Objective:

In this study, we evaluated the efficacy of low-dose naltrexone (LDN) among a patient population diagnosed with generalized autonomic dysfunction.

Background:

LDN has been researched as a novel off-label therapy for several neurological conditions. Autonomic disorders, such as POTS and fibromyalgia, involve a diminished ability to regulate autonomic functions. Our aim was to contribute to existing literature and better understand changes in autonomic dysfunction patients' symptomatology after starting treatment with LDN.

Design/Methods:

In this IRB-approved case series, the charts of 29 autonomic dysfunction patients who
underwent a trial of LDN at our tertiary care autonomic center were reviewed. Active medicines,
primary diagnoses, tolerability, and scores on patient-reported outcome measures (Composite
Autonomic Symptom Score [COMPASS-31]) were collected at initiation of LDN and 3-9 months
before and after. Patients with these timepoints were used in distinct analyses of subjective
symptom burden based on COMPASS-31 subscores (gastrointestinal, orthostatic, secretomotor,
vasomotor, pupillomotor, and bladder).

Results:

11 of 27 patients with neuropathic pain as a symptom reported an improvement in the severity
throughout their treatment course. 9 of 29 patients discontinued the therapy due to various
reasons including stabilization of symptoms, lack of perceived benefit, or economic strains.
5 of 29 experienced adverse side effects including nocturia, insomnia, nightmares, chronic
nausea, migraines, and brain fog. Analysis of COMPASS-31 scores displayed improvement of
gastrointestinal symptoms in 9 of 29 patients and improvement of orthostatic symptoms in 4 of
29 patients.

Conclusions:

Through retrospective chart review it is seen that LDN therapy is largely tolerated and safe to
use. Patients experienced minimal to no side effects, and based on this case study, LDN
appeared to reduce the severity of pain in dysautonomia patients seen in our tertiary care
autonomic center. Additional studies would be needed to show the effects of LDN in a larger
sample size to make results more generalizable.