Obesity, a chronic low grade inflammation
Obesity associated health complications are thought to be in part due to the chronic low grade pro inflammation, that characterizes this disease.
A quote from a recent article on obesity. In our clinic we regular see obese diabetic patients, suffering from chronic pain. Sometimes this pain resembles neuropathic pain, sometimes it is more of a Fibromyalgia sort.
Low Dose Naltrexone (LDN)
We gained some experience in treating chronic pain by using low dose naltrexone (LDN), sometimes together with low dose tramadol and would like to share this experience.
Without going into the pharmacological details, the quote above is followed with the conclusion:
- Our observations that pro inflammatory 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. 
No new treatments approaches yet, but…
Obesity is now generally considered as a chronic low-grade inflammatory state. The literature supporting that obesity is linked to an overall low grade inflammation, and associated with 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 can be found. And in line with this that weight loss in obese children reduced the low grade inflammation! 
Other molecules have comparable action, although probably less intense, such as molecules in green tea. Not uninteresting is the finding that LDN in obese animal models reduce the feeding behavior.
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 reduction and energy improvement, as well as improvement of quality of life.
LDN in chronic pain states 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 up regulates our endogenous opiate receptors, and the up regulated state is a fact when tramadol enters the system. By cycling between and low dose opiate antagonist, LDN and 50 mg tramadol, an opiate agonist we enhance the analgesic effects. And side effects are minimal. Or, alternatively we combine LDN with Palmitoylethanolamide.
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, revision march 2014
‘Obesity, a chronic low grade inflammation’
Watch our video’s about Neuropathy.
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