Do you use naltrexone in your patients with fibromyalgia?

I do not use low-dose naltrexone as a first-line agent for patients with fibromyalgia. Well-designed RCTs (Due Bruun et al., PMID 38258677; Bested et al., PMID 38226027) have not shown significant improvements in pain or other outcomes in the overall population of patients with fibromyalgia. That sa...

Anecdotally, I've found LDN helpful in patients with FM who also have prominent dysautonomia symptoms -- as the usual agents [cyclobenzaprine, gabapentin, pregabalin, milnacipran, etc] can often exacerbate their dysautonomia symptoms.

I have also used with patients with FM who may have addictive beh...