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March 13, 1978

Treatment of Peripheral Diabetic Neuropathy

Author Affiliations

University of Chicago Pritzker School of Medicine Chicago

JAMA. 1978;239(11):1037. doi:10.1001/jama.1978.03280380037011

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To the Editor.—  The recent BRIEF REPORT by Davis and associates prompts me to share my observations about the use of tricyclic antidepressants and phenothiazines for the management of pain syndromes.In my work as a consulting psychiatrist to three university-affiliated pain clinics located in two different geographic settings, I have noted the frequent use by neurosurgeons and anesthesiologists of amitriptyline and fluphenazine as well as amitriptyline and chlorprothixene for the management of chronic pain. The drugs are prescribed in low doses, and analgesic results are usually evident within three to four days, thus being consistent with the results reported by Davis and associates. Although I wonder about the operation of the placebo factor, I now find myself using these drugs for certain pain syndromes and noting some success.Although these drugs are not addicting and tolerance does not occur, they are not without hazard. The tricyclics, especially amitriptyline, have