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August 8, 1986

Amitriptyline and Fluphenazine for Painful Diabetic Neuropathy-Reply

Author Affiliations

University of California, San Francisco Veterans Administration Medical Center San Francisco

JAMA. 1986;256(6):713-714. doi:10.1001/jama.1986.03380060038013

In Reply.—  Our study demonstrated that patients with painful diabetic neuropathy experience pain relief when treated with placebos, and, after a review of the literature, we concluded that no valid objective data exist that support the view that amitriptyline and fluphenazine are any more effective than placebos in treatment of this condition and cautioned against their inappropriate use. Another study using pyridoxine as the active drug also found a placebo response in patients with painful diabetic neuropathy and reached similar conclusions.1We were interested to hear of Dr Ritter's success with amitriptyline and fluphenazine in treating his own spinal arachnoiditis, but that does not bear directly on our study, which was designed in the context of previous uncontrolled studies on painful diabetic neuropathy (cited in our article). These studies described pain relief within one to several days following initiation of therapy with amitriptyline and fluphenazine and resumption of pain