To the Editor.—
As a long-term user of amitriptyline and fluphenazine for chronic pain, I take issue with the recent article by Mendel et al.1 Having taken this drug combination for approximately five years, I tried several times to discontinue its use because of undesirable side effects. Each time I did so, it was very apparent that it took ten to 12 days to reach maximal benefit as well as to lose all drug effect. With this in mind, I feel a valid study would require at least a month's trial of both drug and placebo, as well as an interval between trials of at least two weeks. The fact that my severe leg dysesthesias are the result of postsurgical spinal arachnoiditis rather than diabetic neuritis does not alter my opinion in any way.
Ritter D. Amitriptyline and Fluphenazine for Painful Diabetic Neuropathy. JAMA. 1986;256(6):712–713. doi:10.1001/jama.1986.03380060038011
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