Dr. Amy Nett: Yeah, exactly. This is a tough one. I think it depends on what the patient wants. I have some patients who are on the biological TNF blockers and they say, “No way. I’m not coming off this. I have no interest in coming off of it. I just want to do what we can.” You’re saying opioid for the rheumatoid arthritis pain. Yeah, completely understood. I think this has to be a conversation with the patient because I think that transition is potentially going to be difficult, and it would depend, too, how much work you’ve done from a functional medicine perspective. I would get everything as dialed as you can. Bring down inflammation as much as you can, and then if the patient wants to come off—and that’s a big “if” because not everyone does—but if the patient has expressed interest in saying, “My goal is to get off of these,” then do everything you can. Do all of the immune support, the curcumin, your prebiotics, probiotics. Get the gut dialed, anything you can to help calm the immune system, and also remember the meditation and mindfulness piece. Again, if they’re interested in coming off, meditation, mindfulness, explain that there are physiologic changes. We can take someone’s blood before and after a 20-minute meditation or mindfulness session, and we’ll actually see a decrease in markers of inflammation. Bring all the pieces you can, and then taper down the opioid as much as possible. See if they’re open to coming off that TNF blocker, and then you can try the LDN, absolutely.
LDN doesn’t work as well as I would sometimes like it to. I listen to the LDN conference each year, and I always have this hope, and I think, OK, this is going to do it, and it doesn’t always. Sometimes it helps, but I would say it’s almost 50/50 in my patients, whether or there’s a lot of benefit to LDN or not. I think it’s always worth a try because it’s so benign. The side effect profile of low-dose naltrexone is so minimal, the primary issue being a sleep disturbance. And then if they have a sleep disturbance because you take LDN before bed, move it to morning and have the patient take low-dose naltrexone in the morning for about a week. Normally people will acclimate at that point. Then they can reintroduce a before-bed dose. I think it’s always worth a try to do low-dose naltrexone, but it’s hard getting people off the opioids and the TNF-alpha blockers.
Hopefully that answers your question there. Part three of that was if I use it for chronic pain, and the answer is yes, but limited experience, so I’ll get back to you in terms of how that goes.