Amitriptyline and fluphenazine in the treatment of postherpetic neuralgia.
BACKGROUND
Postherpetic neuralgia (PHN) is a vexing problem occurring in 10 to 20 percent of people with from herpes zoster (shingles). Anecdotal reports show that fluphenazine enhances the effects of amitriptyline for the treatment of PHN. The aim of this study was to determine, in a controlled manner, whether this was the case.


METHODS
In a double-blind placebo-controlled study, 49 patients with PHN were randomly assigned to four treatment groups: Group 1, amitriptyline; Group 2, amitriptyline and fluphenazine; Group 3, fluphenazine; Group 4, a placebo. An active placebo was used to mimic the anticholinergic side effects of dry mouth. The study lasted 8 weeks, with weekly progress evaluations with use of visual analog scales (VAS), the McGill Pain Questionnaire (MPQ), and a side-effects scale.


RESULTS
A statistically significant decrease was seen in pain in Groups 1 and 2, and no significant changes were seen in Groups 3 and 4. There was no significant difference when fluphenazine was added to amitriptyline.


CONCLUSIONS
These data support the effectiveness of amitriptyline in treatment of PHN, but do not support the addition of fluphenazine.
Graff-Radford
S B
SB
UCLA Pain Management Center, Los Angeles, California, USA.
Shaw
L R
LR
Naliboff
B N
BN
D000368:Aged; D000639:Amitriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005476:Fluphenazine / Q000009:adverse effects / Q000627:therapeutic use*; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D000639:Amitriptyline; D005476:Fluphenazine