD
7450 Griffin Road, Suite 180/190
Davie, Fl 33314
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