343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2198152

Low Dose Naltrexone Versus Gabapentinoid Standard of Care Treatment for Fibromyalgia: A Retrospective Cohort Study

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Poster Presenter

Andrew Aboujaoude

Authors

Andrew Aboujaoude

Affiliations

Columbia University

Part of Topic

Scientific Abstracts > Chronic Pain

Title:

Low-Dose Naltrexone vs. Gabapentinoid Standard of Care Treatment for Fibromyalgia: A Retrospective Cohort Study

Introduction:

• Fibromyalgia, a CNS disorder, causes debilitating chronic pain.

• The current standard of care includes gabapentinoids and SNRIs to combat neurotoxicity and lack of monoamine neurotransmitters.

• Gabapentinoids and SNRIs have been shown to cause side effects yet achieve only minimal pain relief.

• An alternative treatment Low-Dose Naltrexone (LDN) has been shown to decrease inflammation by enhancing the anti-inflammatory microglia phenotype, which could potentially be a more effective therapy for fibromyalgia with less side effects.

• Studies treating fibromyalgia with LDN against a placebo show promising improvements in pain scores, but comparisons against standard of care remain largely limited.

Methods:

• Retrospective cohort study of fibromyalgia patients at the Columbia University Pain Clinic from January 1, 2020, to June 15, 2025.

• 20 patients total: 10 treated with gabapentinoids and 10 treated with LDN.

• VAS Pain Scores and reported side effects were documented using patients’ electronic medical records.

Results:

• There was a significant decrease in LDN VAS pain scores when compared to gabapentinoid VAS pain scores.

• The median pain reduction was LDN = –1.83 versus gabapentinoid = 0 (p= 0.03).

• Fewer LDN patients (10%) reported side effects compared to gabapentinoid patients (70%) (p= 0.02).

• For the gabapentinoid patients, the most common side effects were cognitive (42.8%).

Discussion:

• This study suggests that LDN is more effective for managing fibromyalgia pain and has a lesser side effect profile than the standard of care gabapentinoids.

• The microglia anti-inflammatory enhancing mechanism of LDN may help explain why it is effective in managing fibromyalgia pain.

• With more research, LDN could eventually be incorporated as a standard of care therapy for fibromyalgia.

• Future directions should include the development of randomized controlled trials of LDN versus gabapentinoids in larger, multi-site cohorts.

Limitations:

• Small sample size (n=20)

• Retrospective Design

• Single Center Study

References:

1. Ruschak I, Montesó-Curto P, Rosselló L, Aguilar Martín C, Sánchez-Montesó Toussaint L (2023). Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review. Healthcare (Basel), 11(2), 223.

2. InformedHealth.org. (2022, May 24). Fibromyalgia: Learn more – Medication for the treatment of fibromyalgia. Institute for Quality and Efficiency in Health Care (IQWiG).

3.Kučić N, Rački V, Šverko R, Vidović T, Grahovac I, Mršić-Pelčić J (2021). Immunometabolic Modulatory Role of Naltrexone in BV-2 Microglia Cells. Int. J. Mol. Sci., 37(4), 367-378.

4. Due Bruun K, Christensen R, Amris K, Vaegter H, Blichfeldt-Eckhardt M, Bye-Møller L, Holsgaard-Larsen A, Toft P (2023). Naltrexone 6 mg once daily versus placebo in women with fibromyalgia: a randomised, double-blind, placebo-controlled trial The Lancet Rheumatology, 6(1), e31-e39.

5. Vatvani AD, Patel P, Hariyanto TI, Yanto TA (2024). Efficacy and safety of low-dose naltrexone for the management of fibromyalgia: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Korean J Pain.