Q&A Joint pain worse with LDN?
Q: I'm trying to determine if the joint pain I am having can be from the LDN. I'm currently at 3 mg and my feet and thumbs have been hurting more and more. Thinking back I'm beginning to think it started increasing when I started the LDN. Can LDN increase the pain vs making it better? Thank you.
A:
Yes — it can happen, although it’s not the usual pattern. LDN is generally used to reduce pain and inflammation, but a subset of patients report an initial flare or worsening of symptoms, including pain, especially during dose increases.
What the evidence suggests
Most reviews and reports describe LDN as having mild side effects and potential pain-reducing effects, but they also note that some people can experience temporary symptom worsening or intolerance during titration.
Some clinical and observational sources specifically mention that pain, fatigue, flu-like symptoms, sleep disturbance, or other odd symptom flares can happen early on or after dose changes.
How this fits your pattern
If your feet and thumbs started hurting more after starting LDN, the timing makes LDN a reasonable suspect, especially if the increase tracked with dose escalation to 3 mg.
That said, joint pain can also be from the underlying condition LDN is being used to treat, so the key question is whether there’s a clear dose-response relationship and whether symptoms improve when the dose is lowered or held.
Practical next step
A common approach is to contact the prescriber and consider one of these: hold the dose, reduce to the last tolerated dose, or stop briefly and rechallenge more slowly if appropriate.
Because you’re describing progressive pain rather than a short-lived mild side effect, I would not just “push through” without discussing it with the prescribing clinician.
Red flags
If the pain is accompanied by visible swelling, redness, warmth, fever, rash, new weakness, or significant morning stiffness, that points more toward an inflammatory or other medical cause than a simple LDN side effect.
Also, if there is any opioid use, that needs to be reviewed immediately because naltrexone can precipitate withdrawal and complicate symptom interpretation.
A reasonable bottom line: LDN can occasionally worsen pain, but this is not common; your timeline makes it plausible enough that dose adjustment or a brief stop-and-reassess discussion with the prescriber is appropriate.
About Dr. Kim
Dr. Yoon Hang "John" Kim is a board-certified integrative medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil and holds certifications in preventive medicine, medical acupuncture, and integrative/holistic medicine. Through his telemedicine practice, Dr. Kim specializes in utilizing LDN or Low Dose Naltrexone for treating autoimmune conditions, chronic pain, integrative oncology, and complex conditions including fibromyalgia, chronic fatigue, MCAS, and mold toxicity. He is the author of three books and more than 20 articles, and has helped establish integrative medicine programs at institutions nationwide.
Professional: www.yoonhangkim.com | Clinical: www.directintegrativecare.com
