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May 23, 1990

Fluphenazine and Postherpetic Neuralgia-Reply

Author Affiliations

University of Washington Multidisciplinary Pain Center Seattle

University of Washington Multidisciplinary Pain Center Seattle

JAMA. 1990;263(20):2750. doi:10.1001/jama.1990.03440200052021

In Reply.—  Dr Hurtig is correct in expressing his concerns about the extrapyramidal side effects of fluphenazine hydrochloride. I had prefaced my suggestions about its use with the fact that therapy for postherpetic neuralgia is often less than satisfactory and had followed my treatment suggestions with the caveat about extrapyramidal side effects and particularly warned against using this medication in dosages greater than 10 mg/d.I well recognize that the use of fluphenazine has not passed any litmus test, but few of the therapies for chronic pain treatment have. In rereading my paragraph, I should perhaps have stressed more the tricyclic antidepressant component of this particular combination, which, as Dr Hurtig correctly states, has been validated in appropriate trials.The use of fluphenazine was first suggested by Taub1 at the first meeting of the International Association for the Study of Pain. We have used the medication at the University of