Dear Dr. Eskapa,

I searched for an answer to my inquiries on the board but can't find what I need... I have an autoimmune disease that has me in and out of chronic pain, and while I am VERY fortunate to not have an addiction problem with pain medications, I do now have the task of managing intermittent Vicodin use with TSM. It's been 7 days since my last dose of Nal (50mg) and I took Vicodin this evening after getting hit with intense pain, and call me crazy, but it isn't working?? I also have a nasty headache. I guess I'm just worried because when I need these pain meds, I really need them, so I'm wondering if it's possible for naltrexone to alter or diminish their effects in the long run or with continued use. How long does it really take for naltrexone and any residual effects to get out of the system, and does it/is it possible for opiod receptors to be permanently altered? And if it takes 24/48hrs for Naltrexone to be out, then why do 'official' warnings state 5 - 7 day intervals? Does it leave anything in its wake I need to know about? I read somewhere about a rebound effect of increased opiod receptors, etc.

Thank you so much for your work, your time, and all you've done for 'us.' There are so many grateful hearts and families who are so thankful for your contribution to this field, and I am one of them!

Best,

Es

PS - I apologize for the urgency of the subject line... maybe I should revise? I am just in intense physical pain and hoping to figure out what's going on!

Hey Es

I will be in the same predicament next week as I go for surgery and if I am not able to get relief afterwards, I'll be bummed, that's for sure....And having to stop cold turkey after drinking for so long will be a challenge

I was told that there are non opioid pain meds out there. I don't know which ones they are,...But maybe if you ask your GP they might be able to get you some....My thoughts are with your situation. BEst, Jim

Wow, I can't believe you didn't get very many responses. Probably because it sounds like you need to be working with a doctor on this. I do know from other research that Naltrexone has been used in very small doses (5mg) to treat Fibromyalgia. Apparently, it makes the opiate receptors super-sensitive as opposed to blocking them. So, my interpretation is that the higher doses of Naltrexone are contributing to the Vicodin not working. I do believe I read somewhere in the book that continued use of Naltrexone should be reported to medical personnel in the event of severe pain because they may need to use something else besides opiates. I'm sorry you are in so much pain, but it looks like you may need to talk to your doctor. Perhaps he/she can prescribe another type of pain med. Wishing you much success. Maxie

Naltrexone is given to people who have OD on opiates. When used to treat opiate addicts it may cause acute withdrawal syndrome and possibly death. If you frequently need opiates for pain, you should not be involved in TSM. There is no permanent damage done to your opiate receptors when naltrexone blocks them; Nal should 'wash out' within two days max. The phenomenon of up regulation may make you more sensitive to opiates.

Continual blockade of the opiodergic system causes up-regulation of the opiate receptors and supersensitivity (Pert et al., 1973; Zukin et al., 1982; Hyytiaa et al., 1999).

Talk to your Doc.