Long standing post-herpetic neuralgia resistant to standard anti-neuropathy medication showing quick dramatic improvement following treatment with sympathomimetic amines

Abstract

Purpose: To determine if treatment with dextroamphetamine sulfate can alleviate severe chronic post-herpetic neuralgia that failed to respond to standard drugs typically used for neuropathy. Materials and Methods: An 88-year-old man with a five-year history of severe post-herpetic neuralgia pain who had failed to respond to pregabalin, and duloxetine was offered 15 mg of amphetamine salts extended release capsules. Eventually he was increased to 30 mg extended release capsules. Results: Within the first month of treatment there was significant relief of his pain with just 15 mg extended release capsule. After two months the dosage was increased to 30 mg extended release capsules and he has had at least a 90% reduction in pain which has lasted now five years. Discussion: Not only had this patient failed to respond to standard therapies for neuropathies, but he gained only marginal relief from lidocane patches, hydrocodone, oxydodone (all of which caused nausea), acupuncture, and TENS units. He has had no adverse side effects from the dextroamphetamine sulfate. Though the exact mechanism of action is not known for sure, the main hypothesis for the etiology of the sympathetic neural hyperalgesia syndrome is that the sympathetic nervous system controls cellular permeability, and a sensitive tissue already showing signs of increased permeability allows chemicals and toxic elements to permeate these tissues resulting in inflammation. The permeability problem is further compromised by sympathetic hypofunction. Dextroamphetamine sulfate is thought to stimulate the neurotransmitter dopamine which corrects the problem.