Use of low-dose naltrexone in the management of posttraumatic trigeminal neuropathic pain: a retrospective case series.

Abstract

Objective: Dental practitioners provide treatment of anatomical structures innervated by the trigeminal system, such as the teeth and gingiva, which can be subject to injury even following routine and well-performed dental procedures. As a result, the dental clinician is often presented with patients with neuropathic pain or unusual sensory distortions. In addition, the dental clinician treats patients following facial and oral trauma which may result in chronic pain. Therefore, recognition of posttraumatic trigeminal neuropathic pain (PTTNP) and its management must be considered essential for the dental clinician. Painful neuropathies, including PTTNP, can present as a debilitating form of neuropathic pain that often defies treatment normally effective for other types of somatic pain disorders. Treatment of PTTNP typically involves the use of various classes of medications including antiseizure medications and tricyclic antidepressants. Many patients suffering with PTTNP may have contraindications for these medications due to comorbidities, occupational responsibilities, or medication side effects. An alternative to antiseizure medications and tricyclic antidepressants is the use of low-dose naltrexone.

Method and materials: This study is a retrospective extended case series of patients with PTTNP. The records of 21 patients diagnosed with painful PTTNP at the Center for Temporomandibular Disorders and Orofacial Pain of the Rutgers School of Dental Medicine were analyzed. They met the criteria of PTTNP according to the International Classification of Orofacial Pain and were prescribed low-dose naltrexone. Though a total of 21 patients were included, 12 with all the data present were included in the final analysis. The sex distribution was equal, with six women and six men, with a combined average age of 59.33 ± 13.96 years.

Results: Low-dose naltrexone significantly reduced the patients' report of pain using visual analog scale (VAS) 0 to 10 subjective pain ratings at the follow-up visits compared to the initial VAS. Interestingly, the small group of patients who used low-dose naltrexone in combination with serotonin norepinephrine reuptake inhibitors, demonstrated a lower average VAS score at the first follow-up visit, compared to those who took low-dose naltrexone with other medications. There were no significant side effects reported by the patients. No adverse effects of low-dose naltrexone therapy were reported. Side effects of the medication are rare and, as reported the literature, include mild abdominal distress or vivid dreams. None were reported among this group of subjects.

Conclusion: Based on this retrospective extended case series, low-dose naltrexone appears to be a safe and effective medication for use in chronic PTTNP. These results highlight the need for future studies to elucidate low-dose naltrexone's analgesic mechanism of action and to decisively demonstrate the analgesic effect of low-dose naltrexone in larger cohorts using randomized, double blinded, placebo-controlled clinical studies. (Quintessence Int 2025;56:682-690; doi: 10.3290/j.qi.b6335903).