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Neurobiology and Anesthesiology Branch, National Institute of Dental Research (Drs. Max, Gracely, Smoller, and Dubner), and the Nursing Department, Clinical Center (Ms. Schafer and Ms. Culnane), National Institutes of Health, Bethesda, MD.
In a double-blind, randomized, crossover study, 58 patients with postherpetic neuralgia received 6-week courses of amitriptyline, 12.5 to 150 mg/d; lorazepam, 0.5 to 6 mg/d; or lactose placebo. Doses were titrated to the maximum level tolerated. Patients rated pain in a diary, using lists of verbal descriptors. Forty-seven percent of patients reported moderate or greater relief with amitriptyline, 16% with placebo, and 15% with lorazepam. Mean amitriptyline dose was 65 mg/d. Greater relief was associated with higher amitriptyline doses, up to the maxiumum dose of 150 mg/d, and with higher serum tricyclic levels. Lorazepam did not relieve pain and was associated with severe depressive reactions in four patients.
Address correspondence and reprint requests to Dr. Max, NIDR/NIH Pain Research Clinic, National Institutes of Health, Building 10, Room 3C-403, Bethesda, MD 20892.
Received October 16, 1987. Accepted for publication in final form February 10, 1988.
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