Postherpetic neuralgia treated with flupenthixol and citalopram

S253

r POSTHERPETIC LOPRAM.

NEURALGIA

S. Andersen",

Worm-Petersen, and of Anaesthesiology, Aim

of

TREATED

WITH

S. Johansen,

L. Lang-Jensen*. Herlev Hospital,

Investiqation:

FLUPENTHIXOL P. Zander

Pain Clinic, Copenhagen,

Flupenthixol

AND

Olsen",

CITAr

Department Denmark.

is a potent

neuroleptic

which

has

been shown in animal experiments to have marked antinociceptive effects. Citalopram is a very selective 5HT-reuptake inhibitor which has been shown clinically to possess antidepressant activity. The aim of the present study was to investigate the effects of flupenthixol and citalopram in postherpetic neuralgia. Methods: The trial was a double-blind, cross-over study including placebo. Only patients with postherpetic neuralgia of a duration of more than 4 months vere entered. The patients vere evaluated biveekly for a total of 18 weeks. Results and Conclusion: Twenty-six patients, 17 females and 9 males, were entered. Nineteen patients had a duration of illness of more than 1 year. The study did not demonstrate significant therapeutic effects of either drug in the doses given, i.e. 1 mg flupenthixol/day and 40 mg citalopram/day. The evaluation of the results was, however, difficult because of considerable methodological problems. The advisability of using visual analogue scales for the assessment of pain, depressed mood, and anxiety in this type of patients will be discussed in detail.

BENEFICfAL EFFECTSiOF FLUPENTH$XOL ON CAN ER PAIN PATIENTS s L.Landa, H.Breivik , S.Huseb#* ,,A.Elgen* , and F.Rennem **l,Fi Department9 of Anesthesiolo q, Universities of Trondheim and Bergen , Namdal Hospital , Norway. Aim of Investigation: Cancer patients with pain requiring opioid analgesics often need a neuroleptic drug for control of side-effects. Chlorpromazine or levomepromazine may be effective, but have undesirable side-effects. Flupenthixol, a non-sedative low dose neuroleptic with clinically proven anxiolytic and antidepressive effects, analgesic and potent antiemetic effects in animal experiments, may be preferable. Methods: 32 patients with cancer pain requiring opioid analgesics were observed for 3 days for pain intensity, anxiety, depression and general wellbeing on visual analogue scales (VAS) and were interviewed by a nurse observer using selected items from a comprehensive psychopathological rating scale (CPRS). They received either flupenthixol 0.5 mg x 2, increasing to 1.0 mg x 2 after one week, or placeti for two weeks in a double blind manner. The patients marked their pain intensity, depression, anxiety and general wellbeing during the previous day and night on VASscales. After one and two weeks the patients were interviewed for CPRSscore, global effect and side-effects of ongoing treatment. Results: The pain intensity increased slightly in the placebo group and decreased slightly in the flupenthixol group. VAS-values for depression, anxiety and general wellbeing as well as the CPRS-scores improved significantly in the flupenthixol group (P(O.01, 0.05, 0.05, 0.05 respectively). No side-effects were observed from flupenthixol treatment.