Without going into the pharmacological details, the quote above is followed with the conclusion:

Our observations that proinflammatory factors increase calcium sensing receptor (CaSR) levels in adipocytes, and the reported ability of CaSR to elevate cytokine levels, open new aspects in the study of obesity inflammatory state pathophysiology, providing a potential novel therapeutic prevention and treatment target. ^[1] 

Obesity is now generaly considered as a chronic low-grade inflammatory state. ^[2][3][4] The literature supporting that obesity is linked to an overall low grade inflammation, and associated with it chronic pain states, is overwhelming. However, it did not yet result in new treatment approaches.  It is interesting to note even in young children the enhanced inflammation vcan be found, and in line with this that weight loss in obese children reduced the low-grade inflammation! ^[5][6]

In our clinic we work with low dose naltrexone (LDN). There is quite some literature supporting the analgesic effects of LDN AND the anti-inflammatory activity of the same molecule. ^[7] Other molecules have comparable action, although probably less intense, such as molecules in green tea. ^[8] Not uninteresting is the finding that LDN in obese animal models reduce the feeding behaviour. ^[9]

Recently a high dose naltrexone regime, together with bupropion reduced bodyweight in obese individuals, though the reduction was not overall very impressive. ^[10][11] We think the dose selected (32 mg) is far to high up and creates many side effects. In our hands, even 1 mg naltrexone has biological actions, such as pain redcution and energy improvent, as well as improvement of quality of life. 

Low dose naltrexone in chronic painstates in obesity 

Due to the fact that LDN has anti-inflammatory actions as well as analgesic actions, we sometimes prescribe naltrexone in a low dose regime (1-2.5 mg, od) to patients. If the chronic pain state is difficult to treat, we might add a low dose regime of tramadol. Between intake of both drugs 12 hours. The naltrexone upregulates our endogenous opiate receptors, and the upregulated state is a fact when tramadol enters the system. By cycling between en low dose opiate antagonist, LDN and 50 mg tramadol, a opiate agonist we enhance the anagesic effects, and side effects are minimal.

We feel this is a new inroad in treating obese patients suffering from severe pain, worthwhile exploring.

August 2010, Jan M. Keppel Hesselink, MD, PhD 

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