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Am Fam Physician. 2024;109(2):105

Author disclosure: No relevant financial relationships.

To the Editor:

We want to thank Dr. Winslow and colleagues for their excellent review of fibromyalgia.1 A patient recently presented to our practice who was taking recommended medications for fibromyalgia without much relief. The patient approached us about using low-dose naltrexone (Revia). A PubMed search showed that low-dose naltrexone (1 to 5 mg) has been used off-label to treat inflammation and pain in fibromyalgia, multiple sclerosis, and Crohn disease.2 The mechanism of action is the modulation of neuroinflammation, specifically, the release of inflammatory chemicals in the central nervous system and the modulation of glial cells.3 Randomized, placebo-controlled trials are being conducted to add more data to the literature.4,5 Although low-dose naltrexone shows promise in relieving pain symptoms for people with fibromyalgia, a challenge is its limited availability. Currently, oral naltrexone is available only in 50-mg tablets. Compounding pharmacies may be able to create low-dose naltrexone, but insurance coverage presents another challenge. After discussing the potential benefits and risks, the patient decided to try one-half of the 50-mg tablet and found some relief.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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