ID# 1907918 Low Dose Naltrexone for treatment of Facial Dysesthesia: A Case Report

William Chang; Joysree Subramanian

doi:10.1016/j.neurom.2025.08.403

Introduction Patient: Patient is a 31 y/o female who present to the pain clinic for chronic diffuse facial pain in the setting of suspected erythromelalgia variant. She has undergone extensive workup for this with multiple treatment trial with persistent pain, discomfort and interference with function and daily life. Patient was started on low dose naltrexone 3 mg qhs with significant improvement of her symptoms. Introduction: The pain has had a history of chronic 3 year history of painful burning facial flushing. Episodes last for 20 minutes to 3 hours worse with heat and warmth. She mitigates triggers by having a cool place and ice packs. She reports location in the anterior face and neck diffusely with her whole face feeling warm but not necessarily painful like her face. She was seen by neurology who felt her symptoms were related with erythromelalgia and dermatology who felt this was a variant of erythromelalgia. Patient have tried conservative management with lifestyle modification, dietary changes and various medications without relief. Patient tried diphenhydramine with no benefit, clonidine which was discontinued due to “outbreak”, duloxetine which was not beneficial, prednisone with temporary improvement. She was also on paroxetine and gabapentin which provided minimal improvement. Patient was started on low dose naltrexone initially (3 mg nightly) with significant improvement of her symptoms. Methods Case Report Setting: Outpatient Pain Clinic. Results Erythromelalgia is a rare condition characterized by episodes of redness, heat, and pain in the extremities, typically affecting the hands and feet. Our patient was believed to have a variant of erythromelalgia affecting the face. The symptoms usually occur in response to triggers like heat, exercise, or stress, and can range from mild to severe. The exact cause is unknown, but it's thought to involve abnormalities in the blood vessels or nerve function. Management focuses on symptom relief and may include medications like aspirin, anticonvulsants, or calcium channel blockers, as well as lifestyle adjustments to avoid triggers. The patient failed multiple treatment trial with persistent pain and discomfort. Low dose naltrexone was initiated which provided significant benefit. There is evidence that supports safety and tolerability for management of chronic pain and inflammation [1]. Conclusion This case demonstrates an application for low dose naltrexone for the management of facial dysesthesia secondary to erythromelalgia refractory to typical conservative measures. Continued research and studies are required to fully assess its indications and outcomes and compare it to the alternative treatment options. Further randomized controlled trials are needed to determine the efficacy of low-dose naltrexone due to insufficient evidence supporting its use in these disease states [1].

ID# 1907918 Low Dose Naltrexone for treatment of Facial Dysesthesia: A Case Report

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