Q: I have had pain in many parts of my body for years. Like the proverbial frog in boiling water, as my pain increased, I just dealt with it because I seem to have so many side effects from medications.
My doctor put me on low-dose naltrexone (LDN). It is not an opioid, and it has definitely helped me with my pain so I can think and stay active.
Some people have switched from opioids to LDN, but medical oversight is essential. Not all doctors know how to do this correctly. I wish more of them would educate themselves in its use.
A: Naltrexone is an opioid blocker that is prescribed to help people overcome addictions like alcoholism and a dependence on narcotics. When used for such purposes, the dose is 50 mg.
There is growing interest in low-dose naltrexone (1.5 to 5 mg) for conditions such as Crohn’s disease, fibromyalgia and multiple sclerosis (Pharmacotherapy, March 2018). At such low doses, naltrexone appears to help regulate the immune system and reduce inflammation. This drug requires a prescription. Low-dose naltrexone is only available from compounding pharmacies.
Q: I had a full right knee replacement. Within 24 hours post-surgery, I had blood clots in both calves. I was immediately put on Coumadin.
I was changed from Coumadin to Xarelto after a few months and have been on it ever since, along with a daily low-dose aspirin.
I have no idea what Xarelto and daily aspirin are doing to my body. All my physicians say that I must stay on it for the rest of my life because once you have a blood clot, you are then at higher risk for more.
A: We are shocked that you did not receive medicine to prevent blood clots prior to your knee replacement. That is now considered standard practice.
A study just published in JAMA Surgery (online, Oct. 17, 2018) demonstrates the importance of anticoagulant treatment for knee replacement surgery.
Surprisingly, aspirin was just as effective as drugs like rivaroxaban (Xarelto), warfarin (Coumadin) and low-dose heparin. The authors conclude that aspirin alone, at a cost of $2 a month, is “simple, safe, and does not require monitoring.”
You may have to continue on an anticoagulant indefinitely. This is something your doctor will need to review periodically since all anticoagulant medications pose a risk of bleeding.
Q: My doctor prescribed 800 mg of ibuprofen a couple of times a day for the pain and inflammation of a severely twisted knee. When I took my blood pressure a few weeks later, it was 180/96. That's much higher than my usual 124/76.
That scared me, so I searched your website for answers. I discovered that ibuprofen can raise blood pressure. What else can I use for the pain?
A: Ask your doctor whether topical NSAIDs like diclofenac gel would help your pain without causing hypertension. You will need to monitor your blood pressure even with a drug like Voltaren gel.
Other options that should not raise your blood pressure include anti-inflammatory herbs such as ashwagandha, boswellia, ginger and turmeric. Bromelain derived from pineapple and Knox gelatin also might be beneficial. You can learn more about them in our online resource, “Alternatives for Arthritis.” It is available at www.PeoplesPharmacy.com.
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