Pain can have a devastating effect on the quality of life of patients in palliative medicine. Thus far, majority of research has been centered on opioid-based pain management, with a limited empirical evidence for the use of nonopioid medications in palliative care. However, opioid and nonopioid medications such as nonsteroidal anti-inflammatory drugs have their limitations in the clinical use due to risk of adverse effects, therefore, there is a need for more research to be directed to finding an alternative approach to pain management in comfort care setting. The purpose of this article is to discuss a potential new drug that would adequately alleviate pain and enhance quality of life without significant risks of adverse effects that would limit its use. Naltrexone is a reversible competitive antagonist at μ-opioid and κ-opioid receptors, which when used at standard doses of 50 to 150 mg was initially intended for use in opioid and alcohol use disorders. However, it was discovered that its use in low doses follows alternate pharmacodynamic pathways with various effects. When used in doses of 1 to 5 mg it acts as a glial modulator with a neuroprotective effect via inhibition of microglial activation. It binds to Toll-like receptor 4 and acts as an antagonist, therefore inhibiting the downstream cellular signaling pathways that ultimately lead to pro-inflammatory cytokines, therefore reducing inflammatory response. Its other mode of action involves transient opioid receptor blockade ensuing from low-dose use which upregulates opioid signaling resulting in increased levels of endogenous opioid production, known as opioid rebound effect. Low dose naltrexone has gained popularity as an off-label treatment of several autoimmune diseases including multiple sclerosis and inflammatory bowel disease, as well as chronic pain disorders including fibromyalgia, complex regional pain syndrome, and diabetic neuropathy. Low-dose naltrexone (LDN) may also have utility in improving mood disorders and the potential to enhance the quality of life. This article will therefore propose the potential off-label use of LDN in management of nonmalignant pain in the palliative medicine setting.

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: INTRODUCTION : Osteoarthritis (OA) is a degenerative disease that predominantly affects geriatric population. However, geriatric patients are not often treated according to specific geriatric recommendations. OA also belongs to highly prevalent disorders managed mostly by symptomatic, analgetic drug treatment. The aim of this diploma thesis was to evaluate to which extend are clinical guidelines for management of OA focused (generallly and in areas of individual pharmacotherapeutic strategies) on specific aspects of rational geriatric pharmacotherapy. Diploma thesis was completed as a recherche thesis (part I.) for follow-up studies dealing with rationality of analgetic drug treatment in older patients (rigorous thesis of M. Miklasová MS, Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, 2016). METHOD : 4 national and 3 international clinical guidelines for management of osteoarthritis in accessible languages, published between 2005 and 2014 years, were identified by literature search conducted between 9/2015- 3/2017. Following guidelines were included : czech (2012), german (2009), australian (2009), american (2012) and recommendations of international societies OARSI (2008-2010), EULAR (2005, 2007) and NICE (2014).This diploma...