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Final Program


Final Program

1149 - Use of Low Dose Naltrexone To Treat Neuropathic Pain After Severe TBI In A Pediatric Patient: A Case Study

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • NI

    Naldine A. Isaac, MD

    Medical Resident
    Shirley Ryan Ability Lab- Northwestern
    New Rochelle, New York, United States

    • Co-Author(s)

  • EK

    Emily J. Kivlehan, MD

    MD Attending Physician
    Shirley Ryan AbilityLab
    Chicago, Illinois, United States

Case Diagnosis: Severe Traumatic Brain Injury; Neuropathic Pain

Case Description: A teenage patient presented to acute inpatient rehabilitation three months after sustaining a severe traumatic brain injury (TBI) status post cranioplasty, hydrocephalus, and right ICA dissection. Examination notable for impaired alertness, impaired communication without speaking ability, flaccid lower extremities and spastic upper extremities.  Post-traumatic agitation was managed with bromocriptine, and a clonidine patch. He was on methylphenidate for neurostimulation. EMG demonstrated length-dependent axonal neuropathy. Participation in therapy was limited by pain behaviors and emotional distress; which additionally led to poor sleep. Functional progress plateaued. Despite polypharmacy including scheduled acetaminophen, oxycodone, and gabapentin; pain was uncontrolled and the patient would communicate pain in his bilateral arms.

Discussions:

The patient was started on low dose naltrexone (LDN) 2mg daily with plan to increase by 1 mg weekly until a goal dose of 4 mg. His sleep improved significantly upon starting the medication. Once at goal dosing, the patient was able to wean off acetaminophen and bromocriptine after two weeks. He was able to make gains in therapy such as more consistent command follow, improvement in his speech and swallowing abilities. His Coma Recovery Scale (CRS) improved from 10 pre-dose to 18 at goal dosing. 

LDN is used in the treatment of chronic pain. It has also shown benefits in adult patients after TBI due to its anti-inflammatory and neuroprotective effects in the acute setting. To our knowledge, this is the first case of using LDN to treat neuropathic pain in a pediatric patient after sustaining a severe TBI.

Conclusions:

This patient achieved pain control after starting LDN and successfully weaned off of his other pain medications. This was tolerated well and without adverse effects. A telephone discussion with his PCP was necessary to ensure that he would be able to continue on this dosing upon returning home.