Last update:
29-Apr-2026

Chronic pain is a significant concern in multiple sclerosis (MS), particularly in the extremities, trigeminal neuralgia, back pain, and headaches. Pain management in MS patients is challenging due to the disease's progressive and relapsing-remitting nature. Naltrexone, an opioid receptor antagonist, has demonstrated the ability to inhibit T and B cell proliferation at low doses, exhibiting anti-inflammatory and analgesic effects against chronic pain. The aim of this article is to highlight the potential of naltrexone in addressing the underlying pathological mechanisms in MS, particularly chronic pain. A series of studies involving MS patients across different forms of the disease has shown that naltrexone, administered in doses of 3−5 mg daily, is both tolerable and safe. Additionally, it can enhance patients' quality of life (QoL) and reduce fatigue, especially in those with relapsing-remitting multiple sclerosis (RRMS), with many of its effects considered to be dose-dependent. However, concrete evidence regarding its impact on inflammation markers are lacking. In primary progressive MS (PPMS), low-dose naltrexone (LDN) has been shown to increase peripheral β-endorphin levels in blood and significantly reduce spasticity, with these effects retaining even up to onemonth post-treatment. Although many of these results are preliminary, and much more clinical findings are in need, naltrexone seems promising as an active substance that could aid in the management of the progression and the symptoms of MS, with pain reducing effects.

Key words: Chronic pain, Inflammation, Multiple sclerosis, Naltrexone.